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On Friday afternoon, the Centers for Disease Control and Prevention (CDC) issued the long-awaited new guidance for cruise ships. The CDC stated that COVID-19  vaccinations will be “critical” to resuming normal operations. The new guidance provides the cruise industry with the four basic requirements which establish minimum health protection requirements:

  • Increased reporting of COVID-19 cases from daily to weekly;
  • Routine testing of crew members based on each ship’s color status;
  • Preparation of agreements with port authorities and local health authorities to ensure that cruise lines have necessary infrastructure to manage COVID-19 cases on their ships, including healthcare and housing to isolate, quarantine. treat and tests infected people and those individuals in close quarantine with those exposed.
  • Establishing a plan and timeline for vaccination of crew and “port personnel,” who are widely defined as including port agents/greeters, security personnel, transportation staff (including drivers of buses and shuttle-van), baggage handlers, check-in staff, cleaners/janitorial staff, longshoremen, maritime pilots, and delivery drivers.

In addition, the CDC updated the color-coding system to classify cruise ship COVID status and decreased the time for a “red” ship to become “green.”

Vaccinations, Medical and Housing Agreements

The CDC requires that the cruise lines makes arrangements with all local port and local health authorities (“where the ship intends to dock or make port”) regarding the vaccinations of passengers, crew members and port personnel, as well as medical treatment and housing for those individuals and close contacts who become infected or ill with COVID-19 and isolated and quarantined. The agreements must include the total number of ships (and total number of passengers and crew) to be operated at of the port. The cruise line must consider whether the number of people could potentially overwhelm the available medical supplies and ability of local health officials. The agreements must be signed by the cruise line’s chief executive officer (CEO). chief compliance officer (CCO), and highest-ranking medical officer.

The next stage of the the CDC’s conditional sailing order will include simulated cruises to permit crew and port personnel to demonstrate compliance with the new COVID-19 protocols with volunteer passengers.

Vaccinations Arrangements

The Guidance includes several refences to the CDC’s recommendation that all passengers and crew members, as well as port personnel, be vaccinated, including:

  • A plan and timetable for vaccinating crew members before the cruise ship resumes passengers operations;
  • Proposals how to maximally protect passengers and crew members from infection and spread  of COIVD-19;
  • Education of passengers, crew and port personnel about the importance of vaccinations; and
  • “Vaccination clinics” to educate and encourage port personnel who are expected to interact with passengers and crew to become vaccinated.

The CDC makes clear that even fully vaccinated persons must still wear masks in terminals and on ships while traveling in the U.S.

Medical Arrangements

The medical arrangements required to be prepared and approved must be able to provide for the “emergency medical transportation of critically ill persons with suspected or confirmed COVID-19 from the ship to a shoreside medical facility …” The cruise line must specify the primary as well as the secondary medical facilities suited to provide the necessary level of care.

An additional requirement of the CDC is that it “must include clear protocols that avoid medical evacuations at sea to the greatest extent possible” for both COVID-19 and non-COVID-19 related medical reasons. Protocols must rely on commercial resources (e.g., ship tender, chartered standby vessel, chartered airlift) for unavoidable medical evacuation at sea and be designed to minimize the burden to the greatest extent possible on Federal, State, and Local government resources, including U.S. Coast Guard resources.

Housing Arrangements 

The cruise lines must make agreements with one or more shoreside facilities for isolation and quarantine of person with suspected or confirmed COVID-19 and their close contacts. The shoreside housing must meet CDC guidelines for the isolation ad quarantine, including sperate bedroom, bathrooms and living space.

Issues Raised By the New Guidance – Who Will Pay for Hospital, Medical and Travel Costs When Passengers Become Infected?

The technical guidance is silent regarding who must pay for the cost of  medical treatment and housing of those passengers and crew members infected with the virus. The CDC also does not explain who will bear the costs of the housing, food and living expenses of those required to be isolated and quarantined. Under the General Maritime Law governing crew members, the maritime employer (i.e., cruise line) must provide for all expenses related to the medical treatment of a crew member. But it is less than clear who will be responsible for such costs related to a guest who contracts coronavirus on a ship. If there is not a clear requirement that the cruise lines pay for these costs, then the cruise line will look to the passengers. Most health insurance policies typically do not cover shipboard medical problems, particularly during a pandemic. Most travel insurance policies exclude COVID-19 liabilities.

Guests who find themselves infected during a cruise and have to return to port and be quarantined, will find themselves with uninsured medical, housing, and travel expenses and unable to exercise their legal rights if the anticipated liability waivers are upheld.

There is language in the “Royal Promise” drafted by Royal Caribbean for sailing from Singapore that the cruise line will “cover COVID-19-related costs up to $25,000 SGD ($20,000 USD) per person in your travel party, for onboard medical costs, cost of any required quarantine, and travel home.” Royal Caribbean claims that “We’ll Never Stop Taking Care of You.” But by the very terms of the “Royal Promise,” Royal Caribbean promises that it will absolutely stop caring for those guests who become infected and require onboard medical expenses, evacuation and quarantine which exceed $20,000 USD, which is arguably not sufficient to cover such emergency expenses. The “promise” relates to only “onboard” medical expenses and does not appear to cover any “shore-side” medical expenses or hospital costs.

Royal Caribbean misleadingly promises that “We’ll Never Stop Taking Care of You.” But it truth the cruise line will stop paying for any medical expenses the moment you leave the cruise ship where you were infected. An infected guest and his or her family who incur evacuation, emergency room and intensive care treatment, medicines, intubation and a respirator potentially face catastrophic uninsured expenses in a worse case scenario.

Will Cruise Fans Agree to be Vaccinated?

There are a number of cruise fans who have voiced their frustration over not being permitted to immediately resume vacationing again at sea. There is a significant number of people who have decided not to be vaccinated. A Gallup poll finds that those who agreed to be vaccinated (91%) versus those who will not (51%) are split along Democrat and Republican lines. Royal Caribbean recently faced a boycott call on Twitter when it announced that will begin sailing from Nassau in June and its passengers are required to be vaccinated. Read: Notorious Fringe Doctor Calls for Boycott of Royal Caribbean on Twitter.

Complicating matters is the fact that a significant number of people in Florida support Governor DeSantis’ recent executive order prohibiting mandatory vaccinations of Florida residents. At the same time. Governor DeSantis joined a laundry list of Republican politicians like Senators Rick Scott, Marco Rubio, Lisa Murkowski, and Dan Sullivan and Representatives Gus Bilirakis, Mario Diaz-Balart, Carlos A. Gimenez, Bill Posey, John Rutherford, Maria Elvira Salazar, Michael Waltz and Don Young in placing pressure on the CDC to drop all conditions and permit cruise ships to sail from U.S. ports. Governor DeSantis went as far as to threatened to sue the CDC if it did not cave into the Republican demands. Ironically, DeSantis efforts to rally anti-vaxxers against vaccine passports effectively undercuts his efforts to re-open cruising from Florida and the rest of the U.S.

The Ball is Back in the Cruise Lines’ Lap

Will the cruise lines choose to be in compliance with the CDC? Will they devote the necessary time and effort to make the appropriate arrangements to arrange with all port and health authorities to provide vaccinations of passengers, crew members and port personnel, as well as medical treatment and housing for those individuals who become infected with COVID-19? Or will they take their ships and home-port them in Mexico and the Caribbean? Will the recent move by Royal Caribbean (and Crystal Cruises) of home porting a cruise ship in the Bahamas to dodge the CDC’s authority be the next trend by the foreign-incorporated and flagged cruise industry?

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Image Credit: Port of Miami (top) –  Marc Averette – CC BY 3.0, commons / wikimedia; CDC Logo – Centers for Disease Control and Prevention – Public Domain, commons / wikimedia; ; medical evacuation for cruise passengers at port of Miami – CHARLES TRAINOR JR/ Miami Herald; CoCo Cay – Royal Caribbean via Avoiding the CDC, Royal Caribbean to Begin Cruises from the Caribbean.