How the first cruise of the Covid era got ready to safely set sail

By Andrea Kane and Nadia Kounang, CNN

It’s anchors aweigh and full steam ahead for the Celebrity Edge.

On Saturday, the cruise ship, owned by the Royal Caribbean Group, will become the first to sail from a U.S. port since the US Centers for Disease Control and Prevention brought the industry to a halt more than 15 months ago with a no-sail order that was ultimately extended a number of times. It is scheduled to sail from Fort Lauderdale on a seven-night trip that will take it around the Caribbean, with ports of call in Mexico and the Bahamas.

CNN Chief Medical Correspondent Dr. Sanjay Gupta got an exclusive early look at the procedures and safety features in place to make cruising in the Covid era possible. The question is, will they be enough to keep passengers and crew coronavirus-free?

Smooth sailing or troubled waters?

For die-hard cruise fans, this event, after several false starts, has been a long time coming. For the more skeptical, the event is tempting fate to once again reveal that cruise ships are floating petri dishes for one infectious disease or another. It will be a long while before the world forgets the high-profile saga of the Diamond Princess, which saw more than 700 coronavirus infections on board, and others like it — a situation made worse and more dramatic by nationwide lockdowns and travel bans that left some ships literally racing toward any welcoming port.

For cruising to be possible in the Covid era, leaders in the industry convened the Healthy Sail Panel — which included experts in the public health, infectious diseases, biosecurity, maritime and hospitality industries — to come up with recommendations to make the experience healthier and safer for guests and crew. These wide-ranging recommendations, developed before vaccines became available, dovetail with the Covid-19 Member Policy of the industry’s largest trade group, Cruise Lines International Association, and with the requirements and guidelines for cruise ships set forth by the CDC, which has been — up to now — deciding the circumstances under which ships can sail from the United States.

Dr. Calvin Johnson, the chief medical officer for Celebrity, told CNN neither he nor the crew are apprehensive. “I think everyone really believes in — because they were part of it — the protocols that we’ve developed, the processes we put in place,” he said.

“This has been over a year of consistent, methodical, science-based, operational examinations to look at the business, how it operates, and how we can do it safely. Putting in place protocols to protect our crew, and then looking at what it will look like when our guests come back to protect them — and so it’s been a process that brought us to this place,” he said.

The industry battens down the hatches

So, what’s the plan to make sailing safer? This summer at least, there will be fewer people on board; the Edge is sailing at 40% of its capacity. Because the coronavirus is spread through airborne particles, fewer people, less crowding and good ventilation can make a big difference.

“For this start-up period, we’re sailing with a reduced capacity to give us all a chance to get used to the protocols and to really allow for natural social distancing,” said Susan Lomax, head of global public relations at Celebrity Cruises. She said the cruise line does not plan to exceed 50% capacity on any of its trips this summer. Because of the reduced capacity, cabin occupancy will be spaced out and people will be put into cabins with windows that face outward. Crew members will get their own cabins.

Lomax said filtration experts from the University of Nebraska were asked to evaluate the ventilation/HVAC system and pronounced it “better than what hospitals have.”

Linsey Marr, an environmental engineer and professor at Virginia Tech, agrees the Edge’s ventilation system is more than adequate. “The combination of high air change rates and high-quality filters … will greatly reduce the amount of virus that can build up in the air. Thus, it is unlikely that people will be exposed to elevated levels of virus in cabins and public indoor spaces,” she told CNN. “If this is the case, then the biggest risk comes from being in close proximity, within the exhaled respiratory plume of an infected individual.”

Yuguo Li, from the department of mechanical engineering at The University of Hong Kong, sides with Marr.

“Taking all evidence so far, I highly believe that SARS-CoV-2 is predominantly transmitted by the short-range inhalation route in inadequately ventilated spaces. We have studied about 20 outbreaks of SARS-CoV-2, and performed ventilation measurement for 10 of them, all supporting this hypothesis,” Li wrote in an email. His study on the Diamond Princess was published online in April in the journal Building and Environment and his editorial appeared in the journal Indoor Air in mid-May.

“For the Diamond Princess outbreak, we showed that their cabin ventilation might be sufficient, and suspect that infections occurred in the public areas. There are two major factors in these public areas: First, in gyms and dancing floors, people perform high [energy] activities with more droplet release and higher inhalation flow, hence infection risks are high … Second, if occupancy is not controlled in these public spaces, the ventilation per person can be even lower. In some spaces such as restaurants, people cannot wear masks,” he explained.

On the Edge, other procedural changes include staggered arrival and departure times to prevent large crowds, and a muster drill — the mandatory safety exercise done at the start of every trip — done virtually instead of in person, again to avoid large crowds. And, food lovers need not fear: the all-you-can-eat buffets will still be a staple of the dining experience, but instead of self-serve, crew members will lend a hand.

In the unfortunate event of an outbreak, the Edge has the capacity to manage 33 patients, and there are four ICU beds. The entire medical area is on a separate ventilation system.

Contact tracing plans that make use of the ship’s CCTV have been drawn up, there are protocols for isolation and quarantining, and disinfection procedures following positive cases.

Importantly, Royal Caribbean has agreements with a number of countries to act as disembarkation ports, should there be a need to get people off the ship.

“There’s no longer any ‘Oh my gosh, we’re sailing for days and no one will take us,’ ” said Lomax. “There’s no reason to wait till the end of the cruise; we have the ability to go to those disembarkation ports if and as needed.”

Vaccines are game changers

But everyone, from those in the cruise industry to health experts, says the real game changers are vaccines, which offer up to 95% protection against symptomatic Covid-19. Even if there are breakthrough infections, vaccines reduce the amount of virus in the body, making people less infectious to others.

“It’s really the vaccines that have enabled us to return to cruising with a low enough level of risk of transmission,” said Marr.

On the Edge, 100% of the crew and at least 95% of passengers are vaccinated, which considerably lowers the risk of people getting infected and sparking an outbreak.

However effective vaccines are, it’s unclear whether, when and where they can be mandated on future cruises. The CDC currently advises unvaccinated people against going on a cruise — but that’s just guidance. Additionally, Florida is one of several states that has banned businesses from requiring customers to provide proof of vaccination, although upcoming cruises leaving from ports in Washington state and Alaska are expected to have vaccination requirements.

And to top it off, a federal district judge in Tampa recently concluded the CDC’s restrictions on the cruise industry are likely unconstitutional and the agency is overstepping its legal authority. So, starting July 18, the agency will no longer be able to enforce its sailing rules, including requirements that either 95% of passengers be vaccinated or that the ship successfully conduct a simulated voyage. The judge gave the CDC until July 2 to propose more modest guidelines.

In navigating these murky, fluctuating rules, Lomax said that the Edge capped at 5% the number of cabins for people who choose not to disclose their vaccination status. They are counted as unvaccinated. People presumed to be unvaccinated will have to wear masks in public areas and will also have to undergo additional Covid-19 testing — both to board and midway through the cruise — at their own expense. Everybody has to be tested before disembarking in the United States.

“With 95% of passengers vaccinated, that’s far more than we have in any country. And we know that the higher vaccination rates have really brought down cases. So I think it’s probably reasonable for healthy vaccinated people to go on a cruise,” said Marr. “The risk of an outbreak on a cruise ship, together with the measures that they’re taking requiring unvaccinated people to wear masks, the overall risk of an outbreak should be quite low. And I’d be surprised if we saw something like the Diamond Princess again.”

But, despite all the precautions, the experience is still not guaranteed to be 100% coronavirus-free, if the Celebrity Millennium is any example. That ship, carrying the first North American paying passengers, set sail in early June out of St. Maarten, and made several ports of call. The crew were all fully vaccinated as were more than 95% of passengers. Nonetheless, two passengers tested positive for coronavirus at the end of the trip.

“In term of vaccination, the protection is not 100%. Sufficient vaccination protects us from developing a chain of infection, i.e. sustained infection in a large population but … that means sporadic outbreaks can still occur particularly with the new variants of concern,” Li noted.

Johnson, Celebrity’s CMO, said the incident was unfortunate but it shows the system is working. “It certainly got my attention,” he said.

“But we also know that, if we look [at] the world around us, in every venue infections are happening every day. And so we fully anticipate that… as thorough as our efforts are and as much as we do prevent, on the front end, virus from coming on board the ship, that it can happen,” he said. “It’s why we have protocols, we have a process; we’ve trained our folks to know what to do when we do identify this. We work very quickly to identify and isolate that, and prevent and stop the spread.”

But perhaps the most reassuring statement for would-be cruise goers comes from Marr, who said that she would not stop her healthy, vaccinated, 70-year-old cruise-loving mother from taking one.

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CNN Health’s Keri Enriquez and Michael Nedelman contributed to this story