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CLIA crafting 'curb to curb' framework for safe cruising in COVID-19 era

CRUISE Brian Salerno.jpg
'We have to have protocols in place ... We have to be very transparent,' CLIA SVP Brian Salerno said
The cruise industry is taking a holistic approach to planning for COVID-19 safety when sailing is allowed. This entails a 'curb to curb' strategy, from start (time of booking) to finish (returning home).

Resuming operations is 'a ways off but it's not too soon to plan for, not only the companies and ships but destinations,' Brian Salerno, SVP maritime policy, Cruise Lines International Association, told Seatrade Cruise News. 

'We have to have protocols in place ... We have to be very transparent,' Salerno said in a wide-ranging interview that touched on everything from doctors' notes to evacuation plans.

Health authorities aren't setting specific requirements — at least not yet. Salerno would be 'very surprised' if the US Centers for Disease Control and Prevention did that. Instead, cruise lines are tasked to come up with robust plans for the authorities to review.

Sharing protocols with the public

CLIA has been briefing its executive partners but the association hasn't talked much publicly about the COVID-19 protocols in development. Mainly, that's because the science for dealing with the virus is rapidly evolving.

'Very specific measures that make sense today may not have two months ago,' Salerno noted, and things are likely to change before cruising can restart.

Still, Salerno's aim is to have 'overarching goals to share within the next few weeks. There's a strong desire to provide public information — ports, terminals and tour operators need to know. They need that framework for coordination so we're consistent and maintain procedures. The cruise industry doesn't control all those things but we should have some standard of commonality.'

A framework

CLIA's approach to building the COVID-19 framework is deciding objectives then how to go about achieving them. The association hopes its template could be used globally, adapted to local conditions.

'Every company is going to develop something that is unique to their operations,' Salerno said.

A planning group under Salerno's maritime policy department numbers nearly 20 senior managers from member lines. They oversee a spectrum of areas at their companies — the acquisition of equipment, training, purchasing, ship design, finance, logistics and operations. The group holds two to three calls a week.

Advice is sought from the medical community, both within the cruise industry including CLIA's medical working group, and from external epidemiologists to 'help us really understand the nature of the problems so we can come up with the right solutions,' Salerno said.

This includes assessing a flood of proposals for new technologies and sanitation solutions.

Notes for age and pre-existing conditions 'still on the table'

CLIA's 'curb to curb' approach starts with the time of booking, entailing the kinds of questions to ask a customer and the type of health information that will be required.

The previous stateside mandate for anyone 70 and older and anyone with a pre-existing condition to present a doctor's note in order to cruise isn't among CLIA's current protocols because ships aren't boarding passengers now. Only crew, government officials and port service providers are coming on, and they're subject to what the association deems appropriate screening measures to preserve a safe environment.

'Age and pre-existing conditions are still on the table,' Salerno said. 'To the extent they are still risk factors, they're categories of data we have to consider.' Requiring a doctor's note has been an area of concern for many, so that's been decoupled from age at the moment. In future, there may be guidance from CDC on this.

Among the concerns is that getting a doctor's note may be challenging in some countries, depending on the healthcare system. In Canada, for example, that would be more complicated than in the US. So this requires some thought, Salerno said, to achieve the objective of screening people at high risk.

Before operations resume, CLIA will issue a revised set of screening protocols reflecting what the medical community has learned about COVID-19. As Salerno explained, it's tough to determine the criteria at this point because 'the knowledge base on this virus is changing almost daily.'

At the terminal

Screening at the terminal should ensure infected persons don't embark. Testing everyone for COVID-19 is the ideal solution, however given the uncertainty about the availability of test kits, that may not be practical.

Salerno said temperature screening is still on the table and most likely will be part of the protocols. All technologies are being looked at, and all or a combination may be suitable. These could include infrared and airport-type portals that measure temperature and respiration.

The key is being able to screen multiple people very rapidly.

Social distancing

Social distancing will be a reality on ships for the foreseeable future.

Buffets may not be possible. Dining room seating will be more spread out. The same types of protocols followed at restaurants ashore will be followed at sea.

Destinations/shore excursions

'The shoreside aspect is 'critical,' Salerno stressed. Lines control what happens on their ships, but destinations are another matter.

Cruises are expected to resume in a gradual or phased approach, since the virus is at different stages in different parts of the world. 'It also depends on who's ready to accept us,' Salerno said, 'and who has procedures in place, those places with tighter controls, a carefully thought-out plan.'

Cruise lines want to 'make sure shore excursions are done with a view to protection, including the sites to be visited, the transportation to and from.' Social distancing will need to continue shoreside.

Of course, such procedures will protect the destinations' residents, as well.

Enhanced medical capabilities/evacuation plans

Ships will have enhanced medical capabilities, including enhanced staffing, with medical team redundancy should a doctor or nurse become sick. Medical centers will have the ability to assess whether symptomatic people have COVID-19.

Asymptomatic carriers are a challenge. People carrying the virus can test negative for a couple days and pass it to others. 'We want to identify the virus early on,' Salerno said. 'Ideally, we'd have the ability to test on board fairly early on.'

Quarantine space/evacuation plan

A certain number of staterooms may be set aside as a quarantine area in case of an outbreak. Ships will have to be prepared to isolate sick people in a dedicated space apart from other passengers and the crew, except for those crew who are properly trained to care for them and outfitted with personal protective equipment.  

Cruise ship medical facilities currently provide a certain level of critical care, which will be enhanced. There's been discussion of health authorities requiring full intensive care units, but Salerno said only that 'the expectation would be that we'd do everything we can on board the ship and take care of everything we can.

'What we're looking at are procedures for medical evacuation that can be done without burdening public resources.' Commercial entities have that capability. Having pre-identified resources, including airports and hospitals, will be part of the plan.

At disembarkation, it will be important to have a mechanism for contact tracing in the event someone becomes sick.

Crew

'Care of the crew is absolutely vital,' Salerno said. 'Even though crew are younger and tend to be more resilient, we don't want them catching [the virus]. We don't want them transmitting it.'

Proper sanitation in the crew areas is an 'essential element' of the COVID-19 framework.

And crew will be key to the on-board surveillance for the virus, which means training them to be alert, have situational awareness and know what steps to take.

Luggage handling and stores

When it comes to COVID-19 safety, even the mundane operations like luggage handling and bringing on stores have to be accounted for in the planning. 

And much more.

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