'A strategy for reducing the risks for COVID-19 among cruise ship passengers and crew should cover the entire process, beginning at the time of booking and extending until passengers and crew have returned to their homes. National policies for accepting incoming tourists to cross borders and to board cruise ships at the turnaround ports should also be considered in cruise line plans,' the guidance said.
Shorter cruises, limited port calls
A gradual approach to restarting operations is advised, including short itineraries, such as three to seven days, along with a limited number of port calls.
'The willingness and capacity of countries included in the itinerary should be explored, and arrangements should be in place to accept possible or confirmed COVID-19 cases disembarking from cruise ships, as well as possible contacts and anyone else wishing to disembark,' the guidance said.
According to the International Health Regulations 2005, designated ports must have the capacities to provide appropriate public health emergency response by establishing and maintaining a public health emergency contingency plan. Interoperability of the port public health emergency contingency plan with the cruise ship contingency plan/outbreak management plan should be ensured.
Arrangements for medical treatment ashore, including possible air evacuation, and arrangements for repatriation of passengers and crew should be included in the cruise line plan. Facilities for shoreside transport and quarantine should be agreed in advance.
Adequate testing for COVID-19 on board or ashore, crew training and a commitment to immediately reporting any possible case to the next port of call are other prerequisites of restarting service.
Ships must be able to individually isolate 5% of passengers and 5% of crew on board when it will not be possible to disembark those who need to be quarantined or isolated within 24 hours from detection of the first possible COVID-19 case. When it will be possible to disembark passengers and crew within that 24-hour window, isolation space on board will be required for only 1% of passengers and 1% of crew.
EU Healthy Gateways will support inspection of COVID-19 prevention and control by providing a checklist based on the advice document, training inspectors, scheduling at an EU level to avoid duplication of inspections and keeping an EU database to record inspections. It will not be necessary to undergo inspection before starting operations. This could be arranged at any date and at any port, in agreement with the company and the inspectors.
CLIA welcomes the guidance
Cruise Lines International Association welcomed the document.
'The primary concern of CLIA and its member lines is the health and safety of its passengers and crew. This guidance from the public health authorities in Europe provides a useful resource for cruise lines as they prepare to resume operations,' CLIA Europe Secretary-General Tom Boardley said.
CLIA and its member lines were involved in the development of the guidance and will continue to work with EU Healthy Gateways to assess the practicality and suitability of the guidance as a pan-European framework moving forward.
No doctor's note required
There is no requirement that older people or those with underlying health conditions obtain a doctor's note to cruise. However, anyone over 65 or those of any age with chronic disease (cardiovascular, diabetes, respiratory) and immunocompromised individuals should be advised to see a doctor to assess if they are fit to travel, the guidance stated.
Many recommendations cover familiar ground, but others seem new.
Activities organized by age group
For example, the guidelines suggest activities and services on board could be organized according to age group, so that older individuals are separated from other age groups. Crew members in high risk groups could work in positions where there is little or no interaction with other individuals.
Another recommendation is dividing passengers and crew into cohorts. Each group could be given scheduled times for food service, embarking and disembarking and participating in some on-board activities. Interaction between each cohort should be avoided as much as possible. If it is not possible to maintain separate cohorts/groups on board, they should be kept for shore-based activities. Consideration may be given to cohorting groups of children for the duration of the voyage.
The guidance covers pre-trip and embarkation screening, crew training, prevention measures, outbreak response, physical distancing, mask wearing, hand hygiene and 'respiratory etiquette' (sneezing/coughing).
When it comes to masks, they are strongly recommended for both crew and passengers in any area where interaction with others occurs and maintaining physical distancing (1.5 meters) cannot be guaranteed. This specifically includes during embarkation at the terminal, on buses during transport, walking/passing in narrow corridors, in elevators, visiting the medical facility and in lifeboats.
Crew should wear masks when interacting with passengers including when handling food and cleaning cabins and when working with other crew when 1.5 meters distance cannot be maintained.
The correct use of masks and hand sanitation should be provided via such means as audio messages, leaflets, TV, infographics, websites, electronic posters and in terminals.
The ventilation of all occupied spaces of the ship should operate continuously and provide as much outside air as possible. Direct air flow should be diverted from groups of passengers when possible. Bathroom exhaust fans should run continuously. If it's not possible to completely stop air recirculation, the ship should explore improving air filtration and using HEPA filters or ultraviolet germicidal irradiation.
Bye bye mini-bars?
Elevated cleaning procedures are detailed, including special considerations for cabins.
For example, it is advised to remove any item that can't be cleaned and disinfected between occupancies, such as menus, magazines, coffee/ tea packaging and mini-bar products (unless these are served from dispensers). This also goes for coffee makers and kettles.
Instead, such items could be available on request, and the mini-bar can be used as a refrigerator and should be disinfected after each check-out.
A disposable cover should be placed on the TV and the air-conditioning remote controls to facilitate proper disinfection, unless these items can be easily and adequately cleaned and disinfected.
Standards for food safety and preparation are detailed. It is recommended that all self-service food operations are avoided. Disposable salt, pepper and other containers are advocated — counter to the cruise industry's recent shift to bulk products for environmental reasons/plastics reduction.
Individual dining options, including room service, are recommended to provide food to passengers’ cabins, in order to avoid overcrowding in restaurants and other food service areas.
Distancing, reducing face-to-face interactions
Online bookings, orders and purchases should be encouraged, as well as the use of contactless cards for payments. Forms that need to be completed may be made available online.
Areas like reception should be reconfigured to allow social distancing. The use of a sneeze guard/transparent screen at the reception and other service and information points is recommended.
Suggestions for children's areas, entertainment venues and casinos are covered. A record of anyone using the fitness area should be kept, and machines should be positioned at least two meters apart and cleaned after each use.
No indoor swimming
The operation of indoor swimming pools is discouraged. Removing walls or roofs to allow natural ventilation could be allowed. The number of swimmers in any pool should be limited and small hot tubs should be used only by bathers staying in the same cabin at a time.
Interface between ship- and shore-based personnel should be limited. Lines and terminal operators should ensure distancing inside facilities, and consider limiting the number of taxis and coaches to prevent crowding. Disinfection of luggage, especially the hand contact parts, may be considered before loading luggage on board.
Excursion providers should offer similar precautions as those on the ship. Upon reboarding, health screening such as temperature checks is advised.
Outbreak control, routine testing
The guidance goes into specifics about outbreak response, control and reporting.
And it delves into testing.
Cruise lines could consider testing all incoming passengers. However, testing 'should not give a false sense of security' since it has limitations such as the inability to detect incubating infection.
Pooling of five samples from asymptomatic persons can increase testing capacity with existing equipment.
Testing for antibodies as a condition for embarking is not supported by the current scientific knowledge.
Before resuming operations, lines should test all crew already on board for COVID-19, along with incoming crew. In addition, periodic testing can be conducted for all crew at regular intervals, such as every two weeks. Pool sample methods could be used.
In addition, daily contactless temperature checks are advised.
The full guidance is here.