Public Health Responses to COVID-19 Outbreaks on Cruise Ships — Worldwide, February–March 2020

Leah F. Moriarty, MPH; Mateusz M. Plucinski, PhD; Barbara J. Marston, MD; Ekaterina V. Kurbatova, MD, PhD; Barbara Knust, DVM; Erin L. Murray, PhD; Nicki Pesik, MD; Dale Rose, PhD; David Fitter, MD; Miwako Kobayashi, MD, PhD; Mitsuru Toda, PhD; Paul T. Canty, MD; Tara Scheuer, MPH; Eric S. Halsey, MD; Nicole J. Cohen, MD; Lauren Stockman, MPH; Debra A. Wadford, PhD; Alexandra M. Medley, DVM; Gary Green, MD; Joanna J. Regan, MD; Kara Tardivel, MD; Stefanie White, MPH; Clive Brown, MD; Christina Morales, PhD; Cynthia Yen, MPH; Beth Wittry, MPH; Amy Freeland, PhD; Sara Naramore, MPH; Ryan T. Novak, PhD; David Daigle, MPH; Michelle Weinberg, MD; Anna Acosta, MD; Carolyn Herzig, PhD; Bryan K Kapella, MD; Kathleen R. Jacobson, MD; Katherine Lamba, MPH; Atsuyoshi Ishizumi, MPH, MSc; John Sarisky, MPH; Erik Svendsen, PhD; Tricia Blocher, MS; Christine Wu, MD; Julia Charles, JD; Riley Wagner, MPH; Andrea Stewart, PhD; Paul S. Mead, MD; Elizabeth Kurylo, MCM; Stefanie Campbell, DVM; Rachel Murray, MPH; Paul Weidle, PharmD; Martin Cetron, MD; Cindy R. Friedman, MD


Morbidity and Mortality Weekly Report. 2020;69(12):347-352. 

In This Article

Grand Princess

During February 11–21, 2020, the Grand Princess cruise ship sailed roundtrip from San Francisco, California, making four stops in Mexico (voyage A). Most of the 1,111 crew and 68 passengers from voyage A remained on board for a second voyage that departed San Francisco on February 21 (voyage B), with a planned return on March 7 (Table). On March 4, a clinician in California reported two patients with COVID-19 symptoms who had traveled on voyage A, one of whom had positive test results for SARS-CoV-2. CDC notified the cruise line, which began cancelling group activities on voyage B. More than 20 additional cases of COVID-19 among persons who did not travel on voyage B have been identified from Grand Princess voyage A, the majority in California. One death has been reported. On March 5, a response team was transported by helicopter to the ship to collect specimens from 45 passengers and crew with respiratory symptoms for SARS-CoV-2 testing; 21 (46.7%), including two passengers and 19 crew, had positive test results. Passengers and symptomatic crew members were asked to self-quarantine in their cabins, and room service replaced public dining until disembarkation. Following docking in Oakland, California, on March 8, passengers and crew were transferred to land-based sites for a 14-day quarantine period or isolation. Persons requiring medical attention for other conditions or for symptoms consistent with COVID-19 were evaluated, tested for SARS-CoV-2 infection, and hospitalized if indicated. During land-based quarantine in the United States, all persons were offered SARS-CoV-2 testing. As of March 21, of 469 persons with available test results, 78 (16.6%) had positive test results for SARS-CoV-2. Repatriation flights for foreign nationals were organized by several governments in coordination with U.S. federal and California state government agencies. Following disinfection of the vessel according to guidance from CDC's Vessel Sanitation Program, remaining foreign nationals will complete quarantine on board. The quarantine will be managed by the cruise company, with technical assistance provided by public health experts.

On February 21, five crew members from voyage A transferred to three other ships with a combined 13,317 passengers on board. No-sail orders§§ were issued by CDC for these ships until medical logs were reviewed and the crew members tested negative for SARS-CoV-2.

§§CDC has the authority to institute a no-sail order to prevent ships from sailing when it is reasonably believed that continuing normal operations might subject newly arriving passengers to disease.