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. 2022 Feb 11;74(3):490-497.
doi: 10.1093/cid/ciab433.

Cruise Ship Travel in the Era of Coronavirus Disease 2019 (COVID-19): A Summary of Outbreaks and a Model of Public Health Interventions

Sarah Anne J Guagliardo  1 , Pragati V Prasad  1 , Andrea Rodriguez  1 , Rena Fukunaga  1 , Ryan T Novak  1 , Lauren Ahart  1 , Jared Reynolds  1 , Isabel Griffin  1 , Ryan Wiegand  1 , Laura A S Quilter  1 , Stephanie Morrison  1 , Keisha Jenkins  1 , Hilary K Wall  1 , Aimee Treffiletti  1 , Stefanie B White  1 , Joanna Regan  1 , Kara Tardivel  1 , Amy Freeland  1 , Clive Brown  1 , Hannah Wolford  1 , Michael A Johansson  1 , Martin S Cetron  1 , Rachel B Slayton  1 , Cindy R Friedman  1
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Cruise Ship Travel in the Era of Coronavirus Disease 2019 (COVID-19): A Summary of Outbreaks and a Model of Public Health Interventions

Sarah Anne J Guagliardo et al. Clin Infect Dis. .

Abstract

Background: Cruise travel contributed to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) transmission when there were relatively few cases in the United States. By 14 March 2020, the Centers for Disease Control and Prevention (CDC) issued a No Sail Order suspending US cruise operations; the last US passenger ship docked on 16 April.

Methods: We analyzed SARS-CoV-2 outbreaks on cruises in US waters or carrying US citizens and used regression models to compare voyage characteristics. We used compartmental models to simulate the potential impact of 4 interventions (screening for coronavirus disease 2019 (COVID-19) symptoms; viral testing on 2 days and isolation of positive persons; reduction of passengers by 40%, crew by 20%, and reducing port visits to 1) for 7-day and 14-day voyages.

Results: During 19 January to 16 April 2020, 89 voyages on 70 ships had known SARS-CoV-2 outbreaks; 16 ships had recurrent outbreaks. There were 1669 reverse transcription polymerase chain reaction (RT-PCR)-confirmed SARS-CoV-2 infections and 29 confirmed deaths. Longer voyages were associated with more cases (adjusted incidence rate ratio, 1.10, 95% confidence interval [CI]: 1.03-1.17, P < .003). Mathematical models showed that 7-day voyages had about 70% fewer cases than 14-day voyages. On 7-day voyages, the most effective interventions were reducing the number of individuals onboard (43.3% reduction in total infections) and testing passengers and crew (42% reduction in total infections). All four interventions reduced transmission by 80.1%, but no single intervention or combination eliminated transmission. Results were similar for 14-day voyages.

Conclusions: SARS-CoV-2 outbreaks on cruises were common during January-April 2020. Despite all interventions modeled, cruise travel still poses a significant SARS-CoV-2 transmission risk.

Keywords: SARS-CoV-2; cruise ship; mathematical modeling; outbreaks.

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