Technical Instructions for Mitigation of COVID-19 Among Cruise Ship Crew

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CDC has issued an Order that requires face masks to be worn by all travelers while on public transportation including all passengers on board and all personnel operating maritime conveyances traveling into, within, or out of the United States. Masks are also required while indoors at U.S. transportation hubs, including seaports and ferry terminals. Travelers are not required to wear a mask in outdoor areas of a conveyance. For more information on this mask requirement, see the Frequently Asked Questions.

Summary of Recent Changes

August 27, 2021

Added language reflecting that as of July 23, 2021, the Conditional Sailing Order (CSO) and accompanying measures, such as technical instructions, are nonbinding recommendations for cruise ships arriving in, located within, or departing from a port in Florida. However, CDC will continue to operate the CSO as a voluntary program for such ships should they choose to follow the CSO measures on a voluntary basis. Added definition of “gray” designated ships under the color-coding system for ships opting not to follow the CSO.

Revised screening testing for fully vaccinated close contacts and newly embarking crew, and routine screening of fully vaccinated crew, for cruise ships operating under the CSO, including those choosing to follow CSO measures on a voluntary basis. This change was due to the increased transmissibility of some SARS-CoV-2 variants of concern and evidence of breakthrough cases in fully vaccinated individuals.

Clarified the following: isolation practices for COVID-19-like illness; which medical management sections are for crew and passengers; and shore leave for crew-only ships.

Removed the “Boarding Non-Essential Crew” section.


July 13, 2021

Clarified documentation of recovery. Updated Screening Testing Frequency by Ship Color Status Table. Updated information for tests that do not have the U.S. Food and Drug Administration (FDA) reference panel available and provided additional requirements for use of self tests. Updated color criteria and removed the Preventive Measures Based on Ship Status table.


June 4, 2021

Clarified mask use for crew who are not fully vaccinated. Removed attestations for commercial travel status. Updated Preventive Measures Based on Ship Status table.


May 14, 2021

Clarified testing and quarantine options based on vaccination status.

Purpose

This document provides instructions for CDC’s Framework for Conditional Sailing Order (CSO) for cruise ship operations in U.S. waters, including for ships choosing to follow CSO measures on a voluntary basis, to ensure health and safety protections for travelers (crew and passengers) in a way that mitigates the risk of spreading COVID-19.

Except for cruise ships operating out of Florida ports, as a condition of obtaining or retaining permission to engage in any cruise ship operations in U.S. waters, the Framework for Conditional Sailing Order (CSO) pdf icon[PDF – 40 pages], published in the Federal Registerexternal icon on November 4, 2020, requires that cruise ship operators take adequate safeguards for crew, as demonstrated through laboratory testing for SARS-CoV-2 infection and other measures, to prevent, mitigate, and respond to the risk of COVID-19 on board cruise ships.

These instructions are not intended as, and do not constitute, a comprehensive statement regarding a cruise ship operator’s applicable duties and obligations under the Framework for Conditional Sailing Order. Except for cruise ships operating out of Florida ports, cruise ship operators must establish mechanisms to ensure compliance with this Order, including any plans adopted pursuant to the Order, and immediately notify CDC and United States Coast Guard (USCG) within 24 hours of any deviations, whether intentional, or as a result of error or omission.

These instructions reflect CDC’s reasoned judgement based on the best available current science regarding the subject areas covered in the document. Cruise ship operators should carefully consider and incorporate these instructions in developing their own health and safety protocols.

CDC will update these instructions for cruise ships as needed to reflect the state of the pandemic and notify cruise lines when these instructions are updated.

Preventive Measures

Cruise ships involve the movement of large numbers of people in settings where they are likely to have close contact with one another. Close-contact environments facilitate transmission of respiratory viruses from person to person through exposure to respiratory droplets, aerosols, or contact with contaminated surfaces. Cruise ships may also be a means by which infected persons travel between geographic locations.

To reduce spread of SARS-CoV-2, the virus that causes COVID-19, CDC recommends that cruise ship operators:

  • Explore options to vaccinate crew for COVID-19. This includes encouraging crew to get the COVID-19 vaccine when eligible and the vaccine is available.
  • Minimize the number of crew sharing a cabin or bathroom to the extent practicable.
  • Instruct crew members to remain in cabins as much as possible during non-working hours
  • Cancel all face-to-face employee meetings, group events (such as employee trainings), or social gatherings
  • Close all crew bars, gyms, and other group settings
  • Implement physical distancing of crew members who are not fully vaccinated when working or moving through the ship (maintaining at least 6 feet [2 meters] from others)
  • Instruct crew members to wear a face mask when outside of individual cabins
  • Modify meal service to facilitate physical distancing (e.g., reconfigure dining room seating, stagger mealtimes, encourage in-cabin dining)
  • Eliminate self-serve dining options at all crew and officer messes
  • Discourage handshaking – encourage the use of non-contact methods of greeting
  • Promote respiratory and hand hygiene and cough etiquette
  • Place hand sanitizer (containing at least 60% alcohol) in multiple locations and in sufficient quantities to encourage hand hygiene
  • Ensure handwashing facilities are well-stocked with soap and paper towels
  • Place posters that encourage hand hygiene to help stop the spread in high-trafficked areas

Note: Some measures are not necessary for crew who are fully vaccinated.

Surveillance for COVID-19

Note: This section applies to cruise ships operating under the CSO, including those choosing to follow CSO measures on a voluntary basis.

  • As an interim replacement to the Maritime Conveyance Cumulative Influenza/Influenza-Like Illness (ILI) Form for each international voyage, CDC requires daily submission of the “Enhanced Data Collection (EDC) During COVID-19 Pandemic Form” during the period of the Framework Order. This EDC Form will be used to conduct surveillance for COVID-19 on board cruise ships using cumulative reports of confirmed COVID-191 and COVID-19-like illness 2, which includes acute respiratory illness (ARI), influenza-like illness (ILI), pneumonia, and additional COVID-19-like illness (aCLI) clinical criteria.
  • Access to the online EDC form has been provided to cruise lines by the Cruise Lines International Association (CLIA) or CDC. Cruise lines that do not have access should contact CLIA or CDC (email eocevent349@cdc.gov).
  • In addition to this daily surveillance via the online EDC form, cruise ship operators should continue to report to USCG via Advance Notice of Vessel Arrival (ANOA), which constitutes the most timely source of illness information when the cruise ship is within waters subject to the jurisdiction of the United States.

CDC may publish these surveillance data on its website or in other documents to inform the public.


[1] Confirmed COVID-19 means laboratory confirmation for SARS-CoV-2, the virus that causes COVID-19, by viral test.

[2] COVID-19-like illness clinical criteria include the following:

  • Persons with at least one or more of the following symptoms: fever, cough, difficulty breathing, shortness of breath, new olfactory disorder, or new taste disorder; OR
  • Persons with at least two or more of the following symptoms: sore throat, nasal congestion, runny nose (rhinorrhea), chills, rigors, muscle or body aches (myalgias), headache, fatigue, vomiting, or diarrhea …in the absence of a non-infectious diagnosis as determined by the ship’s physician (e.g., allergies); OR
  • Persons with severe respiratory illness with at least one of the following:
    • Clinical or radiographic evidence of pneumonia,
    • Acute respiratory distress syndrome (ARDS).

CSO Phase 1 Shoreside COVID-19 Laboratory Screening Testing of All Crew

Note: This section applies to cruise ships operating under the CSO, including those choosing to follow CSO measures on a voluntary basis.

  • In preparation for the resumption of passenger operations, cruise ship operators must have adequate health and safety protections for crew members while they build the onboard laboratory capacity needed to test crew and future passengers. By December 29, 2020 (60 days after the effective date of the Framework Order)*, cruise ship operators were expected to collect clinical specimens for SARS-CoV-2 testing from all crew, regardless of vaccination status, currently onboard their cruise ships. Ships that are entering U.S. waters for the first time under the CSO must complete these Phase 1 requirements.
  • Phase 1 viral (NAAT or antigen) testing may be conducted on board or at a shoreside laboratory. Specimen collection for all crew must occur within a 48-hour time period.
  • If a shoreside laboratory is used, it must be a Clinical Laboratory Improvement Amendments (CLIA)-certified laboratory.
  • Examples of available NAATs for SARS-CoV-2 include but are not restricted to reverse transcription polymerase chain reaction (RT-PCR), reverse transcription loop-mediated isothermal amplification (RT-LAMP), transcription-mediated amplification (TMA), nicking enzyme amplification reaction (NEAR), and helicase-dependent amplification (HDA).
  • Nucleic acid amplification tests (NAAT) must meet the following standards:
    • Be CLIA-waived by FDA;
    • Be evaluated on the FDA reference panel iconexternal icon for SARS-CoV-2 and possess a limit of detection (LoD) value ≤18,000 NDU/ml.1 For tests that do not have the FDA reference panel available, tests will be accepted using sensitivity data ≥ 95% from clinical samples as indicated in the manufacturer’s instructions for use (IFU);
    • Allow for specimen-to-instrument transfer in a way that minimizes the risk of contamination.
  • For more information on NAAT, please visit: cdc.gov/coronavirus/2019-ncov/lab/naats.html
  • Antigen test systems must meet the following standards:
    • Be CLIA-waived by FDA;
    • Allow for specimen-to-test system transfer in a way that minimizes the risk of contamination.
  • For antigen testing, cruise ship operators should follow CDC’s Interim Guidance for Antigen Testing for SARS-CoV-2.
  • Prior to collecting specimens and conducting testing: Cruise ship operators must contact CDC at eocevent349@cdc.gov at least 7 calendar days prior to collecting specimens. Include “Laboratory Screening Testing of All Crew Onboard [SHIP NAME]” in the subject line as part of your request for CDC approval.
  • CDC’s response to the cruise ship operator’s email may include additional information regarding best practices that may assist cruise ship clinicians or public health staff in collecting and transporting specimens.
  • CDC may oversee the onboard collection of crew specimens through remote means allowing for visual observation.
  • All specimens for a ship’s crew must be tested at the same laboratory and not divided between different shoreside laboratories.
  • If the shoreside laboratory does not provide specimen collection kits, then CDC must approve the cruise ship operator’s selection of a supplier for the specimen collection kits.
  • Cruise ship operators must report all laboratory results in aggregate to CDC through the Enhanced Data Collection (EDC) form.
    • To ensure the integrity of testing, persons with positive NAAT results must not be retested, and the original positive results must be reported. Subsequent negative NAAT results do not negate an initial positive result.
  • Persistent Positives: CDC considers all positive viral test (NAAT or antigen) results as new cases unless the individual is asymptomatic and has documentation of recovery from COVID-19 in the previous 90 days. Cruise ship operators must have a protocol for evaluating documentation of recovery, including reviewing previous laboratory results. Documentation of recovery includes the following:
    • Paper or electronic copies of the crew member’s previous positive viral test result (dated no more than 90 days ago), and
    • A signed letter, on official letterhead that contains the name, address, and phone number of a licensed healthcare provider or public health official, stating that the crew member has been cleared to end isolation and therefore can travel. A letter that states that the crew member has been cleared to end isolation to return to work is also acceptable. The letter does not have to specifically mention travel.
  • Medical personnel should document all positive SARS-CoV-2 test results (pre-embarkation, throughout crew members’ contract duration, and post-disembarkation) in the ship’s medical records. These medical records must be made available for CDC inspection upon request.
  • Crew who test positive for SARS-CoV-2 should not be re-tested (e.g., as part of a contact tracing investigation) until 90-days post lab-confirmed diagnosis, unless they are symptomatic and no alternate infectious etiology (e.g., influenza, respiratory syncytial virus [RSV], Legionella, Streptococcal pharyngitis) has been identified through laboratory testing. These symptomatic crew must be isolated and re-evaluated, including retesting, regardless of prior positive test results.
  • CDC has provided an alternative to ships sailing out of foreign ports with passengers and repositioning to the U.S., in lieu of operating with no passengers for 14 days prior to resuming passenger operations in U.S. waters. Cruise ship operators may contact CDC at eocevent349@cdc.gov to request this information.

*Note: For cruise ship operators with ships that have not been in U.S. waters during the period of the No Sail Order (NSO) or CSO, or voluntarily withdrew their ships, the 60-day period will begin upon: (1) CDC’s confirming to the cruise ship operator in writing that the operator has a complete and accurate NSO response plan, including having submitted to CDC a signed Acknowledgment of No Sail Order Response Plan Completeness and Accuracy; and (2) submission of the EDC form for the 14 days preceding the cruise ship’s expected arrival in U.S. waters.


[1] NDU=RNA NAAT detectable unit; CDC’s 2019-nCOV RT-PCR diagnostic panel was used to define the LoD cut-off value. A high LoD indicates that the assay has a lower sensitivity which may result in more false negative results, especially in asymptomatic infected people. A lower LoD represents an assay’s ability to detect a smaller amount of viral genetic material in a given sample, signaling a more sensitive test.

Onboard COVID-19 Testing for Symptomatic Travelers (Crew and Passengers) and Close Contacts

Note: This section applies to cruise ships operating under the CSO, including those choosing to follow CSO measures on a voluntary basis.

  • All travelers onboard the cruise ship with signs and symptoms of COVID-19, regardless of vaccination status, must be isolated and tested for SARS-CoV-2 infection immediately upon notifying medical staff of symptom onset. Results must be reported to CDC in aggregate through the EDC form.
  • Because of the potential for asymptomatic and pre-symptomatic transmission, it is important that close contacts of individuals with SARS-CoV-2 infection be quickly identified and tested.
    • o Close contacts who are fully vaccinated must receive a viral test (NAAT or antigen) but do not need to quarantine.
    • Close contacts who are not fully vaccinated must immediately receive a NAAT, quarantine until 14 days after last exposure, and receive a NAAT on day 14, before the end of quarantine.
Onboard COVID-19 Testing for Symptomatic Travelers (Crew and Passengers) and Testing and Quarantine of Close Contacts
Not Fully Vaccinated Travelers Fully Vaccinated Travelers
Testing of Travelers with Signs and Symptoms of COVID-19 NAAT Viral (NAAT or antigen)
*Antigen-negative must be confirmed with NAAT
Testing and Quarantine of Asymptomatic Close Contacts without Documentation of Recovery in Past 90 Days Testing: NAAT immediately and at 14 days

Quarantine: 14 days (if both test results negative)

Testing: Viral (NAAT or antigen) at 3-5 days post-exposure
Quarantine: Not Applicable^
Testing and Quarantine of Asymptomatic Close Contacts with Documentation of Recovery in Past 90 Days Testing: Not Applicable
Quarantine: Not Applicable
Testing: Not Applicable
Quarantine: Not Applicable

 ^ Individual must wear a mask when outside of cabin until 14 days after the exposure or until after their test result is negative

  • All cruise ships must procure NAAT point-of-care equipment to test symptomatic travelers (and identified close contacts, regardless of vaccination status).
    • This test system must:
      • Be CLIA-waived by FDA;
      • Be evaluated on the FDA reference panelexternal icon for SARS-CoV-2 and possess a limit of detection (LoD) value ≤18,000 NDU/ml. For tests that do not have the FDA reference panel available, tests will be accepted using sensitivity data ≥ 95% from clinical samples as indicated in the manufacturer’s IFU;
      • Allow for specimen-to-instrument transfer in a way that minimizes the risk of contamination.
      • Prior to procuring a NAAT point-of-care equipment: Cruise ship operators must contact CDC at eocevent349@cdc.gov at least 7 calendar days prior to collecting specimens. Include “NAAT Point-of-Care Equipment and Assay to Test Symptomatic travelers [SHIP NAME]” in the subject line as part of your request for CDC approval.
  • At their discretion, cruise ships may procure antigen test systems to test symptomatic travelers who are fully vaccinated.
    • Antigen test systems must:
      • Be CLIA-waived by FDA;
      • Allow for specimen-to-test system transfer in a way that minimizes the risk of contamination.
    • For antigen testing, cruise ship operators should follow CDC’s Interim Guidance for Antigen Testing for SARS-CoV-2.
    • Cruise ship operators may, at their discretion, contact CDC at eocevent349@cdc.gov prior to procuring antigen test systems to ensure the selected test meets the specifications listed above. Include “Diagnostic Testing for Travelers – [SHIP NAME]” in the subject line.
  • Symptomatic persons with COVID-19-like illness who initially test negative for SARS-CoV-2 via NAAT and for whom no alternative etiology is identified (e.g., influenza, Legionella, Streptococcal pharyngitis, infectious mononucleosis, or respiratory syncytial virus [RSV]):
    • Must be isolated for COVID-19 per CDC guidelines, and
    • May be retested via NAAT collected at least 24 hours after the initial COVID-19 test
      • Isolation may be discontinued if the repeat NAAT result is negative.
      • If an alternate infectious etiology is identified (through either laboratory testing or clinical diagnosis), routine infection control precautions (e.g., isolation) recommended for the diagnosis should be followed.
      • For example, if symptomatic person has only vomiting and diarrhea and tests negative for COVID-19 twice, then acute gastroenteritis (AGE) protocols should be followed.
    • Cruise ships should report only final diagnostic test results on EDC.
  • Cruise ships must follow the requirements in section CSO Phase 2 through Phase 4 Screening Testing Specifications below.

Symptomatic Travelers (Crew and Passengers)

Note: This section applies to cruise ships operating under the CSO, including those choosing to follow CSO measures on a voluntary basis.

Identifying and isolating travelers with possible symptoms of COVID-19 as soon as possible is essential to minimize transmission of the virus. Crew must self-isolate immediately and inform the onboard medical center if they develop a fever (100.4°F / 38°C or higher), begin to feel feverish, develop acute respiratory symptoms (cough or difficulty breathing), or other symptoms of COVID-19. Passengers who become symptomatic should follow ship-specific protocols.

Cruise ship medical personnel and cruise line telemedicine providers should reference CDC’s COVID-19 website Information for Healthcare Professionals for the latest information on infection control, clinical management, collecting clinical specimens, evaluating patients who may be sick with or who have been exposed to COVID-19, or identifying close contacts. For additional information, please refer to Interim Guidance for Ships on Managing Suspected or Confirmed Cases of Coronavirus Disease 2019.

Isolation of Symptomatic Travelers (Crew and Passengers) and Confirmed Cases and Quarantine of Close Contacts

Note: This section applies to cruise ships operating under the CSO, including those choosing to follow CSO measures on a voluntary basis.

Travelers with COVID-19-like illness (CLI) must be isolated using the same procedures as a traveler with confirmed COVID-19. If the symptomatic traveler has a negative SARS-CoV-2 test result, they must continue to follow CDC’s COVID-19 isolation guidance. Isolation may be discontinued if a repeat NAAT result—collected at least 24 hours from the initial COVID-19 test—is negative. If an alternate infectious etiology is identified (through either laboratory testing or clinical diagnosis), routine infection control precautions (e.g., isolation) recommended for the diagnosis should be followed. For example, if symptomatic person has only vomiting and diarrhea and tests negative for COVID-19 twice, then acute gastroenteritis (AGE) protocols should be followed.

Quarantine of asymptomatic travelers who are not fully vaccinated that are identified as close contacts of symptomatic travelers or confirmed cases is also needed to minimize transmission of SARS-CoV-2 on board. See the section Onboard COVID-19 Testing for Symptomatic Travelers (Crew and Passengers) and Close Contacts above for details about quarantine based on vaccination status.

  • Isolate or quarantine travelers in single-occupancy cabins, with private bathrooms, with the door closed.
  • Selection of cabins for isolation or quarantine should consider the following:
    • Proximity to the medical facility and gangways for ease of patient transport
    • Location in dead-end corridors or low-traffic areas to minimize potential exposures
    • Spacing between other occupied cabins to reduce transmission risk
    • Absence of interconnecting doors to reduce accidental exposures
    • Positioning within view of security cameras for enforcement of isolation or quarantine
    • Presence of balconies for psychological morale
  • Isolated or quarantined travelers must have no direct contact with other travelers except for designated medical staff.
  • Designated medical staff or other personnel must wear proper personal protective equipment (PPE) per CDC guidance when in proximity to isolated or quarantined travelers.
  • Meals should be packaged in disposable dining ware with single-use cutlery and must be delivered to individual cabins with no face-to-face interaction during this service.
  • Cabins housing isolated or quarantined travelers should not be cleaned by crew members. Supplies such as paper towels, cleaners, and disinfectants, and extra linens can be provided to isolated or quarantined persons so they can clean their cabin by themselves as necessary.
  • Food waste and other trash should be collected and bagged by the isolated or quarantined traveler and placed outside the cabin during designated times for transport to the waste management center for incineration or offloading.
  • Soiled linens and towels should be bagged in water-soluble bags by the isolated or quarantined traveler and placed outside the cabin during designated times for transport to the laundry room.
  • Consider use of surveillance cameras or security personnel to ensure compliance with isolation or quarantine protocols wherever possible.

Medical Management of Suspected or Confirmed COVID-19

Note: This section applies to cruise ships operating under the CSO, including those choosing to follow CSO measures on a voluntary basis.

Cruise ship medical centers are recommended to follow the operational guidelinesexternal icon published by the American College of Emergency Physicians (ACEP). Ships should carry a sufficient quantity of PPE, medical and laboratory supplies listed on CDC’s Interim Guidance for Ships on Managing Suspected or Confirmed Cases of Coronavirus Disease 2019. Maintaining adequate supplies of antipyretics (e.g., acetaminophen and ibuprofen), antivirals and other therapeutics for COVID-19, if commercially available, other antimicrobial medications, oral and intravenous steroids, and supplemental oxygen is also recommended. Information to estimate needed medical staffing and equipment can be found in the Federal Healthcare Resilience Task Force Alternate Care Site Toolkit pdf icon[PDF – 227 pages]external icon, Supplement 2. As treatment and testing become more available in the United States, cruise ships must align with the latest CDC recommendations.

Disembarking Travelers (Crew and Passengers) to Obtain Medical Care

Note: This section applies to cruise ships operating under the CSO, including those choosing to follow CSO measures on a voluntary basis.

Cruise lines are responsible for the medical care of ill or infected persons on board, including those who need hospitalization on board. Cruise ship operators should have clear protocols that avoid medical evacuations at sea to the extent possible for COVID-19 and non-COVID-19-related medical reasons. Protocols must rely on commercial resources (e.g., ship tender, chartered standby vessel, chartered airlift) for unavoidable medical evacuations at sea and be designed to minimize the burden on federal (including U.S. Coast Guard), state, and local government resources. All medical evacuations at sea must be coordinated with the U.S. Coast Guard.

  • Traveler must wear a face mask (i.e., a cloth mask or surgical mask) covering their mouth and nose during the disembarkation process and throughout transportation to the shoreside healthcare facility, if a mask can be tolerated and does not interfere with medical treatment (e.g., supplemental oxygen administered via an oxygen mask).
  • If a traveler is known to be infected with or has symptoms compatible with COVID-19:
    • All escorting personnel should wear appropriate proper PPE per CDC guidance.
    • The cruise ship operator must ensure a separate pathway or sanitary corridor where the disembarking traveler will exit with their personal belongings such as luggage.
    • The pathway used for disembarkation, any potentially contaminated surfaces (e.g., handrails) along the pathway, and any equipment used (e.g., wheelchairs) should be cleaned and disinfected immediately after disembarkation (see Cleaning and Disinfection section below).

Discontinuation of Isolation for Travelers (Crew and Passengers)

Note: This section applies to cruise ships operating under the CSO, including those choosing to follow CSO measures on a voluntary basis.

Isolation may be discontinued for symptomatic travelers with suspected or confirmed COVID-19, or asymptomatic crew with laboratory-confirmed COVID-19, once criteria outlined in CDC’s guidance for Discontinuation of Isolation for Persons with COVID-19 Not in Healthcare Settings are met. Symptomatic persons with CLI who initially test negative via COVID-19 NAAT and no alternative etiology is identified (e.g., influenza, Legionella, Streptococcal pharyngitis, infectious mononucleosis, or respiratory syncytial virus [RSV]):

  • must be isolated for COVID-19 per CDC guidelines, and
  • may be retested via NAAT collected at least 24 hours after the initial COVID-19 test
    • Isolation may be discontinued if the repeat NAAT result is negative.
    • If an alternate infectious etiology is identified (through either laboratory testing or clinical diagnosis), routine infection control precautions (e.g., isolation) recommended for the diagnosis should be followed.
    • For example, if a symptomatic person has only vomiting and diarrhea and tests negative for COVID-19 twice, then acute gastroenteritis (AGE) protocols should be followed.

Disembarking Travelers (Crew and Passengers) who Test Positive for SARS-Cov-2 and Close Contacts

Note: This section applies to cruise ships operating under the CSO, including those choosing to follow CSO measures on a voluntary basis.

Screening Testing of All Newly Embarking Crew

Note: This section applies to cruise ships operating under the CSO, including those choosing to follow CSO measures on a voluntary basis.

  • On the day of the crew members’ embarkation, cruise ship operators must collect specimens for SARS-CoV-2 viral testing1 from all2 newly embarking land-based crew (see table below).
  • Medical personnel should document all positive SARS-CoV-2 test results (pre-embarkation, throughout crew member’s contract duration, and post-disembarkation) in the ship’s medical records. These medical records must be made available for CDC inspection upon request.
  • Cruise ship operators must report results in aggregate to CDC daily through the EDC form.
  • Crew who test positive for SARS-CoV-2 should not be re-tested (e.g., as part of a contact tracing investigation) until 90-days post lab-confirmed diagnosis, unless they are symptomatic. Symptomatic crew must be isolated and re-evaluated, including retesting for SARS-CoV-2. If an alternate infectious etiology (e.g., influenza, respiratory syncytial virus [RSV], Legionella, streptococcal pharyngitis) is identified through laboratory testing; routine infection control precautions recommended for the diagnosis should be followed.
  • Cruise ships must follow the requirements in section CSO Phase 2 through Phase 4 Screening Testing Specifications below.
Screening Testing and Quarantine for All Newly Embarking Crew
Not Fully Vaccinated Crew Fully Vaccinated Crew
Embarkation Day Testing NAAT Viral (NAAT or antigen)
Embarkation Quarantine Testing [& Duration] Quarantine; NAAT on day 7
[end quarantine after day 7 if negative]
No Quarantine; No Testing
Routine Screening Testing Viral (NAAT or antigen) Viral (NAAT or antigen)
Disembarkation Day Testing Viral (NAAT or antigen) At cruise ship operator’s discretion

Embarkation Quarantine and Testing for All Newly Embarking Crew

  • All embarking land-based crew who are:
    • fully vaccinated do not need to quarantine but must be tested at embarkation. If the crew member’s results are positive, they must be isolated until criteria are met for discontinuation of isolation according to the most current CDC guidance.
    • not fully vaccinated must be immediately quarantined in single-occupancy cabins, with private bathrooms and must be tested via onboard NAAT point-of-care equipment or at a shoreside laboratory on day 7 of quarantine (i.e., specimen collection must occur on day 7 [prior to leaving quarantine]). If the crew member’s results are:
      • Pending, they must remain in quarantine until the test result is available.
      • Positive, they must be isolated until criteria are met for discontinuation of isolation according to the most current CDC guidance.

[1] Viral tests for SARS-CoV-2 include nucleic acid amplification tests (NAAT) and antigen tests. Examples of NAAT include but are not restricted to reverse transcription polymerase chain reaction (RT-PCR), reverse transcription loop-mediated isothermal amplification (RT-LAMP), transcription-mediated amplification (TMA), nicking enzyme amplification reaction (NEAR), helicase-dependent amplification (HDA). Tests used must be cleared or authorized for emergency use by the FDA.

[2] CDC considers all positive viral test results as new cases, unless laboratory documentation of a previous SARS-CoV-2 by viral test result within the previous 90-days is provided and the individual is asymptomatic. Cruise ship operators may use confirmatory testing for a positive antigen screening test following Interim Guidance for Antigen Testing for SARS-CoV-2. Cruise ship operators must have a protocol for evaluating documentation of recovery, including reviewing previous laboratory results.

CSO Phase 2A Routine COVID-19 Screening Testing of All Crew

Note: This section applies to cruise ships operating under the CSO, including those choosing to follow CSO measures on a voluntary basis.

As per CDC’s Framework for Conditional Sailing Order, after the completion of the initial 60-day crew testing requirement, laboratory testing for every crew member must be conducted on a weekly basis or at such other intervals as required by CDC.

CDC revised the color-coding criteria by reducing the 14-day duration of color status to 7-days based on the increased availability of onboard testing, routine screening testing protocols, and daily reporting via the EDC form.

Screening Testing^ Frequency by Ship Color Status

S
creening Testing^ Frequency by Ship Color Status
Ships Operating with Only Crew Ships Operating with Passengers*
  Not Fully Vaccinated Crew Fully Vaccinated Crew Not Fully Vaccinated Crew Fully Vaccinated Crew
Red Weekly Every two weeks Weekly Every two weeks
Yellow Weekly Every two weeks Weekly Every two weeks
Orange Every two weeks Every two weeks Weekly Every two weeks
Green Every 28 days Every 28 days Every two weeks Every two weeks

^Screening Testing is defined as testing of asymptomatic crew who have not been identified as a close contact to a confirmed case or a case of COVID-19-like illness.

*Once a ship has commenced a simulated or restricted voyage, it falls under the “Ships Operating with Passengers” column.

  • Cruise ship operators must collect specimens for SARS-CoV-2 viral testing for routine screening testing of all crew, regardless of vaccination status (as outlined above in the Screening Testing Frequency by Ship Color Status table). Please see the Interim Public Health Recommendations for Fully Vaccinated People | CDC.
  • Repeat Testing of Positive Results: To ensure the integrity of testing, persons with positive NAAT results must not be retested, and the original positive results must be reported. Subsequent negative NAAT results do not negate an initial positive NAAT result. Confirmatory testing for a positive antigen screening test should take place as soon as possible after the antigen test, and not longer than 48 hours after the initial antigen testing. If more than 48 hours separate the two specimen collections, or if there have been opportunities for new exposures, a NAAT should be considered a separate test – not a confirmation of the earlier test.
  • Staggered Testing: Cruise ship operators at their discretion may stagger whole ship crew testing during the corresponding color-coding interval (e.g., weekly, every two weeks, every 28 days). For example, the cruise ship operator may choose to test the same percentage of crew on each day of the week if required to test weekly. To ensure consistency, screening testing must be completed within 4 consecutive days of each color-coding interval and the testing schedule for each crew member should remain the same across all color-coding intervals.
  • Cruise ships must follow the requirements in section CSO Phase 2 through Phase 4 Screening Testing Specifications below.

CSO Phase 2 through Phase 4 Screening Testing Specifications

Note: This section applies to cruise ships operating under the CSO, including those choosing to follow CSO measures on a voluntary basis.

  • When choosing a testing method, cruise ship operators should consider the differences in sensitivity between NAAT and antigen tests. At this time, CDC prefers NAAT because it is less likely to miss cases of SARS-CoV-2 infection (i.e., higher sensitivity) when compared to antigen testing.
  • Tests must be performed as authorized under their Emergency Use Authorization (EUA) and described in the manufacturer’s instructions for use (IFU). Any specimen type and source specified in the IFU may be used and must be collected by, or under the supervision of, a health care professional.
    • Refer to the U.S. Food and Drug Administration (FDA) website for a list of the SARS-CoV-2 point-of-care and rapid tests that have received Emergency Use Authorization (EUA)external icon.
      • Tests that have been authorized for use in a point-of-care setting will have a W, for Waived, in the Authorized Settings column of the FDA table.
      • The laboratory or testing site must use a test authorized for point-of-care use by the FDA and must follow the manufacturer’s instructions for each test.
  • Cruise ship operators must immediately transport the specimens to the testing equipment location. Locations may include a CLIA-certified laboratory, onboard laboratory, pier-side equipment, or an offsite area.
  • Viral test (including NAAT and antigen tests) systems must:
    • Be CLIA-waived by FDA;
    • Allow for specimen-to-test system transfer in a way that minimizes the risk of contamination.
  • If SARS-CoV-2 antigen tests that are FDA cleared or authorized under the EUA are used for the screening of asymptomatic individuals without known exposure, these tests must be performed according to the frequency and intervals specified in the test’s IFU to ensure adequate detection of infected individuals. For antigen testing, cruise ship operators should follow CDC’s Interim Guidance for Antigen Testing for SARS-CoV-2.
  • Shoreside testing is to be conducted by a CLIA-certified laboratory using a viral test.
  • For NAAT, the test must have been FDA cleared or authorized for emergency use by FDA and be a laboratory-based test or a test performed in a CLIA-certified laboratory.
    • Tests must be evaluated on the FDA reference panelexternal icon for SARS-CoV-2 with a limit of detection (LoD) value ≤18,000 NDU/ml prior to use, or,
    • If test has not been evaluated on the FDA reference panel, sensitivity data must be ≥ 95% using clinical samples included in the manufacture’s IFU must be taken into consideration.
  • Self-tests, sometimes referred to as home tests or at-home tests, are tests performed by an individual at home or anywhere outside of a CLIA-certified laboratory and are not permitted at this time to meet the screening or diagnostic testing requirements of the CSO.
  • Self-collection of the sample is permitted with the following stipulations:
    • Self-collection must be permitted in the IFU.
    • The specimen must be collected under the observation of trained medical staff.
    • Trained medical staff may only observe the collection of a single individual at a time.
  • Staff conducting screening testing staff must be trained and competent in specimen collection, be able to properly use testing equipment, follow all manufacturer’s instructions, and have access to and use recommended personal protective equipment (PPE) for specimen collection, handling, and testing.
    • CDC may ensure competency by conducting oversight of these practices through remote, visual observation.
    • Cruise ship operators must maintain onboard SARS-CoV-2 testing equipment to manufacturer’s specifications.
  • The SARS-CoV-2 virus has developed mutations with the potential to negatively impact the performance of tests for its detection.
    • FDA webpage provides information regarding the potential impact of viral mutations on COVID-19 tests.
    • CDC will continue to assess the information provided by the FDA, public health authorities, and the test manufacturer to determine which test should remain in use or be approved for future use.
  • Clarification regarding requirement for “CLIA-waived point-of-care testing” as used in the Framework Order:
    • All facilities in the United States that perform laboratory testing on human specimens for health assessment or the diagnosis, prevention, or treatment of disease are regulated by the Centers for Medicare and Medicaid Services (CMS) under the Clinical Laboratory Improvement Amendments of 1988 (CLIA).
    • Waived COVID-19 diagnostic test systems include those cleared or with an EUA by FDA for point-of-care use (e.g., outpatient medical facilities or mobile clinics) and those tests categorized by FDA as waived after FDA approval or clearance (though no COVID-19 tests have been cleared or approved yet). Laboratories that perform only waived tests must obtain and maintain, at minimum, a Certificate of Waiver.
    • CLIA allows for a primary site (e.g., a shoreside corporate office) to have a CLIA Certificate of Waiver and perform testing at temporary sites (e.g., cruise ship medical centers).
    • Under the Framework Order, cruise ship operators must use viral tests that are cleared or authorized for emergency use by FDA.
      • For onboard testing, cruise ship operators must use a point-of-care test that is “CLIA-waived” (i.e., tests that have been determined by FDA to be simple and have a low level of erroneous results through the EUA process or CLIA test categorization process).
        • To the extent that CLIA might apply to a foreign-flagged cruise ship operating or intending to operate in U.S. waters, CMS is temporarily exercising enforcement discretion under CLIA for SARS-CoV-2 testing. Specifically, neither CMS nor the State survey agencies on its behalf will require such foreign-flagged cruise ships to obtain a Certificate of Waiver to perform such testing.

Procedures for Embarking Overnight Contractors, Vendors, and Visitors

Note: This section applies to cruise ships operating under the CSO, including those choosing to follow CSO measures on a voluntary basis.

In lieu of requiring overnight contractors, vendors, and visitors to quarantine on board as detailed in the section Embarkation Quarantine and Testing for Crew above, ships may follow the procedures below if the contractor, vendor, or visitor will be onboard for 7 or fewer nights:

  • For embarkation-day testing, cruise ships must follow the testing requirements outlined for crew in the Screening Testing and Quarantine for All Newly Embarking Crew section.
    • If test is negative, the contractor, vendor, or visitor may board the ship.
    • If test is positive before embarkation, contractor, vendor, or visitor should not board until criteria for discontinuing isolation are met.
    • If test result not available same day, contractor, vendor, or visitor must quarantine onboard until the result is available.
      • If negative, individual can be released from quarantine following public health measures above.
      • If positive, individual must remain in isolation on board until criteria for discontinuing isolation are met or disembarked for land-based isolation.
  • Overnight contractors, vendors, and visitors must:
    • Wear masks at all times in indoor areas except individual cabins. Mask use is recommended in crowded outdoor areas.
  • Overnight contractors, vendors, and visitors who are not fully vaccinated (or whose vaccination status is unknown) must also:
    • Observe strict physical distancing
    • Eat all meals in cabin
    • Limit interaction with crew, except to perform duties
    • Receive daily COVID-19 signs and symptom checking
    • Not roam the ship when off duty and return to their cabins when not working

All contractors, vendors, and visitors who are not fully vaccinated and are expected to remain onboard for more than 7 nights are required to quarantine on board as detailed in the section Embarkation Quarantine and Testing for Newly Embarking Crew and are subject to all crew protocols including a negative test at a shoreside or onboard laboratory on day of embarkation.

All overnight contractors, vendors, and visitors, regardless of how many nights they remain on the ship, must be reported on the EDC form as crew members. They must be included in the total number of crew onboard, and their day of embarkation test results must be reported to CDC on the EDC form.

Procedures for Embarking Day Contractors, Vendors, and Visitors

Note: This section applies to cruise ships operating under the CSO, including those choosing to follow CSO measures on a voluntary basis.

  • Day contractors, vendors, and visitors must:
    • Be denied boarding if they are:
      • exhibiting signs or symptoms of COVID-19, or
      • known to have exposure to a person with COVID-19 within the past 14 days, unless they have documentation of recovery from COVID-19 in the past 90 days.
    • Wear a mask for the duration of their visit onboard the ship:
      • Required indoors.
      • Recommended outdoors unless fully vaccinated.
    • Maintain appropriate physical distancing of 6 feet (2 meters) when possible if not fully vaccinated or if vaccination status is unknown.
    • Observe proper hand hygiene.
  • For persons who are fully vaccinated and are known to have been exposed to a person with COVID-19 within the past 14 days, cruise ship operators may choose to deny boarding.
  • Cruise ship operators must ensure that all areas in which day contractors, vendors, and visitors worked while onboard are cleaned and disinfected after they exit the areas.

Crew Monitoring

Note: This section applies to cruise ships operating under the CSO, including those choosing to follow CSO measures on a voluntary basis.

Cruise ship operators should educate crew members about the signs and symptoms of COVID-19; the need to notify cruise ship medical staff immediately if symptoms develop; and the importance of not working and isolating in their cabins while sick with fever or other symptoms or COVID-19 until they meet criteria for discontinuation of isolation according to CDC guidance, as determined by cruise ship medical staff.

Crew who are not fully vaccinated must be monitored daily for signs and symptoms of COVID-19. If cruise ship operators can provide thermometers, self-temperature checks are preferable.

Disembarking Crew for Repatriation and Shore Leave

Note: This section applies to cruise ships operating under the CSO, including those choosing to follow CSO measures on a voluntary basis.

  • For crew members who disembark for repatriation, but whose travel arrangements are cancelled:
    • If crew member re-embarks the same day of disembarking (i.e., without an overnight shoreside stay), then:
      • Ship re-embarkation testing is not required
      • Quarantine is not required
    • If crew member re-embarks less than 48 hours from disembarking and with an overnight shoreside stay, then:
      • Ship re-embarkation testing is not required
      • Quarantine is required until next disembarkation or for 7 days if test-negative on day 7, whichever is lesser (unless crew member is fully vaccinated or recovered in past 90 days, in which case quarantine is not required)
    • If crew member re-embarks more than 48 hours from disembarking, then:
      • Ship re-embarkation testing is required
      • Quarantine is required until next disembarkation or for 7 days if test-negative on day 7, whichever is lesser (unless crew member is fully vaccinated or recovered in past 90 days, in which case quarantine is not required)
  • Crew members who recovered from COVID-19 more than 90 days ago are subject to the same conditions for disembarkation as other crew members on board the ship, according to their vaccination status.
  • Crew-only Ships: Cruise ship operators, at their discretion, may advise crew that—if they are fully vaccinated—they may engage in self-guided or independent exploration during port stops or shore leave. The cruise ship operator is additionally advised that foreign or local jurisdictions may have their own requirements.

Cleaning and Disinfection

Current evidence suggests that COVID-19 may remain viable for hours to days on surfaces made from a variety of materials. Cleaning of visibly dirty surfaces followed by disinfection is a best practice measure for prevention of COVID-19 transmission.

In addition to routine cleaning and disinfection strategies, ships should focus on cleaning and disinfecting common areas where crew members may come into contact with infectious persons. Frequent, routine cleaning and disinfection of commonly touched surfaces such as handrails, countertops, and doorknobs with an EPA-registered disinfectantexternal icon effective against coronaviruses is required.

Additional information on cleaning and disinfecting on cruise ships can be found on CDC’s Interim Guidance for Ships on Managing Suspected Coronavirus Disease 2019.

Other environmental considerations include:

  • Wait 24 hours or as long as practical before beginning cleaning and disinfection of cabins vacated by crew members with confirmed or suspect COVID-19.
  • In order to minimize the possibility of dispersing virus through the air, do not shake dirty laundry.
  • Launder soiled linens and towels collected from cabins occupied by isolated or quarantined crew in washing machines set at the warmest appropriate water setting for the items, and dry items completely.
  • Identify pathways to minimize risk of respiratory transmission when crew are required to move in and out of isolation and quarantine corridors and during the transport of waste and soiled linens generated by isolated or quarantined crew members.
  • Designated trolleys/carts used for the transportation of waste and soiled linens from isolated or quarantined cabins must be cleaned and disinfected with an effective disinfectant after each use.

Medical personnel who have direct contact with isolated or quarantined persons and crew members who handle waste or soiled linens must wear proper PPE per CDC’s Interim Guidance for Ships on Managing Suspected Coronavirus Disease 2019.

COVID-19 Color-coding System for Cruise Ships During Simulated and Restricted Voyages

Except for “gray-designated” ships, the color-coding system is applicable to cruise ships operating or planning to operate under the CDC’s Framework for Conditional Sailing Order (CSO), including for those cruise ships choosing to follow CSO measures on a voluntary basis. Status of ships is contingent upon daily submission of the Enhanced Data Collection (EDC) during COVID-19 Pandemic form. For ships currently outside of U.S. waters and not operating under the CSO, submission of the EDC form for 14 days preceding the cruise ship’s expected arrival in U.S. waters is required prior to being assigned a color status.

While cruising will always pose some risk of COVID-19 transmission, CDC is committed to working with cruise ship operators to ensure that cruise ship passenger operations are conducted in a way that mitigates this risk among crew members, passengers, and port personnel.

When a cruise ship notifies CDC of suspected or confirmed cases of COVID-19 on board, CDC determines whether an investigation is needed. The threshold for investigation (see details below) was developed based on several factors, including the need for transparency while acknowledging that cruising is not a zero-risk activity. This investigation gives CDC and the cruise industry the ability to work closely together to protect the health and safety of those on board and in communities. CDC’s objectives for establishing the threshold included mitigating ongoing COVID-19 transmission between voyages and ensuring medical resources on board are not overwhelmed. This threshold may be modified for future restricted passenger voyages based on lessons learned from simulated voyages or completed restricted passenger voyages, the evolution of the pandemic, or other factors.

CDC will investigate cruise ships that reach its investigation threshold for COVID-19 cases among crew or passengers. As part of the investigation, CDC will obtain additional information from the cruise ship, such as case exposure histories, details about close contacts, traveler vaccination rates, and medical capacities. CDC will work closely with the cruise line and consider multiple factors before assigning a “Red” status to the ship (see criteria below).

There are differences between the thresholds for simulated and restricted passenger voyages due to the following factors:

  • Simulated voyages are designed to test the cruise ship operator’s public health procedures and protocols.
  • Simulated voyages typically only occur once per ship and are of a shorter duration (usually 3-5 days) than restricted voyages (usually 5-10 days).
  • Simulated voyages typically have hundreds of passengers on board while restricted voyages can have thousands. Therefore, thresholds needed to be adjusted to account for the differences in passenger capacity between the two types of voyages.
  • Simulated voyages have volunteer “passengers” (e.g., corporate employees, crew members) who may be more likely to adhere to public health requirements.

Ship status is determined using data from the previous 7 days, regardless of voyage dates.

Definition of a COVID-19 Case for the Purpose of Ship’s Color Status

  • A positive viral test result for COVID-19 in any traveler (passenger or crew member)
  • COVID-19-like illness in any traveler (passenger or crew member) with:
    • a negative or repeatedly inconclusive/invalid test result (i.e., never able to register a positive or negative result) for COVID-19 and with no other laboratory-confirmed respiratory pathogens (e.g., influenza, respiratory syncytial virus, Legionella, Streptococcal pharyngitis), or
    • an unavailable test result (e.g., traveler refuses to be tested, testing resources unavailable onboard).
  • The following persons are not included when determining a ship’s color status:
    • passengers who test positive on day of embarkation who do not board the ship, or
    • newly embarking crew members who test positive during quarantine.

Green Ship Criteria

  • No reports of COVID-19 or COVID-19-like illness (CLI) for 7 days, as determined by a qualified medical professional, and
  • On-time (by 1200 ET) daily submission of EDC form during past 7 days.

Orange Ship Criteria

  • COVID-19 or CLI has been reported in the past 7 days, and the ship is below CDC’s investigation threshold:
    • Restricted Voyages:
      • Cases reported in less than 0.10% of passengers (e.g., if 6500* passengers are on board, it would take at least 7 passenger-cases during the previous 7 days to meet CDC’s investigation threshold), and
      • No crew cases reported.
    • Simulated Voyages:
      • Cases reported in less than 1.5% of passengers, and
      • Cases reported in less than 1.0% of crew.
    • Ships with Crew Only (i.e., not yet submitted requests for simulated voyages or applications for restricted voyages, pending CDC approval, or sailing at a later date).
      • Cases reported in less than 1.0% of crew.

Yellow Ship Criteria

  • Ship is at or above CDC’s investigation threshold:
    • Restricted Voyages:
      • Cases reported in 0.10% or more of passengers (e.g., if 6500* passengers on board, CDC’s investigation threshold is met if there are 7 or more cases among passengers occurring during the previous 7 days), or
        • This percentage includes passenger cases occurring within 5 days of disembarkation that CDC was notified of by state or local health departments.
      • One or more cases reported in crew.
    • Simulated Voyages:
      • Cases reported in 1.5% or more of passengers, or
      • Cases reported in 1.0% or more of crew.
    • Ships with Crew Only (i.e., not yet submitted requests for simulated voyages or applications for restricted voyages, pending CDC approval, or sailing at a later date).
      • Cases reported in 1.0% or more of crew.
  • OR
  • During the past 7 days, the ship failed to submit one or more daily EDC submissions on time (by 1200 ET). On a weekly basis, CDC emails all ships a reminder to submit the EDC form. In addition, CDC sends a reminder email if a ship does not submit their EDC form.

*The largest cruise ships can carry up to 6500 passengers on board.

Red Ship Criteria

  • For a ship to be considered at Red status, the ship has:
    • sustained transmission of COVID-19 or CLI, or
    • potential for COVID-19 cases to overwhelm on board medical center resources.
  • In addition, CDC will work closely with the cruise line and consider multiple factors before assigning a “Red” status to the ship. These factors may include, but are not limited to the following:
    • Percent of passengers and crew on board who are fully vaccinated.
    • Variants of concern are identified among cases on board.
    • Epidemiologic data from EDC reporting (e.g., symptomatic persons on board requiring medical care)
    • Epidemiologic links between cases.
    • Number of hospital beds, ventilators, oxygen, and other medical supplies on board relative to the number of cases on board.
    • Ship has not replied to CDC’s request for information within 48 hours.
    • During the past 7 days, the ship missed one or more daily submissions of the EDC form. On a weekly basis, CDC emails all ships a reminder to submit the EDC form. In addition, CDC sends a reminder email if a ship does not submit their EDC form.

Gray-designated Ships

  • As of July 23, 2021, the CSO and accompanying measures, such as technical instructions, are nonbinding recommendations for cruise ships arriving in, located within, or departing from a port in Florida. CDC is continuing to operate the CSO as a voluntary program for such ships that choose to follow the CSO measures voluntarily. Ships operating out of Florida ports that choose to not follow the CSO are designated as “Gray.” This designation means that CDC has not reviewed or confirmed the cruise ship operator’s health and safety protocols.
Summary of Past Changes

April 2, 2021

Added the Routine COVID-19 Laboratory Screening Testing of All Crew Section, the Procedures for Embarking Contractors Overnight and Visitors Overnight Section, and the Procedures for Embarking Day Contractors and Day Visitors Section. Clarified laboratory parameters and testing options. Updated surveillance reporting requirement to daily, revised the color-coding system, and COVID-19-like illness definition.


December 31, 2020

Clarified “CLIA-waived point-of-care testing” in the context of CDC’s Framework for Conditional Sailing Order.


December 23, 2020

Expanded testing options to include nucleic acid amplification tests (NAATs), such as reverse transcription polymerase chain reaction (RT-PCR), reverse transcription loop-mediated isothermal amplification (RT-LAMP), and transcription-mediated amplification (TMA).


November 3, 2020 Update

Renamed this document to Technical Instructions and added information about CDC’s Framework for Conditional Sailing Order. Added instructions for laboratory testing.


September 30, 2020 Update

Added information about the third extension to CDC’s No Sail Order, effective September 30, 2020.


July 23, 2020 Update

Added information about the second extension to CDC’s No Sail Order, effective July 16, 2020.


June 1, 2020 Update

Added requirements for use of commercial travel to disembark crew members and clarified routine testing for SARS-CoV-2 infection.


April 28, 2020 Update

Clarified the stipulations for disembarking asymptomatic crew for transfer or repatriation.


April 21, 2020 Update

Clarified that notification to health departments for disembarking crews must include health departments with jurisdiction for the seaport and those with jurisdiction for the crew members’ residence.