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

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CDC 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 at all U.S. transportation hubs, including seaports and ferry terminals. For more information on this mask requirement, see the Frequently Asked Questions.

Summary of Recent Changes

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.


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.

Purpose

This document provides instructions for the initial phases of CDC’s Framework for Conditional Sailing Order for cruise ship operations in U.S. waters to ensure health and safety protections for the crew prior to resuming passenger operations in a way that mitigates the risk of spreading COVID-19.

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 duties and obligations under the Framework for Conditional Sailing Order. 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 for the additional phases of resuming cruise ship passenger operations, as described in the Order and in future conditional sailing orders. CDC will 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

Some exceptions to these measures can be made for those ships that have met the “Green”, “Orange”, or “Yellow” criteria. Additionally, some measures are not required for crew who are fully vaccinated. See COVID-19 Color-coding System for Cruise Ships During the Initial Phases of Conditional Sailing Order.

Surveillance for COVID-19

  • 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 COVID-19-like illness 1, 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] 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

  • 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 currently onboard their cruise ships and arrange for the transportation and testing of those specimens at a shoreside laboratory facility. Ships that are entering U.S. waters for the first time under the CSO must complete these Phase 1 requirements.
  • Phase 1 testing must be conducted by a Clinical Laboratory Improvement Amendments (CLIA)-certified laboratory using nucleic acid amplification tests (NAATs). 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), cleared or authorized for emergency use by the U.S. Food and Drug Administration (FDA) and that have been evaluated on the FDA reference panelexternal icon for SARS-CoV-2 with a limit of detection (LOD) value 18,000 NDU/ml 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 laboratory documentation of a previous SARS-CoV-2 viral test result within the previous 90 days is provided and the individual is asymptomatic. Cruise ship operators must have a protocol for evaluating documentation of recovery, including reviewing previous laboratory results.
  • 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.

*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 28 days preceding the cruise ship’s expected arrival in U.S. waters.


[2] NDU=RNA NAAT detectable unit; CDC’s laboratory 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 material in a given sample, signaling a more sensitive test.

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

  • 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.
    • Close contacts who are fully vaccinated do not need to quarantine and or test.
    • 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: Not Applicable
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
  • All cruise ships must procure NAAT point-of-care equipment to test symptomatic travelers who are not fully vaccinated (and identified close contacts who are not fully vaccinated).
    • 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;
      • Allow for specimen-to-instrument transfer in a way that minimizes the risk of contamination.
  • 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.
  • Cruise ships must follow the requirements in section CSO Phase 2 through Phase 4 Screening Testing Specifications below.

Screening Testing of All Newly Embarking Crew

  • 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 At cruise ship operator’s discretion*
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) At cruise ship operator’s discretion¥
Disembarkation Day Testing Viral (NAAT or antigen) At cruise ship operator’s discretion

* While embarkation testing is not required, international travelers arriving in the U.S. are recommended to be tested 3-5 days after arrival, including those who are fully vaccinated. Cruise operators may follow this recommendation at their discretion.

¥ Routine viral screening testing for fully vaccinated crew is at the cruise ship operator’s discretion. Please see the Interim Public Health Recommendations for Fully Vaccinated People | CDC

Embarkation Quarantine and Testing for All Newly Embarking Crew

  • All embarking land-based crew who are:
    • fully vaccinated do not need to quarantine but may be tested at the cruise ship operator’s discretion. 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 and be tested via onboard NAAT point-of-care equipment or at a shoreside laboratory on day 7 of quarantine (i.e., test 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 U.S. Food and Drug Administration (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

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 28-day duration of color status to 14-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

Screening Testing^ Frequency by Ship Color Status
Ships Not Intending to Enter into Port Agreements (and not boarding non-essential crew) Ships Not Boarding Non-Essential Crew Ships Boarding Non-Essential Crew
Red Weekly Weekly Weekly
Orange Every two weeks Every two weeks Every two weeks
Yellow N/A N/A N/A
Green Every 28 days Every 28 days 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.

  • Cruise ship operators must collect specimens for SARS-CoV-2 viral testing for routine screening testing of all unvaccinated crew (as outlined above in the Screening Testing Frequency by Ship Color Status table). Routine viral screening testing for fully vaccinated crew is at the cruise ship operator’s discretion. 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

  • 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 that has been evaluated on the FDA reference panelexternal icon for SARS-CoV-2 with a limit of detection (LOD) value 18,000 NDU/ml.
  • Self-tests are not permitted at this time.
  • 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 on Molecular Tests Impacted by SARS-CoV-2 Mutationsexternal icon 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 emergency use authorization (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

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:
    • Observe strict physical distancing if not fully vaccinated (or if vaccination status is unknown)
    • Eat all meals in cabin
    • Limit interaction with crew, except to perform duties
    • Receive daily COVID-19 signs and symptom checking
    • Wear masks at all times in indoor areas, except individual cabins. Mask use is recommended in outdoor areas if not fully vaccinated (or if vaccination status is unknown)
    • 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

  • 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 are fully vaccinated or 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.
  • 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.

Boarding Non-Essential Crew

As a condition of a ship’s obtaining controlled free pratique to board non-essential crew, CDC must verify that the cruise ship operator has documented the approval of all U.S. port and local health authorities where the ship intends to dock or make port during one or more simulated voyages or restricted passenger voyages. Cruise ship operators must follow all requirements of the Technical Instructions for a Cruise Ship Operator’s Agreement with Port and Local Health Authorities under CDC’s Framework for Conditional Sailing Order and continue to follow these Technical Instructions for screening testing of embarking crew and the quarantine and isolation of crew.

The cruise ship operator must contact CDC at eocevent349@cdc.gov at least 7 calendar days in advance of the first embarkation of non-essential crew. The request for CDC approval should include “Request for Non-essential Crew Embarkation for SHIP NAME” in the subject line. Once CDC approves the request the ship will no longer be required to submit any crew (essential or non-essential) embarkation requests to CDC. Non-essential crew cannot be transferred to another ship that has not received approval from CDC to board non-essential crew.

Crew Monitoring

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 must be monitored daily for signs and symptoms of COVID-19. If cruise ship operators can provide thermometers, self-temperature checks are preferable.

Disembarking Asymptomatic Crew

  • Crew members who test positive for COVID-19 cannot travel commercially until they have fully recovered from COVID-19 based on CDC criteria for discontinuing isolation.
    • Use of commercial transportation by crew members who have recovered from COVID-19 and met criteria for release from isolation according to CDC guidance may occur as follows:
      • Cruise ship medical personnel are responsible for providing the crew member with a medical certificate stating that the crew member has recovered from COVID-19 and met CDC’s criteria for discontinuing isolation.
      • The medical certificate must meet the requirements of Department of Transportation regulationsexternal icon (14 Code of Federal Regulations § 382.23(c)(2)).
  • Crew members with signs and symptoms of COVID-19 cannot travel commercially until COVID-19 has been ruled out.
  • Crew members who are identified as close contacts:
    • If fully vaccinated or recovered from COVID-19 in the past 90 days, commercial travel is permitted and there is no requirement for quarantine or testing.
    • If not fully vaccinated and did recover from COVID-19 in the past 90 days, commercial travel is not permitted until quarantine and testing requirements are completed.
  • If travel is needed urgently for crew members who are not permitted to travel commercially, travel may occur following CDC Interim Guidance for Transporting or Arranging Transportation by Air into, from, or within the United States of People with COVID-19 or COVID-19 Exposure.
  • 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.

  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 means acute respiratory illness (ARI), influenza-like illness (ILI), diagnosis of pneumonia, or other signs and symptoms of COVID-19.

Symptomatic Crew Members

Identifying and isolating crew 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.

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 Crew and Confirmed Cases and Quarantine of Close Contacts

Crew with COVID-19-like illness (CLI) must be isolated using the same procedures as a crew member with confirmed COVID-19. If the symptomatic crew member has a negative SARS-CoV-2 test result, they must continue to follow CDC’s COVID-19 isolation guidance. Quarantine of asymptomatic crew who are not fully vaccinated that are identified as close contacts of symptomatic crew 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 crew 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 crew members must have no direct contact with other crew 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 crew members.
  • 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 crew should not be cleaned by other 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 crew member 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 crew member 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

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 Toolkitexternal icon, Supplement 2. As treatment and testing become more available in the United States, cruise ships must align with the latest CDC recommendations.

Disembarking Crew Members to Obtain Medical Care

Cruise lines are responsible for the medical care of ill or infected persons on board, including those who need hospitalization. Cruise ship operators should have clear protocols that avoid medical evacuations at sea to the extent possible for either 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.

  • Crew member 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 crew member is known to be infected with or has symptoms compatible with COVID-19:
    • All escorting personnel should wear appropriate proper PPE per CDC guidance.
    • Cruise ship operator must ensure a separate pathway or sanitary corridor where the disembarking crew member 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

Isolation may be discontinued for symptomatic crew 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.

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 the Initial Phases of the Framework for Conditional Sailing Order

The color-coding system is only applicable to cruise ship operators with a complete and accurate No Sail Order response plan for crew management. Cruise company officials must sign an acknowledgment of the completeness and accuracy of their response plan. Status of ships is contingent upon daily submission of the Enhanced Data Collection (EDC) during COVID-19 Pandemic. For ships currently outside of U.S. waters and not operating under the CSO, submission of the EDC form for 28 days preceding the cruise ship’s expected arrival in U.S. waters is required prior to being assigned a color status.

Green Ship Criteria

  • No confirmed cases of COVID-19 or COVID-19-like illness for 14 days, as determined by a qualified medical professional.
  • If the ship received ship-to-ship transfers within the past 14 days, crew must have come from a ship that was not Red.
  • If land-based crew embarked, they were immediately quarantined (unless fully vaccinated or recovered in past 90 days) upon embarking the ship.

Note: To maintain Green status, ships must submit a daily EDC form to CDC. Failure to submit by 0900 ET each day changes ship status to Red. Green ship status means that CDC considers the ship to be currently unaffected by COVID-19 based on information provided by the cruise ship operator.

Orange Ship Criteria

Orange ship status in the absence of pre-existing Red ship status or a case report on the same day that would change the ship’s status to Red.

  • One or more cases of confirmed COVID-19 among newly embarking crew that:
    • Were diagnosed within their embarkation quarantine period,
    • As determined by a qualified medical professional, had a non-contact embarkation process and no unvaccinated close contacts were identified during the embarkation process (i.e., absence of exposures during embarkation), and
    • The ship had no other confirmed cases of COVID-19 onboard during the past 14 days.

OR

  • One or more cases of COVID-19-like illness with negative or repeatedly inconclusive/invalid (i.e., never able to register a positive or negative result) test results for COVID-19 within the past 14 days (with no other laboratory-confirmed respiratory pathogens [e.g., influenza, RSV, Legionella, Streptococcal pharyngitis])
    • Diagnosed either within or outside of their embarkation quarantine period, and
    • The ship had no other confirmed cases of COVID-19 onboard during the past 14 days.
  • If the ship received ship-to-ship transfers within the past 14 days, crew must have come from a ship that was not Red.
  • If land-based crew embarked, they were immediately quarantined (unless fully vaccinated or recovered in past 90 days) upon embarking the ship.

Yellow Ship Criteria

  • Ship was previously designated Green or Orange, but now has 1 or more COVID-19-like illness cases pending SARS-CoV-2 test results due to lack of onboard testing capability (e.g., ran out of testing cartridges or ship is still within 60-day Phase 1 CSO requirements).
    • If all cases negative for SARS-CoV-2, ship status goes to Orange
    • If any cases are positive for SARS-CoV-2, ship status changes to Red (must re-sign attestation after meeting Green criteria again)
    • If crew with COVID-19-like illness are not tested for SARS-CoV-2 or if results are not available within 1 week of the first case being reported, ship status changes to Red.
  • If the ship received ship-to-ship transfers within the past 14 days, crew must have come from a ship that was not Red. If not, ship status changes to Red.
  • If land-based crew embarked, they were immediately quarantined (unless fully vaccinated or recovered in past 90 days) upon embarking the ship. If not, ship status changes to Red.

Red Ship Criteria

  • One or more cases of confirmed COVID-19 that do not meet criteria for Orange status, or
  • Ship received ship-to-ship transfers from a ship that was Red,
  • If land-based crew embarked, they were not immediately quarantined (unless fully vaccinated or recovered in past 90 days) upon embarking the ship, or
  • During the past 14 days, the ship missed one or more daily submissions of the EDC form.

COVID-19 Color-coding System for Cruise Ships During the Initial Phases of the CSO

COVID-19 Color-coding System for Cruise Ships During the Initial Phases of the CSO
Preventive Measures Based on Ship Status
GREEN ORANGE YELLOW RED
Asymptomatic Crew Restrictions Minimize the number of crew sharing a cabin or bathroom to the extent practicable Recommended Recommended Recommended Recommended
Instruct crew members to remain in cabins as much as possible during non-working hours Not Required or Recommended Not Required or Recommended Not Required or Recommended Required
Cancel all face-to-face employee meetings, group events (such as employee trainings), or social gatherings Not Required or Recommended Not Required or Recommended Recommended Required
Close all crew bars, gyms, or other group settings Not Required or Recommended Not Required or Recommended Recommended Required
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) Recommended Recommended Recommended Required
Instruct crew members to wear a face mask when outside of individual cabins and around others* Required indoors per CDC’s Mask Order

Recommended outdoors for crew who are not fully vaccinated
Required indoors per CDC’s Mask Order

Recommended outdoors for crew who are not fully vaccinated
Required indoors per CDC’s Mask Order

Recommended outdoors for crew who are not fully vaccinated
Required indoors per CDC’s Mask Order 

Recommended outdoors for crew who are not fully vaccinated
Modify meal service to facilitate physical distancing (e.g., reconfigure dining room seating, stagger mealtimes, encourage in-cabin dining) Not Required or Recommended Not Required or Recommended Recommended Required
Eliminate self-serve dining options at all crew and officer messes Recommended Recommended Recommended Required
Discourage handshaking – encourage the use of non-contact methods of greeting Recommended Recommended Recommended Required
Promote respiratory and hand hygiene and cough etiquette Required Required Required Required
Place hand sanitizer (containing at least 60% alcohol) in multiple locations and in sufficient quantities to encourage hand hygiene Required Required Required Required
Place posters that encourage hand hygiene to help stop the spread in high-trafficked areas Required Required Required Required

* This recommendation applies when no passengers are on board. Refer to the COVID-19 Operations Manual for Simulated and Restricted Voyages under the Framework for Conditional Sailing Order for requirements and recommendations for when passengers are on board.

Summary of Past Changes

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.