Technical Instructions for Simulated Voyages by Cruise Ship Operators under CDC’s Framework for Conditional Sailing Order

Summary of Recent Changes

May 14, 2021
Clarified screening and laboratory testing requirements for passengers.

Audience

This document is intended to assist cruise ship operators in preparing to conduct simulated (“trial”) voyages in advance of restricted passenger voyages under a COVID-19 Conditional Sailing Certificate. This includes conducting simulated voyages insofar as practicable to test the efficacy of the cruise ship operator’s ability to mitigate the risks of COVID-19 onboard its cruise ship as per the terms of CDC’s Framework for Conditional Sailing Order (CSO), developing an after-action report, and addressing any identified deficiencies.

Purpose

This document provides technical instructions for Phase 2B of CDC’s CSO for cruise ship operations in U.S. waters to ensure health and safety protections for travelers (crew and future passengers) and port personnel prior to resuming passenger operations in a way that mitigates the risk of spreading COVID-19.

These instructions are not intended as, and do not constitute, a comprehensive statement regarding a cruise ship operator’s duties and obligations under CDC’s CSO. 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.

Notifying and Requesting CDC Approval to Conduct a Simulated Voyage

A cruise ship operator should notify CDC and request CDC’s approval to conduct a simulated voyage at least 30 calendar days[1] prior to the date on which the cruise ship operator proposes to conduct the simulation. Submit notifications and requests to CDC electronically through eocevent349@cdc.gov. Additionally, this notice and request for approval must:

  • Specify the dates and location of the proposed simulation.
  • Verify that the cruise ship operator is eligible to conduct a simulated voyage as per the terms of the CSO and these technical instructions.
  • Submit documentation that the cruise ship operator has a written agreement (or a multi-port agreement) with all U.S. port and local health authorities where the cruise ship intends to dock or make port during a simulated voyage. The written agreement must specifically include the name of the cruise ship that will be conducting the simulation and meet the standards of the CSO and CDC’s technical instructions for Phase 2A of CDC’s CSO.
  • Provide a copy of the cruise ship operator’s proposed written notification to volunteer passengers. This written notification must advise volunteer passengers that they are participating in health and safety protocols that are unproven and untested in the United States for purposes of simulating a cruise ship voyage and that sailing during a pandemic is an inherently risky activity. At the cruise ship operators’ discretion, this written notification can occur through website posting, email, or written letter to the volunteer passengers.
  • Provide a copy of the cruise ship operator’s proposed informed consent form to be signed by all persons who will be participating as volunteer passengers in the simulated voyage. This proposed informed consent must advise all such persons that the simulated voyage will be conducted on a consensual basis and not as a condition of employment or in exchange for consideration or future reward. For the purpose of these technical instructions, passage on board the ship, accommodations, provision of food and beverages, participation in shore excursions and private island visits, and attendance at entertainment events while participating as part of a simulated voyage will not be deemed a form of consideration. At the cruise ship operator’s discretion, this written informed consent can be obtained either on paper or electronically using a digital signature.
  • Identify and provide one or more points of contact for persons who will be overseeing and implementing the proposed simulation for each cruise ship. This must include points of contact who will be physically present on the ship during the simulated voyage.
  • Include the protocols or practices to be simulated, which must, at a minimum, incorporate the requirements for conducting simulated voyages under these technical instructions.
  • Be signed by the cruise ship operator’s responsible officials, meaning the Chief Executive Officer (or equivalent) of the operating cruise company and all parent companies, the Chief Compliance Officer (or equivalent) of the operating cruise company and all parent companies, and the highest-ranking Medical Officer of the operating cruise company and all parent companies.
  • Certify under 18 U.S.C. § 1001 that all of CDC’s requirements relating to the protection of crew onboard cruise ships in U.S. waters (i.e., Phase 1 of the CSO) have been satisfied and continue to be met.

CDC will respond to these requests in a timely manner. CDC may deny the request to conduct a simulated voyage if the cruise ship operator is not in compliance with any of CDC’s requirements for the mitigation of COVID-19 onboard cruise ships, technical instructions, or orders, or if in CDC’s determination the simulated voyage does not provide adequate safeguards to minimize the risk of COVID-19 for all participants. CDC may also oversee and inspect any aspect of the simulated voyage, including through in-person or remote means allowing for visual observation.


[1] The 30-calendar day timeframe is suggested as a guideline. CDC will respond to submissions within 5 business days. CDC expects to quickly approve applications that are both complete and accurate.

Eligibility for Conducting a Simulated Voyage

As part of the cruise ship operator’s notification and request to conduct a simulated voyage, a cruise ship operator must verify that it meets the following eligibility criteria:

  • The cruise ship operator has received a determination by CDC that a plan submitted in response to the No Sail Order and Suspension of Further Embarkation; Notice of Modification and Extension and Other Measures Related to Operations published at 85 FR 21004 (April 15, 2020) (i.e., “No Sail Order response plan”), as modified and extended July 16, 2020 (published at 85 FR 44085 (July 21, 2020)), and September 30, 2020 (published at 85 FR 62732 (October 5, 2020)) is complete and accurate, including having submitted to CDC a signed Acknowledgment of No Sail Order Response Plan Completeness and Accuracy.
  • The cruise ship operator has continued to submit the Enhanced Data Collection (EDC) form as specified in CDC technical instructions or orders. If the cruise ship has been operating outside of U.S. waters, the cruise ship operator has submitted the EDC form during (at a minimum) the 28 days preceding the ship’s expected arrival in U.S. waters and will continue to submit the EDC form after the ship enters U.S. waters.
  • The cruise ship operator has observed and continues to observe all elements of its No Sail Order response plan including by following the most current CDC recommendations and guidance for any public health actions related to COVID-19, or if any deviations from the plan have occurred such deviations have been reported and corrective actions taken to the satisfaction of CDC.
  • The cruise ship operator has arranged for and submitted and continues to arrange for and submit laboratory test results as required by CDC for every crew member on board ships operating in U.S. waters. If the cruise ship operator has ships operating outside of U.S. waters and intends for these ships to return to operating in U.S. waters while the CSO remains in effect, then the operator has arranged for and submitted laboratory test results as required by CDC for every crew member on board these ships.
  • If the cruise ship received any ship-to-ship transfers in the last 14 days, crew must have come from a ship that was not Red.
  • If the cruise ship received any land-based embarking crew, such crew were laboratory tested for SARS-CoV-2 upon embarkation and quarantined per CDC technical instructions or orders immediately upon embarking the ship.
  • The cruise ship operator has a written agreement (or a multi-port agreement) with all U.S. port and local health authorities where the cruise ship intends to dock or make port during a simulated voyage. The written agreement must specifically include the name of the cruise ship that will be conducting the simulation and meet the standards of the CSO and CDC’s technical instructions for Phase 2A of CDC’s CSO. The written agreement must include a:
    • port component (including a vaccination component) between the cruise ship operator and port authority to determine the number of cruise ships operating out of any single port in order to not overburden the public health response resources of any single jurisdiction in the event of a COVID-19 outbreak;
    • medical care component between the cruise ship operator and health care entities, addressing evacuation and medical transport to onshore hospitals for passengers and crew in need of medical care, in accordance with CDC technical instructions and orders; and
    • housing component between the cruise ship operator and one or more shoreside facilities for isolation and quarantine of passengers or crew members with COVID-19 and close contacts, identified from the day of embarkation through disembarkation for each voyage.

Requirements Relating to Volunteer Passengers

A simulated voyage must be designed and conducted insofar as practicable to test the efficacy of the cruise ship operator’s ability to mitigate the risk of COVID-19 onboard a cruise ship. This includes using volunteers simulating the role of passengers. A cruise ship operator must observe the following requirements relating to volunteer passengers:

  • The minimum number of required volunteer passengers for each simulated voyage must be at least 10% of the maximum number of passengers permitted onboard for the first two restricted voyages as per the terms of the cruise ship operator’s Phase 2A agreement with U.S. port and local health authorities.
  • The cruise ship operator must advise volunteer passengers of CDC’s Travel Health Notice for COVID-19 and Cruise Ship Travel prior to the simulated voyage. At the cruise ship operators’ discretion, this information can be provided via linking to CDC’s webpage, through email, or written letter to the volunteer passengers.
  • All volunteer passengers must be informed in writing that they are participating in a simulation of health and safety protocols that are unproven and untested in the United States for purposes of simulating a cruise ship voyage and that sailing during a pandemic is an inherently risky activity. At the cruise ship operators’ discretion, this written notification can occur through website posting, email, or written letter to the volunteer passengers. A copy of this written notification must also be provided to CDC as part of the cruise ship operator’s notification and request to conduct a simulated voyage.
  • All volunteer passengers must be at least eighteen years old or older on the day of the simulation and at the time that their consent to participate is obtained.
  • The cruise ship operator must ensure all volunteer passengers have either:
    • Proof of being fully vaccinated against COVID-19 using an U.S. Food and Drug Administration (FDA)-authorized vaccine or a vaccine product that has received emergency use listing from the World Health Organization (WHO); or
    • If not fully vaccinated, written documentation from a healthcare provider or self-certified statement that the volunteer passenger has no medical conditions that would place the volunteer at high risk for severe COVID-19 as determined through CDC guidance.
  • The simulation must be conducted with the signed informed consent of all participants and not as a condition of employment or in exchange for consideration or future reward. For the purpose of these technical instructions, passage on board the ship, accommodations, provision of food and beverages, participation in shore excursions and private island visits, and attendance at entertainment events while participating as part of a simulated voyage will not be deemed a form of consideration. The cruise ship operator must document this signed informed consent for each participant in writing, either on paper or electronically. The cruise ship operator must also preserve the paper or electronic consent forms and make them available to CDC upon request at any time while the CSO remains in effect.
  • All volunteer passengers must be evaluated for signs and symptoms of COVID-19 prior to embarkation and disembarkation. Cruise ship operators must educate all volunteer passengers about the signs and symptoms of COVID-19 and the need to notify cruise ship medical staff immediately if symptoms develop.
  • All volunteer passengers must agree in writing to post-disembarkation specimen collection for COVID-19 testing at 3 to 5 days after completion of the simulated voyage, unless they are fully vaccinated or have documentation of recovery from COVID-19 in the past 90 days. Cruise ship operators are advised that as a condition of receiving a COVID-19 Conditional Sailing Certificate, at least 75% of all volunteer passengers who are not fully vaccinated and do not have documentation of recovery from COVID-19 must provide their post disembarkation specimen to the selected laboratory (see options for post-disembarkation testing below) for COVID-19 testing within the specified time frame. CDC may lower the 75% post-disembarkation testing requirement for future simulated voyages based on lessons learned from previous simulated voyages and other factors.
  • To facilitate contact tracing, the cruise ship operator must advise all volunteer passengers to notify the cruise ship operator if they develop symptoms of COVID-19 or are diagnosed with COVID-19 with any SARS-CoV-2 viral test within 14 days after the voyage. Passengers who develop symptoms within 14 days should be advised to be tested. The cruise ship operator must in turn report aggregate results to CDC in the after-action report or through an amended after-action report.

Requirements Relating to the General Components of a Simulation and Simulated Activities

A simulated voyage must be designed and conducted insofar as practicable to test the efficacy of the cruise ship operator’s ability to mitigate the risk of COVID-19 on board a cruise ship. This includes observing the general components of a simulation and simulating the following shipboard activities:

  • At least one simulation must be conducted for each ship for which the cruise ship operator intends to commence restricted passenger voyages. The simulation(s) must occur prior to the cruise ship operator’s application for a COVID-19 Conditional Sailing Certificate under the CSO.
  • The cruise ship’s color-coding status must be Green or Orange at the time of the simulated voyage. If the cruise ship’s color-coding status is Yellow or Red, then the simulation must be postponed until such time as the ship’s status changes to Green or Orange. Cruise ship operators will not be required to submit a new request to conduct a simulated voyage in the event of postponement, but operators must notify CDC of the revised dates of the simulation.
  • If the cruise ship operator has entered into a Phase 2A agreement with the port or local health authority of more than one port and the cruise ship operator intends for the ship to dock at more than one U.S. port during restricted passenger voyages, then the simulated voyage(s) must include each U.S. port.
  • The cruise ship operator must maintain a list of all passengers, crew, port personnel, and other persons who participated in the simulated voyage. This list must be preserved and made available to CDC upon request at any time while the CSO remains in effect.
  • Simulated voyages must be between 2-7 days in length with a least one overnight stay[2] to test the efficacy of the cruise ship operator’s ability to mitigate the risk of COVID-19 onboard the cruise ship, including through embarkation, disembarkation, and post-disembarkation testing.
  • Activities conducted on voyages that occurred outside of U.S. waters during the period of the No Sail Order (NSO) and the CSO that were not conducted as part of a CDC-approved simulated voyage, do not count towards the activities that must be simulated on a simulated voyage. However, cruise ship operators may incorporate best practices and lessons learned from these voyages as part of the simulation and in the after-action report submitted to CDC.
  • The cruise ship operator must meet standards during the simulated voyage for hand hygiene, use of face masks, and social distancing for passengers and crew, as well as ship sanitation, as required by CDC technical instructions or orders.
  • The cruise ship operator must modify meal service and entertainment venues to facilitate social distancing during the simulated voyage.
  • The following activities must be simulated onboard each ship for which the cruise ship operator intends to commence restricted passenger voyages before applying for a COVID-19 Conditional Sailing Certificate. However, at the cruise ship operator’s discretion, these activities may be conducted as part of the same simulated voyage or as part of separate simulated voyages:
    • Embarkation and disembarkation procedures, as approved by U.S. port and local health authorities as part the cruise ship operator’s Phase 2A agreements, including procedures for terminal check-in.
    • Onboard activities, including seating and meal service at dining and entertainment venues.
    • Medical evacuation procedures.
    • Transfer of symptomatic passengers or crew, or those who test positive for SARS-CoV-2, from cabins to isolation rooms.
    • Onboard and shoreside isolation and quarantine, as per the terms of the cruise ship operator’s Phase 2A agreements, of at least 5% of all passengers and non-essential crew.
    • Recreational activities that the cruise ship operator intends to offer as part of any restricted passenger voyages, e.g., casinos, spa services, fitness classes, gymnasiums.
    • Private-island shore excursions if any are planned during restricted passenger voyages. The following measures must be observed on the private island:
      • Only one ship can port at the island at any one time.
      • A routine screening testing protocol must be implemented for island staff who are expected to interact with volunteer passengers or crew, unless they are fully vaccinated or have documentation of recovery from COVID-19 in the past 90 days.
      • Mask use and social distancing must be observed in indoor areas while on the island.
    • Port of call shore excursions if any are planned during restricted passenger voyages. The following measures must be observed on port of call shore excursions:
      • Shore excursions must only include passengers and crew from the same ship.
      • Cruise ship operator must ensure all shore excursion tour companies facilitate social distancing, mask wearing, and other COVID-19 public health measures throughout the tour while in any indoor areas.
      • Cruise ship operators must have a protocol for managing persons with COVID-19 and close contacts at all foreign ports of call. At a minimum, the protocol must include the following:
        • Disembarkation and housing of persons with suspected or confirmed COVID-19 needing shore-based hospital care and their travel companion(s) for the duration of their isolation or quarantine period.
        • Commercial repatriation of U.S.-based persons with COVID-19 and close contacts only after meeting criteria to end isolation and quarantine per CDC guidance. For commercial repatriation of foreign-based persons with COVID-19 and close contacts, cruise ship operators must consult with all relevant public health authorities.

[2] To fully test all procedures during a simulated voyage, CDC recommends a minimum voyage length of 3 days with 2 overnight stays.

Requirements Relating to Screening and Laboratory Testing

Cruise ship operators must screen passengers for signs or symptoms of COVID-19 and screen for a known close contact exposure to a person with COVID-19 within the past 14 days.

  • Passengers with signs or symptoms of COVID-19
    • Deny boarding if not fully vaccinated and without documentation of recovery[1].
    • May board at operator’s discretion if fully vaccinated or with documentation of recovery and embarkation day test is negative by viral test (antigen-negative must be confirmed with NAAT. 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.
  • Passengers who have a known close contact exposure in the past 14 days
    • Deny boarding if not fully vaccinated and without documentation of recovery [1]
    • May board at operator’s discretion if:
      • fully vaccinated and asymptomatic
      • with documentation of recovery from COVID-19 and asymptomatic

A cruise ship operator must observe the following requirements relating to laboratory testing of passengers and crew who are not fully vaccinated or do not have documentation of recovery from COVID-19 [1] as part of a simulated voyage:

  • Day of Embarkation Testing: testing must be performed by NAAT using one of the following testing instruments and processes with same day results:
      • Previously approved Phase 1 shoreside laboratory, or
      • Previously approved Phase 1 onboard point-of-care equipment, or
      • Other testing instruments and processes approved by CDC
        • 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 for approval. Include “Additional Laboratory Screening Testing for Passenger Voyages on [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.

    • Results must be available prior to boarding the cruise ship. Volunteer passengers who test positive for SARS-CoV-2 should be denied boarding, unless determined to be a persistent positive by cruise ship medical personnel.
  • Day of Disembarkation Testing: testing must be performed by NAAT using one of the following testing instruments and process with same day results:
    • Previously approved Phase 1 shoreside laboratory, or
    • Previously approved Phase 1 onboard point-of-care equipment, or
    • Other testing instruments and processes approved by CDC
      • 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 for approval. Include “Additional Laboratory Screening Testing for Passenger Voyages on [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.
    • Results must be available before the passenger leaves the cruise ship, seaport, or offsite testing location, but specimen collection and testing can occur onboard or shoreside.
  • Post Disembarkation Testing Options: To validate the efficacy of the cruise ship operator’s ability to mitigate the risk of COVID-19 onboard the cruise ship, post disembarkation testing for volunteer passengers is required for simulated voyages.
    • As a condition of receiving a COVID-19 Conditional Sailing Certificate, cruise ship operators must have at least 75% of all passengers who are not fully vaccinated and do not have documentation of recovery from COVID-19 provide their post disembarkation specimen to the selected laboratory for COVID-19 testing 3 to 5 days after completion of the simulated voyage. Passengers who are fully vaccinated or who have documentation of recovery from COVID-19 [1] are exempt from post disembarkation testing. CDC may lower the 75% post-disembarkation testing requirement for future simulated voyages based on lessons learned from previous simulated voyages and other factors.
    • The cruise ship operator must in turn report aggregate results to CDC in the after-action report.
    • Cruise ship operators have the option of supplying all volunteer passengers with a self-collected nasal mid-turbinate nucleic acid amplification test (NAAT) specimen collection kit to be shipped directly to a laboratory.
      • All volunteer passengers must:
        • Receive education on self-collection technique.
        • Be instructed to collect the specimen 3 to 5 days after completion of the simulated voyage for testing.
        • Be instructed to store and ship the specimen directly to the laboratory within the specifications of the manufacturer.
      • The shoreside laboratory must use a NAAT that has been authorized for emergency use by FDA and that has been evaluated on the FDA reference panel external iconfor SARS-CoV-2 with a limit of detection (LOD) value ≤18,000 NDU/ml. CDC must approve the cruise ship operator’s selection of a CLIA-certified laboratory. All additional requirements as listed for Shoreside COVID-19 Laboratory Screening Testing of All Crew, above, must also be followed.
    • Cruise ship operators can alternatively direct volunteer passengers to obtain a nasopharyngeal (NP) specimen at a shoreside laboratory for SARS-COV-2 testing 3 to 5 days after completion of the simulated voyage for testing.
      • The shoreside laboratory must use a NAAT that has been authorized for emergency use by FDA and that has been evaluated on the FDA reference panel for SARS-CoV-2 with a limit of detection (LOD) value ≤18,000 NDU/ml. CDC must approve the cruise ship operator’s selection of a CLIA-certified laboratory. All additional requirements as listed for Shoreside COVID-19 Laboratory Screening Testing of All Crew, above, must also be followed.
  • Cruise ship operators must conduct laboratory testing of any passengers or crew who report illness consistent with COVID-19 during the simulated voyage (as well as any identified close contacts) using point-of-care equipment and parameters approved by CDC as part of Phase 1 of the CSO. Refer to the Technical Instructions for Mitigation of COVID-19 Among Cruise Ship Crew for requirements of onboard COVID-19 testing for symptomatic travelers and close contacts.
  • Cruise ship operators must continue to conduct routine screening testing of crew according to the corresponding color-coding interval. 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.

[1]Documentation of recovery from COVID-19 includes the following:

  • Paper or electronic copies of their 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 traveler has been cleared to end isolation and therefore can travel. A letter that states that they have been cleared to end isolation to return to work or school is also acceptable. The letter does not have to specifically mention travel.

Considerations Genetic Sequencing

If positive specimens are identified within 14 days after the voyage, it may be difficult to differentiate between exposures that occurred on board the ship and after disembarkation. In such situations the cruise ship operator may wish to request that a laboratory conduct genetic sequencing of SARS-CoV-2-positive specimens to determine the likelihood that the exposures occurred on board. If sequencing is being considered, please consult with CDC for additional information and instructions through eocevent349@cdc.gov. Results should also be made available to CDC as part of the after-action report. CDC will be available to assist cruise operators in interpreting results of any genetic sequencing.

  • If sequencing will be performed: specimens can be stored at 2–8°C for no more than 72 hours from the time of collection. The 72-hour timeframe is a strict requirement for specimen quality. Specimens that require storage longer than 72 hours must be frozen at ≤ -70°C.
  • If specimens are shipped: prior to shipping, specimens should be frozen at ≤ -70°C and shipped on dry ice. The quality of the specimen directly affects sequencing and virus culture success. Ideally, specimens should have a reverse transcription polymerase chain reaction (RT-PCR) cycle threshold (Ct) value of ≤28. If Ct values are not available, specimens that are positive/strong positive for SARS-CoV-2 may be sent (avoid weakly positive samples).

Advisory Related to Terminating a Simulated Voyage to Protect Health and Safety

CDC advises cruise ship operators that it may require them to immediately end a simulated voyage and take other actions to protect the health and safety of volunteer passengers and crew if a threshold of COVID-19 cases is met or exceeded during the simulation. During simulated voyages, this threshold is met when 1.5% of COVID-19 cases is detected in passengers or 1.0% of COVID-19 cases is detected in crew. This threshold may be modified for future simulated voyages or restricted passenger voyages based on lessons learned from simulated voyages or restricted passenger voyages, the evolution of the pandemic, or other factors. In the event that a simulated voyage is ended early to protect health and safety, CDC will consult with the cruise ship operator regarding any deficiencies to be noted in the operator’s action-action report and how such deficiencies are to be corrected prior to approving any additional simulated voyages.

In addition, if a simulated voyage is ended early due to the above threshold being met or exceeded during the simulation, the cruise ship operator will have to repeat the simulated voyage at a later date. If the threshold for the voyage is met or exceeded during the simulation, the cruise ship operator will also have to advise all travelers to avoid commercial air travel or ground transportation for 14-days post voyage, unless they have one of the following:

  • Proof of being fully vaccinated against COVID-19 using an U.S. Food and Drug Administration (FDA)-authorized vaccine or a vaccine product that has received emergency use listing from the World Health Organization (WHO), or
  • Documentation of recovery from COVID-19 in the past 90 days, which includes the following:
    • Paper or electronic copies of their 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 traveler has been cleared to end isolation and therefore can travel. A letter that states that they have been cleared to end isolation to return to work or school is also acceptable. The letter does not have to specifically mention travel.

Requirements Related to the Simulated Voyage After-Action Report (AAR)

A cruise ship operator must observe the following requirements relating to the post-simulation after-action report:

  • The cruise ship operator must document in writing any deficiencies observed in its health and safety protocols and describe how the cruise ship operator intends to address those deficiencies prior to applying for a COVID-19 Conditional Sailing Certificate. A deficiency is any significant departure from the cruise ship operator’s health and safety protocols or, if such health and safety protocols are followed, any documented transmission of COVID-19 that requires a change, modification, or adjustment of the operator’s protocols to ensure safer and healthier sailing.
  • The cruise ship operator must report all post-disembarkation test results in aggregate to CDC in the after-action report. To obtain a COVID-19 Conditional Sailing Certificate, cruise ship operators must have at least 75% of all passengers who are not fully vaccinated and do not have documentation of recovery from COVID-19 provide their post disembarkation specimen to the selected laboratory for COVID-19 testing. CDC may lower the 75% post-disembarkation testing requirement for future simulated voyages based on lessons learned from previous simulated voyages and other factors.
  • The after-action report must include the cruise ship operator’s assessments and conclusions regarding the efficacy of its health and safety protocols at mitigating the risk of COVID-19 onboard a cruise ship and whether any changes, modifications, or adjustments to these protocols will occur based on “lessons learned” from the simulated voyage.
  • Where appropriate, the cruise ship operator may incorporate into the after-action report discussion of best practices and lessons learned from voyages that occurred outside of U.S. waters during the period of the NSO or CSO and were not a part of the simulation.
  • Where appropriate, the cruise ship operator may incorporate into the after-action report photographic, video, testimonial, or other evidence documenting that the simulated voyage was conducted in accordance with the cruise ship operator’s health and safety protocols and these technical instructions.
  • The after-action report must be submitted to the CDC as soon as practicable at the end of the simulation and as part of the cruise ship operator’s application for a COVID-19 Conditional Sailing Certificate.
  • CDC may conduct such oversight and inspection of simulated voyages as it deems necessary in its discretion, including through in-person or remote means allowing for visual observation. The findings and/or observations of these inspections will be shared with the cruise ship operator and must be incorporated into the operator’s after-action report.

CDC will provide the cruise ship operator with a template for completing the after-action report after approving the operator’s request to conduct a simulated voyage.

Role of Vaccinations During Simulated Voyages

  • For purposes of CDC vaccination guidance, cruise ships are considered residential, non-healthcare, congregate settings representing a global population.
  • CDC may adjust testing parameters (e.g., types and specimen sources) and quarantine timeframes for all travelers based on increased vaccination coverage in the U.S. and globally, and advancements in testing options.

Option in Lieu of a Simulated Voyage

In lieu of conducting a simulated voyage, cruise ship operator responsible officials, at their discretion, may sign and submit to CDC an attestation under 18 U.S.C. § 1001 that 95 percent of crew (excluding any newly embarking crew in quarantine) are fully vaccinated and submit to CDC a clear and specific vaccination plan and timeline to limit cruise ship sailings to 95 percent of passengers who have been verified by the cruise ship operator as fully vaccinated prior to sailing.

Simulated Voyages and the Passenger Vessel Safety Act

Cruise ship operators are advised that CDC has no responsibility for enforcing requirements relating to the Passenger Vessel Safety Act and no authority to waive these statutory requirements.

CDC’s Mask Order

All persons, including port personnel, crew, and passengers (including those that are fully vaccinated) are advised that CDC’s Order requires wearing of masks on conveyances entering, traveling within or leaving the United States, and in U.S. transportation hubs (see maritime-specific Frequently Asked Questions) remains in effect.

Reporting to Federal Agencies During Simulated Voyages

CDC requires daily submission of the “Enhanced Data Collection (EDC) During COVID-19 Pandemic Form” for passengers and crew. This EDC Form will be used to conduct surveillance for COVID-19 on board cruise ships using cumulative reports of COVID-19-like illness, 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 must continue to report to USCG via Advance Notice of Vessel Arrival (ANOA) as required by regulation.  Cruise ship operators are reminded that USCG considers COVID-19 illness on board a cruise ship a hazardous condition and must be immediately reported to the local Captain of the Port when the cruise ship is within waters subject to the jurisdiction of the United States.

Acute Gastroenteritis (AGE) cases must be reported to CDC’s Vessel Sanitation Program (VSP) in accordance with VSP’s 2018 Operations Manual.

Illnesses of public health concern that are neither COVID-19 nor AGE, and all deaths must be reported to the CDC Quarantine Station with jurisdiction for the port.