Health

  • Medical Facilities

    The CLIA members have taken a proactive role in addressing the quality of shipboard medical care, and many cruise ship physicians are members of the American College of Emergency Physicians (ACEP) and serve on that organization's Cruise Ship and Maritime Medicine Section.

    As a result of cooperative efforts between experienced cruise ship physicians and ACEP, CLIA cruise lines traveling regularly on itineraries beyond the territorial waters of the coastal state, have agreed to meet or exceed the requirements of the ACEP Health Care Guidelines for Cruise Ship Medical Facilities as revised January 2019. ACEP's guidelines address the facilities, staffing, equipment and procedures for medical infirmaries on cruise ships traveling outside territorial waters of the coastal state. Patients requiring more comprehensive facilities or treatment are typically referred to a shoreside medical facility.

    These guidelines are not intended to constitute medical advice, nor to establish standards of care applicable to the industry as a whole. They reflect consensus among members of the facilities and staffing needs considered appropriate aboard cruise vessels, within the recognized limitations of the sea environment. However, the practices of individual cruise lines and shipboard physicians may vary depending upon passenger and crew demographics, itinerary, ship's construction and other circumstances.

    The guidelines are generally intended to foster the following goals:

    • To provide reasonable emergency medical care for passengers and crew aboard cruise vessels
    • To stabilize patients and/or initiate reasonable diagnostic and therapeutic intervention
    • To facilitate the evacuation of seriously ill or injured patients when deemed necessary by a shipboard physician

    The ACEP guidelines can be viewed at https://www.acep.org/

  • Public Health

    Last updated 2 March 2021.

    As part of their commitment to passenger and crew safety in the context of communicable diseases, CLIA’s members have adopted the following policy for all oceangoing vessels:

    General Pre-Boarding Health Screening

    All embarking persons are to receive pre-boarding health screening, to assist in preventing the spread of communicable diseases.

    Phased Implementation of Comprehensive COVID-19 Policy Requirements

    CLIA Members have adopted policy requirements related to resumption of operations which were suspended due to the COVID-19 Pandemic. Some of the protocols are relevant to crew care only, while others are only relevant once passenger service operations begin. The expectation is that these policy requirements will be phased in over time depending on where vessels operate and in which manner they are operating. For example, policies applicable to crew members should be implemented immediately, when crew members are onboard, whereas policies applicable to passengers should be implemented as operations begin.

    Operations in U.S. Ports and Waters

    On September 21, 2020, 74 expert recommendations were issued and later adopted by CLIA member lines operating ships with capacity to carry 250 or more persons in U.S. waters and ports. On October 30, 2020, the U.S. Centers for Disease Control and Prevention (CDC) issued its Conditional Sailing Order and is continuing to issue technical instructions. When the CDC finalizes its requirements for passenger operations in the U.S., CLIA will update this Policy to reflect the final protocols applicable to US operations.

    Member Policy for the Mitigation of COVID-19

    Introduction and Scope

    The health and safety of cruise line crew, passengers and the communities where ships visit are an operational imperative and the top priority for CLIA Member cruise lines. Cruise lines should constantly evolve their efforts to protect against the introduction and transmission of infectious illness onboard ships and demonstrate the industry’s continued commitment to public health.

    Prevention, detection, surveillance and response efforts related to SARS-CoV-2, the virus that causes COVID-19 illness must be implemented by all ocean-going member cruise lines in accordance with this Policy and applicable requirements and guidance of governments and health authorities. In the event of any inconsistency between this Policy and any applicable and more stringent requirements or guidance of governments and health authorities, the latter controls (e.g., the Framework for Conditional Sailing issued by the U.S. Centers for Disease Control and Prevention provides specific requirements for operations in U.S. waters).

    Except where prohibited by applicable law or restrictions imposed by governmental authorities, this Policy, which may be supplemented by cruise line-specific plans and procedures, applies to all CLIA ocean-going cruise lines worldwide carrying 100 or more persons onboard traveling on itineraries to international waters. This Policy has been informed by expert health advisors and other industry-initiated expert groups around the globe, in close coordination with ports and regional and national governments and health authorities.

    The measures implemented by cruise lines operating in all regions are to be continuously evaluated against the evolution of the global pandemic. The measures implemented by CLIA Members at initial restart may be adjusted as circumstances change over time including the discontinuation or persistence of travel restrictions, updated guidance from cognizant health authorities, low or high levels of community spread, increased herd immunity, new virus strains, and the development and availability of effective rapid testing, treatments and vaccines.

    A Sample Pre-Embarkation Health Declaration is included in Annex I as a template which can be adapted to the specific requirements of member cruise lines and any unique requirements of the geographic areas in which ships operate.

    Policy Objectives

    In adopting this Policy, CLIA Members should endeavor to:

    • Implement a comprehensive prevention, surveillance and response strategy from the time of booking, through the cruise itinerary and at disembarkation;
    • Mitigate the potential for embarkation of any person with COVID-19;
    • Promote transparent shipboard communications and timely reporting of symptoms by passengers, crew and any other persons that interact with or board the ship;
    • Detect SARS-CoV-2 among passengers and crew;
    • Train crew to recognize and report signs of COVID-19;
    • Provide guidance and advice to passengers and crew to recognize signs and symptoms of COVID-19, emphasize personal hygiene measures, encourage the reporting of illness and to follow the recommended prevention measures on board;
    • Immediately isolate and clinically manage possible and confirmed cases of SARS-CoV-2 onboard ships;
    • Quarantine all identified close contacts of SARS-CoV-2 cases to minimize onboard transmission;
    • Report cases to cognizant health authorities and stakeholders;
    • Implement contingency response plans and measures;
    • Where appropriate, safely and efficiently disembark and repatriate confirmed SARS-CoV-2 cases and their close contacts consistent with response protocols, including pre-arranged, private resources without overburdening government resources;
    • Implement strategies to reduce potential transmission among passengers, crew, persons that interact with or board the ship, and the communities ships visit;
    • Implement enhanced cleaning and disinfection practices;
    • Employ effective products and technologies to mitigate the spread of SARS-CoV-2.

    Implementation Assumptions

    The risk of introduction and transmission of SARS-CoV-2 onboard ships can be significantly mitigated, but not eliminated.

    No single measure, standing alone, will prevent transmission of SARS-CoV-2; a comprehensive prevention strategy is necessary to minimize the risk of introducing and spreading the virus onboard ships. The proactive and stringent measures implemented at initial restart may be adjusted as circumstances change over time. Cruise lines are to monitor the epidemiological situation in ports of embarkation, disembarkation and at destinations and should coordinate with authorities to verify that routine disembarkations and pre-arranged contingency plans remain applicable. Cruise lines are to engage with partners in the broader cruise community including ports, terminals, local governments, health authorities and health providers to align cruise line procedures and requirements with the capabilities and capacity of available shoreside infrastructure that support cruise line operations. Shorter voyages may assist in reducing exposure potential and provide operational flexibility for cruise line operators to remain in closer proximity to pre-arranged locations where contingency disembarkation plans can be readily activated. International travel restrictions will persist and fluctuate depending on the prevalence of COVID-19 in the locations to and from which individuals travel.

    General Principles

    Cruise lines are to assess the need for passenger capacity control measures based on the unique design and characteristics of ships, operational management of passenger flows onboard and loading strategies. Pre- embarkation screening measures are to be utilized to assist in detecting symptomatic individuals; individuals who have knowingly had close contact with, or helped care for, anyone with SARS-CoV-2; individuals who are currently subject to health monitoring for possible SARS-CoV-2 exposure; and, when appropriate, individuals who have traveled from or through areas of heightened SARS-CoV-2 activity. Entry screening measures imposed by governments for passengers arriving by international air travel will supplement enhanced cruise line pre- embarkation testing and screening procedures to mitigate the risk of boarding passengers from countries with heightened SARS-CoV-2 activity.

    Testing policies and approaches will change over time as technology continues to improve, including test type, equipment, throughput, and sensitivity and specificity.

    Members are to coordinate with port and local health authorities in the disposition of confirmed cases and close contacts who are denied boarding. Passengers and crew who test positive for SARS-CoV-2, or who have symptoms consistent with COVID-19, should only be allowed ashore in coordination with health authorities at the destination for the purpose of medical treatment and/or repatriation. The medical priority should be to disembark confirmed SARS-CoV-2 cases as soon as safely and reasonably possible. Members should pre-identify locations along the intended cruise itinerary route, capable and willing to facilitate the disembarkation of passengers for onward travel, based on informed consultation with relevant port and health authorities.

    Precautionary measures which are applicable to all travelers, based on the requirements or guidance of health authorities or required by the transportation providers for the health and safety of passengers and employees, should be followed by crew just as with other traveler.

    Safety and health measures in destinations and on shore excursions should be comparable to those on the ship and should adhere to local health authority requirements; temperature checks, physical distancing within groups, distancing from other groups or populations ashore, and use of face masks and personal hygiene (including hand washing/ sanitizing) are important mitigation measures.

    Phases of Members’ Return to Passenger Service

    To demonstrate that protocols can be successfully implemented on board, cruise lines are to use a phased approach before resumption of full operations. A predetermined series of phases will enable cruise operators to carefully monitor the newly implemented health and safety protocol and to assess their effectiveness prior to advancing to the next phase. There is no set timeline for any phase. Evaluation of the protocols will follow a process of continuous improvement.


    Phase 1 - Initial Restart:

    Protocols will be the most stringent when initial commercial sailings resume in accordance with guidance from public health officials. Initial heightened restart precautions should include consideration of short duration cruises, limited destinations, and controlled shore excursions.

    Phase 2 - Demonstrated Effectiveness of Protocols - Modified Full Resumption:

    Based upon success of initial restart, and confidence in the efficacy of the protocols implemented, some early heightened restrictions can be modified. Itineraries may be expanded based upon coordination with destinations. However, all members are to apply all applicable protocols holistically across the full spectrum of the cruise, from time of booking through final disembarkation and return home.

    Phase 3 - Availability of Effective Treatments, Therapeutics and/or Vaccines - Modified Full Resumption:

    Protocols will remain in effect, but screening and testing measures may be modified based upon the availability of effective treatments, therapeutics and/or vaccines coupled with the guidance provided by health authorities. Physical distancing requirements and wearing of face masks may be re-evaluated consistent with health advice.

    Phase 4 - The New Normal:

    COVID-19 is no longer a Global Public Health Emergency. Cruise Line protocols are modified so that pre-embarkation testing for SARS-CoV-2 is no longer required. Ships are able to operate with no enduring Public Health restrictions on itineraries. Pre-boarding health screening, cleaning and disinfection procedures and onboard health protocols will continue to exceed pre-COVID levels as recommended by health authorities.

    Member Protocols

    The protocols outlined below apply at initial restart of passenger operations. These are intended to be adapted during the course of the pandemic to reflect the most up to date understanding of COVID-19 prevention, detection and treatment methods. The protocols are divided into the following sections:

    1. Medical Facilities, Equipment and Supplies, Staffing and Procedures
      1. Medical Facilities
      2. Medical Equipment and Supplies
      3. Medical Staffing
      4. Procedures
    2. Ship Configuration and Sanitation
    3. Measures for Crew
    4. Measures for Passengers Through the Full Spectrum of the Cruise Experience
    5. Communications from the Time of Booking
    6. Prior to Embarkation and in Terminals
    7. Onboard Ships
    8. At Destinations
    9. At Disembarkation
    10. Case Detection and Management
    11. Response Mobilization
    12. Implementation, Audit and Review
    13. Supplemental Procedures Specific to Brands/Ships
    1. Medical Facilities, Equipment, Staffing and Procedures

    Meet or exceed the requirements of the Health Care Guidelines for Cruise Ship Medical Facilities of the American College of Emergency Physicians (ACEP) as revised January 2019. ACEP’s guidelines address the facilities, intensive care room and inpatient bed requirements, staffing, equipment, and procedures for medical infirmaries on these cruise ships. Patients requiring more comprehensive facilities or treatment are typically referred to a shoreside medical facility. The ACEP guidelines can be viewed at https://www.acep.org.

    Because the SARS-CoV-2 virus and COVID-19 disease present new challenges that require additional measures to provide for the health of passengers, crew and the destinations ships visit, Members are to supplement their existing commitment under the ACEP Guidelines for medical facilities, equipment and supplies, staffing, training, and procedures as set forth below.

    1. Medical Facilities
      • Modify or enhance medical facilities and shipboard accommodation spaces to provide sufficient onboard critical care capacity for COVID-19 cases and to separate potentially infectious persons from those presenting with noninfectious diseases. This includes the capacity to provide for intensive care of COVID-19 cases that may become critically ill from SARS-CoV-2 or other unrelated
      • The needs and capacities across the industry, and within cruise brands, are not uniform; likewise, cruise lines have varying capabilities and limitations on ships’ ability to convert space based on their current design and construction along with variations in anticipated care needs on different ships and In determining the appropriate ratio of inpatient beds and intensive care-capable beds onboard (beds with 360 degree access with additional capability for oxygen supply, infusion devices, ventilators and monitoring equipment for vital signs including cardiac monitoring), consideration should be given to the number of persons who may need care and the length of time they are expected to need care onboard before they can be disembarked, among other factors. Further development of the ACEP Guidelines will be an important consideration. This is an area where close monitoring is warranted as cruising resumes to determine if the ratios are appropriate. Once the pandemic subsides, cruise lines may opt to reduce intensive care-capable bed capacity.
      • Medical Equipment and Supplies
      • Supplement the medical equipment and supplies specified by the ACEP Guidelines 2019 and increase the types and quantity carried This should at least include effective policies and procedures, diagnostic equipment to test for SARS-CoV-2 and Influenza A/B, face masks, and personal protective equipment (PPE). This should further take into account any requirements of authorities where the ship is operating and as appropriate be adapted based on ship operating capacity and passenger demographics.
      • Medical Staffing
      • Augment shipboard medical staffing beyond the requirements of the ACEP Guidelines 2019. Focus should be on providing an appropriate ratio and mix of medical professionals based on the number of crew and passengers onboard, and maintaining a reserve of professionals that can be accessed if Augmented staff may include additional doctors experienced in critical care, nurse practitioners (or equivalent) and registered nurses, as well as specialists, both onboard and ashore. The number of additional staff and qualifications are to be coordinated by cruise lines taking into account the requirements of authorities in the region of operations and should be adapted based on ship operating capacity, passenger demographics and proximity and availability of pre-arranged and responsive shoreside resources.
      • Identify one or more individuals onboard each ship to be responsible for the overall public health and environmental health aspects of ship This includes the specific responsibility to inform and oversee the implementation and execution of prevention measures, action on audit items and all components of the response to any infectious disease onboard.
      • Designate a cruise line-specific centralized entity ashore for all inquiries and aspects related to COVID-19 case management, passenger and crew disposition and disembarkation
      • Procedures
      • Employ enhanced shipboard communications and procedures to promote illness reporting;
      • Implement a program of daily temperature checks for passengers and Any person with a temperature at or above 38˚C or 100.4˚F is to be provided with and use appropriate PPE, and report to their cabin or a designated location for medical evaluation. Crew presenting with fever at or above 38 ˚C or 100.4˚F or symptoms consistent with COVID-19 are to refrain from all work responsibilities and remain isolated pending evaluation and direction from shipboard medical staff;
      • Employ routine symptom screening methodologies to help identify potential SARS-CoV-2 infections as quickly as
      • Conduct health evaluations of suspect cases in their cabins, wherever possible, to minimize potential exposure;
      • For individuals in isolation or quarantine, carry out all services by trained crew equipped with PPE in accordance with current health guidance;
      • Coordinate with ports, terminals, and service providers to facilitate appropriate distancing within terminals for all pre-boarding screening and processing, provide appropriate PPE when necessary, and efficiently and effectively clean and disinfect
      • Implement medical treatment plans that are consistent with the current understanding of COVID-19 and optimal treatment protocols, as well as the specific clinical needs of each
      • Where possible, establish relationships with shore-based medical facilities that can provide remote consultation via telemedicine in order to enhance the clinical management of cases of COVID-19.
      • 2. Ship Configuration and Sanitation
        • Designate reserved cabins for the isolation of possible and confirmed cases of COVID-19 and the quarantining of their close The location of these rooms, to the extent possible, should facilitate effective monitoring by medical staff and minimize passengers and crew foot traffic in the area. Ship air flow patterns should also be considered in selecting the location for these cabins.
        • Manage passenger and crew population density in order to facilitate physical distancing
        • Implement air management risk mitigation strategies by increasing fresh air changes and reducing recirculation where possible using enhanced filtration and other technologies to maximize system effectiveness. Air management strategies should be optimized taking into consideration any constraints posed by the age of the ship and existing ventilation design, and should be focused on public areas and high traffic
        • Employ enhanced sanitation protocols to help protect against the risk of SARS-CoV-2 transmission via inanimate surfaces or objects onboard in port terminals, and cruise line operated
        • Use cleaning methods and disinfectants that are effective against SARS-CoV-2 and which conform with applicable health authority
        • In accordance with the ship’s Outbreak Prevention and Response Plan (OPRP), implement procedures to verify maintenance of regular cleaning and disinfection schedules as well as enhanced schedules when elevated levels of respiratory illness or other infectious diseases are possible or confirmed
        • Provide hand-washing and/or hand sanitization equipment at entrances to common areas where people congregate such as passenger and crew dining venues, entertainment venues, child activity centers and throughout crew areas and work CLIA Members are to post signage at handwashing sinks and hand sanitizing stations to provide guidance on effective hygiene techniques and designate crew to supervise use.
        • 3. Measures for Crew
        • Conduct 100% testing of all crew members for SARS-CoV-2, reporting of any positive results to the cruise line medical director, or equivalent, for appropriate action:
        • Prior to their departure from home;
        • Prior to embarking the ship;
        • Upon conclusion of a minimum 7-day quarantine onboard or For quarantine periods of 14 days or longer, a test is required if mandated by a cognizant health authority; and
        • Periodically, at an appropriate frequency (at least monthly) when operating with passengers;
        • Conduct health screening of all crew prior to At a minimum, this screening should include symptom history checks, based on health guidance, for symptoms consistent with COVID-19, Acute Respiratory Illness, Influenza-like Illness, and pneumonia in the 14 days before embarkation, and a temperature check of the crew member. Any crew member with a temperature reading at or above 100.4 degrees F / 38 degrees C or who reports symptoms of fever or illness is to receive further enhanced medical screening to determine whether they will be permitted to board.
        • Deny boarding to all crew members who, within 14 days prior to embarkation, have had contact with, or helped care for, anyone who tested positive for SARS-CoV-2 or was suspected or diagnosed as having COVID-19, or who themselves are currently subject to health monitoring for possible exposure to COVID-19.
        • Perform daily health symptom screening of employees and other staff (e.g., luggage porters and transportation providers), service technicians, pilots, port state control officials and other similar personnel who may board the ship for short periods of time while in port or while the ship is transiting inbound or outbound, but who do not sail on the itinerary with the Appropriate PPE, to include a face mask, should be worn by these individuals at all times.
        • Require wearing of face masks by all crew onboard in public spaces, back of house areas and service areas, in terminals, at destinations, and during shore Notable exceptions include when a crewmember is in their cabin and when eating or drinking.
        • Require crew members to practice physical distancing consistent with shoreside health authority requirements;
        • Provide training to crew at initial embarkation and at periodic intervals on aspects related to infection control, physical distancing, mask-wearing, proper hand hygiene, surveillance, identification and reporting of symptoms of respiratory illness, scenario response plans, contact tracing, quarantine, isolation, and disembarkation protocols, PPE usage, cleaning and disinfection procedures, and proper use of equipment and chemicals. Information on COVID-19 and company procedures are to be communicated by way of postings in crew areas and on crew television Members are to conduct periodic drills on prevention, surveillance, and response protocols.
        • Actively encourage and reinforce a culture of transparency and collective responsibility among crew for following protocols and creating a safer
        • Provide opportunities for crew to disembark from the ship at destinations; however, only when able to maintain a similar level of safety to that provided onboard and during guest shore excursions with regard to the risk of exposure to SARS-CoV-2.
        • Limit crew cabin occupancy, where possible, to 2 crew members who are partners or who work in the same area or department
        • Provide crew access to mental health support resources, in-room entertainment and/or Wi-Fi access when required to undergo quarantine or isolation on
        • 4. Measures for Passengers Through the Full Spectrum of the Cruise Experience
          1. Communications from the Time of Booking
            • Communicate with prospective passengers prior to booking, before they travel to the ship and upon arrival in ports and at terminals regarding SARS-CoV-2 risks, health screening requirements and safety precautions, reporting responsibilities, hygiene measures, and prevention, surveillance and response protocols. Prospective passengers are to be informed that they will not be allowed to sail if they do not affirmatively state their willingness to abide by all prescribed health protocols throughout the cruise itinerary, both on board and Information is to be communicated by the most effective means available including, for example, by online booking tools with passenger confirmation of acknowledgment; travel agent communications; and informational materials sent directly to guests by mail, email and/or text messages.
            • Following a cruise booking, provide prospective passengers with instructions for complying with the public health screening and testing requirements established by the cruise line. CLIA Members are to communicate to the prospective passenger that for any SARS-CoV-2 tests conducted prior to arrival at the terminal for embarkation, documented proof of negative SARS-CoV-2 test results will be a prerequisite to boarding the
            • Advise prospective guests that there are conditions that are considered to represent increased risk of severe illness from SARS-CoV-2, provide a link to a government agency website which maintains an up-to-date list of those conditions, and recommend that anyone having those conditions consult with their doctor prior to
            • Provide guests with a pre-departure packing list for sanitation and hygiene products including helpful items to reduce the risk of infection and transmission, and to advise of the onboard availability of items such as hand sanitizer, masks and disposable
            • Prior to Embarkation and in Terminals
            • Verify that terminals are cleaned and disinfected prior to, throughout, and following, each embarkation consistent with local protocols, and where feasible, analogous to the cleaning and disinfection protocols in use on ships. During embarkations, regular cleaning and sanitizing is to be conducted on a continuous basis throughout the arrival zone, passenger-processing zone and the sanitary Elevated cleaning and disinfection protocols are to be implemented upon detection of possible or confirmed COVID-19 cases and in related processing/treatment areas of such persons. Terminals should remain closed until time of boarding and access should only be granted to vetted personnel consistent with overall prevention, cleaning and disinfection procedures. Touchpoints throughout the terminal should be minimized.
            • Stagger guest arrivals at embarkation terminals to reduce crowding and to facilitate physical distancing during all aspects of the pre-embarkation Where possible, Members are to implement processes and protocols for touchless check-in and speedier boarding to reduce contact and potential congestion in the terminal. Embarkation terminals are to be staffed by trained personnel wearing appropriate PPE.
            • Implement measures in the terminal to facilitate physical distancing through various means including posted signage, staff engagement and public address system announcements, line ropes and posts, floor markings for spacing, directional arrows for traffic flow and/or logical sequencing of movement through pre-embarkation testing, health screening, security and document
            • Prior to boarding, require that all prospective passengers complete a health declaration for illness and contact history screening and attest to their willingness to abide by all prescribed health
            • Require that all embarking persons have a negative SARS-CoV-2 test result prior to Any individuals who have received a positive SARS-CoV-2 test result within 14 days prior to embarkation, and their close contacts, are to be denied boarding.
            • Require all embarking persons undergo pre-boarding health * Screening is to include verification that symptoms consistent with COVID-19, Acute Respiratory Illness, Influenza-like Illness, and pneumonia have not been present within 14 days before embarkation; and a temperature check. Any individual with a temperature reading at or above 100.4 degrees F / 38 degrees C, or who is exhibiting any symptoms consistent with COVID-19, is to receive further medical evaluation to determine whether they will be permitted to board.
            • Deny boarding to all persons who, within 14 days prior to embarkation, have had contact with, or helped care for, anyone suspected or diagnosed as having COVID-19, or who tested positive for SARS-CoV-2, or who themselves are currently subject to health monitoring for possible exposure to COVID-19.
            • Manage, consistent with notifications to health authorities for possible or confirmed cases of COVID-19, such cases and close contacts from the pre-boarding process through onward
            • Implement pre-boarding screening measures in a manner in which personal data is collected, stored and destroyed consistent with applicable data privacy
            • The pre-boarding screening measures may be updated upon approval of the CLIA Global Executive Committee to reflect evolving developments and/or guidance from public health authorities. A Sample Pre- Embarkation Health Declaration is included at Annex
            • Onboard Ships
            • Require wearing of masks by all passengers onboard when inside in all public spaces and outside whenever physical distancing cannot be maintained; notable exceptions include when passengers are in their cabin, when eating or drinking, or
            • Align physical distancing on board ships consistent with shoreside health authority Physical distancing onboard can be achieved through one or more measures including, but not limited to:

            » Directional controls for movement of all persons in high traffic areas including passageways, stairways and other common areas;

            » Appropriately distanced seating in theaters, dining facilities and other common venues;

            » Operational measures in recreational water facilities, fitness centers, shops, child activity centers and casinos;

            » Modified capacity, as appropriate, based on the size and design of the ship;

            » Modified entertainment showings and meal services to control venue capacity;

            » Distancing measures wherever lines develop including gangways, embarkation portals and muster stations;

            » Increased use of outdoor venues for group events;

            » Staggered or alternative procedures for muster drills in consultation with flag State authorities;

            » Reduced occupancy in elevators;

          2. Provide in-cabin guidance, informational broadcasts on mobile devices and/or televisions, and daily Captain’s announcements to include reminders on the importance of maintaining the health of passengers and crew by practicing physical distancing, wearing masks, exercising proper hand hygiene, and recognizing and reporting COVID-19 symptoms.
          3. Position crew members at dining and entertainment venues, as feasible, to oversee handwashing and hand sanitizer
          4. Designate crew members to serve passengers in
          5. At Destinations
          6. Coordinate port visits only with destinations that have implemented SARS-CoV-2 mitigation protocols and when the prevalence of SARS-CoV-2 in the destination does not present an unacceptable level of
          7. Make arrangements with port partners, as appropriate for each itinerary and consistent with guidance from health authorities, for various disembarkation scenarios of COVID-19 cases so that SARS-CoV-2 infected individuals and their close contacts can disembark the ship, receive treatment, isolate or quarantine as appropriate, and travel home as coordinated by the cruise
          8. Timely report cases of illness to all intended destinations in accordance with local health reporting guidance and consistent with the requirements of the International Health Regulations (2005) Maritime Declaration of Health in order to facilitate prompt and informed decision-making and overall
          9. Coordinate with destination port operators to provide for an appropriate level of cleaning and sanitation in destination terminals or disembarkation areas, for consistency with the cruise operator’s prescribed protocols and with local health
          10. Provide guests with information about potential exposure risks and how to minimize their risk of contracting SARS- CoV-2 at any planned
          11. Only permit disembarkations at private islands, remote stops on expeditionary cruises, and/or as part of organized shore excursions at ports of call, according to the cruise operators’ prescribed protocols that meet or exceed the applicable requirements and guidance of governmental or health Strict adherence to these restrictions is to be required of all passengers with denial of re-boarding for non-compliance or, where such denial is not possible due to the remoteness of an itinerary, employ alternative control measures coordinated by the cruise operator that provide at least an equivalent level of safety for any passengers that do not comply.
          12. Stagger guest disembarkation at destinations to reduce crowding and to facilitate physical distancing during all aspects of the disembarkation
          13. Maintain physical distancing for crew, passengers or cohorted groups of passengers traveling together who disembark on private islands, company-owned ports and in destinations during shore
          14. Require wearing of face masks by all passengers in all destinations and during excursions when physical distancing cannot be
          15. Instruct all persons re-embarking the ship from the destination terminal or tender to immediately utilize handwashing sinks or hand sanitization stations (located close to the point of embarkation).
          16. At Disembarkation
          17. Stagger guest departures at the port where the cruise itinerary concludes to reduce crowding and to facilitate physical distancing during all aspects of the disembarkation
          18. Maintain passenger tracking and tracing information for at least 30 days to facilitate post-cruise communication; applicable data privacy protections are to be
          19. 5. Case Detection and Management
          20. Conduct health evaluations of suspect cases in their cabins, when possible, including use of any available shipboard telemedicine tools to reduce potential
          21. On board ships, carry and use diagnostic test kits authorized by cognizant health authorities to test passengers and crew who present with COVID-19
          22. Immediately isolate possible or confirmed cases of SARS-CoV-2 or COVID-19 in pre-designated, reserved isolation
          23. Require all persons interacting with isolated patients, including medical staff, food handlers and cleaning staff, to use appropriate PPE (e.g., protective clothing, face masks, gloves) to reduce the risk of further transmission. Disposable overalls, goggles, and face shields are to be available for use when direct interaction with isolated patients is necessary. Interaction with isolated individuals is to be limited to only those necessary. All other visitation should be
          24. Implement response protocols to quickly identify and quarantine close contacts, as defined by health authorities, of possible or confirmed SARS-CoV-2 or COVID-19 cases and to medically assess and appropriately manage them consistent with the advice of such Close contact exposure to be determined based on guidance and requirements of local health authorities.
          25. Utilize contact tracing capabilities including, for example, response team investigations and, where available, shipboard closed-circuit television (CCTV) analysis, guest management systems such as wearable technology, mobile apps and keycard use to identify and expeditiously inform other passengers and crew of potential close contact
          26. Utilize risk-based response plans based on each ship’s ability to manage various levels of onboard COVID-19 cases and close contacts;
          27. Conduct screening and testing of disembarking passengers who are close contacts of confirmed SARS-CoV-2 and COVID-19
          28. Separate cases or close contacts that disembark the ship from other
          29. 6. Response Mobilization
          30. Make arrangements as appropriate for each itinerary and consistent with guidance from health authorities for various disembarkation scenarios of COVID-19 cases and close contacts. The medical priority will be to disembark confirmed COVID-19 cases as soon as safely and reasonably practical, consistent with the protocols in place, and managed in conjunction with disembarkation of passengers with critical medical needs unrelated to COVID-19.
          31. Make arrangements for services in advance, as appropriate for each itinerary and consistent with guidance from health authorities, for transportation providers, shoreside quarantine and medical facilities for case management and in the event infectious illness exceeds onboard management
          32. Coordinate with strategic ports along the intended itinerary route so that, if needed, the cruise line can arrange for passengers and crew members to receive medical treatment and for repatriations and crew changes to be organized.
          33. Establish a communications plan, with a pre-assigned communications lead in advance, to share timely, relevant information with crew and guests on board the ship in the event of a SARS-CoV-2 infection during or after the Members should have systems in place to coordinate information about SARS-CoV-2 infections to relevant health authorities.
          34. Upon disembarkation in response to meeting predetermined case thresholds and/or cruise cancelation, carry out enhanced ship cleaning and disinfection
          35. 7. Implementation, Audit and Review
          36. Implementation of this Policy is a condition of CLIA membership and must be verified by Member cruise line CEOs either prior to initial restart or during annual review of the CLIA Compendium of Member Policies, whichever is earlier in time. The protocols associated with this Policy are either to be incorporated into each ship’s Safety Management System (SMS) and/or subject to third party auditing or an equivalent level of
          37. Following any cruise with a COVID-19 outbreak, Members are to conduct a review at the first opportunity to identify lessons learned and opportunities for
          38. The CLIA Global Medical Working Group will serve as a forum for exchange of information and identification of successful measures for consideration by other
          39. Where existing CLIA environmental, safety or security policies, or elements thereof, conflict with this policy, Members are to implement a mitigation strategy that provides an equivalent level of safety consistent with guidance from health
          40. 8. Supplemental Procedures Specific to Brands/Ships
          41. Develop plans as needed to implement this policy and to reflect all necessary details for ship or fleet-specific prevention, surveillance and response protocols applicable in the ports and regions in which they operate. Such plans are to also address contractual services, if any, that provide for applicable medical response measures and procedures for transport and care