cruise ship 400 covid cases

COVID-19 Spreads to 89 Cruise Ships, Prompting a U.S. CDC Investigation

T he U.S. Centers for Disease Control and Protection identified 89 cruise ships with COVID-19 cases on Tuesday, nearly all of which have met the threshold for a formal investigation.

Democratic Senator Richard Blumenthal urged cruise companies and health agencies to stop ships from sailing, saying they are “repeating recent history as petri dishes of Covid-19 infection.” Operators such as Carnival Corp. have implemented safeguards including mandatory masking and proof of vaccination, but the fast-spreading omicron variant has triggered an increasing number of infections and reports of ships being turned away at ports.

“Time for CDC & cruise lines to protect consumers & again pause—docking their ships,” Blumenthal said in a tweet.

Roger Frizzell, a spokesperson for Carnival, said in an email that “our health and safety protocols put in place have proven to be effective time and time again over the past year with our sailings being restarted across each of our brands.”

Of the 86 cruise ships under investigation by the CDC, Carnival operates 32, Royal Caribbean Cruises Ltd. operates 25 and Norwegian Cruise Line Holdings Ltd. operates 15. Four ships operated by Walt Disney Co.’s Disney Cruise Line are now also under watch, according to the CDC website. The list is rapidly changing and the next stage for ships with outbreaks could involve taking additional public health measures.

Royal Caribbean, Norwegian, Disney Cruise Line and Viking Cruises didn’t immediately respond to requests for comment.

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“Health and safety is the cruise industry’s highest priority,” said Bari Golin-Blaugrund, a spokesperson for the Cruise Lines International Association trade group, in an email. “In fact, the latest data show that cases have occurred less frequently on cruise ships than on land, with a greater proportion of asymptomatic or mild cases.”

Shares of cruise operators rebounded Tuesday along with the travel sector. As of 12:35 p.m. New York time, Carnival was up 1.2%, Royal Caribbean gained 0.4% and Norwegian was little changed. Of the three, only Royal Caribbean shares have had positive returns this year and they have significantly trailed the broader market, up less than 6% year to date compared to a 27% gain in the S&P 500 Index.

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U.S. CDC investigating nearly 70 cruise ships hit by COVID-19 cases

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• Section 8 - Road & Traffic Safety
• Section 8 - Motion Sickness

Cruise Ship Travel

Cdc yellow book 2024.

Author(s): Kara Tardivel, Stefanie White, Aimee Treffiletti, Amy Freeland

Cruise Ship Medical Capabilities

Illness & injury, infectious disease health risks, noninfectious health risks, travel preparation.

Cruise ship travel presents a unique combination of health concerns. Travelers from diverse regions brought together in the often crowded, semi-enclosed shipboard environment can facilitate the spread of person-to-person, foodborne, and waterborne diseases. Outbreaks on ships can be sustained over multiple voyages by crewmembers who remain onboard, or by persistent environmental contamination. Port visits can expose travelers to local diseases and, conversely, be a conduit for disease introduction into shoreside communities.

Some people (e.g., those with chronic health conditions or who are immunocompromised, older people, pregnant people) merit additional considerations when preparing for a cruise. Because travelers at sea might need to rely on a ship’s medical capabilities for an extended period, potential cruise passengers with preexisting medical needs should prepare accordingly by calling the cruise line’s customer service center to learn what type and level of health care services are (and are not) available on specific ships.

Medical facilities on cruise ships can vary widely depending on ship size, itinerary, cruise duration, and passenger demographics. Generally, shipboard medical centers can provide medical care comparable to that of ambulatory care centers; some are capable of providing hospitalization services or renal dialysis. Although no agency officially regulates medical practice aboard cruise ships, the American College of Emergency Physicians (ACEP) published consensus-based guidelines for cruise ship medical facilities in 1995, and updated the guidelines in 2013. ACEP guidelines , which most major cruise lines follow, state that cruise ship medical facilities should be able to provide quality medical care for passengers and crew; initiate appropriate stabilization, diagnostic, and therapeutic maneuvers for critically ill or medically unstable patients; and assist in the medical evacuation of patients in a timely fashion, when appropriate.

Cruise ship medical centers deal with a wide variety of illnesses and injuries; ≈10% of conditions reported to cruise ship medical centers are an emergency or require urgent care. Approximately 95% of illnesses are treated or managed onboard, with the remainder requiring evacuation and shoreside consultation for dental, medical, or surgical issues. Roughly half of all passengers seeking medical care are >65 years old.

Medical center visits are primarily the result of acute illness or injury. The most frequently reported diagnoses include respiratory illnesses (30%–40%); injuries from slips, trips, or falls (12%–18%); seasickness (10%); and gastrointestinal (GI) illness (10%); 80% of onboard deaths are due to cardiovascular events.

Infectious Disease Outbreaks

The most frequently reported cruise ship outbreaks involve GI infections (e.g., norovirus), respiratory infections (e.g., coronavirus disease 2019 [COVID-19], influenza), and other vaccine-preventable diseases (VPDs), such as varicella. Although cruise ships do not have public health authority, to reduce the risk of introducing communicable diseases, some ships conduct medical screening during embarkation to identify ill passengers, prevent them from boarding, or require isolation if permission to board is given.

Before travel, to help limit the introduction and spread of communicable diseases on cruise ships, prospective cruise ship travelers and their clinicians should consult the Centers for Disease Control and Prevention (CDC) Travelers’ Health website for updates on outbreaks and destination-specific travel health notices. People who become ill with a communicable disease before a voyage should consult their health care provider and delay their travel until they are no longer contagious. When booking a cruise, travelers should check the trip cancellation policies and consider purchasing trip cancellation insurance (see Sec. 6, Ch. 1, Travel Insurance, Travel Health Insurance & Medical Evacuation Insurance ).

Travelers who become ill during a voyage should seek care in the ship’s medical center; the onboard staff will provide clinical management, facilitate infection-control measures, and take responsibility for reporting potential public health events. For information on how to report travelers who become ill with suspected communicable diseases after they return home from a cruise, see Sec. 8, Ch. 8, Airplanes & Cruise Ships: Illness & Death Reporting & Public Health Interventions .

Gastrointestinal Illnesses

During 2006–2019, rates of GI illness among passengers on voyages lasting 3–21 days fell from 32.5 to 16.9 cases per 100,000 travel days. Despite the decrease, outbreaks continue to occur. CDC assists the cruise ship industry to prevent and control the introduction, transmission, and spread of GI illnesses on cruise ships. See information on cruise ship GI illnesses and updates on GI illness outbreaks involving ships with US ports of call, specifically.

On cruise ships, >90% of GI illness outbreaks with a confirmed cause are due to norovirus. Characteristics of norovirus that facilitate outbreaks include a low infective dose, easy person-to-person transmissibility, prolonged viral shedding, absence of long-term immunity, and the ability of the virus to survive routine cleaning procedures (see Sec. 5, Part 2, Ch. 16, Norovirus ). For international cruise ships porting in the United States during 2006–2019, an average of 12 norovirus outbreaks occurred each year.

Other Sources of Gastrointestinal Illness

GI outbreaks on cruise ships also have been caused by contaminated food or water; most outbreaks were associated with  Campylobacter ,  Clostridium perfringens , or enterotoxigenic  Escherichia coli .

Protective Measures

Travelers can reduce the risk of acquiring a GI illness on cruise ships by frequently washing hands with soap and water, especially before eating and after using the restroom. Travelers should call the ship’s medical center promptly, even for mild symptoms of a GI illness, and strictly follow cruise ship guidance regarding isolation and other infection-control measures.

Respiratory Illnesses

Respiratory illnesses are the most common medical complaint on cruise ships. During the pretravel visit, evaluate whether vaccines or boosters (e.g., COVID-19, influenza) are needed and emphasize the importance of practicing good respiratory hygiene and cough etiquette while onboard. As with GI illnesses, cruise ship passengers should report respiratory illness to the medical center promptly and follow isolation recommendations as instructed.

Coronavirus Disease 2019

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), the virus that causes COVID-19, spreads more easily between people in close quarters, and multiple studies have concluded that transmission rates of SARS-CoV-2 among travelers on ships are much greater than in other settings. Cruise ship COVID-19 outbreaks can tax onboard medical and public health resources. Ship-to-shore medical evacuations to facilities capable of providing higher levels of medical care can present logistical challenges and pose additional risks to ill patients.

Cruise passengers and crewmembers who are not up to date with their COVID-19 vaccines are at increased risk for severe illness, hospitalization, medical evacuation, and death. Since cruising will always pose some risk of SARS-CoV-2 transmission, ensure that people planning cruise ship travel are up to date with their vaccinations, and assess their likelihood for developing severe COVID-19. For people at increased risk of severe COVID-19 regardless of their vaccination status (e.g., pregnant people, people who are immunocompromised), discuss the potential health hazards associated with cruise ship travel. CDC has developed recommendations and guidance designed to help cruise ship operators provide a safer and healthier environment for crewmembers, passengers, port personnel, and communities.

Historically, influenza has been among the most often reported VPDs occurring on cruise ships. Because passengers and crew originate from all regions of the globe, shipboard outbreaks of influenza A and B can occur year-round, with exposure to strains circulating in different parts of the world (see Sec. 5, Part 2, Ch. 12, Influenza ). Thus, anyone planning a cruise should receive the current seasonal influenza vaccine ≥2 weeks before travel if vaccine is available and no contraindications exist. For people at high risk for influenza complications, health care providers should discuss chemoprophylaxis and how and when to initiate antiviral treatment.

See additional guidance on the prevention and control of influenza on cruise ships .

Legionnaires’ Disease

Less common on cruise ships, Legionnaires’ disease is nevertheless a treatable infection that can result in severe pneumonia leading to death (see Sec. 5, Part 1, Ch. 9, Legionnaires’ Disease & Pontiac Fever ). Approximately 10%–15% of all Legionnaires’ disease cases reported to CDC occur in people who have traveled during the 10 days before symptom onset. Clusters of Legionnaires’ disease associated with hotel or cruise ship travel can be difficult to detect, because travelers often disperse from the source of infection before symptoms begin. Data reported to CDC during 2014–2015 included 25 confirmed cases of Legionnaires’ disease associated with cruise ship exposures.

In general, Legionnaires’ disease is contracted by inhaling warm, aerosolized water containing the bacteria,  Legionella . Transmission also can sometimes occur through aspiration of  Legionella -containing water. Typically, people do not spread  Legionella  to others; a single episode of possible person-to-person transmission of Legionnaires’ disease has been reported. Contaminated hot tubs are commonly implicated as a source of shipboard  Legionella  outbreaks, although potable water supply systems also have been culpable. Improvements in ship design and standardization of water disinfection have reduced the risk for  Legionella  growth and colonization.

Diagnosis & Reporting

People with suspected Legionnaires’ disease require prompt antibiotic treatment. When evaluating cruise travelers for Legionnaires’ disease, obtain a thorough travel history of all destinations during the 10 days before symptom onset to assist in identifying potential sources of exposure, and collect urine for  Legionella  antigen testing. Most cruise ships have the capacity to perform this test, which detects  L. pneumophila  serogroup 1, the most common serogroup.

Perform culture of lower respiratory secretions on selective media to detect non– L. pneumophila  serogroup 1 species and serogroups. Culture also is used for comparing clinical isolates to environmental isolates during an outbreak investigation. Notify CDC of any travel-associated Legionnaires’ disease cases by sending an email to [email protected]. Quickly report all cases of Legionnaires’ disease to public health officials, who can determine whether a case links to previously reported cases and work to stop potential clusters and new outbreaks.

Other Vaccine-Preventable Diseases

Although most cruise ship passengers come from countries with routine vaccination programs (e.g., Canada, the United States), many of the crew are from low- or middle-income countries where immunization rates can be low. Outbreaks of hepatitis A, measles, meningococcal disease, mumps, pertussis, rubella, and varicella have all been reported on cruise ships. The majority (82%) of these outbreaks occur among crewmembers; prior to the COVID-19 pandemic, varicella was the most frequently reported VPD. Other VPDs (e.g., pertussis) occur more often among passengers.

Each cruise line sets its own policies regarding vaccinations for its crew; some have limited or no requirements. Thus, all passengers should be up to date with routine vaccinations before travel, as well as any required or recommended vaccinations specific for their destinations. People of childbearing age should have documented immunity to measles, rubella, and varicella (either by vaccination or titer) before cruise ship travel.

Vectorborne Diseases

Some cruise ship ports of call include destinations where vectorborne diseases (e.g., dengue, Japanese encephalitis, malaria, yellow fever, Zika) are known to be endemic. In addition, new diseases can surface in unexpected locations; chikungunya was reported for the first time in the Caribbean in late 2013, with subsequent spread throughout the region and numerous other North, Central, and South American countries and territories. Zika was first reported in Brazil in 2015, and subsequently spread across the Caribbean and Latin America, sparking concern because of its association with microcephaly and other congenital abnormalities in the fetus. For disease-specific information, see the relevant chapters of Section 5.

For guidance on how to avoid bites from mosquitoes and other disease-transmitting arthropod vectors, both onboard and while on shore at ports of call, see Sec. 4, Ch. 6, Mosquitoes, Ticks & Other Arthropods . For specific details on yellow fever vaccination and malaria prevention, see Sec. 2, Ch. 5, Yellow Fever Vaccine & Malaria Prevention Information, by Country .

Stresses of cruise ship travel include varying weather and environmental conditions, and unaccustomed changes to diet and levels of physical activity. Despite modern stabilizer systems, seasickness is a common complaint, affecting up to 25% of travelers (see Sec. 8, Ch. 7, Motion Sickness ). Note that travel is an independent risk factor for behaviors such as alcohol and illicit drug use and misuse (see Sec. 3, Ch. 5, Substance Use & Substance Use Disorders ), and unsafe sex (see Sec. 9, Ch. 12, Sex & Travel ).

Cruise ship travelers have complex itineraries due to multiple short port visits. Although most port visits do not include overnight stays off ship, some trips offer travelers the opportunity to venture off the ship for ≥1 night. These excursions can complicate decisions about exposures and the need for specific antimicrobial prophylaxis, immunizations, and other prevention measures.  Boxes 8-04  and  8-05  summarize recommended cruise travel preparations and healthy behaviors during travel for health care providers and cruise ship travelers.

Box 8-04 Healthy cruise travel preparation: a checklist for health care providers

Risk assessment & risk communication.

☐ Discuss itinerary, including season, duration of travel, and activities at ports of call. ☐ Review the traveler’s medical and immunization history, allergies, and any additional health needs. ☐ Discuss relevant travel-specific health hazards and risk reduction. ☐ Provide travelers with documentation of their medical history, immunizations, and medications.

VACCINATION & RISK MANAGEMENT

☐ Provide routinely recommended (age-specific), required (yellow fever), and recommended vaccines. ☐ Discuss safe food and water precautions. ☐ Discuss insect bite prevention. ☐ Provide older travelers with a baseline electrocardiogram, especially those with coronary artery disease.

MEDICATIONS BASED ON RISK & NEED

☐ Consider prescribing malaria chemoprophylaxis if itinerary includes stops in malaria-endemic areas. ☐ Consider prescribing motion sickness medications for self-treatment.

Box 8-05 Healthy cruise travel preparation: a checklist for travelers

☐ Carry prescription drugs in original containers with a copy of the prescription and a physician’s letter. ☐ Check the Centers for Disease Control and Prevention (CDC) Outbreak Updates for International Cruise Ships website for gastrointestinal outbreaks. ☐ Consider purchasing additional insurance coverage for overseas health care and medical evacuation. ☐ Consult medical and dental providers before cruise travel. ☐ Consult CDC Travelers’ Health website for travel health notices . ☐ Defer travel while acutely ill. ☐ Evaluate the type and length of the planned cruise in the context of personal health requirements. ☐ Notify the cruise line of additional health needs (e.g., dialysis, supplemental oxygen, wheelchair). ☐ Pack Environmental Protection Agency (EPA)–registered insect repellent; consider treating clothes and gear with permethrin. ☐ Pack sunscreen.

DURING TRAVEL

☐ Avoid contact with people who are ill. ☐ Follow safe food and water precautions when eating off ship at ports of call. ☐ Maintain good fluid intake and avoid excessive alcohol consumption. ☐ Practice safe sex. ☐ Report all illnesses to ship’s medical center and follow their recommendations. ☐ Use insect bite precautions during port visits, especially in vectorborne disease–endemic areas or areas experiencing outbreaks of vectorborne diseases (e.g., Zika, yellow fever) ☐ Use sun protection. ☐ Wash hands frequently with soap and water; if soap and water are not available, use ≥60% alcohol–based hand sanitizer.

POST TRAVEL

☐ See CDC’s latest post-cruise health guidance regarding coronavirus disease 2019.

Travelers with Additional Considerations

Travelers with chronic illnesses and travelers with disabilities who have additional needs (e.g., dialysis, supplemental oxygen, wheelchairs) should inform their cruise line before traveling. Highly allergic travelers and travelers with underlying medical conditions should carry a file that contains essential, pertinent health information (e.g., allergies, blood type, chest radiograph [if abnormal], chronic conditions, electrocardiogram, medication list, primary and/or specialty care provider contact information). Travelers also should bring any medications recommended by their health care provider (e.g., an epinephrine auto-injector) to help facilitate care during a medical emergency. For detailed information on preparing travelers who have additional considerations for international travel, including severe allergies, chronic illness, disabilities, or immune compromise, see Section 3.

Pregnant Travelers

Most cruise lines have policies that do not permit people to board after their 24th week of pregnancy. Contact cruise lines directly for specific guidance before booking. For additional information on preparing pregnant people for international travel, see Sec. 7, Ch. 1, Pregnant Travelers .

Insurance Coverage

All prospective cruise travelers should verify coverage with their health insurance carriers and, if not included, consider purchasing additional insurance to cover medical evacuation and health services received onboard cruise ships and in foreign countries (see Sec. 6, Ch. 1, Travel Insurance, Travel Health Insurance & Medical Evacuation Insurance ).

The following authors contributed to the previous version of this chapter: Kara Tardivel, Stefanie B. White, Krista Kornylo Duong

Bibliography

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Jenkins KA, Vaughan GHJ, Rodriguez LO, Freeland AL. Acute gastroenteritis on cruise ships—United States, 2006–2019. MMWR Morb Mortal Wkly Rep. 2021;70(6):1–19. 

Kordsmeyer A-C, Mojtahedzadeh N, Heidrich J, Militzer K, von Münster T, Belz L, et al. Systematic review on outbreaks of SARS-CoV-2 on cruise, navy and cargo ships. Int J Environ Res Public Health. 2021;18(10):5195. 

Millman AJ, Kornylo Duong K, Lafond K, Green NM, Lippold SA, Jhung MA. Influenza outbreaks among passengers and crew on two cruise ships: a recent account of preparedness and response to an ever-present challenge. J Travel Med. 2015;22(5):306–11. 

Mouchtouri VA, Lewis HC, Hadjichristodoulou C. A systematic review for vaccine-preventable diseases on ships: evidence for cross-border transmission and for pre-employment immunization need. Int J Environ Res Public Health. 2019;16(15):2713. 

Payne DC, Smith-Jeffcoat SE, Nowak G, Chuwkwuma U, Geibe JR, Hawkins RJ, et al. SARS-CoV-2 infections and serologic responses from a Sample of U.S. Navy service members—USS Theodore Roosevelt, April 2020. MMWR Morb Mortal Wkly Rep 2020;69(23):714–21. 

Peake DE, Gray CL, Ludwig MR, Hill CD. Descriptive epidemiology of injury and illness among cruise ship passengers. Ann Emerg Med. 1999;33(1):67–72. 

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Public Health Responses to COVID-19 Outbreaks on Cruise Ships — Worldwide, February–March 2020

Weekly / March 27, 2020 / 69(12);347-352

On March 23, 2020, this report was posted online as an MMWR Early Release.

Please note: This report has been corrected .

Leah F. Moriarty, MPH 1 ; Mateusz M. Plucinski, PhD 1 ; Barbara J. Marston, MD 1 ; Ekaterina V. Kurbatova, MD, PhD 1 ; Barbara Knust, DVM 1 ; Erin L. Murray, PhD 2 ; Nicki Pesik, MD 1 ; Dale Rose, PhD 1 ; David Fitter, MD 1 ; Miwako Kobayashi, MD, PhD 1 ; Mitsuru Toda, PhD 1 ; start highlight Paul T. Cantey, MD 1 ; end highlight Tara Scheuer, MPH 3 ; Eric S. Halsey, MD 1 ; Nicole J. Cohen, MD 1 ; Lauren Stockman, MPH 2 ; Debra A. Wadford, PhD 2 ; Alexandra M. Medley, DVM 1 ,4 ; Gary Green, MD 5 ; Joanna J. Regan, MD 1 ; Kara Tardivel, MD 1 ; Stefanie White, MPH 1 ; start highlight Clive Brown, MD 1 ; end highlight Christina Morales, PhD 2 ; Cynthia Yen, MPH 2 ; Beth Wittry, MPH 1 ; Amy Freeland, PhD 1 ; Sara Naramore, MPH 3 ; Ryan T. Novak, PhD 1 ; David Daigle, MPH 1 ; Michelle Weinberg, MD 1 ; Anna Acosta, MD 1 ; Carolyn Herzig, PhD 1 ; Bryan K Kapella, MD 1 ; Kathleen R. Jacobson, MD 2 ; Katherine Lamba, MPH 2 ; Atsuyoshi Ishizumi, MPH, MSc 1 ; John Sarisky, MPH 1 ; Erik Svendsen, PhD 1 ; Tricia Blocher, MS 2 ; Christine Wu, MD 3 ; Julia Charles, JD 1 ; Riley Wagner, MPH 1 ; Andrea Stewart, PhD 1 ; Paul S. Mead, MD 1 ; Elizabeth Kurylo, MCM 1 ; Stefanie Campbell, DVM 1 ; Rachel Murray, MPH 1 ; Paul Weidle, PharmD 1 ; Martin Cetron, MD 1 ; Cindy R. Friedman, MD 1 ; CDC Cruise Ship Response Team; California Department of Public Health COVID-19 Team; Solano County COVID-19 Team ( View author affiliations )

What is already known about this topic?

Cruise ships are often settings for outbreaks of infectious diseases because of their closed environment and contact between travelers from many countries.

What is added by this report?

More than 800 cases of laboratory-confirmed COVID-19 cases occurred during outbreaks on three cruise ship voyages, and cases linked to several additional cruises have been reported across the United States. Transmission occurred across multiple voyages from ship to ship by crew members; both crew members and passengers were affected; 10 deaths associated with cruise ships have been reported to date.

What are the implications for public health practice?

Outbreaks of COVID-19 on cruise ships pose a risk for rapid spread of disease beyond the voyage. Aggressive efforts are required to contain spread. All persons should defer all cruise travel worldwide during the COVID-19 pandemic.

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An estimated 30 million passengers are transported on 272 cruise ships worldwide each year* ( 1 ). Cruise ships bring diverse populations into proximity for many days, facilitating transmission of respiratory illness ( 2 ). SARS-CoV-2, the virus that causes coronavirus disease (COVID-19) was first identified in Wuhan, China, in December 2019 and has since spread worldwide to at least 187 countries and territories. Widespread COVID-19 transmission on cruise ships has been reported as well ( 3 ). Passengers on certain cruise ship voyages might be aged ≥65 years, which places them at greater risk for severe consequences of SARS-CoV-2 infection ( 4 ). During February–March 2020, COVID-19 outbreaks associated with three cruise ship voyages have caused more than 800 laboratory-confirmed cases among passengers and crew, including 10 deaths. Transmission occurred across multiple voyages of several ships. This report describes public health responses to COVID-19 outbreaks on these ships. COVID-19 on cruise ships poses a risk for rapid spread of disease, causing outbreaks in a vulnerable population, and aggressive efforts are required to contain spread. All persons should defer all cruise travel worldwide during the COVID-19 pandemic.

During February 7–23, 2020, the largest cluster of COVID-19 cases outside mainland China occurred on the Diamond Princess cruise ship, which was quarantined in the port of Yokohama, Japan, on February 3 ( 3 ). On March 6, cases of COVID-19 were identified in persons on the Grand Princess cruise ship off the coast of California; that ship was subsequently quarantined. By March 17, confirmed cases of COVID-19 had been associated with at least 25 additional cruise ship voyages. On February 21, CDC recommended avoiding travel on cruise ships in Southeast Asia; on March 8, this recommendation was broadened to include deferring all cruise ship travel worldwide for those with underlying health conditions and for persons aged ≥65 years. On March 13, the Cruise Lines International Association announced a 30-day voluntary suspension of cruise operations in the United States ( 5 ). CDC issued a level 3 travel warning on March 17, recommending that all cruise travel be deferred worldwide. †

Diamond Princess

On January 20, 2020, the Diamond Princess cruise ship departed Yokohama, Japan, carrying approximately 3,700 passengers and crew ( Table ). On January 25, a symptomatic passenger departed the ship in Hong Kong, where he was evaluated; testing confirmed SARS-CoV-2 infection. On February 3, the ship returned to Japan, after making six stops in three countries. Japanese authorities were notified of the COVID-19 diagnosis in the passenger who disembarked in Hong Kong, and the ship was quarantined. Information about social distancing and monitoring of symptoms was communicated to passengers. On February 5, passengers were quarantined in their cabins; crew continued to work and, therefore, could not be isolated in their cabins ( 6 ). Initially, travelers with fever or respiratory symptoms and their close contacts were tested for SARS-CoV-2 by reverse transcription–polymerase chain reaction (RT-PCR). All those with positive test results were disembarked and hospitalized. Testing was later expanded to support a phased disembarkation of passengers, prioritizing testing of older persons, those with underlying medical conditions, and those in internal cabins with no access to the outdoors. During February 16–23, nearly 1,000 persons were repatriated by air to their home countries, including 329 persons who returned to the United States and entered quarantine or isolation. § , ¶

The remaining passengers who had negative SARS-CoV-2 RT-PCR test results,** no respiratory symptoms, and no close contact with a person with a confirmed case of COVID-19 completed a 14-day ship-based quarantine before disembarkation. Those passengers who had close contact with a person with a confirmed case completed land-based quarantine, with duration determined by date of last contact. After disembarkation of all passengers, crew members either completed a 14-day ship-based quarantine, were repatriated to and managed in their home country, or completed a 14-day land-based quarantine in Japan.

Overall, 111 (25.9%) of 428 U.S. citizens and legal residents did not join repatriation flights either because they had been hospitalized in Japan or for other reasons. To mitigate SARS-CoV-2 importation into the United States, CDC used temporary “Do Not Board” restrictions ( 7 ) to prevent commercial airline travel to the United States, †† and the U.S. Departments of State and Homeland Security restricted travel to the United States for non-U.S. travelers.

Among 3,711 Diamond Princess passengers and crew, 712 (19.2%) had positive test results for SARS-CoV-2 ( Figure 1 ). Of these, 331 (46.5%) were asymptomatic at the time of testing. Among 381 symptomatic patients, 37 (9.7%) required intensive care, and nine (1.3%) died ( 8 ). Infections also occurred among three Japanese responders, including one nurse, one quarantine officer, and one administrative officer ( 9 ). As of March 13, among 428 U.S. passengers and crew, 107 (25.0%) had positive test results for COVID-19; 11 U.S. passengers remain hospitalized in Japan (median age = 75 years), including seven in serious condition (median age = 76 years).

Grand Princess

During February 11–21, 2020, the Grand Princess cruise ship sailed roundtrip from San Francisco, California, making four stops in Mexico (voyage A). Most of the 1,111 crew and 68 passengers from voyage A remained on board for a second voyage that departed San Francisco on February 21 (voyage B), with a planned return on March 7 (Table). On March 4, a clinician in California reported two patients with COVID-19 symptoms who had traveled on voyage A, one of whom had positive test results for SARS-CoV-2. CDC notified the cruise line, which began cancelling group activities on voyage B. More than 20 additional cases of COVID-19 among persons who did not travel on voyage B have been identified from Grand Princess voyage A, the majority in California. One death has been reported. On March 5, a response team was transported by helicopter to the ship to collect specimens from 45 passengers and crew with respiratory symptoms for SARS-CoV-2 testing; 21 (46.7%), including two passengers and 19 crew, had positive test results. Passengers and symptomatic crew members were asked to self-quarantine in their cabins, and room service replaced public dining until disembarkation. Following docking in Oakland, California, on March 8, passengers and crew were transferred to land-based sites for a 14-day quarantine period or isolation. Persons requiring medical attention for other conditions or for symptoms consistent with COVID-19 were evaluated, tested for SARS-CoV-2 infection, and hospitalized if indicated. During land-based quarantine in the United States, all persons were offered SARS-CoV-2 testing. As of March 21, of 469 persons with available test results, 78 (16.6%) had positive test results for SARS-CoV-2. Repatriation flights for foreign nationals were organized by several governments in coordination with U.S. federal and California state government agencies. Following disinfection of the vessel according to guidance from CDC’s Vessel Sanitation Program, remaining foreign nationals will complete quarantine on board. The quarantine will be managed by the cruise company, with technical assistance provided by public health experts.

On February 21, five crew members from voyage A transferred to three other ships with a combined 13,317 passengers on board. No-sail orders §§ were issued by CDC for these ships until medical logs were reviewed and the crew members tested negative for SARS-CoV-2.

Additional Ships

The Diamond Princess and Grand Princess had more than 800 total COVID-19 cases, including 10 deaths. During February 3–March 13, in the United States, approximately 200 cases of COVID-19 were confirmed among returned cruise travelers from multiple ship voyages, including the Diamond Princess and Grand Princess, accounting for approximately 17% of total reported U.S. cases at the time ( 10 ). Cases linked with cruise travel have been reported to CDC in at least 15 states. Since February, multiple international cruises have been implicated in reports of COVID-19 cases, including at least 60 cases in the United States from Nile River cruises in Egypt ( Figure 2 ). Secondary community-acquired cases linked to returned passengers on cruises have also been reported (CDC, unpublished data, 2020).

Public health responses to COVID-19 outbreaks on cruise ships were aimed at limiting transmission among passengers and crew, preventing exportation of COVID-19 to other communities, and assuring the safety of travelers and responders. These responses required the coordination of stakeholders across multiple sectors, including U.S. Government departments and agencies, foreign ministries of health, foreign embassies, state and local public health departments, hospitals, laboratories, and cruise ship companies. At the time of the Diamond Princess outbreak, it became apparent that passengers disembarking from cruise ships could be a source of community transmission. Therefore, aggressive efforts to contain transmission on board and prevent further transmission upon disembarkation and repatriation were instituted. These efforts included travel restrictions applied to persons, movement restrictions applied to ships, infection prevention and control measures, (e.g., use of personal protective equipment for medical and cleaning staff), disinfection of the cabins of persons with suspected COVID-19, provision of communication materials, notification of state health departments, and investigation of contacts of cases identified among U.S. returned travelers.

Cruise ships are often settings for outbreaks of infectious diseases because of their closed environment, contact between travelers from many countries, and crew transfers between ships. On the Diamond Princess, transmission largely occurred among passengers before quarantine was implemented, whereas crew infections peaked after quarantine ( 6 ). On the Grand Princess, crew members were likely infected on voyage A and then transmitted SARS-CoV-2 to passengers on voyage B. The results of testing of passengers and crew on board the Diamond Princess demonstrated a high proportion (46.5%) of asymptomatic infections at the time of testing. Available statistical models of the Diamond Princess outbreak suggest that 17.9% of infected persons never developed symptoms ( 9 ). A high proportion of asymptomatic infections could partially explain the high attack rate among cruise ship passengers and crew. SARS-CoV-2 RNA was identified on a variety of surfaces in cabins of both symptomatic and asymptomatic infected passengers up to 17 days after cabins were vacated on the Diamond Princess but before disinfection procedures had been conducted (Takuya Yamagishi, National Institute of Infectious Diseases, personal communication, 2020). Although these data cannot be used to determine whether transmission occurred from contaminated surfaces, further study of fomite transmission of SARS-CoV-2 aboard cruise ships is warranted.

During the initial stages of the COVID-19 pandemic, the Diamond Princess was the setting of the largest outbreak outside mainland China. Many other cruise ships have since been implicated in SARS-CoV-2 transmission. Factors that facilitate spread on cruise ships might include mingling of travelers from multiple geographic regions and the closed nature of a cruise ship environment. This is particularly concerning for older passengers, who are at increased risk for serious complications of COVID-19 ( 4 ). The Grand Princess was an example of perpetuation of transmission from crew members across multiple consecutive voyages and the potential introduction of the virus to passengers and crew on other ships. Public health responses to cruise ship outbreaks require extensive resources. Temporary suspension of cruise ship travel during the current phase of the COVID-19 pandemic has been partially implemented by cruise lines through voluntary suspensions of operations, and by CDC through its unprecedented use of travel notices and warnings for conveyances to limit disease transmission ( 5 ).

Acknowledgments

Staff members responding to COVID-19 outbreaks on cruise ships; Japan’s Ministry of Health, Labour and Welfare; California Department of Public Health; cruise ship passengers; Princess Cruises; Christina Armantas, Matthew Bacinskas, Cynthia Bernas, Brandon Brown, Teal Bullick, Lyndsey Chaille, Martin Cilnis, Gail Cooksey, Ydelita Gonzales, Christopher Kilonzo, Chun Kim, Ruth Lopez, Dominick Morales, Chris Preas, Kyle Rizzo, Hilary Rosen, Sarah Rutschmann, Maria Vu, California Department of Public Health, Richmond and Sacramento; Ben Gammon, Ted Selby, Solano County Public Health; Medic Ambulance Service; NorthBay HealthCare; Sutter Solano Medical Center; Kaiser Permanente Vallejo Medical Center; Kaiser Permanente Vacaville Medical Center start highlight ; field teams at repatriation sites; National Institute of Infectious Diseases, Japan end highlight .

CDC Cruise Ship Response Team

Casey Barton Behravesh, CDC; Adam Bjork, CDC; William Bower, CDC; Catherine Bozio, CDC; Zachary Braden, CDC; Mary Catherine Bertulfo, CDC; Kevin Chatham-Stephens, CDC; Victoria Chu, CDC; Barbara Cooper, CDC; Kathleen Dooling, CDC; Christine Dubray, CDC; Emily Curren, CDC; Margaret A. Honein, CDC; Kathryn Ivey, CDC; Jefferson Jones, CDC; Melissa Kadzik, CDC; Nancy Knight, CDC; Mariel Marlow, CDC; Audrey McColloch, CDC; Robert McDonald, CDC; Andrew Klevos, CDC; Sarah Poser, CDC; Robin A. Rinker, CDC; Troy Ritter, CDC; Luis Rodriguez, CDC; Matthew Ryan, CDC; Zachary Schneider, CDC; Caitlin Shockey, CDC; Jill Shugart, CDC; Margaret Silver, CDC; Paul W. Smith, CDC; Farrell Tobolowsky, CDC; Aimee Treffiletti, CDC; Megan Wallace, CDC; Jonathan Yoder, CDC.

California Department of Public Health COVID-19 Team

Pennan Barry, California Department of Public Health; Ricardo Berumen, III, California Department of Public Health; Brooke Bregman, California Department of Public Health; Kevin Campos, California Department of Public Health; Shua Chai, California Department of Public Health; Rosie Glenn-Finer, California Department of Public Health; Hugo Guevara, California Department of Public Health; Jill Hacker, California Department of Public Health; Kristina Hsieh, California Department of Public Health; Mary Kate Morris, California Department of Public Health; Ryan Murphy, California Department of Public Health; Jennifer F. Myers, California Department of Public Health; Tasha Padilla, California Department of Public Health; Chao-Yang Pan, California Department of Public Health; Adam Readhead, California Department of Public Health; Estela Saguar, California Department of Public Health; Maria Salas, California Department of Public Health; Robert E. Snyder, California Department of Public Health; Duc Vugia, California Department of Public Health; James Watt, California Department of Public Health; Cindy Wong, California Department of Public Health.

Solano County COVID-19 Team

Meileen Acosta, Solano County Department of Public Health; Shai Davis, Solano County Department of Public Health; Beatrix Kapuszinsky, Solano County Department of Public Health; Bela Matyas, Solano County Department of Public Health; Glen Miller, Solano County Department of Public Health; Asundep Ntui, Solano County Department of Public Health; Jayleen Richards, Solano County Department of Public Health.

Corresponding author: Leah F. Moriarty, [email protected] , 770-488-7100.

1 CDC COVID-19 Response Team; 2 California Department of Public Health; 3 Solano Public Health, Fairfield, California; 4 Epidemic Intelligence Service, CDC; 5 Sutter Medical Group of the Redwoods, Santa Rosa, California.

All authors have completed and submitted the International Committee of Medical Journal Editors form for disclosure of potential conflicts of interest. No potential conflicts of interest were disclosed.

* Not including river cruises.

† Warning level 3: avoid non-essential travel due to widespread ongoing transmission: https://wwwnc.cdc.gov/travel/notices/warning/novel-coronavirus-china .

§ Quarantine was used for persons who were exposed; isolation was used for persons who had positive test results for SARS-CoV-2.

¶ Movement for one person with resolved COVID-19 was not restricted.

** Based on Japanese testing procedures, which at the time included taking one oropharyngeal swab.

†† Travel restrictions were lifted when persons had either completed a 14-day monitoring period without symptoms or had met clinical criteria for release from isolation. https://japan2.usembassy.gov/pdfs/alert-20200227-diamond-princess.pdf .

§§ CDC has the authority to institute a no-sail order to prevent ships from sailing when it is reasonably believed that continuing normal operations might subject newly arriving passengers to disease.

• Cruise Lines International Association. 2019 cruise trends & industry outlook. Washington, DC: Cruise Line International Association; 2019. https://cruising.org/news-and-research/-/media/CLIA/Research/CLIA-2019-State-of-the-Industry.pdf
• Millman AJ, Kornylo Duong K, Lafond K, Green NM, Lippold SA, Jhung MA. Influenza outbreaks among passengers and crew on two cruise ships: a recent account of preparedness and response to an ever-present challenge. J Travel Med 2015;22:306–11. CrossRef PubMed
• World Health Organization. Coronavirus disease (COVID-2019) situation reports. Geneva, Switzerland: World Health Organization; 2020. https://www.who.int/emergencies/diseases/novel-coronavirus-2019/situation-reports/
• CDC COVID-19 Response Team. Severe outcomes among patients with coronavirus disease 2019 (COVID-19)—United States, February 12–March 16, 2020. MMWR Morb Mortal Wkly Rep 2020. Epub March 18, 2020. CrossRef
• Cruise Lines International Association. CLIA announces voluntary suspension in U.S. cruise operations. Washington, DC: Cruise Line International Association; 2020. https://cruising.org:443/news-and-research/press-room/2020/march/clia-covid-19-toolkit
• Kakimoto K, Kamiya H, Yamagishi T, Matsui T, Suzuki M, Wakita T. Initial investigation of transmission of COVID-19 among crew members during quarantine of a cruise ship—Yokohama, Japan, February 2020. MMWR Morb Mortal Wkly Rep 2020;69:312–3. CrossRef PubMed
• Vonnahme LA, Jungerman MR, Gulati RK, Illig P, Alvarado-Ramy F. Federal travel restrictions for persons with higher-risk exposures to communicable diseases of public health concern. Emerg Infect Dis 2017;23:S108–13. CrossRef PubMed
• Ministry of Health, Labour and Welfare. About new coronavirus infections [Japanese]. Tokyo, Japan: Ministry of Health, Labour and Welfare; 2020. https://www.mhlw.go.jp/stf/seisakunitsuite/bunya/0000164708_00001.html
• Mizumoto, K., Kagaya, K., Zarebski, A. and Chowell, G. Estimating the asymptomatic proportion of coronavirus disease 2019 (COVID-19) cases on board the Diamond Princess cruise ship, Yokohama, Japan, 2020. Eurosurveillance 2020;25. CrossRef
• CDC. Coronavirus disease 2019 (COVID-19): cases in U.S. Atlanta, GA: US Department of Health and Human Services, CDC; 2020. https://www.cdc.gov/coronavirus/2019-ncov/cases-in-us.html

Abbreviation: N/A = not applicable.

FIGURE 1 . Cumulative number of confirmed coronavirus disease 2019 (COVID-19) cases* by date of detection — Diamond Princess cruise ship, Yokohama, Japan, February 3–March 16, 2020

Source: World Health Organization (WHO) coronavirus disease (COVID-2019) situation reports. https://www.who.int/emergencies/diseases/novel-coronavirus-2019/situation-reports/ .

* Decline in cumulative number of cases on February 13 and February 25 due to correction by WHO for cases that had been counted twice.

FIGURE 2 . Cruise ships with coronavirus disease 2019 (COVID-19) cases requiring public health responses — worldwide, January–March 2020

Suggested citation for this article: Moriarty LF, Plucinski MM, Marston BJ, et al. Public Health Responses to COVID-19 Outbreaks on Cruise Ships — Worldwide, February–March 2020. MMWR Morb Mortal Wkly Rep 2020;69:347-352. DOI: http://dx.doi.org/10.15585/mmwr.mm6912e3 .

MMWR and Morbidity and Mortality Weekly Report are service marks of the U.S. Department of Health and Human Services. Use of trade names and commercial sources is for identification only and does not imply endorsement by the U.S. Department of Health and Human Services. References to non-CDC sites on the Internet are provided as a service to MMWR readers and do not constitute or imply endorsement of these organizations or their programs by CDC or the U.S. Department of Health and Human Services. CDC is not responsible for the content of pages found at these sites. URL addresses listed in MMWR were current as of the date of publication.

All HTML versions of MMWR articles are generated from final proofs through an automated process. This conversion might result in character translation or format errors in the HTML version. Users are referred to the electronic PDF version ( https://www.cdc.gov/mmwr ) and/or the original MMWR paper copy for printable versions of official text, figures, and tables.

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Cruise lines dropped COVID-19 rules. How did that affect cases? We got numbers from the CDC.

David Hancock spent his September vacation doing things he'd never done. He went on a cruise for the first time, hugged a sloth at an animal park in Honduras, and at some point during the trip, likely contracted COVID-19.

The 36-year-old firefighter had avoided infection for two years, but tested positive the morning after he and his wife, Melissa, who had been celebrating their 15th wedding anniversary, returned home to Savannah, Tennessee.

But not even COVID-19 could put a damper on their Royal Caribbean International sailing. "I went all that time since COVID began without getting it ... so I went and got it on a cruise ship," he told USA TODAY.

"But because I was vaccinated and boosted, my symptoms were mild," he said, adding that he would definitely go on a cruise again.

Cruise lines change COVID-19 rules: Royal Caribbean, Disney Cruise Line further lift requirements

'Was it worth the risk? I don't think so': What it's like to cruise with fewer COVID rules

Many recent cruise line policy changes reflect a shifting approach to the pandemic. Major cruise lines, including Royal Caribbean, Carnival Cruise Line, and Norwegian Cruise Line International dropped their vaccine requirements for many sailing in early September and eased testing rules, about two weeks before Hancock left for his seven-night voyage.

However, after the Centers for Disease Control and Prevention ended its COVID-19 Program for Cruise Ships in July and stopped updating its related webpage , COVID-19 spread amid the more relaxed approaches has been a relative mystery.

But data from the CDC obtained by USA TODAY through a Freedom of Information Act request shed some light on the numbers cruise lines reported to the agency after the rules were changed.

What COVID-19 case numbers did cruise lines report to the CDC?

The numbers also only represent new COVID-19 cases identified by positive viral tests on cruise ships entering or leaving from the U.S. The data does not show the test positivity rate or the number of passengers on the sailings.

►Norwegian began welcoming all passengers regardless of vaccination status on Sept. 3 and dropped all pre-cruise testing requirements for vaccinated passengers 12 and older. In the weeks that followed, the cruise line reported similar numbers to the weeks leading up to the rule change. The week beginning Sept. 4, the cruise line reported 138 new cases, and reported another 161 the following week. For the week of Sept. 18, two weeks after dropping requirements , Norwegian reported 204 new cases, and just 25 the following week.

The cruise line had previously reported 234, 164 and 184 cases in the three weeks leading up to the change, respectively.

►Carnival made similar changes on Sept. 6, scrapping its requirement for unvaccinated passengers to apply for a vaccine exemption  and further easing its pre-cruise testing rule for vaccinated passengers on many sailings.

The cruise line reported 193 new cases for both the weeks of Sept. 11 and the following week and another 144 during the week beginning Sept. 25.

Carnival had previously reported 214, 265, and another 214 new cases in the three weeks leading up to the change, respectively, including the week of Sept. 4.

►Royal Caribbean also began welcoming all travelers regardless of vaccination status and further eased pre-cruise testing for vaccinated passengers for many sailings on Sept. 5.

The line reported 341 new cases the week of Sept. 11, and 306 the week after. The line then reported another 237 new cases for the week of Sept. 25. In the weeks preceding the change, Royal Caribbean had reported 448, 311, and 348 new cases, respectively, including the week of Sept. 4.

Dr. Peter F. Rebeiro, an assistant professor of medicine in the Division of Infectious Diseases at Vanderbilt University Medical Center, said,   generally speaking, if unvaccinated passengers who test negative – as they were required to at the time – are mixed in with a mostly-vaccinated group, the "overall risk is not going to spike a huge amount,"   he said. However, he noted that vaccinated passengers can still spread the virus.

Rebeiro also noted that if transmission among the general population is lower at the time a passenger boards a cruise, the likelihood they will spread the virus is lower.

Anne Madison, a spokesperson for the Cruise Lines International Association, the industry's leading trade group, emphasized the safety of cruise travel.

"CLIA-member cruise lines have a strong track record for effectively managing COVID-19 by making science-driven and medically informed decisions – and continue to have health protocols in place that exceed those of nearly any other venue or travel sector outside of healthcare settings," she said in an emailed statement.

Madison added that as a condition of their membership, cruise lines must keep up certain protocols, including "maintaining elevated public health measures to mitigate the introduction or spread of COVID-19 on board ships" and sailing with high vaccination levels among passengers and crew members, among others.

Story continues below.

What does that mean for passengers?

The data did not show a consistent pattern in new cases for other major cruise lines, including Celebrity Cruises, Princess Cruises, or Holland America Line, either. Celebrity made similar changes on Sept. 5, while Princess and Holland America did so on Sept. 6.

During roughly the same period, the weekly COVID-19 case rate per 100,000 people steadily declined in the U.S., from 209 the week of Aug. 17 to 96.5 the week of Oct. 5, according to CDC data .

The "CDC has determined that the cruise industry has access to the necessary tools to prevent and mitigate COVID-19 on board," CDC spokesperson Tom Skinner said in an emailed statement. "While CDC provides guidance for cruise ships operating in U.S. waters under CDC’s jurisdiction, individual cruise lines will determine their own specific COVID-19-related requirements for cruise travel. Any decrease in the volume or frequency of routine screening testing of crew by cruise lines may result in lower counts of asymptomatic cases."

Victoria Alvarez knew Carnival had eased its protocols by the time she got on her Caribbean cruise in late September. Living in Florida, she said, she was used to more relaxed rules .

But the risk of getting COVID-19 did cross her mind during the trip. The 27-year-old business administration manager said the ship was crowded, particularly in the dining and entertainment venues.

Alvarez, who is vaccinated and boosted, said she and her friends took some extra precautions of their own, such as eating outside when they could and avoiding the pools, which were packed. "We just saved our swimming for the islands," she said.

"I don't know if I just haven't been in crowds like that in a while, but it was just, like, it's a lot," she added of the experience.

What precautions can people take?

Anna Bershteyn, an assistant professor in the Department of Population Health at New York University Grossman School of Medicine, said that there may be other factors the data does not reflect, "but it doesn't seem that this policy (change) had any consistent effect across cruise lines."

While there are still many COVID-19-related deaths across the country each day, she said, many people have been assessing their own risk tolerance. "It comes to this decision, what are the precautions that people should take versus going back and living life?" Bershteyn said.

Cruises will return to Japan: Country reopens to international cruise ships for first time since the pandemic

Sailing then and now: Holland America's anniversary transatlantic crossing highlights how cruising has changed

While not all passengers have felt completely safe on cruises since many lines relaxed their rules, Hancock said he and his wife are planning on taking another cruise with Royal Caribbean, even as it has further rolled back requirements .

"I feel as though COVID's not going to be going anywhere," Hancock said "It's kind of with us for the long haul. It's just a matter of preparations people take and what risks they're willing to take."

Bershteyn recommended travelers take steps to protect themselves, first by staying up to date on all the vaccine doses they are eligible for. She also recommended they make a plan with their doctor in case they do get sick, and contact the cruise line to see what options they would have.

If travelers have taken those steps, she said, she would advise travelers who want to take a cruise to go ahead. "We can't put our life on hold indefinitely, but we do want those safety nets in place in case something happens," she said.

Bershteyn also recommended travelers look for opportunities to take extra precautions when doing so "is not going to take away" from the experience, which she noted may be different for each traveler. In her case, she wears a face mask when she is in crowded places such as airports, while others may opt to eat outdoors when possible.

Have you gone on a cruise recently? What was your experience like?

This article originally appeared on USA TODAY: CDC data shows COVID-19 numbers on cruises after vaccine rules dropped

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On Cruise Ships, Omicron Puts Safety Protocols to the Test

Many lines are adjusting their masking, testing and vaccine rules, while criticism is mounting about the lack of transparency in reporting positive cases to passengers and crew members.

By Ceylan Yeginsu

By the time the Norwegian Breakaway cruise ship docked in New Orleans on Dec. 4, after a weeklong cruise that included stops in Belize, Honduras and Mexico, 17 coronavirus cases had been identified on the ship, including a case of the new Omicron variant. The local and federal health authorities were notified — but not all the disembarking passengers.

“I only found out after I got home and saw it on the news,” said Betsy Rodriguez, a retired veterinarian who took the Caribbean cruise with her daughter. “We felt pretty safe knowing everyone on the ship was vaccinated, but I guess it would have been good to know people tested positive so we could have been more careful.”

Since the cruise industry restarted operations in the United States this June, its efforts to keep the coronavirus at bay — or at least contained, unlike the major outbreaks experienced in 2020 — have been largely successful. Most cruise companies mandate full vaccinations for crew and most passengers, and have implemented strict health and safety protocols to swiftly identify coronavirus cases onboard and reduce their spread.

But in recent months, as new and highly contagious variants have emerged and case numbers steadily increase worldwide, these measures are being put to the test. Many lines are adjusting their masking, testing and vaccine rules, while criticism is mounting about the lack of transparency in reporting positive cases to passengers and crew members during sailings.

A crew member on the Breakaway, who spoke on the condition of anonymity because he was not permitted to speak to the news media, said he first heard about the outbreak from a friend and fellow employee. When he contacted management, they neither shared the number of positive cases nor identified who was infected.

“I would like to know who tested positive because this new variant spreads very quickly and I have a medical condition which means I need to be very careful and protect myself,” he said, voicing concern that if he became sick, he could be sent back to his home country. “I can’t afford that because I need to take care of my family at home.”

Most cruise companies do not publicly announce the number of coronavirus cases identified during sailings, but all cruise ships operating to and from U.S. ports must submit daily numbers to the Centers for Disease Control and Prevention, which uses a color-coded system to inform the public whether the number of cases is above or below the agency’s threshold for an investigation. Sharing this data is one of many requirements in the Framework for Conditional Sailing Order, a series of C.D.C. guidelines that cruise companies must follow to operate in U.S. waters.

The 17 cases on board the Norwegian Breakaway were first publicly reported by the Louisiana State Department of Health on Dec. 4. All passengers and crew members — more than 3,200 people — onboard were fully vaccinated, following the company’s policy.

Norwegian declined to comment on its policies for reporting cases on board its ships or whether any additional Breakaway crew members tested positive after passengers disembarked.

“All the identified cases onboard were asymptomatic,” a company spokesman said in a statement. “We implemented quarantine, isolation and contact tracing procedures for identified cases and tested all individuals on Norwegian Breakaway before disembarkation.” In addition, he said, passengers were given “post-exposure and quarantine public health guidance” as laid out by the C.D.C.

Reporting to the C.D.C.

The coronavirus wreaked havoc on the cruise industry in the early stages of the pandemic , infecting hundreds of cruise passengers and workers, and requiring the sector to shut down for 18 months. To begin sailing, cruise ships had to agree to the C.D.C.’s Conditional Sailing Order, which is valid until Jan. 15.

Among the safety measures the order requires — beyond submitting the daily number of coronavirus cases — is a prevention and control plan for each cruise ship. The plan, said Bari Golin-Blaugrund, a spokeswoman for the Cruise Line International Association trade group, includes “procedures for informing passengers and crew members that a threshold of Covid-19 has been met or exceeded.”

“The reporting requirements and practices of the cruise industry are practically unmatched compared to other sectors in the United States, especially within the travel and tourism sector,” she said.

In a C.D.C. report of coronavirus data published last month, cruise operators had reported 1,359 positive cases between June 26 and Oct. 21. During that time, 49 hospitalizations, 38 medical evacuations and one death occurred because of coronavirus infections detected onboard cruise ships.

The report highlighted several large outbreaks, including one in which a symptomatic passenger who tested positive on a ship in July was linked to 20 additional cases over two sailings. One ship reported 58 positive between July 24 and Aug. 28 and another reported 112 cases over four consecutive voyages, which ended on Sept. 7. Most of the cases were breakthrough infections in fully vaccinated passengers.

While the C.D.C. relies on data reported by the cruise companies, the agency also carries out inspections to make sure that cruise ships are in compliance.

With the rise of Delta and Omicron variants, and as the virus surges across the world, cruise lines have been adjusting their health and safety protocols, reinstating measures like mask mandates and requiring additional testing from passengers. Starting Jan. 13, Disney Cruise Line will require all children over the age of 5 to be fully vaccinated against the coronavirus.

Demand remains high

Despite the new restrictions and risks posed by new variants, demand for future cruises remains high. Carnival, the world’s largest cruise company, reported that its bookings for the second half of 2022 have surpassed bookings for 2019. Royal Caribbean said the Delta variant had hit bookings in 2021 and 2022, but not for 2023.

“I think what people have been saying is, I want to get out there, but I don’t want to do it too soon. I want to make sure that things have stabilized,” Richard D. Fain, chairman and chief executive of Royal Caribbean Cruises, said in the company’s last earnings call in October.

Miranda Gibson, 63, an avid cruiser from Tampa, Fla., took two cruises this summer, but then canceled three cruises she had planned for the rest of the year because of her concerns over the Delta variant.

“The first cruise I took in June in the Caribbean was heaven because everyone was vaccinated, Covid was under control and it was the first time in so long that we could have some carefree fun,” she said.

“Now with the variants everything is prickly again and you can’t really get a true relaxing cruise experience when you are worrying about Covid and masks and rules,” she explained. “I’m booked in June 2022 and I know I’ll be tempted to go before then but I’m going to wait until it’s safer.”

Others believe cruise ships are among the safest vacation environments, because of the vaccine requirements and testing protocols.

“When you’re on a plane, or in a hotel or at a theme park you don’t know who has Covid around you,” said Timothy Ryan, 67, a retired financial trader from Miami who has 16 cruises booked through 2022. “On a cruise, it’s detected right away and the positive cases are isolated, so you can continue your vacation in a Covid-free bubble. I really don’t know a safer way to travel.”

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Coronavirus Updates

The coronavirus crisis, covid-19 outbreaks hit 3 cruise ships as florida breaks record for new cases.

The Associated Press

Employees of Nomi Health check in a long line of people for COVID-19 tests on Tuesday in North Miami, Fla. Marta Lavandier/AP hide caption

Employees of Nomi Health check in a long line of people for COVID-19 tests on Tuesday in North Miami, Fla.

MIAMI — A COVID-19 outbreak took place on a South Florida-based cruise ship for the third time this week, as the number of coronavirus cases in Florida hit its highest level since the start of the pandemic.

An undisclosed number of passengers and crew aboard the Carnival Freedom cruise caught the virus so the ship was denied entry to Bonaire and Aruba, Carnival said in a statement.

Thousands more flights canceled on Christmas Day, putting a damper on holiday travel

The ship has 2,497 passengers and 1,112 crew members and was scheduled to return to Miami on Sunday following an 8-day cruise. Passengers were required to be vaccinated and they were tested before leaving last Saturday, according to Carnival.

"Carnival Freedom is following all protocols and has a small number on board who are in isolation due to a positive COVID test," the statement said. "Our protocols anticipate this possibility and we implement them as necessary to protect the health and safety of our guests and crew."

48 tested positive for COVID-19 on Royal Caribbean cruise ship docking in Miami

Ashley Peterson, a passenger on the ship, tweeted a photo of a Dec. 22 letter from the ship's captain apologizing for being unable to make stops in Aruba and Bonaire. The letter said passengers would get $100 per room in onboard credit, as well refunds for planned excursions.

It was the third outbreak this week affecting cruise ships operated by Carnival and Royal Caribbean departing Miami and Fort Lauderdale.

Meanwhile, Florida had 31,758 new COVID-19 cases on Friday, breaking a record for the most cases in a single day since the start of the pandemic in the U.S. in March 2020, according to data from the U.S. Centers for Disease Control and Prevention.

Over a dozen COVID cases were found on a cruise ship that docked in New Orleans

The new record was driven by the spread of the new omicron variant through the Sunshine State.

The previous single-day highest number of cases was in last August, during the height of the delta variant wave in Florida, when 27,802 cases were reported.

• cruise ships

Nearly 140 people onboard a cruise ship sick in gastrointestinal illness outbreak

Around 140 people have fallen sick with a gastrointestinal illness onboard the Cunard Queen Victoria cruise ship that docked in Fort Lauderdale, Florida, on Jan. 22 when the CDC began monitoring the outbreak.

According to the U.S. Centers for Disease Control and Prevention , 123 passengers and 16 crew members have reported being ill during a three-week leg of the voyage as of Thursday. Around 1,800 passengers and 960 crew members are onboard the ship in total.

The predominant symptoms of the gastrointestinal illness include diarrhea and vomiting. The cause of the outbreak remains unknown, according to the CDC.

The Queen Victoria is on a 107-night world voyage. The cruise ship is scheduled to stop in San Francisco on Feb. 6 and Honolulu on Feb. 12 before sailing to countries in Oceania, according to the Cunard website . 

In response to the outbreak, the Queen Victoria crew has reportedly "increased cleaning and disinfection procedures" and "isolated ill passengers and crew." 

"Cunard confirms that a small number of guests had reported symptoms of gastrointestinal illness on board Queen Victoria, Cunard Cruise Line told NBC News in a statement.

"They immediately activated their enhanced health and safety protocols to ensure the well-being of all guests and crew on board. Measures have been effective,” Cunard added.

The CDC's Vessel Sanitation Program continues to remotely monitor the situation, including "reviewing the ship's outbreak response and sanitation procedures."

Medical staff on cruise ships under U.S. jurisdiction are required to report gastrointestinal illness cases to the Vessel Sanitation Program when at least two percent of people onboard are infected.

Katherine Itoh is a news associate for NBC News.

Carnival Cruise Line reverses an unpopular Covid-era policy

W hile it's easy to forget (and some people don't want to remember) the Covid pandemic devastated the cruise industry. All sailings from U.S. ports stopped for a roughly 15-month period and when they returned, things were not the same.

Once the cruise lines got permission to sail again, it was — at least at first — under heavy restrictions from the Centers for Disease Control (CDC). Ships sailed at very limited capacity, social distancing was enforced, masks were required in indoor public spaces, and proof of vaccination was required.

Related: Carnival Cruise Line fixing broken (and very important) system

In addition to keeping people apart, the cruise lines also stepped up their cleaning regimen and tried to limit the amount of commonly touched services. For months, it seemed like multiple crew members did nothing but sanitize handrails, and tables could not be used until the had been properly cleaned.

Most cruise lines also largely eliminated paper on their ships. This included having menus and the daily schedule being available via QR codes, although paper menus were always offered for people who requested them. 

Getting rid of printed daily schedules including Royal Caribbean's Cruise Compass and Carnival's Fun Times was a controversial decision. It's one that made sense for both safety and environmental reasons, and it also removed an expense for the cruise lines.

Passengers, however, did not like it, and both Royal Caribbean and Carnival have made some changes.

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Carnival brings pack the paper Fun Times

Royal Caribbean has largely continued to push passengers to use its app for its onboard schedule. You can usually request a paper copy of the Cruise Compass and sometimes they are offered at Guest Services.

Carnival Cruise Line ( CCL ) has fully reversed its pandemic-ear policy, according to a recent post from Brand Ambassador John Heald. 

"Interesting to see that some people didn’t realize that we now have the paper copy of Fun Times" delivered to your cabin and as you see from today’s cover photo, they are available from the coffee shop as well," he shared.

Heald then asked his followers how they keep track of onboard activities, giving them four choices:

• A: I read the paper copy of the Fun Times Plus, and have it downloaded on the Hubb app.
• B: I only read the paper copy of the Fun Times.
• C: I only read the Fun Times from the Hubb app.
• D: I do not read the Fun Times.

Over 4,100 of Heald's followers voted and shared their opinions.

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Most Carnival passengers want a paper Fun Times

"On the last few cruises I have learned how to use the Hubb app but I still enjoy coming back to the cabin at night and reading the Fun Times in bed to see what I am going to not miss the next day," wrote Susan Natale.

Many people seem to use both.

"I love both! And, I bring a highlighter to markup the paper copy. It makes my little nerd paper-loving heart happy," shared Linda Leon.

Other passengers like the paper version of the Fun Times as a keepsake.

"I actually grab it from guest services when I walk by not to use on the ship but to have a memory of all the fun events (one day I’ll put it all together in a scrapbook…eventually," added Sara Rose Curry. 

Others like to be able to leave their phone in the room.

"I like having the paper copy so I don’t have to always carry my phone or any other device with me," wrote Linda Sargent Carraway.

Related: Carnival Cruise Line reverses an unpopular Covid-era policy

But while many people share those sentiments, others don't think the printed version should be left in every room.

"I am sad that the paper Fun Times is delivered to every cabin. It's a waste of paper for many people. Having it available for people who need it is one thing, going back to a paper copy for each cabin creates so much waste," posted Barbara J. Valentine.

Related: Get the best cruise tips, deals, and news on the ships from our expert cruiser

Matador Original Series

What it's really like to catch covid on a cruise right now.

B ack in 2020, few things were scarier than catching COVID on a cruise ship. Today, it really isn’t so bad.

On November 26, 2023, I embarked on Holland America’s Nieuw Statendam for a 14-day transatlantic crossing. The voyage started from Rome, Italy, made stops in southern Spain and the Azores, and involved 10 days at sea, including seven consecutive days while crossing the ocean from Ponta Delgada, Azores, to Fort Lauderdale, Florida. Unfortunately, my last two days on board were spent masked and locked away in my cabin with what was likely COVID.

Holland America’s beautiful Nieuw Statendam. Photo: Jesse Adams

It was not the first time that I traveled with Holland America. Back in October 2022, my partner and I sailed to Alaska with the cruise line, and the trip was so perfect in every way that we decided to trust them with our vacation again.

Unlike what we experienced during our Alaskan cruise, however, this sailing was full or nearly full (the ship can accommodate around 2500 passengers), which means that the human density in common areas was much higher. The bars, dining venues, and the theater always felt busy.

Another significant difference between our October 2022 and December 2023 cruises was the level of COVID precautions required by the cruise line. Before boarding our Alaskan cruise, we had to provide proof of our COVID vaccination and the result of a negative COVID test, and while we did not have to wear masks during the sailing, every member of the crew did. This time around, nothing was required of us and the crew members did not wear masks. It was like being back in 2019 — except for the inordinate amount of people coughing and sniffling.

Holland America is, of course, not the only cruise eschewing to ask passengers to provide proof of vaccination or to get tested. Just about every single cruise line out there, just like every airline, resort, or hotel, is doing the same. The terror that COVID induced in us in the first two years of its existence is seemingly behind us. It’s made travel a lot less stressful and a lot more enjoyable. It’s made people a lot more careless, too.

This past November, it only took a few days on board the cruise ship for my partner and I to realize that some people were sick. Sick with what, however, we did not know and I’m not sure they did either. It could as easily be the common cold, bronchitis, as it could be COVID. Many people, whether on cruise ships or at home, have stopped testing themselves every time they have a runny nose or feel a little off.

Tested or not, COVID or not, what gets my goat, however, is when those who are sick decide that protecting others isn’t part of their agenda. On this trip, it seemed obvious that nobody remembered the basic rules of hygiene that we were all recently so careful to apply. Sick passengers on the ship rarely sneezed and coughed in their elbow, or washed their hands after blowing their nose or before enjoying a meal. Very few recalled that wearing a mask was a simple courtesy that could spare others from getting what they have.

The onboard theater where people were coughing, sneezing, and sniffling to their hearts’ content. Photo: Jesse Adams

Fewer than five days into our trip, my partner and I were spending anxious hours in the theater, bars, and lounges sitting as far away from the obviously unhealthy passengers and using hand sanitizers generously. We are not clean freaks or germaphobes, we just did not want our hard-earned vacations ruined.

But the inevitable happened anyway. Two days before our arrival in Florida, I woke up feeling poorly. I did not cough, I did not sneeze, I did not have a fever, but I did have a runny nose, had a headache, was tired and weak, and felt generally unwell. I made the decision to stay in my cabin until I felt better, and masked up and washed my hands as often as possible so that my partner stayed healthy. I enjoyed the movies available on the TV, the comfy bed, and the great ocean view from our balcony. I ordered room service and used the “Do not disturb” sign on the door so that crew members would not come in. I stayed in my cabin until it was time for me to leave the ship. By then, I felt better, but remained masked and as far away from others as possible until I got home.

While neither the FAQs page nor the Travel Well section on Holland America’s website mentions what happens to passengers who catch COVID on their ships, cruisers who are active on online message boards Cruise Critic explain that isolation is still the standard procedure for those who feel sick during a voyage.

According to the participants on Cruise Critic, if you feel unwell during your Holland America cruise, a call to the medical center will allow you to get tested by a medical professional who will determine if you indeed have an infectious disease that requires you to stay in your cabin for a few days. On Holland America’s ship, the standard duration of the isolation period seems to be five days (just as the CDC recommends ), after which you get retested and examined to gauge whether or not you can mix up with the rest of the passengers again. Until recently, and according to the same message board, Holland America offered Future Cruise Credit (FCC) to those who need to isolate themselves for several days.

Other cruise lines have similar policies. According to their FAQs page , P&O requires a minimum of five days in isolation and offers FCC. The same goes for Virgin Voyages who requires passengers to isolate for an indeterminate amount of time and offers Future Voyage Credit (FVC) for the days spent in confinement.

However, not all cruise lines offer FCC. For example, according to their website, Cunard and Aurora Expeditions also requires several days of isolation for passengers testing positive for COVID but makes no mention of FCC.

Be mindful of the details of your travel insurance regarding COVID — some might cover the trip interruption due to the confinement — and inquire about COVID-specific protocols upon making your booking with a cruise line.

I’m pretty sure I know exactly who got me sick. A handful of days before my symptoms started, an elderly woman sitting a few feet away from me at the Dutch Cafe spent her time blowing her nose, coughing in my direction, and looking generally miserable. It seemed she had no qualms about spreading her germs onto others.

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Maui hosts first cruise ship since start of the pandemic

State confirms there were covid-19 cases aboard grand princess but said that they did not disembark, jan 13, 2022 by colleen uechi 5 min read.

KAHULUI — A commercial cruise ship of nearly 2,000 passengers sailed into the Kahului Harbor on Wednesday for the first time since the start of the pandemic, signaling the return of a mode of travel that some worry will pose a health risk at a time of record-high cases on Maui.

The Grand Princess arrived at 6:52 a.m. with 1,188 passengers and departed at 6 p.m., according to the state Department of Transportation.

Not all passengers came ashore after some tested positive for COVID-19 or came in close contact with someone who caught the virus. Neither the Transportation Department nor the Health Department could say how many cases were onboard.

“As of Jan. 12 there are no cases onboard the Grand Princess requiring hospitalization or additional medical attention,” DOT spokesperson Shelly Kunishige said Wednesday. “Close contacts of the COVID positive individuals identified through the procedural surveillance testing have been isolated and not allowed to disembark. No COVID positive individuals whether symptomatic or asymptomatic have been allowed to disembark.”

Kunishige pointed out that disembarking passengers and crew have gone through the Safe Travels program screening, which requires people traveling to Hawaii from out of state to show proof of vaccination or a negative COVID test taken prior to travel.

The Grand Princess, which according to the company’s website has a guest capacity of 2,600, arrived in Honolulu on Sunday, according to hawaii.portcall.com, which is run by the Department of Transportation. It stopped at Nawiliwili Harbor in Kauai on Monday before traveling to Hilo on Tuesday and arriving at Kahului on Wednesday.

“There were a few bumps in the morning because (this is) the first cruise ship in Kahului Harbor for two years,” DOT Harbors Maui District Manager Duane Kim said Wednesday evening as he waited for the Grand Princess to depart.

Kim said that the buses offering shore excursions were spread out to avoid crowding among disembarking passengers. He didn’t have an exact count for the number of people who came ashore but said the bulk of passengers on cruise ships tend to disembark in port.

Like many other industries, the harbor faces staffing challenges, but Kim said the current crew should be sufficient as cruise ships return to Maui.

Five more ships are expected in Kahului Harbor this month, Kim said, including the Carnival Miracle on Saturday, Insignia on Monday, the Ruby Princess on Jan. 22, the Koningsdam on Jan. 26 and the Grand Princess on Jan. 27, according to hawaii.portcall.com.

Lahaina Harbor will host Residences at Sea’s The World from Saturday to Monday and Insignia on Wednesday.

Certain cruise lines are returning to Hawaii after signing port agreements that requires ships to have onboard testing and medical capacity as well as evacuation plans for passengers or crew in need of care and isolation and quarantine protocols.

As of Wednesday, the U.S. Centers for Disease Control and Prevention had assigned the Grand Princess a “yellow” status, meaning that reported cases had met the threshold for CDC investigation. This means cases were reported in 0.10 percent or more of passengers or one or more cases reported among the crew on restricted voyages; 1.5 percent or more of passengers or 1 percent or more of the crew on simulated voyages; and 1 percent or more of the crew on ships with crew only.

Standing along the edge of Kahului Harbor watching the surfers and the cruise ship in the distance, Haiku resident and retired nurse Connie Layer said that she was worried about the potential impacts of returning cruise ships on local hospitals during the current surge in COVID-19 cases.

“I don’t think our health infrastructure can really handle it right now, personally,” said Layer, who worked at Maui Memorial Medical Center for 25 years and at Kula Hospital for another eight years. “I feel very strong for my friends that are nurses in the emergency room, in the ICU. They are really hurting.”

Layer also wasn’t sure whether the potential economic boost was worth the health risks.

“I don’t know how much business these bring because I think people spend all their money on going on the cruise ship,” she said. “They eat on the cruise ship. They might buy trinkets. So I’m not sure if the economy warrants this kind of (activity).”

Haiku resident John Bruder, who comes to Kahului Harbor regularly for surfing, wing foiling and other sports, wasn’t surprised about the return of the cruise travel.

“It’s inevitable. They’ve been out for a long time,” Bruder said. “The economy, you know, needs these tourists here. And I wouldn’t want to go on a cruise, but certain people do. I would just say if you’re worried about it, get vaccinated, because this new variant is very contagious.”

Bruder didn’t want to see the hospitals overwhelmed but added that “I don’t think that banning cruises is going to make a big difference to the health of the population on the island.”

“The infections are going crazy before the cruise ship was here,” he pointed out.

One unexpected drawback is that the cruise ship blocks the wind, “so now when the cruise ship is here we’re not going to be able to wing foil in the harbor,” Bruder said. “But that’s just selfish, just my own interests.”

* Colleen Uechi can be reached at [email protected].

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Saratov: The city that almost came up overnight

The downtown with church in evening beams of the sun. Source: Shutterstock / Legion-Media

Once one of the Russian Empire’s largest cities, Saratov is home to a conservatory, one of Russia’s most famous and oldest circuses and perhaps the finest art collection in provincial Russia. Throw in long pedestrian avenues, the legacy of the Volga Germans and the mighty Volga River and you start to see the fuller picture of this city that was literally built over night.

Saratov is a great place to feel the immense grandeur of the Volga River. Saratov offers an unusual collection of architecture from the pre-revolutionary and Soviet period and its large center makes for an excellent place to take an aimless walk through centuries of Russian history literally living on top of each other.

The city which was built over night

Ukek, a Golden Horde city, was situated nearby until Tamerlane destroyed it in 1395. Saratov was founded in 1590 and soon became a popular stop between Europe and Asia. Located 858 kilometers southeast of Moscow, it was one of three lower Volga cities founded as forts to protect recently acquired territories at the Empire’s edge over a five-year span (1586-1590), along with present day Volgograd and Samara. Saratov was actually constructed significantly north of the city. The wooden buildings were disassembled, sent downstream and erected quickly allowing Saratov to appear practically overnight.

A view of Saratov from the Volga river. Source: Lori/Legion-Media

By the early 1800s Saratov had grown to be a significant port city and the railroad arrived in 1870. The city experienced a boom during World War II as many factories and institutes were relocated here, although it was closed during Soviet times as it was the site of a military aircraft manufacturing plant.

Saratov and neighboring city Engels (combined metro area today of over one million) were home to hundreds of thousands of Germans in the 18  th  , 19  th  and early 20  th  centuries. Originally invited by the Tsars to spur agricultural development in the area, the Volga Germans went on to hold prominent regional roles. Many were deported to Central Asia and Siberia during World War II, with many of those that remained immigrating to Germany in the 1980s. 

The bridge between Saratov and Engels. Source: Lori/Legion-Media

The bridge connecting Saratov with its twin city across the Volga, Engels, was the longest in the Soviet Union when completed in 1965 at 2,826 meters long. The architecture is quite diverse on the Volga waterfront with luxury apartments mingling with log cabins. Make sure to see the Balneological Clinic for an example of an old sanatorium. There are numerous cafes along the river, as well as a pedestrian zone. From the River Port at St. Naberezhnaya Kosmonavtov 7a it is possible to take a cruise as far south as Astrakhan, as far north as St. Petersburg and all major cities on the Volga River, as well as Moscow. Cruises operate from early May until mid-September and a schedule can be found here:  rech-vokzal.ru .

The evening city of Saratov with the bridge through the Volga River. Source: Shutterstock/Legion-Media

Surprisingly, Saratov went three full centuries before a promenade was built along the river. One of the main attractions here is a statue dedicated to the first man in space, Yuri Gagarin. Gagarin first moved to Saratov to continue his studies in 1951 at the Saratov Industrial Technical School. He studied tractors and spent his weekends volunteering at a local aviation club where he learned to fly. He also worked part time on the Volga docks. 

A walk through the city center

The city’s main artery is Moskovskaya St., which leads from the Volga through the heart of the city, however, Saratov’s soul can be found on Prospekt Kirova, one of Russia’s first pedestrian zones. Until 1917 it was known as Nemetskaya St. in honor of the large German population. Many sights are located here, as well as dozens of bars and restaurants. Several statues dot the landscape including a bronze statue of an accordion player and one of a young man waiting for his love with flowers as inspired by this  song about Saratov .

The oldest balneological clinic in Saratov. Source: Lori/Legion-Media

The Leonid Sobinov State Conservatory  opened in 1912 at Kirova 1 not far from the entrance to the charming Park Lipki. At the time it was only the third in the country as Saratov was then the third largest city in Russia and the largest on the Volga (16  th  largest today).

The Nikitin Bothers Circus  at the top of Kirova (away from the Volga) was the second stationary circus in Russia (the first is in Penza). This is probably the best place in town to see tigers and clowns under the same roof. Across the street is the Kryty Rynok, a covered market built in 1916. Behind the market is an example of a classic Soviet movie palace, Pobeda; it opened in 1955. If walking away from the circus towards the Volga there are well-preserved examples of proletarian communal buildings constructed in the 1920s on the left.

The building of the Saratov State Art Museum named after Alexander Radishchev. Source: Shutterstock/Legion-Media

Also of note on the street is the cinema Pioneer at Kirova 11. It was previously a Catholic Church serving the German population. Partially destroyed during the Soviet period, a fragment of the original wall can be seen inside.

One block parallel to Kirova is Teatralnaya Square. Here is the  Saratov Academic Theater of Opera and Ballet , built in 1875. Across the square is  Radishchev Museum , featuring one of the finest art collections in provincial Russia. Named for the controversial 18  th  century writer who grew up nearby (and whose grandson provided the initial collection), this was the first art museum in Russia to open its doors to the public. Today it counts numerous famous Russian painters in its collections including works by Repin, Shishkin and Falk.

The bridge out of the past to the future

Monument to Chernyshevsky and conservatory in the city center of Saratov. Source: Shutterstock/Legion-Media

One of the city’s most famous residents is Nikolai Chernyshevsky (1828-1889). A socialist, philosopher and writer, he is best known for his 1863 utopian novel, “What is to be Done?” It tells the story of Vera Pavlovna, an emancipated woman and the ascetic revolutionary Rakhmetov, who sleeps on nails and eats raw steak. The book had an enormous influence on Lenin; today the main public university is named for him and  his museum  is located at Chernyshevskogo St. 142.

Park Pobedy is the city’s largest and is located at about three kilometers from the Volga. It hosts the National Village of the Peoples of Saratov Region, an open-air architectural and ethnographic museum. 

All rights reserved by Rossiyskaya Gazeta.

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Ukraine war latest: Russian officials 'thrown out of meeting' for breaking custom; new photos emerge of Putin and Kim's day out

Vladimir Putin has arrived in Vietnam for a state visit after he spent the day in North Korea yesterday, where he signed a defence pact with Kim Jong Un. Got a question on the Ukraine war? Submit it below for our specialists to answer.

Thursday 20 June 2024 19:16, UK

• Vladimir Putin arrives in Vietnam for state visit
• Russia and North Korea sign new defence deal
• Russian officials 'thrown out of meeting' for breaking custom
• South Korea condemns pact and says it will reconsider weapons for Ukraine
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That's all of our live coverage on the conflict for now. 

We'll bring you any major developments overnight, and we'll be back with our regular updates in the morning. 

Volodymyr Zelenskyy has said he is "deeply grateful" for Joe Biden's decision to prioritise air defence deliveries for Ukraine. 

The Ukrainian president said his country was in critical need of the capabilities to protect its cities and civilians from Russian attacks. 

"The partnership between Ukraine and the United States is strong and unwavering. Together, we are protecting life against terror and aggression," he added. 

It comes after the US said a recent defence pact signed by Russia and North Korea was a "cause for concern". 

The recently signed defence pact between Russia and North Korea is a cause of concern but is no surprise, the White House has said.

Speaking to reporters, White House spokesman John Kirby said the agreement between the two countries was a sign of Russia's desperation for foreign assistance in the Ukraine war.

The deal has seen both countries vow to help each other if they faced armed aggression, and replaces previous treaties between the countries. 

Russia said the pact was needed because of "the deep evolution of the geopolitical situation in the world and the region".

Mr Kirby also said the US would reprioritise planned deliveries of foreign military equipment to go to Ukraine, which is in "desperate need" of more air defence capabilities.

Vladimir Putin has warned that South Korea would be making a "big mistake" if it decides to supply weapons to Ukraine. 

The Russian president's comments come after South Korea said a new defence agreement between North Korea and Moscow was "absurd" and it would reconsider sending arms to Kyiv as a result. 

Mr Putin said Seoul had nothing to worry about when it came to the mutual defence pact. 

Russian state media quoted him as saying that Moscow expected its cooperation with North Korea to serve as a deterrent to the West. 

He also refused to rule out supplying high-precision weapons to the country. 

Russia is considering making changes to its nuclear weapons doctrine, Vladimir Putin has said. 

The Russian president made the comments while speaking to reporters at the end of his Vietnam trip. 

The existing doctrine states that Russia may use such weapons in response to a nuclear strike or in the event of a conventional attack that poses an existential threat to the country. 

Ukrainian troops have been launching mid-range reconnaissance drones in Kharkiv.

Russian forces crossed into parts of the northeastern region last month, and officials claim they have seized at least a dozen villages.

But Ukrainian President Volodymyr Zelenskyy has said Kyiv's forces are gradually pushing Russian troops out of the contested area.

A police search is under way for a woman who allegedly desecrated the graves of Ukrainian soldiers.

Kyiv city's prosecutor's office said the unknown woman vandalised the graves this morning. 

Commemorative plaques and lamps were torn off and broken, it said.

The Ukrainian flag was also "mutilated", it added.

"Operational investigations and searches are being carried out to establish the woman's identity," the office said in post on Telegram. 

If caught and found guilty, the woman could face up to five years in prison. 

We have been reporting today on Vladimir Putin's visit to Vietnam.

Here is a recap of what the Russian president has been up to: 

• Mr Putin signed a series of deals with his Vietnamese counterpart To Lam during his state visit;
• The two leaders signed agreements to further co-operation on education, science and technology, oil and gas exploration and health;
• They also agreed to work on a road map for a nuclear science and technology centre in Vietnam;
• Following the talks, Mr Putin said that the two countries share an interest in "developing a reliable security architecture" in the Asia-Pacific region based on not using force and peacefully settling disputes with no room for "closed military-political blocs";
• The Russian leader also met Vietnam's Prime Minister Pham Minh Chinh and is scheduled to meet Communist Party general secretary Nguyen Phu Trong - Vietnam's most powerful politician;
• The trip has resulted in a sharp rebuke from the US embassy in the country.

Volodymyr Zelenskyy has said Romania's decision to provide his country with two Patriot air defence systems will strengthen security in Ukraine and throughout Europe.

"This crucial contribution will bolster our air shield and help us better protect our people and critical infrastructure from Russian air terror," the Ukrainian president said on X.

The Patriot, which stands for Phased Array Tracking Radar for Intercept on Target, is a surface-to-air missile defence system.

For months now, Ukraine has been calling for countries to provide more air defence systems to help protect it from Russian attacks. 

The next NATO leader is now all but certain after Dutch Prime Minister Mark Rutte's last rival dropped out of the race.

He's now the only person running to be Jens Stoltenberg's successor when he steps down from the secretary-general role in October. 

Romanian President Klaus Iohannis dropped out of the race earlier today and Hungary lifted its veto on Mr Rutte's candidacy, paving the way for NATO to put on a show of unity over support for Ukraine.

Mr Rutte's appointment could be sealed by a meeting of NATO ambassadors in the coming days, or by the leaders when they meet in Washington in July for the alliance's 75th birthday.

NATO secretaries-general are responsible for chairing meetings and guiding consultations among the 32 member countries to ensure that the organisation, which operates on consensus, can continue to function.

Mr Rutte has already had to assure Hungary that he will not force it to take part in NATO plans to provide support to Ukraine.

Turkey, which had voiced opposition to Mr Rutte's bid earlier this year, has also lifted its objections. 

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What we know about a drone strike the Kremlin says killed three people on a Russian air base

Three military personnel were killed in drone attacks on two Russian air bases hundreds of kilometres from the front lines in Ukraine, Russian authorities claimed on Monday.

What happened?

In detailing the attacks on the air bases, the Russian defence ministry said it had shot down two Ukrainian drones. The ministry also stated that three Russian servicemen were killed and four others were injured by debris, and two aircraft were slightly damaged as the drones were shot down.

The Engels-2 air base houses bomber aircraft that are part of Russia's strategic nuclear forces.

"The Kyiv regime, in order to disable Russian long-range aircraft, made attempts to strike with Soviet-made unmanned jet aerial vehicles at the military airfields Dyagilevo, in the Ryazan region, and Engels, in the Saratov region," the Russian defence ministry said.

It said the drones, which were flying at low altitude, were eventually intercepted by air forces and shot down.

The deaths were reported on the Ryazan base.

The ministry called it a "terrorist act" aimed at disrupting its long-range aviation.

Kremlin spokesman Dmitry Peskov told reporters at a morning briefing that President Vladimir Putin was aware of the incidents, but declined further comment.

Who is responsible?

Ukraine did not directly claim responsibility, but Ukrainian officials did post cryptic messages on social media possibly referring to the attacks.

One of Ukrainian President Volodymyr Zelenskyy's advisers, Mykhailo Podolyak tweeted, saying "if something is launched into other countries’ airspace, sooner or later unknown flying objects will return to [their] departure point".

If Ukraine did carry out the attacks, they were the deepest military strikes it has conducted inside Russia since the invasion that started in February.

The New York Times reported  that an anonymous senior Ukrainian official had said the drones were launched from Ukrainian territory and that at least one of the strikes was made with the help of special forces close to the base, to help guide the drones to the target.

The Russian defence ministry did not state where the drones had originated, but Russian military bloggers said it was likely they were launched by Ukrainian scouts.

Did Russia retaliate?

Just hours after the Kremlin claimed Ukraine attacked the Russian air bases, it released another massive missile barrage upon Ukraine.

In the retaliatory barrage, missiles knocked out basic services in several Ukrainian regions, part of Moscow's strategy to inflict more pain as winter approaches and temperatures drop below zero.

Mr Zelenskyy said four people were killed in Monday's retaliation.

Ukraine's air force claimed it shot down more than 60 of the 70 missiles.

“Every downed Russian missile is concrete proof that terror can be defeated,” Mr Zelenskyy said in his nightly address.

Ukraine said early indications showed Russia fired 38 cruise missiles from carriers in the Caspian Sea and from the southern Rostov region.

In addition to that, 22 Kalibr cruise missiles were fired from Russia's Black Sea fleet. Long-range bombers, fighter jets and guided missiles were also involved, it said. 

In Ukraine's capital, Kyiv, people quickly filled the central Zoloti Vorota metro station after air raid warnings.

Ukrainian media reported explosions south of Kyiv, in Cherkasy, Krivyi Rih and Odesa. Officials said water, electricity and central heating were cut to many parts of Odesa.

“The enemy is again attacking the territory of Ukraine with missiles!” Kyrylo Tymoshenko, the deputy head of the Ukrainian president’s office, wrote on Telegram.

What do the attacks mean?

The attacks revealed the vulnerability of some of Russia's most strategic military sites, raising questions about the effectiveness of their air defences, if drones managed to get this close.

With the Dyagilevo air base in Ryazan just some 185 kilometres south-east of Moscow, it brings the war a lot closer to home for many Russians.

Russian commentators noted on social media that if Ukraine could strike that far inside Russia, it may also be capable of hitting Moscow.

Earlier attacks that have taken place on Russian bases were just past the border near Belgorod and in Crimea in August, reportedly destroying nine Russian war planes.

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