On May 5, 2021, the CDC released the next two phases, 2B and 3, of the Framework for Conditional Sailing Order (archived) which was originally issued on October 30, 2020 for cruise ships operating or seeking to operate in US waters. The CDC’s Conditional Sailing Order is a phased approach to resuming passenger operations on cruise ships. The initial phases required crew screening to determine the prevalence of COVID-19 among all crew members currently on cruise ships in U.S. waters. Previous phases provided information about agreements between cruise lines and port and local health authorities, updates to the color-coding system used to classify ships’ status with respect to COVID-19 on board, and information about routine crew testing. It has been roughly a month since CDC announced Phase 2A on April 2nd.

Phase 2B and Phase 3, published technical instructions related to cruise ships preparing to conduct simulated (“trial”) voyages in advance of restricted passenger voyages under a COVID-19 Conditional Sailing Certificate. With the issuance of these next two phases, cruise ship operators now have all the necessary requirements and recommendations they need to start simulated voyages before resuming restricted passenger voyages and apply for a COVID-19 conditional sailing certificate to begin sailing with restricted passenger voyages. CDC may adjust these requirements and recommendations based on public health considerations and other factors.

Before we get into the details, CDC issued an option to forego simulated voyages, where the cruise ship operator’s responsible officials, at their discretion, may sign and submit to CDC an attestation under 18 U.S.C. § 1001 that 98 percent of crew are fully vaccinated and submit to CDC a clear and specific vaccination plan and timeline to limit cruise ship sailings to 95 percent of passengers who have been verified by the cruise ship operator as fully vaccinated prior to sailing. All persons, including port personnel, crew, and passengers (including those that are fully vaccinated) are advised that CDC’s Order requires wearing of masks on conveyances entering, traveling within or leaving the United States, and in U.S. transportation hubs remains in effect.

Another key point here, cruise ship operators are still required to follow the requirements of the Passenger Vessel Safety Act as CDC does not have the authority to waive these statutory requirements.

Simulated (Trial) Passenger Voyages

Phase 2B (archived) of CDC’s Conditional Sailing Order is intended to assist cruise ship operators in preparing to conduct simulated (“trial”) voyages in advance of restricted passenger voyages under a COVID-19 Conditional Sailing Certificate. This includes conducting simulated voyages insofar as practicable to test the efficacy of the cruise ship operator’s ability to mitigate the risks of COVID-19 onboard its cruise ship as per the terms of CDC’s Framework for Conditional Sailing Order, developing an after-action report, and addressing any identified deficiencies.

A cruise ship operator should notify CDC and request CDC’s approval to conduct a simulated voyage at least 30 calendar days prior to the date on which the cruise ship operator proposes to conduct the simulation.

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

Volunteer Passenger Requirements

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

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

Trial Cruise Requirements

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

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

Although the next phases were released today, the CDC still recommends avoiding any travel on cruise ships, including river cruises, worldwide, because the risk of COVID-19 on cruise ships is very high. It is especially important that people with an increased risk of severe illness avoid travel on cruise ships, including river cruises. Cruise passengers are at increased risk of person-to-person spread of infectious diseases, including COVID-19, and outbreaks of COVID-19 have been reported on cruise ships because of their congregate (group) settings where COVID-19 spreads easily.

Federal Register: Conditional Sailing Order Technical Instructions and Operations Manual A Notice by the Centers for Disease Control and Prevention on 05/10/2021