howiefrommd

38 minutes ago, Etta1213 said:

What did the Bahamas Paradise line do to satisfy the CDC, that the other large ships/lines find maybe too difficult to satisfy? I'm curious to know how they did satisfy the CDC. Maybe all their crew from US or from the Bahamas? Did the Bahamas maybe agree to accept any pos/sick crew or cruisers into their country if problems arise?

Was just wondering where the information came from that permits any cruise line to cruise pursuant to the April 15 CDC CFR, and subsequent renewals. 

1 hour ago, greykitty said:

Just a small caveat - there have been measles outbreaks in the last few years, generally fueled by those who do not get vaccinations.  Measles has once again become a real and present danger to too many people.  

 

 

The funny (if there can be one) thing with the current measles outbreak is almost all of the younger docs have never seen measles.  When measles started presenting in the ER and offices, the docs went went right to google.  Things have changed lol 

33 minutes ago, Dolebludger said:

I must disagree that a vaccine, widely available and proven, would not fix the problem. I feel that it would be a fix, and the CDC is concerned primarily with pre-vaccine sailings. Possibly, no vaccine is 100% effective in all persons against all possible strains of a given virus. But a vaccine would prevent major outbreaks on ships and elsewhere. For example, smallpox was once a real problem as were measles. Most of us have been vaccinated against these, and they are very much gone as far as I know. Ditto for polio. 
 

When such a vaccine is available against Covid 19, a certificate of vaccination system could be developed, and all one would need do is show their certificate to enter a country, airplane, cruise ship — or anywhere else.

I agree that should a vaccine/immunization be developed that shows efficacy, it potentially would be a significant step in the right direction.  When I was in training in the early 1980's we were hit with the HIV/AIDS virus.  I remember professors (and well respected physicians) saying to us that a vaccine/immunization for this virus could potentially be available in five years or so.   When Norovirus was fist diagnosed in 1968, once again we were told that a vaccine/immunization could be developed. Here we are how many years later still without a vaccine.  At least when a patient gets a diagnoses of HIV today, there are very effective pharmaceutical treatments and it is no longer a death sentence. 

Vaccines are hard to develop, in fact, tremendously hard.  It is not a fact of how much money you throw at something, science takes time.  Eventually we will probably see somewhat of a hybrid, something similar to the flu shot.  

30 minutes ago, Ladys Mom said:

Howie, I think you answered your own question.  There are many Experienced ICU nurses and Intensivist physicians from countries around the world who have successfully treated and conquered COVID.  If the cruise lines would pay them a decent salary, which they wouldn’t balk at given the alternative, they would handle the run of the mill cruise ship health issues and be prepared if passenger or crew came down with the virus.  I think the experience of mitigating and treating COVID has come a long way, if everyone follows the guidelines and patients are treated appropriately.  Not what is going on in the US right now.  As far as who gets treated first, I expect it would be based on The medical triage model.  The sickest go first.

Actually, I was answering another persons question, but fully agree.  In the conversation I have had with Docs and Nurses working on cruise ships)  I have been amazed (not in a good way) at their salary and working conditions.  

From a clinical perspective, patients would be triaged, prioritized and treated accordingly.   In some States, health care systems have developed prioritization protocols to address shortage of respirators, ICU beds etc.  What goes into those calculations are age, comorbidities and potential outcome, 

That I have no answer or idea.  This and many other potential changes, policies and/or procedures is why there will not be a quick fix.  When you look at some of the PR materials that was sent out by the cruiselines (most of them) they all talk about increased sanitation, increased training, more staffing, etc.  Believe me this is not the type of response that will get the regulators rolling on this.  Quantifiable, measurable, actionable response is what will make this move forward.   

16 hours ago, Pcardad said:

 

I know that Allianz is covering my bookings in the event of BK....So it is possible. You should speak to your TA or call them Allianz directly.

Thanks so much. 

5 minutes ago, flossie009 said:

 

 

 

As others have said it is highly unlikely that the CDC would take a more benign attitude towards one cruise line rather than another.

Also, from the CDC's latest No Sail Order it appears that they do not perceive NCLH or Regent to be "squeaky clean"; I quote from page 9:

"On May 22, 2020, CDC sent a Notice of Potential Non-Compliance with the No Sail Order to Norwegian Cruise Line Holdings Ltd (NCLH). The notice stated that CDC had become aware of reports of alleged non-compliance on several NCLH cruise ships including the Norwegian Escape, Norwegian Epic, Norwegian Joy, Oceania Marina, and Seven Seas Navigator."

"On July 2, 2020, CDC sent NCLH an additional notice requesting that it take immediate corrective action to align its practices with the April 15, 2020 Extension and CDC’s Interim Guidance."

 

Rather than comparing one cruise company with another I would be more interested in how the cruise sector compares with other companies in the travel & hospitality industry regarding the potential for virus transmission.

Are the CDC and other regulatory bodies being as pedantic and bureaucratic with airlines, hotels, restaurants & bars? 

I think each sector has their own unique issues in dealing with an aerosolized virus such as COVID-19.  A cruise ship has many more unique challenges than a restaurant or hotel.   

The one big difference between airlines, hotels, restaurants or bars is one of their employees are not going to be your doctor (at least we hope so lol) when a medical crisis arises.  

This will not solely resolve with an agreed upon document from CDC and the cruise line industry, a vaccine/immunization nor will the virus magically disappear.   Eventually CDC and the involved parties will come to a mutually agreed upon plan to address CDC's issues.  As I have said before, once the agreed upon criteria is enacted, then the real hard work starts.  This will not be a matter of putting up a piece of Plexiglas or moving a few tables.

My entire life has been involved with both at the Federal level and upon retirement in the private sector dealing with health care quality analytics.  In the April 15th CFR notice, the following appears:

 "Onboard medical staffing, including number and type of staff, and equipment in sufficient quantity to provide a hospital level of care (e.g., ventilators, facemasks, personal protective equipment) for the infected without the need for hospitalization onshore;"

Although this may sound manageable, to execute such a task is not an easy one.  Over the years I have had the opportunity to either dine with the medical staff and/or get a tour of shipboard medical facilities.  The level of care as articulated in the April 15 CFR notice, is one of an ICU level of care.  This would require Physicians and Nurses with the appropriate level of training to handle tasks such as multiple patients on ventilators, etc.  In the United States this is primarily done by Critical Care Intensivists or Pulmonary Critical Care Physicians.

A few things that come to mind when I think of the many conversations I have had with shipboard physicians over the years.  Many are there for the same reason many of the workers are on the ships.  They come from countries with low pay, low employment prospects and need to support a family.  Most I have spoken with have usually been trained within general medical specialties (equivalent to Family and/or Internal Medical trained physicians in the US). 

Another issue, is the smaller ships (according to ACEP) usually have only one Physician and between one to two Nurses. Note that many cruiselines belong to ACEP, but the physicians staffing the ships are not.  Within the United States we have a tremendous shortage of critical care physicians.  Granted that the cruiseships historically do not hire US physicians (due to cost).  So the question is, where do all of the cruiselines get all of the Critical Care and trained Physicians and Nurses?  

I have a semi-related question.  Unfortunately, I agreed to take a FCC and applied it towards a cruise in January 2022.  If a bankruptcy filing occurs (I would envision a Chapter 11 reorganization) what happens to the FCC?  Also, if the FCC has no value, since it was an FCC, would travel insurance (in my case Allianz) cover it?

Here is the document: https://www.cdc.gov/quarantine/pdf/No-Sail-Order-Cruise-Ships-Second-Extension_07_16_2020-p.pdf

Just finished the document that was issued today, I imagine will be CFR tomorrow.  As they always say, the devil is in the details.  What will need to be accomplished to satisfy the requirements as articulated by CDC is significant.  Referencing page 14 entitled "Lack of Consensus Among Cruise Ship Operators and Need for Additional Industry-led Efforts Regarding Safely Resuming Passenger Operations."  Within that part of the document they reference that "over the next few months" the RCL/NCL work group will come up with recommendations.  My guess would say we are probably looking at four to six months before consensus within the work group, then a sign off from CDC. 

As I have articulated previously, I have worked for or with many of the players involved, and this stuff takes time.  Personally, I believe meeting was has been proposed to date (as far as medical services) is a herculean effort.  

11 hours ago, Travelcat2 said:

 

In my opinion, it depends upon whether or not the virus can be contained.  There is a high percentage of repeat cruisers on Regent and most of them are anxious to cruise but are either afraid or think that following protocol would diminish their onboard experience.  If/when the numbers of new cases are on a downward trajectory and it has been determined that this was caused by wearing masks and distancing, there would likely be a group of cruisers that will return to Regent - even if they have to wear a mask.  

 

In the past couple of months, masks have come a long way.  We are now seeing some pretty sophisticated masks - ones that allow you to see the faces of the person wearing one and have better protection than in the past.  I would love to see people that wear a mask not have to social distance so you can have a conversation with someone near you.  This is not a farfetched idea.

 

IMO, there will be a vaccine within the next 6 months and certainly there will be by the time FCC's expire.  At that point, passengers will need to either have the vaccine or not cruise.  That will be up to them.  Since some of us are already booking cruises (with or without FCC's) I do not expect to see the numbers reduced in the future.  

 

I am finding it interesting that since the pandemic started, people are saving more money by not going out to restaurants, cruising, etc.  I read that people that have credit card debt are paying it down more rapidly than before.  So, those of us that are retired have even more money to put towards cruising than before the pandemic.  And, for now, the 125% FCC's are making Regent cruises more affordable than ever.  

 

 

At this point it appears we as a country are nowhere near containment.  The evidence (with the exception of two States) indicates the opposite.  Masks have come an integral part of life in many countries, and I anticipate we will be utilizing them here for quite some time.   When I was in training (in the early 80s),  is when we first discovered and diagnosed HIV/AIDS.  We had hysteria at that time primarily due to the lack of knowledge we had about such an opportunistic virus.  We still do not have an vaccine/immunization, but have excellent pharmaceutical management. We are still learning everyday about COVID-19.  This is a fierce, easily transmittable virus.

Vaccines take time and work.  I read that there are several that should start phase three trials this summer.  When a trial ends you just do not start administering.  You have to look at the data, etc.   I do personally think in time (certainly not the overly-optimistic time frame that you hear from the talking heads) that we will have a vaccine similar to the flu shot and/or a more effective  symptomatic treatment.   

At this point the Government is investing billions of dollars in vaccine development, unfortunately I think it is politics driving this versus science.  One of the companies that have taken the lead (and has received amazing amounts of taxpayer dollars) has never been able to bring a vaccine to market past three trials.  

Not to ruminate a prior post, due to our dependence on foreign manufacturing, at this point even if a pharma (or several) come up with a vaccine,  we would not even have the glass bottles that would contain the vaccine or even the syringes available.  

Optimism is good.  But I think we need to be honest and understand we are in somewhat uncharted waters.  One other thing one must put into the equation (and this is certainly above my pay grade) is at the end of September, PPP money runs out for businesses.  It is predicted that there will be massive layoffs (airlines as one example).  Put on top of that, many people and businesses have not paid their rent or mortgage in months.  Presently many State and local Governments have enacted policies of no evictions.  Just last month over 5 million people lost their health insurance in the US (due to layoff).  

In my gut, something tells me whether we can cruise in the next year or not, is not high on the list of what many of our scientists, politicians and public health experts are dealing with now.

25 minutes ago, Travelcat2 said:

Interesting information.  Since I cannot open this article, kindly let me know when this outbreak took place on the Disney Wonder?  Since the article mentions passengers, I assume that it was prior to the "voluntary" cruise shut-down and also assume that masks were not worn and distancing wasn't practiced.  

 

I read somewhere on the CC Regent board that since there will be fewer passengers, there will be fewer crew members and the goal is to have a maximum of two crew members in each cabin.  This obviously would be easier to do on some ships than others.  

 

Whatever protocols are put in place for the crew will likely be stringent.  While the crew will likely have to get used to this and won't enjoy wearing a mask most of the time, they will also be happy to be working in a safe environment.

At this point and for quite a way in the future, one of the founding principles will most probably be the wearing of masks of all people (not just staff).  One should imagine it just as in most States that have taken this seriously.  If you cannot social distance, a mask should be worn.  

1 minute ago, Kwaj girl said:

Yet, would those 2 not then become like a 'household' in term of sharing space like a family does in their home?  They then 'share' similar germs and become immune to each other in that regard, no?  Hust a thought....

This will be one of many hurdles they will have to look at and address. Personally (I am not from the infectious disease world) I do not see in the arena of "family."  In an earlier post I referenced a conversation that I had with an ID colleague this weekend.  She will not see her grandchildren, unless she self quarantines for 14 days.  

When reading those April 15 CFR guidelines from CDC, this issue is nothing compared to the systems they will have to have in place to cruise.  Wouldn't you love to be a fly on the wall when they run all of this past their GC and insurers.  

I would defer to our infectious disease/epidemiology partners, but two sharing a room might be a recipe for disaster. 

This is why mask wearing is so important.  Unfortunately, it has turned into a political statement.  If we were all to wear masks and social distance, we could really get a handle on this disease.

Unfortunately, that bis the only tool in our arsenal at this time.  

As a follow up to my previous post, this weekend I was speaking  to an Infectious Disease colleague and shared my post with her.  I should preface my comment with she has never been on or taken a cruise.  In fact, knowing her, she probably has never been on a vacation.

Her response to my post was that I really missed the main crux of the problem of cruise returning to service.   The first question was "how and where do the crew live on the ship?"   I have not been privy to see how the crew lives, but I have had explained to me by various staff members their living arrangements.  Once I shared this, it was like an alarm went off.  The congregate living that occurs is a fundamental problem in the world of COVID-19.  

The next issue was how would you isolate people suspected of or having COVID-19.  This is not like a Norovirus (which she reminded me we still do not have a vaccine/immunization for) this is an aerosolized virus.  This is not just telling someone to stay in their room.  It is conceptualized, that suspected positive/positive people would be in a separate distinct area.  

Once again, if the medical requirements as set forth in the April 15th CFR from CDC are codified, the cruise lines (big or small) face a herculean effort in trying to meet  those requirements.  The level of expertise required of physicians and nurses significantly changes.  

Although one would think that space/ratio should be different,  when you look at it in a public health concept, I am not sure how divergent the end process would be.  I have not cruised on Silversea, but have on Regent. 

Some  hurdles that come to mind are things such as,

Hallways.  If my memory serves me correctly, there are parts of the ship that are served by one common hallway.  In early discussions, the larger ships have been looking into one way hallways (such as some supermarkets have done).  Maintaining safe, appropriate social distancing would be quite difficult in a common shared hallways. 

Elevators. The published guidance regarding safe sharing in elevators  (in relation to COVID-19 safety precautions) seriously limits elevator usage.  Everything from occupancy (no more than 2 people in the average size elevator), to touch-less selection of floors, to continual ongoing sanitation. Granted, many utilize the stairs, but the people who must use elevators may be those of greater risk if exposed.

Dining.  Proper social distancing will be an amazing challenge.  CDC guidance in regards to who, when and how to social distance is challenging.  Unless you come onboard with someone you have had contact with for 14 days will preclude anyone from sharing a table.  Also, even though Regent is generous with space in the Compass Rose, with six feet distancing of tables, some  will have to be removed.  Additionally, many more tables for two will have to be facilitated.

Bars.  Another area were social distancing would be quite difficult.

Shows. Casino. Captains Reception, etc.   The tradition (I forgot the term) of meeting your neighbors and the staff goes around to each floor, wow is that a problem.

Embarkation and Disembarkation. Obviously embarkation can easily be done with staggered check in.   Disembarkation is another animal.  For some reason when a cruise ends, frequently people act like they are being released from prison.  

The biggest obstacle.  The level of medical skill and abilities that will be needed to meet the CDC's current guidance pursuant to the CFR April 15 publication.  

So what I am trying to say is that even though Regent (and other cruise lines with have high passenger/space ratios) will still have a herculean task ahead. 

16 hours ago, fizzy said:

Would anybody have any idea about the methods and protocols that the various Navy ships world wide are using to keep the  sailors safe?  

It is a bit in Governmentalese but here goes....

https://www.public.navy.mil/bupers-npc/reference/messages/Documents/NAVADMINS/NAV2020/NAV20155.txt

1 hour ago, GrJ Berkshire said:

The reports in UK are of the numbers who are anti- vaccine : will that be a problem? Many appear to take the view its their right not to have to follow rules. Will Regent and the cruise lines have the "bottle" to refuse boarding to those without a vaccination certificate ? Will it hold in US law? Would they lose their money, as a result?

Unfortunately even wearing a mask, which is the only thing we have in our arsenal at this point, has turned political.  A significant part of the population (some papers cite as up to 70 percent) would have to be immunized (and develop antibodies) to hope to tame this beast. 

In parts of the US, we have had breakouts of measles, mumps and rubella because of such anti-vaccination  issues.  In speaking with some of the younger pediatricians and emergency room docs, these are only diseases they read about in school, yet did not see during any of their training (residency).  

8 hours ago, Caroldoll said:

I am not an "expert" but I was in medicine for 38 years.  I really believe we will have a vaccine in about late October or early November.  However, the medical field will get the shots first, and then the first responders (there are a lot) and then they will distribute it by age, the oldest first.  There is a possibility that if a person wants to go out of the country to get it, it will be available sooner, but here the oldest will be first and then the cruise lines will let people board who have had the vaccine.  There will be no other answer IN MY OPINION!  So stand by and take the ride!

The CDC presently has an advisory committee (a group of non-governmental subject matter experts) impaneled.  Preliminary results find that the classification is as follows:  1. Critical medical and national security officials; 2. essential workers and those considered at high risk (such as the elderly and those with preexisting conditions); 3. And this is the most controversial at this point, are those people who are disproportionately affected by the virus. 

In speaking with my infectious disease colleagues,  they have doubt of identifying, trialing, manufacturing and getting vaccines out to the public in such a expeditious way.   The real test will be the phase three trials which will look at safety and efficacy.  Something I did not know is that the company leading the charge, has never brought a successful vaccine to market.  Obviously there is much financial incentives for these companies (and there are several working on this)  to get a product to market, but unfortunately these things take time.  

I think the thing that really amazed me was that due to our dependence on foreign manufacturing, that even if 100's of million of doses were to be manufactured, the manufactures (pharma) do not even have the bottles necessary.  On the front line, experts question whether there would even be enough syringes (similar to the PPE problem).   

Since part of this public health issue has become a political, I would not be surprised if FDA just classifies whatever is developed  under a EUA, which would shield the manufactures from liability, and get something out before the election. 

4 minutes ago, Travelcat2 said:

 

And what are your facts based on?  I think that, at this point, we need to state whether something is our opinion or a fact.  If it is a fact, it would help to know the source.  

 

You  have once again misunderstood my post.  I posted that the joint plan would be completed fairly soon.  In the article that I linked, it is stated that their plan would be done by August 31st (which, IMO, is fairly soon).  I. made no comments or predictions about how long it would take for final approval.  

 

Since there has not been a pandemic in our lifetime, people tend to believe almost anything.  It is up to CC members to not state misleading information.

 

howiefrommd - This is not a typical time.  The FDA gave emergency approval to two drugs already and the CDC came up with guidelines for schools very quickly and now refuse to change them to make them weaker - a good thing IMHO).  

 

While it would be helpful to look at the past and make assumptions.  However, there has not been a pandemic for over 100 years.  It appears that the CDC is taking this seriously and would not unnecessarily stop all cruises for months.  

EUA's by FDA are not a rare as one thinks, it is an essential tool within their regulatory ability and they use it judiciously. 

As they say in the movie (and now in a book) "I have been in the room" many times during these type of negotiations take place, I have  worked with or for some of the major players on this consulting panel.   I seriously believe (and this is a personal comment) that this panel nor the CDC is looking at this as anything but a public health decision.  The safety of public health certainly should be paramount to that of the economic conditions effecting the cruise industry. 

I was talking to a colleague about the requirements set forth in the in the CFR April 15. 2020 notice aka the "No Sail Notice."  Just looking at the Medical Management  "operational guidelines" articulating the level of staffing, skill set requirements for personnel, equipment requirements set forth by ACEP makes them lofty goals with questionable attainment.  I know of hospitals in the Unites States that cannot meet those requirements.  

In my humble opinion (with over 30 years) dealing with health car quality analytics and knowing the players, organizations and professionals involved, this is not an easy hurdle or one that can be done quickly.

Actually there are many facets to this.  First, what type of consensus can be made among the consultants in their recommendations.   Obviously, at first they will substantial.  Second, will RCL/NCL find it economically feasible to enact these recommendations, have sign off by their OGC, insurance carriers and operational people.  I have been in many negotiations over the years with various parts of HHS (CDC, CMS and FDA specifically), and their initial meetings, negotiations and enactments typically take time.  Fold into a worldwide pandemic, a Presidential election (in the US) and the potential for a disaster (with the first outbreak on a ship) it will be many months or possibly a year before all the kinks are worked out.

Thought this was interesting: https://bangordailynews.com/2020/07/08/news/hancock/bar-harbor-tells-small-cruise-ship-firm-it-cannot-resume-visits-this-year/

This is what they say on their website "Guest capacity reduced by 25%. Each cruise will sail with a maximum of 75% of the allotted guest capacity. Capacity reductions increase distancing measures and increase the ability for private crew accommodation".  Yet they indicate (to the Bar Harbor councilors) that there will be only 60s guest on each cruise.