CDC details

[ellasmomanddad]

This is an article I just read. I’m particularly curious about number 4 

    4. An outbreak management and response plan must be in place to provision and assist an affected cruise ship that relies on industry resources, e.g.,mobilization of additional cruise ships or other vessels to act as “hospital” ship for the infected, “quarantine” ship for the exposed, and “residential” ship for those providing care and treatment, including the ability to transport individuals between ships as needed.

   I read that, as 3 ships in the fleet need to be hospitals.  Is that even possible with them being billion dollar builds?
https://cruiseradio.net/cdc-details-what-cruise-lines-must-do-to-sail-again/amp/

[fshagan]

The "e.g." means "for example" not "this is required", so I'm sure the cruise lines can come up with alternatives to three different ships as long as the plan is approved. 

 

But even with that example, the initial cruise ship can be the "quarantine" ship for exposed people. We've seen that already. This example then requires two more ships. But they don't have to be new, billion dollar+ ships.

 

The residential ship for medical workers could be much, much smaller and be a contract ship provided by the companies that provide the medical services on board already. Cruise lines could share these ships.

 

The hospital ship for affected passengers could also be a smaller, older ship that the lines share. RCCL might have one, Carnival might have two for all of their lines, and NCL might have one. Or NCL might share one with MSC and other smaller lines.

 

We'll see alternatives to this example that are more creative and achieve the same goals.

[chengkp75]

This requirement is also for "industry resources", so that while demand is down during the start-up and while Covid-19 counter-measures may still be in effect, the cruise lines can band together so that one line can provide a residential ship, and one line can provide a hospital ship, and one line can provide a quarantine ship.  The "residential" ship does not need to be a hospital, it is just a place for health care givers to essentially quarantine while serving the patients on the "quarantine" ship and the "hospital" ship.  The "quarantine ship" also does not need to be a hospital, just a place for those exposed to live in quarantine until they show symptoms and require hospital care.

[Jobeth66]

Note that the CDC order also requires what is essentially a full ICU with trained medical staff on board every ship - including PPE and ventilators.  In addition, every cruise must have a land-based hospital that has agreed in advance to take any passengers that must be medically evacuated, and they must have plans in place to do so at the cruise line's expense and without using government resources (no USCG).  

 

They also have to have plans in place to charter aircraft at their own expense to repatriate passengers - they cannot rely on commercial airlines to do so.

 

Unless they back down on some of these requirements, this is going to take a long time before cruises can come back to US ports.

 

The requirements from the actual CDC order:

 

3.    An appropriate plan is one that adequately prevents, mitigates, and responds to the spread of COVID-19 on board cruise ships and that, at a minimum, must address the following elements:
a.    Onboard surveillance of passengers and crew with acute respiratory illnesses, influenza-like illnesses, pneumonia, and COVID-19, including reporting to HHS/CDC on a weekly basis on overall case counts, methods of testing, and number of persons requiring hospitalization or medical evacuation;
b.    Reports on the number of persons onboard the cruise ship and any increase in the numbers of persons with COVID-19 made to HHS/CDC and USCG on a daily basis for as long as the cruise ship is within waters subject to the jurisdiction of the United States. 

c.    Onboard monitoring of passengers and crew through temperature checks and medical screening, including addressing frequency of monitoring and screening;
d.    Training of all crew on COVID-19 prevention, mitigation, and response activities;
e.    Protocols for any COVID-19 testing, including details relating to the shore-side transport, administration, and operationalization of laboratory work if onboard laboratory work is not feasible;
f.    Onboard isolation, quarantine, and social distancing protocols to minimize the risk of transmission and spread of COVID-19;
g.    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;
h.    An outbreak management and response plan to provision and assist an affected cruise ship that relies on industry resources, e.g., mobilization of additional cruise ships or other vessels to act as “hospital” ship for the infected, “quarantine” ship for the exposed, and “residential” ship for those providing care and treatment, ncluding the ability to transport individuals between ships as needed;
i.    Categorization of affected individuals into risk categories with clear stepwise approaches for care and management of each category;
j.    A medical care plan addressing onboard care versus evacuation to on-shore hospitals for critically ill individuals, specifying how availability of beds for critically ill at local hospitals will be determined in advance and how the cruise ship operator will ensure acceptance at local medical facilities to treat the critically ill in a manner that limits the burden on Federal, State, and local resources and avoids, to the greatest extent possible, medivac situations. If medical evacuation is necessary arrangements for evacuation must be made with commercial resources (e.g., ship tender, chartered standby vessel, chartered airlift) and arrangements made with a designated medical facility that has agreed to accept such evacuees. All medical evacuation plans must be coordinated with the U.S. Coast Guard;
k.    Detailed logistical planning for evacuating and repatriating, both U.S. citizens and foreign nationals, to their respective communities and home countries via foreign government or industry-chartered private transport and flights, including the steps the cruise ship operator will take to ensure those involved in the transport are not exposed; (the use of commercial flights to evacuate or repatriate individuals, both within or from the United States, is prohibited);
l.    The projected logistical and resource impact on State and local government and public health authorities and steps taken to minimize the impact and engage with these authorities; all plans must provide for industry/cruise line management of suspected or confirmed cases of COVID-19 without resource burden on Federal, State, or local governments;
m.    Plan execution in all U.S. geographical areas – all plans must be capable of being executed anywhere in international, interstate, or intrastate waterways subject to the jurisdiction of the United States; and

n. Cleaning and disinfection protocols for affected cruise ships.

 

[fshagan]

20 hours ago, Jobeth66 said:

g.    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;

 

Based on the number of ICU beds available in the US (29.4 per 100,000 people), this could be one or two inside cabins equipped with medical equipment. That's .3 per 1000 people, or 1.5 beds for a crew of 1,000 and 4,000 passengers, if I did my math right. 

 

Even if the CDC determines they should have double the capacity of the average in the US, that's still only 3 or 4 inside cabins set up on the larger ships. There's a cost, sure, but in the overall scheme of things it isn't as insurmountable as it first seems.

[Jobeth66]

9 minutes ago, fshagan said:

 

Based on the number of ICU beds available in the US (29.4 per 100,000 people), this could be one or two inside cabins equipped with medical equipment. That's .3 per 1000 people, or 1.5 beds for a crew of 1,000 and 4,000 passengers, if I did my math right. 

 

Even if the CDC determines they should have double the capacity of the average in the US, that's still only 3 or 4 inside cabins set up on the larger ships. There's a cost, sure, but in the overall scheme of things it isn't as insurmountable as it first seems.

 

Not insurmountable except that they are going to have to agree to have full ICU capability on every single ship, including trained medical personnel and everything that goes with it.  Ventilators have to be serviced every 6 months.  That's an expense.  PPE expires.  That's an expense.  Getting trained/qualified medical staff on every ship for every sailing is an expense.

 

Getting shore-side hospitals to agree to take an unknown number of infected patients with unknown prognoses is going to be a large expense.

 

Getting evacuation plans in place for every single passenger via airlines chartered at the cruise line's expense is a very large expense.

 

It's going to be a lot to get in place, and it's going to take time.  It's not happening overnight.

Edited April 23, 2020 by Jobeth66

[npcl]

4 hours ago, Jobeth66 said:

 

Not insurmountable except that they are going to have to agree to have full ICU capability on every single ship, including trained medical personnel and everything that goes with it.  Ventilators have to be serviced every 6 months.  That's an expense.  PPE expires.  That's an expense.  Getting trained/qualified medical staff on every ship for every sailing is an expense.

 

Getting shore-side hospitals to agree to take an unknown number of infected patients with unknown prognoses is going to be a large expense.

 

Getting evacuation plans in place for every single passenger via airlines chartered at the cruise line's expense is a very large expense.

 

It's going to be a lot to get in place, and it's going to take time.  It's not happening overnight.

The requirement is the the cruise lines to be able to manage WITHOUT shore side hospital resources in the US. and without any expense to local, state or federal government.  Basically if cruise lines sail and a case develops it is up to the cruise line to fully manage off shore.  When passengers do come from an impacted ship to shore their travel home must be by charter flights and private cars.  No public transport.

[Jobeth66]

23 minutes ago, npcl said:

The requirement is the the cruise lines to be able to manage WITHOUT shore side hospital resources in the US. and without any expense to local, state or federal government.  Basically if cruise lines sail and a case develops it is up to the cruise line to fully manage off shore.  When passengers do come from an impacted ship to shore their travel home must be by charter flights and private cars.  No public transport.

 

Read Section j of the requirements - in addition to having a critical-care plan onboard each ship for patients, they ALSO have to have agreements in place with shore-side hospitals at every US port to take critically ill passengers (still without cost to USCG/state/local governments).  So they have to have hospitals that will agree in advance of each sailing to take critically ill patients with no idea how many of those patients there may be and what the prognosis of each is.

 

The CDC requirements are onerous, on purpose, to make it difficult for the ships to sail anytime soon.

[graphicguy]

I'm looking at these requirements and not seeing any deal breakers.  As others point out, most modern cruise ships (say, those that have been built in the last 10-12 years) have what I would consider an ICU, with modern monitoring equipment and beds/cabins that can act as isolation areas.  Older/smaller ships would have to be brought into compliance but the newer bigger ships are already there.

 

I've been all over the Caribbean, and certainly all over North America, and with the possible exception of Haiti, all ports I've been to have hospitals that can handle just about any type of medical function.  Payment for those facilities should be covered by cruise insurance (another very good reason to buy cruise insurance).

 

I wouldn't call any of the provisions onerous, by any stretch.  Different?  Probably, but not in any way that current modern hospital standards can't handle.

 

Being proactive, like taking temperatures upon embarkation (via "no touch"), imposing strict washing routines without exception, training staff to recognize ill passengers, etc would probably cover 99.9% of potential virus spread.  No more "fudging" the health questionnaire...you look or sound sick?  You're not allowed to board.

 

Believe it...the cruise companies want nothing more than to get back to sailing, and they'll take any precautions, and any changes necessary to start up again.  Cost won't be an issue, because regardless of what they have to do, in no way is anywhere close to the cash burn they're experiencing now.

 

As time goes on, I can see some inefficiencies worked out of the system, but they'll accommodate just about anything right now to get those ships moving and passengers sailing.

[latserrof]

6 hours ago, fshagan said:

 

Based on the number of ICU beds available in the US (29.4 per 100,000 people), this could be one or two inside cabins equipped with medical equipment. That's .3 per 1000 people, or 1.5 beds for a crew of 1,000 and 4,000 passengers, if I did my math right. 

 

 

Your math is OK, your logic not so much. What if more than 6 people are infected? Maybe 100? Maybe 600? What then?

[seaman11]

sure they can . have a plan in place, and im sure they are planning that as we speak. 

Edited April 23, 2020 by seaman11

[seaman11]

10 minutes ago, latserrof said:

Your math is OK, your logic not so much. What if more than 6 people are infected? Maybe 100? Maybe 600? What then?

they have their own  cabins no? 

Edited April 23, 2020 by seaman11

[EscapeFromConnecticut]

As the data gets more complete, don't look for CLIA to gain ground. Quite the opposite, everything new has been supporting the CDC's case.

https://www.miamiherald.com/news/business/tourism-cruises/article241914096.html

[latserrof]

3 hours ago, seaman11 said:

they have their own  cabins no? 

And their own ventilators?

[fshagan]

On 4/23/2020 at 2:15 PM, latserrof said:

Your math is OK, your logic not so much. What if more than 6 people are infected? Maybe 100? Maybe 600? What then?

 

Think like a regulator approving these measures, not a real live human being.

 

What criteria will they use for "enough" ICU beds? One for every passenger? We know that won't be it. The US national average seems like it would be a good agreement between the cruise line and the friendly bureaucrat.  My logic is that they will use that as the number is defined, it will be something like that. 

 

So, it's not "what if 6" but rather "what is more likely to happen in negotiations between the company and the government"?

 

[latserrof]

10 hours ago, fshagan said:

 

Think like a regulator approving these measures, not a real live human being.

 

 

First, cruise ships are very different environments than those used for the US national average. On land, there are likely alternative sources of treatment. Not so on a cruise ship, particularly ships that may be denied docking because of the very infections they need to treat.

 

Second, if I were thinking like a regulator, ("the friendly bureaucrat"), I would be in CYA mode and try to make sure the ships had more-than-adequate treatment facilities.

 

Third, the cruise lines have very little negotiating power, if any -- particularly right now.

[fshagan]

On 4/25/2020 at 8:23 AM, latserrof said:

First, cruise ships are very different environments than those used for the US national average. On land, there are likely alternative sources of treatment. Not so on a cruise ship, particularly ships that may be denied docking because of the very infections they need to treat.

 

Second, if I were thinking like a regulator, ("the friendly bureaucrat"), I would be in CYA mode and try to make sure the ships had more-than-adequate treatment facilities.

 

Third, the cruise lines have very little negotiating power, if any -- particularly right now.

 

You could be right. We'll have to wait and see if the CDC requires each line to have three ships standing by in every cruise area, or if they take a route closer to my idea, that the industry and government will come to some satisfactory agreement that is a compromise between that and the former situation. 

[EscapeFromConnecticut]

On 4/25/2020 at 11:23 AM, latserrof said:

First, cruise ships are very different environments than those used for the US national average. On land, there are likely alternative sources of treatment. Not so on a cruise ship, particularly ships that may be denied docking because of the very infections they need to treat.

 

Second, if I were thinking like a regulator, ("the friendly bureaucrat"), I would be in CYA mode and try to make sure the ships had more-than-adequate treatment facilities.

 

Third, the cruise lines have very little negotiating power, if any -- particularly right now.

Three excellent points.

And we've seen what happens when the industry is left to operate without backup: It came crying to governments across the globe looking for emergency help with sick and dying passengers. Shipload after shipload of trouble during a pandemic. Beyond inexcusable ... and we can look for lawsuits and criminal investigations to drive home that point.

https://www.bloomberg.com/features/2020-carnival-cruise-coronavirus/

Of course the cruise lines didn't cause the virus. But their long-established operating procedures and their greed-driven decisions in February and March proved to be catastrophic. 

The cruise industry isn't a victim of bad press, bias, public misconceptions or overzealous regulators. No, it is in devastatingly bad shape right now because of its own actions. 

[cruiserssandr]

On 4/22/2020 at 8:00 AM, xcal185 said:

Hi

I was wondering if you took this package, are you able to book any of the specialty restaurants. Are Teppynaki and Cagney included? 

Yes they are included