possible mandatory COVID testing for Caribbean cruises

[hcat]

Where is the fun?

Guess we'll stay off ships for awhile. We are.enjoying  our new furniture and other home upgrades  financed with funds saved from cancelled cruises!

[d9704011]

12 minutes ago, Dwight1 said:

Your questions are exactly mine. Any test statistically has failures. It’s inevitable among several thousand passengers a few with covid 19 will slip thru undetected. To think otherwise is dreaming. Then like you said what happens??? Cruise cut short? Stuck in your Cabin for 14 days, Miss your original flight home? Many big ifs for a vacation .


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You may even get infected....

[Fouremco]

14 minutes ago, Dwight1 said:

I’ll just have to pick a more reasonable island.

Given the very limited medical facilities in Saint Martin, I'd say that they are being very tough but equally reasonable in their attempt to prevent the virus being brought to the island by tourists.  

[sanger727]

1 hour ago, K.T.B. said:

 

Focusing on the part I highlighted in red:

 

There are 2 tests.  One you get back quickly, but is only about 80% accurate.  Good example of its inaccuracy is what happened to Matthew Stafford when he had a false positive.  The test that is 100% accurate takes many days to come back.  So if they do want to test, they'll need to deal with the outcomes of passengers who get false positives and appropriately reimburse any and all losses.

 

IMO, what they should do is have the passengers get tested by their own doctor prior to the cruise and have the passenger provide documentation upon check-in that they're covid free.

 

No test is 100% accurate. But even if one was, all it tells you is that you are covid free at the moment you are tested (though, even the "accurate" tests have a pretty high false negative rate because you can be carrying the virus without shedding enough to test positive). Even so, the moment you leave the testing site you could be infected. Especially traveling to the port, pre cruise hotel and activities, boarding, etc. There is NO way to prove you are covid free when you board. 

[K.T.B.]

3 hours ago, npcl said:

What test are you referring as being 100% accurate.  The most accurate test out there at detecting active disease is PCR based and the best it can do is a 20% false negative rate depending upon stage of disease.  False positive rates for PCR are less systemic and often involve issues with lab procedures, cross contamination, sample collection and handling, etc.

 

The one that takes over a week to get the results.  It may not be 100%, but it's damn close. The one that's, at best, 80% accurate gives you results in less than 48 hours.  I got that information from Dr. Robert Murphy, who is a professor of infectious disease at Northwestern University`s Feinberg School of Medicine and the executive director of The Institute for Global Health.  He appears daily on the morning news on WGN in Chicago.

Edited August 13, 2020 by K.T.B.

[npcl]

1 hour ago, K.T.B. said:

 

The one that takes over a week to get the results.  It may not be 100%, but it's damn close. The one that's, at best, 80% accurate gives you results in less than 48 hours.  I got that information from Dr. Robert Murphy, who is a professor of infectious disease at Northwestern University`s Feinberg School of Medicine and the executive director of The Institute for Global Health.  He appears daily on the morning news on WGN in Chicago.

Do you know what day?

 

PCR is the gold standard.  The time it takes to get back is dependent upon the sample volume vs lab capacity.

 

It has the same error rate if it takes 1 day, 2 days or a month to get back. Because the false negative error rate is largely a function of the presence of sufficient quantity of virus at the sample site. Patient infected but not shedding the test will come back negative.

 

There are other quicker test such as the one from Abbott that is a 15 minute in office test, but it is not a sensitive as the PCR.

 

Then you get into the antibody tests, which while it may detect active infection in its later stage it is mostly to try to see if some had an earlier infection. However, this test is sometimes misused and is prone to false positive results.  The Ohio Governors false positive test was caused by using an antibody test in place of a diagnostic test. The test that came back negative was a PCR test.

 

Here is the John Hopkins study which one of the best studies in this area

 

https://www.acpjournals.org/doi/10.7326/M20-1495

 

So the question still remains what is the test you are referring as being nearly 100% accurate? I have not been able to find reference to any such test either on line or in medical literature.

 

The best mechanism for being  certain that someone is clear would be 14 day isolation with tests run on day 1, day 7 and day 14.  The cruise lines in Europe have tried test in home country, 14 day quarantine and still had crew test positive before boarding ship with a second test at the end of their quarantine period. WE saw what happened in Alaska with test a home, test 5 days later upon arrival in Alaska with the first being negative and second positive.  Would be interesting to find out if their was third test and what the results would be.

 

I did find this interview with Dr Murphy where he did talk about testing to some degree.  His comments were consistent with the John Hopkins report concerning timing of testing.

 

https://wgntv.com/morning-news/how-do-we-know-if-the-test-are-accurate-dr-robert-murphy-answer-viewer-covid-19-questions-7-21/

 

I will keep looking and see if I can find anything else.

Edited August 13, 2020 by npcl

[markeb]

1 hour ago, K.T.B. said:

 

The one that takes over a week to get the results.  It may not be 100%, but it's damn close. The one that's, at best, 80% accurate gives you results in less than 48 hours.  I got that information from Dr. Robert Murphy, who is a professor of infectious disease at Northwestern University`s Feinberg School of Medicine and the executive director of The Institute for Global Health.  He appears daily on the morning news on WGN in Chicago.

 

I'm not seeing anything near that "accurate", a word I frankly hate. In this context, I don't need the test to be right; I need it to not be wrong! If I'm going to exclude people because I believe they're infected/infectious, I need the highest negative predictive value I can get, which means a very sensitive test that WILL have false positives (which as NCPL has discussed, is extremely unusual in SARS-CoV-2 PCR).  That's arguably different from a clinical diagnostic criteria, and these tests were largely developed along diagnostic criteria, not exclusionary screening criteria. I realize I'm being a little pedantic here, but if you don't want false negatives on the ship, you've got to accept false positives at screening.

 

If what's being said is that a specific PCR is close to 100% accurate in finding SARS-CoV-2 RNA if present, that's an interesting but I'll argue almost irrelevant data point and is centered on the laboratory processing. You have to sample when the virus is present in the specimen your sampling, and that has proven to be the hard part. It's not always there...

[UnorigionalName]

1 hour ago, npcl said:

It has the same error rate if it takes 1 day, 2 days or a month to get back. Because the false negative error rate is largely a function of the presence of sufficient quantity of virus at the sample site. Patient infected but not shedding the test will come back negative.

 

The increase in turn around time for the labs is usually pre-analytic.  The specimens sit around (sometimes at room temperature) while endogenous RNAase gets to much away at the virus for up to 2 weeks before the labs can get around to running the RNA extraction, which is part of the whole test usually as a sample-to-answer platform. (ie you can't split the RNA extraction step and do it first.  Also the RNA extraction reagents ARE the bottleneck so that wouldn't help even if they are separated).

 

So there is very much the fear that the increase in turn around is affecting the performance of the assay.  Also I bet a lot of the false negative tests are also due to poor collecting techniques.  The best assay in the world won't do you any good if people aren't collecting good swabs.

Edited August 13, 2020 by UnorigionalName

[Straughn]

The daughter of a good friend is a Physician’s Assistant. Her boss is very into testing, not just for COVID-19, but a lot of communicable diseases.  He had her take a COVID/nasal swab test in his office. He then sent her to a local testing center which also administered the nasal swab test. The two tests were administered within 2 - 2 1/2 hours of each other. Test one-positive; test 2- negative. Goes to show how unreliable the nasal swab tests can be. Follow up tests done by her boss were negative all but once. She was tested for 14 days straight.

 

So, my test, within 72 hours of boarding,  shows as negative. Am I negative or am I showing a false result?  Or am I positive and showing a false result? That is the question...

[WonderMan3]

6 hours ago, Gracie115 said:

Well we have NO idea how they are doing excursions at this point.  I would bet there would be fewer people on each bus, I would also bet they control where you go and how much (if any) interaction there would be with anyone not on the ship or with the cruise line. I also believe it will cost more than normal.    

 

Doing it this way they control the scenario, they knew where you've been and who you have seen.  Makes perfect sense to me.

 

Well, a normal excursion group is around 40-50 people, so I imagine that this will be more around 25 people. It can't be much less than that unless they plan on increasing excursion prices as the cruise line wants to still make a profit on these tours. I still wouldn't want to be forced into a group of 24 other people when it could be just me and my spouse traveling around by ourselves in port. When you are in the middle of a pandemic where gatherings are discouraged then group shore excursions are the last place I want to be.

[hcat]

The Oceania brochure references the Healthy sail panel and mention  embarkation health screening but no test requirement..indicates ships will have rapid test capability.  

 

Celebrity will probably be similar.

 

Part 2

Mentions crew testing and temp checks multiple times daily

Edited August 13, 2020 by hcat

[hcat]

 

Crew etc

 

Edited August 13, 2020 by hcat

[hcat]

[hcat]

Sorry these were posted out of order..but they can be read if enlarged.

[d9704011]

..... dedicated isolation accommodation should the unlikely need arise.  Fair enough but it would be useful to know what the cruise line has worked out with government agencies/authorities what might be expected to transpire in the event there is a widespread outbreak of CV-19.

 

My next cruise is scheduled for January, 2022.  If any significant portion of this protocol remains necessary, I won’t be making the trip.

[Gracie115]

29 minutes ago, hcat said:

 

Crew etc

 

 

 

We got that brochure today...encouraging and Oceania offering some good pricing.

[Gracie115]

55 minutes ago, WonderMan3 said:

 

Well, a normal excursion group is around 40-50 people, so I imagine that this will be more around 25 people. It can't be much less than that unless they plan on increasing excursion prices as the cruise line wants to still make a profit on these tours. I still wouldn't want to be forced into a group of 24 other people when it could be just me and my spouse traveling around by ourselves in port. When you are in the middle of a pandemic where gatherings are discouraged then group shore excursions are the last place I want to be.

 

No one would force anyone to do anything.  If you don't want the excursion you stay on the ship...and for us right now that would be just fine......I'm sure it would not be a long term thing but to get the ships running again this is a small concession as far as we are concerned. 

[K.T.B.]

3 hours ago, npcl said:

Do you know what day?

 

PCR is the gold standard.  The time it takes to get back is dependent upon the sample volume vs lab capacity.

 

It has the same error rate if it takes 1 day, 2 days or a month to get back. Because the false negative error rate is largely a function of the presence of sufficient quantity of virus at the sample site. Patient infected but not shedding the test will come back negative.

 

There are other quicker test such as the one from Abbott that is a 15 minute in office test, but it is not a sensitive as the PCR.

 

Then you get into the antibody tests, which while it may detect active infection in its later stage it is mostly to try to see if some had an earlier infection. However, this test is sometimes misused and is prone to false positive results.  The Ohio Governors false positive test was caused by using an antibody test in place of a diagnostic test. The test that came back negative was a PCR test.

 

Here is the John Hopkins study which one of the best studies in this area

 

https://www.acpjournals.org/doi/10.7326/M20-1495

 

So the question still remains what is the test you are referring as being nearly 100% accurate? I have not been able to find reference to any such test either on line or in medical literature.

 

The best mechanism for being  certain that someone is clear would be 14 day isolation with tests run on day 1, day 7 and day 14.  The cruise lines in Europe have tried test in home country, 14 day quarantine and still had crew test positive before boarding ship with a second test at the end of their quarantine period. WE saw what happened in Alaska with test a home, test 5 days later upon arrival in Alaska with the first being negative and second positive.  Would be interesting to find out if their was third test and what the results would be.

 

I did find this interview with Dr Murphy where he did talk about testing to some degree.  His comments were consistent with the John Hopkins report concerning timing of testing.

 

https://wgntv.com/morning-news/how-do-we-know-if-the-test-are-accurate-dr-robert-murphy-answer-viewer-covid-19-questions-7-21/

 

I will keep looking and see if I can find anything else.

 

From today:  https://wgntv.com/morning-news/the-vaping-thing-is-much-worse-than-expected-dr-robert-murphy-answers-viewer-covid-19-questions-8-13/

[WonderMan3]

1 hour ago, Gracie115 said:

 

No one would force anyone to do anything.  If you don't want the excursion you stay on the ship...and for us right now that would be just fine......I'm sure it would not be a long term thing but to get the ships running again this is a small concession as far as we are concerned. 

You would be forced into a group if you wanted to leave the ship. I book cruises to visit different ports not to be trapped on the ship for a week or more.

Edited August 14, 2020 by WonderMan3

[npcl]

1 hour ago, K.T.B. said:

 

From today:  https://wgntv.com/morning-news/the-vaping-thing-is-much-worse-than-expected-dr-robert-murphy-answers-viewer-covid-19-questions-8-13/

From this clip

 

when he was talking about an 80% test vs 100% test  he was talking about hypothetical examples trying to say that if you had a perfect test but it took 2 weeks it would be worthless compared to a test that was 80% accurate that you got back in 1 day.  He was not talking about actual tests but more about considerations in testing.

[Gracie115]

8 hours ago, WonderMan3 said:

You would be forced into a group if you wanted to leave the ship. I book cruises to visit different ports not to be trapped on the ship for a week or more.

 

And that's the difference between us....I have never thought of being on a ship as being "trapped!!"  We book TA's because we love sea days, in fact have 2 planned right now (fingers crossed they sail)  The ship, the ocean, the serenity that it brings......ah... I miss that.

[bouhunter]

17 hours ago, Dwight1 said:

I wanted to go to French St Martin instead a cruise in 2021(and cancel the one have) but the local Government there requires the test results no older than 72 hours at your arrival and proof of an international health policy covering covid costs. I agree no here can in the least guarantee that quick a turn around on the test and another Heath insurance. Phooey, I’ll just have to pick a more reasonable island.


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Actually the St Maarten website right now states you must have health insurance, and that "covid insurance" (whatever that is....) is highly recommended.  As for the 72 hour test, seems that would be tough to accomplish right now since people are waiting days for results in many places in the US.  We bought some cheap plane tickets to St. Maarten in January.  Remains to be seen if we will use them.

 

 

Edited August 14, 2020 by bouhunter

[d9704011]

6 minutes ago, bouhunter said:

Actually the St Maarten website right now states you must have health insurance, and that "covid insurance" (whatever that is....) is highly recommended. 

I’m not sure there is a specific CV-19 insurance policy in Canada but here is an excerpt from the Medipac insurance site (very popular with Canadian Snowbirds Association).  I think it pretty much fits the bill for travel/health insurance related to CV-19:

 

The Government of Canada has issued a travel advisory for non-essential travel to all countries due to COVID-19. During the duration of this COVID-19 advisory, Medipac WILL NOT apply Exclusion 29 in the adjudication of claims; i.e. coverage for COVID-19 will be provided.

Where the government warns against all travel (for any reason, including COVID-19) Exclusion 29 will apply. For example, travel on a cruise will not be covered as the government warns against all cruise ship travel.

[sanger727]

11 hours ago, hcat said:

The Oceania brochure references the Healthy sail panel and mention  embarkation health screening but no test requirement..indicates ships will have rapid test capability.  

 

Celebrity will probably be similar.

 

Part 2

Mentions crew testing and temp checks multiple times daily

 

It sounds like they are going to use the rapid testing in the event someone has symptoms. Which makes sense. I couldn't begin to judge which % accurate different types of tests are, but let's say the rapid tests are 80% accurate. If you have COVID symptoms and get a positive test, you should certainly be isolated and determine if others you have been in close contact with should be quarantined.  If you have COVID symptoms and a negative test, you should still be isolated (cause either way you potentially have some contagious disease either way), but won't necessarily quarantine healthy people. Even at 80% accurate with some positives testing negative and some negative testing positive, there isn't alot of harm done either way.  Compare that to testing 100's to 1,000's of people at a potentially 80% accuracy rate; that will lead to 10's to 100's of false positives/negatives that could disrupt the entire cruise.

[WonderMan3]

6 hours ago, Gracie115 said:

 

And that's the difference between us....I have never thought of being on a ship as being "trapped!!"  We book TA's because we love sea days, in fact have 2 planned right now (fingers crossed they sail)  The ship, the ocean, the serenity that it brings......ah... I miss that.

You’re missing the point. I am referring to an itinerary where you can’t get off the ship without being forced into a group. On a normal itinerary where there are both sea and port days where you can do as you please I enjoy that. I like a balance. Without that option of freedom in the ports then it would be 7 or more days onboard the ship some of which would be on a ship just sitting in port which is not a sea day.