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"100% Testing Required for Cruise Ship Passengers According to CLIA"


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After reading the CDC's document on their phased plan to resume cruise ship operations from US ports, a wordy and overly complex presentation that has more to do with justifying their actions than presenting a responsible plan, how testing is going to be done is a bit clearer but not yet crystal clear.

Although I do not know which RAPID testing product RCG will use, I know that it will be a RAPID RT/PCR, diagnostic test not a RAPID antigen test.  If you recall my post where I explained the differences in the three types of testing defined by the CDC (Diagnostic, Screening and Surveillance), you'll know that the RT/PCR test is a diagnotic test and the "gold standard." It is as close to 100% accurate as one can get. There are both self contained RAPID RT/PCR products approved by the FDA that will give results in minutes and RT/PCR tests where a sample is collected and then sent to a lab imposing 3-14d delays in results.

RAPID Antigen tests are for screening. These are self contained, some using a desk top device for processing, some use a cassette, credit card sized device. I think those would be fine, they are less expensive but they are a bit more sensitive to errors in collection and processing than correctly administered and processed RAPID RT/PCR tests - hence the CDC directions to not use antigen tests. This is a lay description of testing from the FDA. It has a different break down of test categories than that of the CDC .... which is reflective of the confusing often contradictory information coming from the federal level. It's still fine if you want to understand the details of testing. 

https://www.fda.gov/consumers/consumer-updates/coronavirus-testing-basics

The CDC has always taken the position that risk reduction has to be as close to obtaining zero risk of infection as possible. I think zero risk of infection is impossible. What needs to occur is a layered mitigation process that reduces risk of infection to manageable levels and the Safe to Sail plan touted that. I thought it was great. The bad news, IMO, on the CDC's plan to lift the no-sail-order is that it is designed to fail...... which I believe is the outcome the CDC wants. The CDC is not the friend of the cruise industry - cruising is the quintessential example of congregate settings that the CDC says must absolutely be avoided in the pandemic environment. We'll see. Back to testing ......

There are several ways to gather samples for RT/PCR tests in order of reliability: nasopharyngeal swabs, nasal swabs and saliva. All three collection methods are subject to operator induced errors. That's why these tests should not be self administered but rather administered by providers trained to do it. An advantage of using RT/PCR tests is that they are considered definitive - you don't have to run a confirmatory test like you would if using a screening approach with RAPID Antigen tests. The CDC does not say which collection method must be used - a bit surprising and this may be somewhere that the public does not have access to.

I don't know if you will have to present some lab based proof that you don't have COVID before your arrival at a cruise terminal. I doubt it. There are just too many variables involving modes of travel that render pre-terminal arrival testing unreliable.  So, you'll arrive at the terminal at your designated time and proceed to a testing station that will probably be before TSA screening and check in. Here you'll get screened. I suspect you'll have already filled out an on-line questionnaire and attested to a list of stuff.  Then you'll be administered a RAPID RT/PCR test get and results in minutes. There will be protocols if you test positive that will involve some form of isolation and handling in accordance with local isolation policies. If you read the CDC document you'll know that the cruise lines have to make specific arrangements, agreed to by local public health and port authorities, to handle COVID positive crew or passenger cases discovered on screening. These will vary by the port you are embarking from. If you make it through screening and board, IMO, you'll be entering the safest bubble in existence. No environment I know of will be safer from becoming infected by the virus.

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3 hours ago, JeffB said:

I don't know if you will have to present some lab based proof that you don't have COVID before your arrival at a cruise terminal. I doubt it. There are just too many variables involving modes of travel that render pre-terminal arrival testing unreliable.

...

If you make it through screening and board, IMO, you'll be entering the safest bubble in existence. No environment I know of will be safer from becoming infected by the virus.

I think the cruise lines will still require a pre-arrival lab confirmation or a similar RT/PCR-type test in addition to the one administered on arrival? Why? Because of your assessment (which the cruise lines probably have also determined, and based on all evidence so far that I would agree with) that the CDC very much wants this to fail.

If there is only the on-arrival screening, some portion of the guests detected by the RT/PCR test will be people who were infected many days ago, and who are pre-symptomatic but highly contagious. But if they combine on-arrival with a mandatory lab test taken 3-5 days before arrival, they will have a double-layer mitigation that catches people who are infected before they even leave their house, cutting down those infectious numbers at the port. Then, with the on-board test they'll pick up the remaining people who were infected but still too low of a titer before they flew / drove to the port; hopefully most of them are not yet contagious, and the mask wearing / constant sanitizing while transitioning through the screening will keep the other passengers safe. That leaves only whatever tiny number of people got exposed that day or a day or two before. (or more? How many days does a person have to be infected before they have sufficient viral titer for RT/PCR?) One would hope that, statistically, that number is now so low that only one ship in 10 or hopefully 20 or 100 gets that one passenger.

As you said, absolutely nothing can get them to zero infections on board 100% of ships. But if they use the two-layer approach to screening they can get a lot closer to that 100% while cutting the risk of passenger exposure to as close to 0% as possible.

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On 10/7/2020 at 12:35 PM, rjac said:

Thanks Jeff. That sounds doable, but the enforcement may be a problem. What will they do to someone who has an afternoon arrival and shows up at 10:00 am? And what about the diamond plus and pinnacle guests in star class cabins, will they get special treatment? By the way, you are very knowledgeable on this subject. Are you in the medical field? 

oops - responded to a wrong post!

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All of this emphasizes that the cruising public will run into a cluster in the opening months. I don't care about my own exposure to a disease with a flat death rate, but all of this complexity and friction isn't worth it until the perception of overkill kicks in. Cruising will suck for a long while.

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2 hours ago, FManke said:

I'm sorry if this question has been answered, and I admit I have not read the entire post. How does the 72hr pre-boarding testing effect those of us that like to take a few days pre-cruise at a departure port? Will they provide locations at port to take the test?

It hasn't been answered yet.

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