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

[JeffB]

I'm hesitant to start a new thread but I've not seen this posted on this web site so, here it is.......

CLIA ocean cruise line members worldwide have agreed to conduct 100% testing of passengers and crew on all ships with a capacity to carry 250 or more persons – with a negative test required for any embarkation," Bari Golin-Blaugrund, vice president of strategic communications for Cruise Lines International Association, said today." 

It was actually yesterday at a virtual CLIA sponsored cruise industry wide conference held about this time every year. There's a ton of misinformation about "testing" out there. I hope to clear the fog with this post:

First there are several general categories of testing. I'm only going to talk about two of them: Diagnostic testing and Surveillance testing. These are the ones you will come across when we start cruising again. Within those categories, there are different types of tests and different manufacturers of them. The ones currently in use in the US are FDA approved, most of them under what is called EUD or Emergency Use Authorization. That process makes it easier to get FDA approval not by lowering the quality bar for them but rather reducing the red tape. You've probably heard that the FDA is being prevented from doing this or that. Not true. They continue to do a great job protecting the public.

Diagnostic tests are molecular tests abbreviated as RT/PCR tests. These tests look for a set of specific markers that differentiate the novel coronavirus (SARS-CoV-2) from its more common corona or common cold viruses. They are both more sensitive and specific than surveillance tests and this is by design not by fault. You will have had one of these if you had a swab placed in you nasophayrngeal cavity to obtain a sample. Right now, if everything goes smoothly, the sample gets packaged at the testing site and sent to a lab. There it takes 2-3d to process these and get a result. They are the gold standard for diagnosing COVID-19. These test costs cost anywhere from $35 to $50; processing costs may add more.

Surveillance tests also look for specific markers of the SARS-CoV-2 virus but they are not as specific and may or may not be as sensitive as an RT/PCR test. They are that way by design to make them what is called RAPID point of care (POC) tests where a sample is collected at the POC and results are available in minutes, not hours or days. The testing devices that you'll encounter (there are other types) are in what is called a cassette about the size of a credit card. If you've had a test for influenza A/B, you've seen one of these.  RAPID POC tests cost under $5 and there are no processing costs.

What about Antibody tests? These are the tests that supposedly can tell you if you HAVE HAD the virus. They look for human immune system response to the virus in the form of antibodies or good guys. Antigen tests look for markers of the virus itself while you are having an ongoing infection. Antibody tests are not terribly accurate. You may have a reason for getting this kind of test. Going on a cruise and complying with pre-cruise testing requirements is not one of them.

Cruise lines may require you to obtain a COVID Antigen test within a certain time period before boarding, test you again in the terminal and again at various points in the cruise.

Before cruise testing at a commercial health care facility: You may be able to obtain a COVID test from your primary care provider but chances are good he's going to write an order for one and send you to a commercial lab to get it done. Ask about whether or not they are doing RAPID POC testing, if they send you to a lab or if they collect a sample at their clinic and send it out. Be aware that your average medical assistant who is answering your phone call may have no clue. Talk to the office manager or message/talk to your own PCP.

Alternatively, you can obtain COVID tests at a local pharmacy licensed to administer them (CVS, Walgreen's and Target that I know of - there may be more). I've been to the CVS web site to see how that works. It's pretty straight forward. Depending on your state's public health guidelines, getting a COVID test may require you to meet certain criteria. At the CVS web site there was a questionnaire. When I ticked I was over 65 and nothing else among the list, bingo, a schedule opened up for me to pick a store near me and a time. Availability of RAPID v. Lab based tests varies by store. In my case, no rapid tests were available. Processing time for a lab based test was described as taking 1-3 days. If you can find a pharmacy offering RAPID POC tests and you are pretty sure you don't have it, pick that over a lab processed test. If you test positive on a pharmacy administered RAPID POC test, you'll need an RT/PCR test to rule in or rule out a COVID diagnosis. Choose the type of test carefully

COVID Testing in the cruise terminal and aboard.  Going through the boarding process, you will potentially be required to obtain two tests, the second only if you test positive on the first. The first test is likely to be a RAPID POC, Cassette based test. I'm reading that, at first, the RAPID POC cassette type test may not be available. In that case you'll be administered a rapid saliva test (the real difference between a RAPID POC and a rapid saliva test like the NBA and MLB are using is in collecting and handling). If you test positive on one of these tests, you'll be administered a second confirmatory test that is going to a lab, possibly aboard ship and you would be quarantined until results are available. Best case is hours, worst case is a day or two depending on what kind of confirmatory testing device they are using. Sounds harsh but the cruise lines want a bubble to the extent possible and they are going to get it.

During the cruise, among other layered mitigation measures, you are going to get a RAPID POC or rapid saliva test periodically for the purpose of surveillance. It's not entirely clear at this point how that will be done. It could involve pool testing - a perfect type of surveillance testing for cruises but that would require some pretty sophisticated lab equipment on board. Crew and ship's company also get surveilled.

IMO, life aboard ship would be safer than anywhere on the planet when it comes to COVID infections under these circumstances. Certainly, protocols have to be followed precisely to guarantee that but even then, it's going to be super safe. With strict controls on tours, possibly only porting at first at private islands, it's pretty obvious to me cruising can be done safely. CDC? What's the hold-up?

   

 

[rjac]

Damn good post, Jeff. Going to be interesting to see how the cruise lines conduct the covid test. A cruise ship with over 2,000 passengers will take quite a long time. Time will tell. 

[JLMoran]

1 hour ago, JeffB said:

If you test positive on one of these tests, you'll be administered a second confirmatory test that is going to a lab, possibly aboard ship and you would be quarantined until results are available. Best case is hours, worst case is a day or two depending on what kind of confirmatory testing device they are using.

Question here is how the cruise line will handle these passengers getting a negative result on the second test. I'm assuming when you say such people will be quarantined that they're staying on land, in a nearby hotel or the like, and not being allowed on board but confined to quarters. If that's correct, will the cruise line then do all that's necessary to get these passengers who come back negative back to the cruise, similar to what they do for passengers who miss the ship on a ship-hosted excursion?

If they will do this, and (hopefully) compensate passengers for any lost days while waiting on the test results, this could still be acceptable to a lot of potential passengers.

[JeffB]

rjac .... I'm reading staggered and enforced terminal arrivals. Trained ships medical staff to administer tests with CDC guidelines for conducting, processing and reporting testing data. We live in Fort Lauderdale and cruise frequently out of both Fort Lauderdale and Miami terminals. Both are big enough to allow spacing and crowd control. I'd say a flow of around 100 guests with 20 time slots each about 20m apart. That's around a 7h boarding process - a little longer than now but there is nothing sacred about 4 or 5pm sail times.  

[rjac]

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? 

[JeffB]

Quote

Question here is how the cruise line will handle these passengers getting a negative result on the second test. I'm assuming when you say such people will be quarantined that they're staying on land, in a nearby hotel or the like, and not being allowed on board but confined to quarters. If that's correct, will the cruise line then do all that's necessary to get these passengers who come back negative back to the cruise, similar to what they do for passengers who miss the ship on a ship-hosted excursion?

Great question/points, JLMoran ........ I'd have to go back to the 77 page Safe-To-Sail plan and find it but I think this situation was specifically addressed. After I post this I'll go back and look. There's also been some other sources out there talking about how MSC and TUI are doing this sort of thing.

If I'm reading your post correctly, your question involves the hypothetical of a passenger with negative pre-embarkation COVID test within the last 3-5d, entering the terminal, testing positive on a RAPID POC test in the terminal and pending the results of the second confirmatory test, right? You want to know what they are going to do with that guest.

First, quarantine would apply to a PAX entering the terminal and getting screened who tested positive on a RAPID POC test even if they had received a negative result on a pre-boarding test 3-5d earlier.

Those PAX, as I read the Safe-To-Sail plan, would receive both a second test and additional medical screening by medical staff. That wasn't described in anything I've read. A boarding denial decision would be made during that process. I would imagine the threshold for denying boarding is going to be low. For example, if any COVID like symptoms are present and there's a positive on the first RAPID test, that PAX isn't going to board.

At this point I'm speculating because this kind of detail wasn't provided in the Safe-To-Sail plan. High risk PAX who test positive on a RAPID test pending results of a confirmatory test and are also asymptomatic are probably going to be told they can't board. I suppose asymptomatic low risk PAX could be given the option to board and remain in their cabin until pending 2nd test results are received. That is going to be a medical staff decision with an MD involved in it. I think it would be rare - better safe than sorry but why have a second test if you didn't intend to allow a low risk guest with a positive RAPID test awaiting a confirmatory 2nd test board? I suspect that contingency has been considered - hence the 2nd test. 

If such low risk PAX granted boarding and remaining in their cabin receive a confirmatory positive on their second test before the ship sails,  perform an expeditious disembarkation. This could be to another cruise ship in the fleet designated for that purpose still on the pier. If another cruise ship, this operation would have been pre-planned, practiced and would be executed trained under cruise line supervision and personnel. If to a local hospital, continue the quarantine, notify local authorities by pre-planned arrangements. disembark under local public health personnel supervision and follow local COVID protocols. Such protocols that I'm speculating about have already been tested in Europe with crew members. To my knowledge there have been no actual guest evacuations or immediate disembarkations for COVID infections during European cruise operations. 

If a guest remaining in a cabin awaiting results receives a confirmatory positive on their second test while underway, again, as I understood the Safe-To-Sail plan, an expeditious evacuation similar to any other medical evacuation would be undertaken. The difference here is that protocols for receiving the COVID infected person at a local medical facility would have been pre-arranged and approved rather than ad-hoc.

As for PAX that tested negative on embarkation but subsequently tested positive while underway, immediate cabin isolation and contact tracing would begin. Depending on symptom presentation while underway, care would be provided up to the medical management capability of the on board medical facility. If exceeded, a medical evacuation would be undertaken and this would have already been pre-planned for, reviewed and approved by the receiving port facility and/or local hospital. If the illness is mild, guest would be treated symptomatically and upon disembarkation a pre-planned protocol for handling such cases would have already been approved by local public health officials and would be executed according to that plan.

How many COVID positive people might this involve? Hard to say but I bet the lines have a good idea and they believe it is a manageable number. The 3d pre-embarkation testing requirement helps to limit the numbers of guests that are going to actually enter the terminal, be processed, re tested and subsequently come up confirmed (by two tests) as COVID positive. There are organizations, including cruise lines operating in Europe, that are implementing and continuously QC improving this approach so, it's not completely new.

I hope I've addressed questions you and others may be asking. Some of it is informed speculation. None of this is perfect. None of it reduces risk of infection on board to zero. But I am absolutely convinced that the Safe-To-Sail panel talked about every one of these things and probably more that I haven't even thought of, developed approaches, some of which were not made public, and have this in hand. I also believe, and this is in the Safe-To-Sail plan, that the cruise lines will release very detailed documents regarding the risk passengers are taking if they decide to cruise and in very clear terms how they are mitigating them as well as planning to handle things if a guest or guests become infected.   

[JeffB]

1 hour ago, 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? 

In a reduced capacity setting, I suspect Diamond and Suite guests may have special access. I could just as well see, under the circumstances, an egalitarian approach where  everyone gets treated without regard to status. Great time though for the lines to support their loyalists with special access perks.

Yes, I am in the medical field. I practiced as a Physician Assistant for 22 years in Emergency and Internal Medicine. I've been retired from practice for a bit over three years. I also write on a whole range of COVID related topics on several blogs ..... my passion is to counter, when it is appropriate to do so, the media's, politicized and generally negative narrative. That narrative is often filled with misinformation, flawed interpretation of data points and, many times that flawed interpretation is taken on knowingly to advance a false narrative.     

[JLMoran]

@JeffB, thanks for the speculation. You covered a good number of cases, but I'm thinking along a slightly different line. My speculation is this:

• Passenger has tested negative in his pre-embark 3-5 days out test
• Arrives at terminal, is asymptomatic, but now tests positive on the RAPID POC test
• Has the interview with the medical team and goes through the process of having the third test sample taken; Royal's policy at this point is that out of an abundance of caution, these "low risk" passengers are denied boarding in case their 3-5 day test simply missed the window, and because the destination ports have informed the line that they will not accept infected passengers for disembark and quarantine
• The passenger is told to find a hotel while they await results of their test and to quarantine for that time

What happens if this passenger comes back negative on the final test? My hope would be that at this point, Royal compensates the passenger for their hotel room and flies them out to meet the ship at the first port stop. But do you think this would be a likely policy that they'd put in place? It could end up invoked much more often than the case of passengers who missed the ship while on a ship-hosted excursion, but boy would it garner a lot of good will and trust among people who decide to take part in these earlier sailings and probably for some time to come yet.

Maybe not practical if it's a 4-night or even 5-night sailing. But on a 7-night sailing, it means still having 5 nights of your vacation on the ship and being able to enjoy the bulk of your vacation.

I'm going to assume that by the time 8+ night sailings are a thing again, that these kinds of policies will likely be gone or the thresholds for denied boarding relaxed.

[JeffB]

1 hour ago, JLMoran said:

What happens if this passenger comes back negative on the final test?

It gets a bit squishy here although I have a strong sense the RCG isn't squishy on this at all. In trying to figure out an answer to this question, the one thing we don't know that they do know is the testing device that RCG intends to deploy for it's first screen and second confirmatory test. My guess is that the device they'll use for the first test is an antigen test using one of many cassette based products that provide results in under 15 minutes. Keep in mind, Antigen tests can be considered diagnostic per the CDC when the subject is symptomatic. They are considered screening tests when the subject is asymptomatic as our cruise embarking cohort would be we would hope. To be diagnostic, to be confirmatory of COVID diagnosis, a second test is required in this cohort.  

The second test could be the Abbot labs, ID-NOW. It's a "molecular test" but to my knowledge it is not a Reverse Transcriptase (RT), Polymerase chain reaction (PCR) test - the gold standard for COVID diagnosis. It simply amplifies the RNA of the SARS-CoV-2 virus so it can be detected. What it does do is provide a second testing platform, using a different technology with a rapidly produced result ...... it is also in the 15 minute range. So, two tests in around 30-40m. Abbot claims that the ID-NOW test can be used as a diagnostic test in a screening or surveillance mode of asymptomatic subjects.

In researching the likely testing devices RCG would use, I cannot confirm that a second test using Abbot's ID-NOW test meets the same CDC criteria as RT/PCR tests to be diagnostic. It may, however, be moot. IOW, RCG considers screening by antigen testing that results in a positive test, followed by a medical evaluation and a second confirmatory test, both done within 30-40m time, is all they need to declare the guest is COVID positive and deny boarding or allow boarding if that second test is negative.

In this circumstance, it seems to me, the question you ask and quoted above isn't relevant because it won't happen in the longer time frame I think you are considering. A guest denied boarding within a 30-40 minute COVID screening/embarkation process is just like any other guest denied boarding ..... except as a confirmed positive by RCG's method of determining that, additional measures defined by local COVID regulations, would pertain to how the guest is handled by local public health authorities once he leaves the terminal. I would think RCG would both compensate the guest denied boarding and will have already coordinated with local port and public health officials on how that guest will be transported, quarantined and if necessary receive appropriate medical care. Does this make sense?

Given other layered mitigation measures and additional surveillance testing, I could certainly argue RCG has created a bubble on a cruise ship with a very small but still a non-zero risk of having an outbreak. From what I gather from the Safe-To-Sail plan, RCG plans to make arrangements with locals for handling COVID positive guests, should it be necessary to disembark them. Is all that enough? I think it is. Will the CDC green light restarting cruising using this among other layered mitigation measures for cruise ships? That seems to be the issue and, I will admit, it is arguable either way.       

  

[rjac]

Whew, boy does my head hurt from reading this blog!

[WAAAYTOOO]

15 minutes ago, rjac said:

Whew, boy does my head hurt from reading this blog!

Good to know.  I thought it was just me !

[JLMoran]

58 minutes ago, JeffB said:

In this circumstance, it seems to me, the question you ask and quoted above isn't relevant because it won't happen in the longer time frame I think you are considering. A guest denied boarding within a 30-40 minute COVID screening/embarkation process is just like any other guest denied boarding ..... except as a confirmed positive by RCG's method of determining that, additional measures defined by local COVID regulations, would pertain to how the guest is handled by local public health authorities once he leaves the terminal. I would think RCG would both compensate the guest denied boarding and will have already coordinated with local port and public health officials on how that guest will be transported, quarantined and if necessary receive appropriate medical care. Does this make sense?

Yup, that all makes perfect sense. I had heard about the Abbot Labs test but was thinking that it was going to be the "cassette-based" RAPID POC test you were mentioning earlier. If they can truly conduct a pair of tests inside an hour for the at-risk passengers, and that number of passengers is small enough that on any given day they don't run out of their supply, then that's probably as good as it will get. I was making the assumption that any secondary test would be RT-PCR and require at least a day to process.

[JeffB]

JL ..... Abbot Labs does have a cassette based product just recently FDA approval under EUA called BINAX-NOW.

While I'm just guessing about the testing devices, and even though I might not need to know, I want to be convinced that a sequence of tests RCG might use during the boarding process is appropriate. After all, I'm defending what RCG is doing to mitigate COVID risks.

I'm facing the same situation in travel planning right now where the kind of test and the time frame I would get it is important. It is illustrative of how important it is to know what COVID tests is most appropriate and where you can find a lab or pharmacy that will administer the one that you need.

I'll be traveling to MI to see my son and his family of five. He's a Dentist and is in a high risk of COVID exposure job. We are at COVID risk by age and are traveling by air to MI at a relatively increased congregate setting risk - an airplane. Who should get tested? All of us, the highest risk individuals? When should we get tested. In that you will be most infectious 3-5d after being exposed, what good does it do to test us air travelers right after we arrive in MI?

All of this is hard.      

[JeffB]

For those of you with your heads spinning over COVID testing as it relates to cruising, you're not alone. This is very complex stuff and I haven't gone into probably 75% of it. 

Just be confident that the Safe-To-Sail panel of experts who went though of all this to come up with testing plans absolutely know how everything should work or if they don't they know who to contact for help. I know how to find resources on line. I know how to interpret scientific studies and what their limitations are but I'm an amateur. Take what I say for what it's worth.

[rjac]

55 minutes ago, WAAAYTOOO said:

Good to know.  I thought it was just me !

Yeah, but it is really good info. Glad we have an expert like this on our blog. 

[cruisellama]

8 hours ago, JeffB said:

I'm hesitant to start a new thread but I've not seen this posted on this web site so, here it is.......

CLIA ocean cruise line members worldwide have agreed to conduct 100% testing of passengers and crew on all ships with a capacity to carry 250 or more persons – with a negative test required for any embarkation," Bari Golin-Blaugrund, vice president of strategic communications for Cruise Lines International Association, said today." 

It was actually yesterday at a virtual CLIA sponsored cruise industry wide conference held about this time every year. There's a ton of misinformation about "testing" out there. I hope to clear the fog with this post:

First there are several general categories of testing. I'm only going to talk about two of them: Diagnostic testing and Surveillance testing. These are the ones you will come across when we start cruising again. Within those categories, there are different types of tests and different manufacturers of them. The ones currently in use in the US are FDA approved, most of them under what is called EUD or Emergency Use Authorization. That process makes it easier to get FDA approval not by lowering the quality bar for them but rather reducing the red tape. You've probably heard that the FDA is being prevented from doing this or that. Not true. They continue to do a great job protecting the public.

Diagnostic tests are molecular tests abbreviated as RT/PCR tests. These tests look for a set of specific markers that differentiate the novel coronavirus (SARS-CoV-2) from its more common corona or common cold viruses. They are both more sensitive and specific than surveillance tests and this is by design not by fault. You will have had one of these if you had a swab placed in you nasophayrngeal cavity to obtain a sample. Right now, if everything goes smoothly, the sample gets packaged at the testing site and sent to a lab. There it takes 2-3d to process these and get a result. They are the gold standard for diagnosing COVID-19. These test costs cost anywhere from $35 to $50; processing costs may add more.

Surveillance tests also look for specific markers of the SARS-CoV-2 virus but they are not as specific and may or may not be as sensitive as an RT/PCR test. They are that way by design to make them what is called RAPID point of care (POC) tests where a sample is collected at the POC and results are available in minutes, not hours or days. The testing devices that you'll encounter (there are other types) are in what is called a cassette about the size of a credit card. If you've had a test for influenza A/B, you've seen one of these.  RAPID POC tests cost under $5 and there are no processing costs.

What about Antibody tests? These are the tests that supposedly can tell you if you HAVE HAD the virus. They look for human immune system response to the virus in the form of antibodies or good guys. Antigen tests look for markers of the virus itself while you are having an ongoing infection. Antibody tests are not terribly accurate. You may have a reason for getting this kind of test. Going on a cruise and complying with pre-cruise testing requirements is not one of them.

Cruise lines may require you to obtain a COVID Antigen test within a certain time period before boarding, test you again in the terminal and again at various points in the cruise.

Before cruise testing at a commercial health care facility: You may be able to obtain a COVID test from your primary care provider but chances are good he's going to write an order for one and send you to a commercial lab to get it done. Ask about whether or not they are doing RAPID POC testing, if they send you to a lab or if they collect a sample at their clinic and send it out. Be aware that your average medical assistant who is answering your phone call may have no clue. Talk to the office manager or message/talk to your own PCP.

Alternatively, you can obtain COVID tests at a local pharmacy licensed to administer them (CVS, Walgreen's and Target that I know of - there may be more). I've been to the CVS web site to see how that works. It's pretty straight forward. Depending on your state's public health guidelines, getting a COVID test may require you to meet certain criteria. At the CVS web site there was a questionnaire. When I ticked I was over 65 and nothing else among the list, bingo, a schedule opened up for me to pick a store near me and a time. Availability of RAPID v. Lab based tests varies by store. In my case, no rapid tests were available. Processing time for a lab based test was described as taking 1-3 days. If you can find a pharmacy offering RAPID POC tests and you are pretty sure you don't have it, pick that over a lab processed test. If you test positive on a pharmacy administered RAPID POC test, you'll need an RT/PCR test to rule in or rule out a COVID diagnosis. Choose the type of test carefully

COVID Testing in the cruise terminal and aboard.  Going through the boarding process, you will potentially be required to obtain two tests, the second only if you test positive on the first. The first test is likely to be a RAPID POC, Cassette based test. I'm reading that, at first, the RAPID POC cassette type test may not be available. In that case you'll be administered a rapid saliva test (the real difference between a RAPID POC and a rapid saliva test like the NBA and MLB are using is in collecting and handling). If you test positive on one of these tests, you'll be administered a second confirmatory test that is going to a lab, possibly aboard ship and you would be quarantined until results are available. Best case is hours, worst case is a day or two depending on what kind of confirmatory testing device they are using. Sounds harsh but the cruise lines want a bubble to the extent possible and they are going to get it.

During the cruise, among other layered mitigation measures, you are going to get a RAPID POC or rapid saliva test periodically for the purpose of surveillance. It's not entirely clear at this point how that will be done. It could involve pool testing - a perfect type of surveillance testing for cruises but that would require some pretty sophisticated lab equipment on board. Crew and ship's company also get surveilled.

IMO, life aboard ship would be safer than anywhere on the planet when it comes to COVID infections under these circumstances. Certainly, protocols have to be followed precisely to guarantee that but even then, it's going to be super safe. With strict controls on tours, possibly only porting at first at private islands, it's pretty obvious to me cruising can be done safely. CDC? What's the hold-up?

   

 

Excellent information - great summary and helpful advisories.

[Traveler]

10 hours ago, JeffB said:

JL ..... Abbot Labs does have a cassette based product just recently FDA approval under EUA called BINAX-NOW.

While I'm just guessing about the testing devices, and even though I might not need to know, I want to be convinced that a sequence of tests RCG might use during the boarding process is appropriate. After all, I'm defending what RCG is doing to mitigate COVID risks.

I'm facing the same situation in travel planning right now where the kind of test and the time frame I would get it is important. It is illustrative of how important it is to know what COVID tests is most appropriate and where you can find a lab or pharmacy that will administer the one that you need.

I'll be traveling to MI to see my son and his family of five. He's a Dentist and is in a high risk of COVID exposure job. We are at COVID risk by age and are traveling by air to MI at a relatively increased congregate setting risk - an airplane. Who should get tested? All of us, the highest risk individuals? When should we get tested. In that you will be most infectious 3-5d after being exposed, what good does it do to test us air travelers right after we arrive in MI?

All of this is hard.      

Very interesting , thank you  .

As evacuation and treatment going to be very expensive I wonder if the cruise line will not force everyone to buy health insurance that covers it .

For testing on board , as you said , they might do daily tests but the will combine the samples per floor or section on the ship , if the results will be positive they  can quarantine this section until repeat the test , this time individual to find the right people. that can save allot of money and time.  

[mattymay]

 

 

 

 

[Traveler]

12 minutes ago, mattymay said:

 

 

 

 

This is very good news , 

It means that people will not need to find a way to do the test and hope that results will come on time but RCL will do so , might save allot of issues (including arguing if a certain lab is certified or not) 

[mattymay]

[cruisellama]

I hate saying this but, now we need the sailing opportunity to take it --- 

[JeffB]

A good step forward re C-19 testing.

Keep in mind there are several categories of tests. This test is a Reverse Transcriptase Polymerase Chain Reaction (RT/PCR) or a molecular test. There are three ways to collect samples: (1) via a nasophayrngeal swab (the most uncomfortable), (2) A nasal swab (not terribly uncomfortable), (3) A saliva sample (spit in a collection pipette). Costco is offering #3. The RT/PCR test is the gold standard. It is a diagnostic test.  All of them are subject to errors induced by collection or processing. I'm not a big fan of  home administered tests when they are easy to get with trained medical supervision/collection at a number of pharmacies and medical clinics at no cost to you. But, it's what's available now, the FDA has green lighted them and it is a part of the federal goal to expand testing as quickly as possible. So, OK.

What the cruise industry needs are screening tests administered by ship's staff trained to collect and process them. I can't say for certain that these are or are not being used on crew members or passengers cruising now. There are several US manufacturers making these. Abbott Labs is one and was the first to be approved by the FDA in May. There are two of them; BINAX ID (the testing device is about the size of a small toaster) and BINX-Now The testing device is a cassette the size of a credit card). Binax ID is the one Trump touted and the one used (not very well) in the WH. Right now there aren't enough of either of these being produced and other pharmaceutical companies have problems crossing the FDA bar. They can be processed from a nasal swab sample in 15m or less. If you have been tested for flu or strep at a clinic this is the same thing. The ones that are being manufactured are being distributed from the federal level to State Agencies for distribution. Health care staff, hospitals, first responders and nursing home staff/residents are getting them now. Distribution will expand as production capacity expands.

CVS has them as an option on their web site but they aren't available. I found 4 outpatient clinics associated with a large Hospital in Atlanta, GA (East Side Hospital System) that were administering the BINAX Now, 15 minute test. When I tried to schedule one all the appointments were booked. You have to be quick when the next day opens - they do them two days at a time. I was traveling to see my grand-kids and got an RT/PCR test before we traveled. It was simple and easy. You can certainly find a CVS, or Little Clinic (Kroger) and I think Target and Walmart pharmacies are doing them (I'd go for the CVS Minute Clinic variety). You may be able to locate a clinic owned by a large hospital system that is doing the 15m tests in your area. Big hospitals may take some of their tests and send them out to clinics they own. Insurance covers these and each will cost your insurer about $100 ($65 and up for the exam/collection, $35 for the test). They don't cost you anything ..... or you can spend 130 bucks at Costco, risk missing up the collection and a false result - mostly negatives.

I can't emphasize the importance of testing, isolation when appropriate and tracing of contacts at scale enough. It is key to normalization of our lives. It has to be done from the Federal level with standard reporting of results to a single Federal entity, standard procedures for isolating the infected and standardized, well defined protocols for tracing. Every state has to follow the same protocols, trace and report the same way.

Cruise ships operating now and when they start out of US ports are microcosms of a national testing strategy. It works to control the virus. Add compliance with the simplest mitigation measures, throw in a vaccine and this thing will be behind us by late July, 2021. The Feds should be getting on this now, are to some extent but the current administration still thinks states should run everything. That approach has resulted in unreliable COVID data that plagues our public health system now. It might get better in January. 

[twangster]

10 hours ago, JeffB said:

I can't emphasize the importance of testing, isolation when appropriate and tracing of contacts at scale enough. It is key to normalization of our lives. It has to be done from the Federal level with standard reporting of results to a single Federal entity, standard procedures for isolating the infected and standardized, well defined protocols for tracing. Every state has to follow the same protocols, trace and report the same way.

Cruise ships operating now and when they start out of US ports are microcosms of a national testing strategy. It works to control the virus. Add compliance with the simplest mitigation measures, throw in a vaccine and this thing will be behind us by late July, 2021. The Feds should be getting on this now, are to some extent but the current administration still thinks states should run everything. That approach has resulted in unreliable COVID data that plagues our public health system now.

I think we are in agreement.  More testing and tracing lets us identify individuals and close contacts who need to quarantine/isolate so that more of our society can be opened.  It's a means to open more, not less as it allows us to "see" the virus and regional trends so that the response can be intelligent as opposed to falling back on draconian widespread shutdowns.

Without becoming political some of the testing problems in the WH appear to be one of reduced testing that would be like saying the Captain of the ship doesn't need to test if everyone else has been tested.   To their credit the WH has helped us understand how not to go about accomplishing this, what doesn't work and why.

Until an effective vaccine is truly widely and readily available around the world there are mitigation steps such as distancing and masks that can be used to compliment increased testing to reduce spread.  These steps help to cover the period between tests when individuals don't yet know they are carrying and spreading the virus.

Cruise operations with proper testing, tracing and isolation can be a means to prove how this can work effectively.  Some public health organizations have used the early outbreaks as a means to learn what didn't work.  This includes failures in nursing homes as well as on ships including Naval vessels.  For those public health organizations that are open to learning from the real world, cruise operations now represent an opportunity to build testing models that can be referenced to scale these concepts on a larger basis to entire countries.

[PaulRC]

On 10/7/2020 at 6:04 PM, JLMoran said:

Passenger has tested negative in his pre-embark 3-5 days out test

I have not found any place around here (South Carolina, USA) that gives you results in a timely manor.  It takes at least 14 days to get the results, and you are superposed to quarantine for the 2 weeks while waiting for the test results.   If RC is going to require test results to be only 3-5 days old they are cutting stats like SC out from cruising!  

 

[MaryCS62]

Here's an intriguing option:

https://www.ecowatch.com/amp/dogs-detect-coronavirus-2648427157

[SpeedNoodles]

26 minutes ago, MaryCS62 said:

Here's an intriguing option:

https://www.ecowatch.com/amp/dogs-detect-coronavirus-2648427157

I'm all for this one, lol.

[stevendom57]

On 10/7/2020 at 4:24 PM, JeffB said:

also write on a whole range of COVID related topics on several blogs

Would it be possible for you to post the locations of the blogs that you write? I am very interested in getting unbiased information about COVID.

[JeffB]

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.

[JLMoran]

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.

[DJsMrs]

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!

[DunkelBierJay]

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.

[FManke]

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?

[Matt]

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.

[FManke]

On 11/5/2020 at 12:43 PM, Matt said:

It hasn't been answered yet.

One of many unanswered questions at this point.

[Dennis M]

On 10/7/2020 at 6:43 PM, rjac said:

Whew, boy does my head hurt from reading this blog!

Too much reading for me. I will wait for the movie. 

[FManke]

4 hours ago, Dennis M said:

Too much reading for me. I will wait for the movie. 

Maybe there's a Cliff's Notes version? 

 

 

[JLMoran]

5 hours ago, Dennis M said:

Too much reading for me. I will wait for the movie. 

Tom Hanks as @Matt!!