Covid Testing Requirements

[flipflopper]

I have 2 Royal Caribbean cruises booked in October 2021, and though not on the same ship, they are back-to-back (leaving on 2nd, the same day the 1st returns). I’m concerned about how I’m going to get required Covid testing prior to departing on the 2nd cruise. Will I have to get tested in my last port on the first cruise, and hope results are ready and sent to me prior to the 2nd cruise, or will testing be available aboard ships? If results from Rapid (Antigen) tests were allowed, it would make it so much easier. Anyone heard if PCR tests will be available onboard?

[twangster]

No firm details on the requirements to cruise, yet.

Testing is speculated to be a requirement but that is just that - speculation. 

We don't know anything with certainty. 

[smokeybandit]

Your test for your 2nd leg would be the required disembarkation test you got on the first leg.  

But as others have mentioned who the hell knows what testing requirements will look like when things actually do start up.

[JeffB]

I'd add this: I'll argue there's 99.9% chance that at start-up, to board, you'll require proof of vaccination or a negative COVID test possibly both. CLIA announced back last fall that all member lines had agreed on a requirement for COVID testing prior to boarding for both passengers and crew members. Several lines have announced all crew-members will be vaccinated. One line has announced all passengers and crew must be vaccinated. You may be able to use a post-sail RAPID Antigen test from your first cruise to board your 2nd cruise. But it gets complicated. See below.

It is less certain whether the requirement for testing will be a PCR test or a RAPID test or even required if proof of vaccination is required. I've read several articles on governments, mostly in Europe, struggling with how to implement "vaccine passports." One of the technical issues identified in the public domain, among many that Europeans working on this are dealing with is that new variants, capable of re-infecting vaccinated people, are out there. I want to emphasize that whether you can acquire a variant after vaccination AND transmit it is far from certain. There is anecdotal evidence that can happen but (1) such re-infections are rare and (2) symptoms have been mild and that implies low viral loads possibly not transmissible at all. Lots of truly unknowns here that we'll learn more about in the next 3 months.  

if it is required for boarding, there is plenty of uncertainty and an equal amount of confusion regarding terminology even among infectious disease experts. For example, what kind of test, how far in advance can you get it, will it be provided by the cruise lines in the terminal at check-in, will there be an added cost to you from your cruise line. Again, lots of unknowns that are being called "technical issues." Regarding terminology review this here - its from the CDC and IDSA (Fauci's home and in this case he's precise). These are US Government official terms but you may not find them being used routinely if you ask a clinic, for example, what should be a simple questions, "what kind of testing do you do. You may or may not get the answer you need.  https://www.idsociety.org/covid-19-real-time-learning-network/diagnostics/rapid-testing/  

Where are you sailing from? Port Everglades in Fort Lauderdale and Port of Miami have nearby, no appointment needed COVID testing clinics offering both kinds of RAPID COVID Tests. A Google search around the port you are leaving from will tell you what you need to know if you need to get a test on your own. The short of it from the link above is that there are both RAPID Antigen tests (results in 15-30 minutes) and RAPID Molecular tests that don't use the same Reverse Transcriptase Polymerase Chain Reaction (RT-PCR) process but have the same diagnostic reliability as a test done using the RT-PCR process have. It's the RT-PCR process that takes up to 72h for results. RAPID Molecular tests that ID the same COVID RNA that RT-PCR tests do with the same reliability produce results in around 30 minutes. They should both be acceptable, hihg reliability, diagnostic tests. Terminology caveats apply. I've seen these advertised. Compared to a RAPID Antigen test that costs $50-100 and Medicare covers them (as well as the RT-PCR tests), the RAPID Molecular tests cost upwards of $250. Medicare probably doesn't cover these. Commercial insurance might.   

Sorry for this long post but none of this is simple and it deserves thorough explanation so you've got some of the facts on the question you asked available to you. 

[flipflopper]

I just went back through a live blog from the Quantum sailing in Singapore in December. The writer was sailing a back to back and was required to have an onboard PCR Covid test on the last sailing day of the first cruise as well as a rapid test the day of debarking/embarking. That does give me some reassurance that I won’t have to find my own PCR test in port somewhere.

[smokeybandit]

The CDC has said it has to be a PCR test. Of course that was from October, so who knows if that'll stay true. If so that introduces a lot of complications, especially for a cruise line on disembarkation if the CDC maintains the rule that all have to be re-tested to leave.

PCR tests themselves only take 6 hours to run, but one's own test might take 72 hours (or upwards of a week) to go from swab to notification of results.

 

[JeffB]

18 minutes ago, smokeybandit said:

The CDC has said it has to be a PCR test. Of course that was from October, so who knows if that'll stay true. If so that introduces a lot of complications, especially for a cruise line on disembarkation if the CDC maintains the rule that all have to be re-tested to leave.

PCR tests themselves only take 6 hours to run, but one's own test might take 72 hours (or upwards of a week) to go from swab to notification of results.

 

I think the CDC would bend on the PCR requirement. It really isn't practical as a pre-boarding requirement. Maybe post sailing as it appears Quantum is doing but that would depend on what local health authorities demanded. I also think that since the CDC made that cruise ship requirement for PCR testing, knowledge about types of testing and how to surveil effectively rather than diagnose has become better understood.   

To be frank, I've learned to question most of the CDC's guidance, not dismiss it, but look carefully at it. Their most obvious blunder was over masks but I think Trump pressured the CDC on that one. There have been plenty of other examples where their public statements based on modeling they subscribed to and guidance provided has been shown to be inaccurate or wrong.  

[flipflopper]

I logged into Royal Caribbean’s Singapore website and found guidance that states the Covid PCR test has to be done 72-48 hours before departure, so that would suggest the elimination of the possibility of having a test in Florida in between cruises on the day of debarking/embarking

 

[JeffB]

Interesting. I don't see that an RT-PCR COVID test is required in the snap-shot of the page you posted. Just that it is a SARS-CoV-2 test. The 2-3d window for pretests certifying you don't have COVID has become the standard window that most countries and conveyances are using, if they require COVID testing, enter/board. Was the requirement for an RT-PCR COVID test somewhere else in the FAQs? 

[WAAAYTOOO]

Aren't the RT-PCR tests the ones that were so unreliable a while back ?

[JeffB]

Yes ..... again the CDC was involved. The problem was bad reagents by design. I don't have the nitty gritty details but it was a bad screw up and had an impact on early testing and tracking that had they gotten this right, if we had gotten masking right, we wouldn't be where we are now. 

[smokeybandit]

PCR tests were never meant to be a primary means of diagnosing any disease. They're supposed to be a diagnostic aid along with symptoms and/or known exposure to truly diagnose covid.  Their issue is they're over relied upon as an outright yes/no for a positive case instead of a "there might be something here" aid.  It's like using a metal detector to prove you found buried treasure, without actually digging to see if it's just a rusty tin can or not.

[JeffB]

Quote

PCR tests were never meant to be a primary means of diagnosing any disease.

The area of testing, aside from the complexity of the actual tests themselves, how they are officially described is fraught with the same kinds of language, terminology and definition problems that tests are.

Context first. There are three purposes generally understood by epidemiologist for testing in viral epidemics and pandemics (1) Diagnosis, (2) Screening and (3) Surveillance. Different tests are more suitable for each of the three purposes although neither the CDC or the FDA mandates a certain test for a certain purpose. What the FDA does do is regulate their use. If you have ever worked in a lab that processes samples of blood, sputum, tissue, etc. for medical purposes, you know what CLIA is (short for the Clinical Laboratory Amendments of 1988 Statute of the Public Health Services Act.)

CLIA is how the FDA accomplishes oversight of clinical lab testing. When a test is used for one of the first two purposes above the FDA establishes quality control standards, e.g. how accurate does a test need to be to serve the purpose for which it is intended. Diagnosis of COVID requires the most rigorous standard for sensitivity and specificity. Diagnosis requires 100% in both categories and RT-PCR tests approved by the FDA are the only tests that meet that standard. Screening requires a less rigorous standard. 

The RT-PCR, a molecular test, is very much used for the sole purpose of arriving at a diagnosis that is 100% correct. The obvious reason for that is that in a hospital or LTC facility, among other specific places, you have to know this with a high degree of accuracy that a COVID diagnosis is correct. Screening has less rigorous standards and therefore less accurate tests, such as antigen tests, are suitable. The FDA has not established lab standards for surveillance testing.

That brings us to embarking on a cruise ship. Does the company operating that ship need a diagnostic test or a screening test for passengers and crew entering the ship? What the cruise company is trying to do is reduce the risk of becoming infected with SARS-2. They are not trying to completely eliminate it. In some settings, yes, you don't want that bug around at all. Use a diagnostic test.  In others, reducing the risk of infection to the lowest practical level should be the goal and layering of of other mitigation measures with reasonably accurate testing products, like cruise ships plan on doing, is the best way to do that.  

So, you tell me which kind of testing you think is needed and which kind of test is best for that purpose? Like I said, be careful about what the CDC has to say and what guidance it issues.     

[smokeybandit]

I'd rather take my chance with a rapid test that might miss one or two than a PCR test that could tell me I'm "positive" even if I was last exposed to covid 3 months ago.

[flipflopper]

8 hours ago, JeffB said:

Interesting. I don't see that an RT-PCR COVID test is required in the snap-shot of the page you posted. Just that it is a SARS-CoV-2 test. The 2-3d window for pretests certifying you don't have COVID has become the standard window that most countries and conveyances are using, if they require COVID testing, enter/board. Was the requirement for an RT-PCR COVID test somewhere else in the FAQs? 

 

[JasonOasis]

I'm almost facing the same dilemma but I have 3 days in between my late October 2021 cruise and my November 2021 cruise. If there is some type of requirement in place what I'm hopping for is cruise lines will either accept a negative COVID test or allow people to board who can show they have been fully vaccinated.

[twangster]

As I rebuilt my cruise calendar anticipating a restart I've made a point of leaving at least 14 days between cruises.  This accommodates any potential tests but also in case the CDC introduces some other time based qualifier.  

[Psycho and Barb]

18 hours ago, flipflopper said:

I logged into Royal Caribbean’s Singapore website and found guidance that states the Covid PCR test has to be done 72-48 hours before departure, so that would suggest the elimination of the possibility of having a test in Florida in between cruises on the day of debarking/embarking

 

So if you've had COVID-19 with 180 days of sailing...You can't sail?

[twangster]

12 minutes ago, Psycho and Barb said:

So if you've had COVID-19 with 180 days of sailing...You can't sail?

in Singapore, yes.  

It may have something to with the tests they are using.  I've heard that some tests may come back positive if there is a history of the virus even if it has long been defeated in that individual and they are no long contagious or capable of spreading the virus from their prior encounter with the virus.

Such a positive test during a cruise would mean terminating the voyage and immediately returning to port even though there is no risk.

I don't know if that is accurate or not, just what I read somewhere.

[smokeybandit]

That would never fly in the USA. You couldn't ban someone from cruising because they had covid 6 months ago.

[flipflopper]

1 hour ago, Psycho and Barb said:

So if you've had COVID-19 with 180 days of sailing...You can't sail?

That appears to be how they are handling the test cruises in Singapore, but doubt that will be the rule when cruises resume in the US.

[flipflopper]

1 hour ago, twangster said:

As I rebuilt my cruise calendar anticipating a restart I've made a point of leaving at least 14 days between cruises.  This accommodates any potential tests but also in case the CDC introduces some other time based qualifier.  

Until I can relocate to Florida, I always try to do back to back cruises to save on airfare costs, but Covid may overly complicate my cruise calendar