The US Coast Guard has ordered foreign passenger vessels with sick passengers to steer clear of US ports and prepare to care for patients on board their vessels for “an indefinite period of time,” or seek help from other countries.

In a marine safety information bulletin published on 29 March, the United States Coast Guard stated that emergency evacuations from such vessels are putting a strain on local medical resources

“This is necessary as shore-side medical facilities may reach full capacity and lose the ability to accept and effectively treat additional critically-ill patients,” the letter read.

The rules apply to any vessel carrying more than 50 people and were signed off by Coast Guard Rear Admiral EC Jones, whose Coast Guard district includes Florida, Puerto Rico, Georgia and South Carolina.

The release used Miami as an example of a port they said was becoming overwhelmed due to the coronavirus pandemic and would no longer be able to accept critically ill patients from offshore.

“Medical facilities in the Port of Miami, for example, are no longer accepting MEDEVAC patients due to limited hospital capacity and it is expected that neighbouring counties will follow suit,” the letter said

Foreign-flagged vessels include those registered in the Bahamas, Panama and other countries, but which are owned by US cruise companies.

The release singles these out directly, writing “foreign-flagged vessels that loiter beyond US territorial seas, particularly those registered to The Bahamas, that require a MEDEVAC to a shoreside facility should seek flag state support prior to seeking support from the limited facilities in the US”

The memo now orders those ships to seek medical care in the countries where they are registered, rather than rely on US medical services.

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While the cruise ship industry is still under a 30-day lockdown preventing all trips from the US from 14 March, many ships still remain at sea from before the suspension.

The Miami Herald, which first reported the document, also said that 17 ships are lined up at Port Miami and Port Everglades, and more than a dozen others miles offshore.

The move comes as Florida's state governor Ron DeSantis pushed back on requests to allow more than 1,000 people to disembark from the Zaandam, where almost 200 passengers have suspected Covid-19 symptoms and four people have died.

If cruise ships wish to evacuate a sick passenger for treatment at the ports they must consult with the Coast Guard which will consider if a transfer is necessary and if enough medical resources are available to accommodate the passenger.

The cruise line will be completely responsible for providing the entire process of treatment from a private ambulance to the hospital bed.