Open this photo in gallery Canadian passengers Chris & Anna Joiner ask for help onboard the MS Zaandam, Holland America Line cruise ship, during the coronavirus outbreak, off the shores of Panama City, Panama March 27, 2020. CHRIS JOINER/Reuters

When Chris and Anna Joiner boarded the MS Zaandam cruise ship in Buenos Aires three weeks ago — the start of a trip to celebrate Mr. Joiner’s recent retirement — they had seen the coverage about the spread of COVID-19 around the world.

But cruise operators insisted they were taking steps to protect passengers, such as banning travellers from China, and the Orleans, Ont. couple feared they would lose thousands of dollars if they cancelled. So they set off on what was supposed to be a 31-day voyage to the Falkland Islands and around the southern tip of Chile.

Now, they are trapped in their rooms as the ship sits anchored just outside the western end of the Panama Canal, after four passengers died amid an apparent outbreak of COVID-19. Two people on board tested positive for the disease and more than 100 passengers and crew have reported flu-like symptoms.

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“I thought I was going to throw up, because it came as such a shock," Ms. Joiner said, recalling when the passengers were told about the deaths.

“All of the sudden, four people are dead. We were a healthy ship one week, four people are dead the next. ... We don’t know what’s going to happen to us.”

Ottawa says there are 248 Canadians, including one crew member, on the cruise, which is operated by Holland America. Healthy passengers were being transferred on Saturday to another Holland America ship, the MS Rotterdam. Ms. Joiner said she has a mild cough so she and her husband remain on the Zaandam.

The ship had been waiting permission to pass through the Panama Canal, which it received on Saturday, as it attempts to reach its final destination of Fort Lauderdale, Fla. It’s not clear when the ship will begin moving again; passengers were told on Saturday evening that work to transfer some passengers to the Rotterdam would continue on Sunday.

Prime Minister Justin Trudeau said the federal government was working with Panama to get the passengers off the ship.

"We know this is a very difficult situation for them, for their families,'' Mr. Trudeau said Saturday.

Foreign Affairs Minister François-Philippe Champagne said on Twitter that he had spoken to his counterpart in Panama, who confirmed that the ship would be permitted to pass through the Panama Canal.

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Global Affairs Canada said it expects the ships to reach an American port in the coming days.

Holland America said it is working with the U.S. Centers for Disease Control and Prevention as it transferred healthy passengers to the Rotterdam. The company said passengers with inside cabins and those over 70 years old were given priority.

Cruise ships quickly emerged as a particularly dangerous place as COVID-19 spread around the world. There have been several examples of large numbers of passengers and crew becoming infected on cruise ships, prompting governments to deny them permission to dock and allow passengers to disembark.

More than 700 people, including 54 Canadians, were infected aboard the Diamond Princess, which sat in quarantine off Japan for weeks.

Earlier this month, the federal government airlifted more than 230 Canadians who were aboard the Grand Princess cruise ship that was held off the coast of California. They were sent to Canadian Forces Base Trenton to be isolated and 13 later tested positive for the disease.

On March 9, two days after the Zaandam departed, the Canadian government recommended against all cruise ship travel and has since urged all Canadians travelling abroad to return home as quickly as possible.

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Christine Mihailedes, who left Calgary with her husband at the beginning of March to celebrate her 60th birthday on the Zaandam, said she knows that some people likely think they were foolish for getting on a cruise ship despite the news about COVID-19.

She said that when she started the trip, the outbreak was still largely focused in China and Europe, and not in South America, where they were headed. They thought it was safe.

“The situation changed very, very quickly,” she said. “We took all the normal precautions, but we really did not see that it was a massive risk."

Ms. Mihailedes praised the work of the ship’s crew and she’s optimistic her ordeal will be over soon. Her husband uses a CPAP machine, which means they won’t be moved to the Rotterdam.

Michele Parent’s 75-year-old mother, Jocelyne Parent, is among the Canadian passengers. The elder Ms. Parent, who lives near Toronto, is healthy and in good spirits, in part because she has an outside cabin and fresh air, her daughter said.

Michele Parent said her mother looked into cancelling her trip due to the COVID-19 outbreak. but was told she would not get a refund.

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“She looked into cancelling, but insurance wasn’t going to cover it," she said

“This was prior to the government saying, ‘Everybody get home.’ She was weeks into her cruise when the red flags were raised about travel and COVID-19.”

Carolyn McCarthy Woodward of Corner Brook, N.L., has been dealing with spotty Internet and phone access to keep in touch with her sister and her husband, who were on the Zaandam but expected to be moved to the Rotterdam.

She said her sister has multiple myeloma, which puts her at a higher risk, but they were doing the best they can to manage.

“She said they’re well taken care of,” said Ms. McCarthy Woodward. “They’ve been looked after, there’s no complaints about the crew.”

With a report from Reuters