Cruise ships sailed on despite the coronavirus, and thousands of people paid the price

A patient is evacuated from the Holland America ship the Zaandam at Port Everglades in Fort Lauderdale on Thursday, April 2, 2020.

Stars and Stripes is making stories on the coronavirus pandemic available free of charge. See other free reports here. Sign up for our daily coronavirus newsletter here. Please support our journalism with a subscription.

MIAMI (Tribune News Service) — As the coronavirus spread across the world in early 2020, hundreds of thousands of people found themselves in what is now understood to be one of the most dangerous places during a pandemic: a cruise ship.

Just how many passengers and crew got sick or died is impossible to know. No global health body or regulatory agency is known to be tracking those statistics. And the cruise industry — which downplayed the dangers to consumers and kept sending out ships despite outbreaks on board and warnings from public health officials — has largely stayed silent about the toll.

So the Miami Herald began tracking outbreaks on board. Already the numbers are alarming. Reporters found that at least 2,592 people have tested positive for COVID-19 during or directly after a cruise and at least 65 people have died, according to a database built by the Herald. That is far more than the industry or public health officials have acknowledged. It’s also likely not the complete picture.

The Herald found COVID-19 cases linked to at least 54 ocean-going cruise ships — roughly one-fifth of the global ocean cruise fleet. That number could grow as more cases are reported.

Reporters gathered the data using records from the U.S. Centers for Disease Control and Prevention, foreign health departments, news reports, cruise companies and interviews with passengers and crew. The Herald is committed to updating information weekly until the COVID-19 pandemic is declared over.

The cruise industry notes that it is possible that some of these people got COVID-19 from a source other than the ship they were on. It is also likely that other passengers and crew contracted the virus without developing symptoms or getting tested.

Passengers and crew paid the price for the industry’s decision to keep cruising — and the U.S. government’s reluctance to shut it down — even after the danger became apparent in early February. That’s when the Diamond Princess ship was sequestered in Japan after a COVID-19 outbreak that left hundreds infected — a clear warning about how dangerous the new coronavirus is on cruise ships.

On March 8, the CDC alerted Americans to stay away from cruising, citing increased risk of COVID-19. Nonetheless, some cruise ships left port on passenger voyages after the travel advisory. At least eight of those ships logged cases of COVID-19, resulting in at least 309 cases of the disease, or 12% of the total known cruise-related cases, the Herald analysis shows. At least three of those people died.

Some ships carried the disease from one cruise to the next. After the disease broke out on the first voyage, the number of cases generally exploded on the subsequent voyages.

While some passengers went straight to the hospital, many sick people returned to their homes, sometimes on commercial flights. Meanwhile, thousands of crew members found themselves marooned at sea in quarantine, sitting ducks for outbreaks. As of publication, at least 922 crew members have been infected and at least 11 have died from COVID-19.

The CDC issued a no-sail order in U.S. waters on March 14 — one day after the industry had already agreed to stop new cruises. But cruises still underway continued, sometimes searching for weeks for a port that would accept the ships.

Ships with COVID-19 cases come from all four of the world’s largest cruise lines: Carnival Corp., Royal Caribbean Cruises Ltd., Norwegian Cruise Line Holdings — all based in Miami — and MSC Cruises, along with a number of smaller lines.

Dr. Roderick King, CEO of the Florida Institute for Health Innovation, said both the public and the industry need to have the kind of data the Herald is compiling.

“Here’s a situation where you have a global pandemic, and you’re running a business where you essentially have self-contained environments where this disease can proliferate quickly,” King said. “By closing your eyes to it, it’s not only detrimental to your business model and ability to bounce back, but it has huge implications on the broader population.”

'Really high standards'

Emilio Hernandez, a passenger from Miami, reluctantly boarded Carnival’s Costa Luminosa cruise in Fort Lauderdale on March 5. He was nervous about COVID-19, but the company wasn’t offering refunds. The cruise was scheduled to go to Puerto Rico and Antigua before crossing the Atlantic Ocean to Europe.

Three days into the cruise, his fears were confirmed. A woman with COVID-19 symptoms was taken off the ship and hospitalized in Puerto Rico. Antigua turned the ship away, and instead of returning to port in Florida, Carnival decided to sail the Luminosa to Europe. The company waited seven days to isolate passengers and give crew members masks and gloves even as more and more people got sick. At least four passengers and one crew member died. Dozens more fell ill, the Herald’s data shows.

Hernandez, 51, and his wife, Barbara, 46, tested positive for COVID-19 after disembarking. Barbara spent a night in the hospital. Both recovered.

“If the cruise ships don’t learn now, how many more people are going to die?” Emilio said. “They need to be held accountable for what they’ve done to their passengers and their crews. They decided that taking their asset back to Italy was more important than my health and the health of all the passengers. That decision has cost people their lives.”

Since the pandemic began, the industry has tried to downplay the severity of the crisis.

Arnold Donald, CEO of Carnival Corp., the world’s largest cruise company, has maintained that “very few” ships have been affected by COVID-19. (At the time of publication, 17% of the company’s ships have been linked to coronavirus.)

“Cruise ships are not the cause of the virus, nor are they the reason for the spread in society,” Donald said last week. “It’s not a dramatic impact compared to how the community spread occurred around the world.”

In an April 15 interview with CNBC, Donald said that passengers in many cases “are at far less risk in a cruise environment than other environments.”

“We have really high standards on cruise ships in dealing with any kind of health risk,” he said. “You don’t go to many places where you have medical records, where there is temperature scanning, there’s lots of deep cleaning going on often and all the time.”

The CDC has warned repeatedly of the increased risk of COVID-19 infection on cruise ships, saying social distancing and thorough disinfecting are difficult to implement on board.

The cruise industry’s lobbying group, Cruise Lines International Association, said companies responded to the crisis with the information available to them at the time. Cruising was shut down on March 13.

“We know now that, tragically, this pandemic affects every setting where people come together to socialize and enjoy shared experiences, which includes cruise ships but it also includes restaurants, hotels, movie theaters and the like,” CLIA spokesperson Laziza Lambert said in an email. “We will use this time during the temporary suspension of operations to review and enhance our protocols to determine ways we can go even further in our efforts to protect the health of passengers, crew and the destinations we visit.”

The industry cruised on

While the rest of the world watched the coronavirus consume China — still believing it was just a flu — the cruise industry had a front-row seat to the catastrophic reality.

In mid-February, the largest coronavirus outbreak outside of China engulfed Carnival’s Diamond Princess cruise ship, which was quarantined in a Japanese port. Hundreds fell sick. At least eight people died.

In response, companies restricted boarding to exclude people who had recently traveled to China, Hong Kong and Macau. But the industry cruised on undeterred. Here’s how it unfolded:

• The week of Feb. 25

Caribbean countries began turning away cruise ships, a clear sign of what was to come.

By the time the industry closed down weeks later, several ships would be stranded at sea with dying people on board and nowhere to dock.

• March 7

Even as the pandemic worsened, the Trump administration stood shoulder-to-shoulder with the cruise companies.

Meeting with industry executives in Fort Lauderdale, one of the busiest U.S. ports, Vice President Mike Pence assured the nation it was “safe for healthy Americans to travel.”

Adam Goldstein, CLIA’s chairman, said the companies were prepared to pay for the transfer of sick passengers and crew to hospitals.

“Given the significance of travel and tourism, it is critical that Americans keep traveling,” Goldstein said. “And yes, we also recognize this is an unprecedented situation with COVID-19. Our commitment here today and going forward is to work closely with government and go above and beyond what we are currently doing.”

That day, one person who worked at Port Everglades as a passenger greeter for a Carnival Corp. subcontractor tested positive, followed by two more in the following days.

Reluctant passengers who didn’t want to lose their money boarded cruise ships, trusting that companies would not be operating if it weren’t safe. Cruise companies weren’t offering refunds, but they were upping cleaning routines on ships and denying boarding to people who recently had traveled to disease hotspots.

Crew members had no choice but return to sea.

• March 8

Late in the day, the CDC and the State Department alerted all Americans to avoid cruise travel, citing an increased risk of COVID-19 infection on ships. At least 1,791 passengers and crew on cruises that left before the advisory were infected, the Herald’s analysis shows.

• March 9

The morning after the travel alert, steadfast cruisers, some in their 80s, lined up at PortMiami to fill out health questionnaires so they could board.

“This is a large global company that won’t expose people,” said Steve Hoffman, 48, from Naples, who was boarding the Carnival Sensation. “I think we’ll be OK.”

Despite the clear CDC warning, the White House’s coronavirus task force said that the cruise lines were working on stronger safety protocols to continue cruises. Dr. Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases, said elderly people with underlying health conditions should avoid cruising.

Meanwhile, CDC and California health officials prepared to transport more than 2,000 cruise ship passengers from Carnival’s Grand Princess to hospitals for care or military bases for quarantine after a COVID-19 outbreak on that ship. Herald data shows at least 125 passengers and 19 crew from the ship have tested positive, and at least five people have died.

• March 11

CLIA sprang into action on Capitol Hill to try to fend off a government-ordered industry shut-down. Lobbyists met with the Florida House delegation to discuss proposals to curb infections on their ships, including barring people over the age of 70 from boarding. More passengers boarded ships. Others hopped off to visit ports around the world.

Around 550,000 passengers were on cruises on March 11, according to CLIA, the same day the World Health Organization declared COVID-19 a pandemic.

• March 12

Princess Cruises, owned by Miami-based Carnival Corp., was the first to stop cruising. The line canceled all new cruises for the next 60 days after government-led quarantines on two of its ships.

• March 13

The rest of the North American cruise fleet followed on March 13, announcing a 30-day pause.

South Florida governments proclaimed their support. Miami-Dade County waived its docking fees, allowing cruise companies to bring their ships to PortMiami at a discount, and offered to turn a warehouse into a triage center to isolate infected passengers.

The industry is an important economic player in South Florida; along with bringing millions of tourists, cruise lines paid nearly $77 million and $60 million in passenger fees to PortMiami and Port Everglades, respectively, in fiscal year 2018.

President Donald Trump tweeted, “It is a great and important industry — it will be kept that way!”

No more cruises, but more infections

By March 17, the CDC elevated its travel warning to require cruise passengers to self-isolate for 14 days after disembarking.

Despite his persistent public plugs for a cruise industry bailout, Trump signed into law on March 27 a federal coronavirus stimulus bill that excludes cruise companies. The companies claim exemption from U.S. income taxes because they are incorporated in foreign countries and register almost all of their ships abroad, too.

Two days later, Republican Gov. Ron DeSantis threatened to turn away a ship full of sick people seeking refuge in a Florida port.

Cruise stocks have slid to historic lows: Carnival Corp. closed at $11.64 per share Wednesday, down 77.31% since Jan. 2, Royal Caribbean Cruises Ltd. closed at $34.01, down 74.74%, and Norwegian Cruise Line Holdings closed at $10.87, down 81.52%. MSC is privately owned.

The pause on operations hasn’t quelled infections on ships.

Some ships that were able to get back to port quickly after March 13 offloaded thousands of cruise passengers without any screening from companies or governments.

Passengers on the Ruby Princess cruise ship that docked in Sydney, Australia, on March 19 walked right off the ship and scattered across the world — despite many showing symptoms of COVID-19. At least 647 people, including 202 crew members, have tested positive, and at least 22 people have died. The ship is the largest source of COVID-19 cases in Australia, and is at the center of a criminal investigation in that country.

Passengers on the MSC Meraviglia disembarked in Miami on March 15 without any screening after a passenger on the previous voyage tested positive. At least two passengers who got off the ship that day contracted COVID-19.

Other ships, like Carnival’s Zaandam and Coral Princess, were forced to sail for more than a week to reach Florida’s shores in early April after every country in the Western hemisphere with a cruise port turned them away.

At least five passengers from the Zaandam tested positive for COVID-19. All of them died, as did one of the crew members who tested positive.

On March 20, the lead physician on the Coral Princess wrote passengers a letter.

“Rest assured that, relatively speaking, Coral Princess is probably one of the safest places in the world to be at this time,” the doctor wrote.

Since then, at least eight passengers and five crew tested positive for COVID-19, and at least two passengers have died from the disease. The ship docked in Miami.

After offloading passengers, ships became incubators for crew infections. Approximately 120 cruise ships with more than 80,000 crew on board are currently sailing in U.S. waters; at least 20 have known or suspected COVID-19 infections, according to the CDC.

During the last passenger cruise on Royal Caribbean’s Oasis of the Seas, the company alerted the CDC of a possible COVID-19 infection on board. On March 26, the company sent an email to passengers from the voyage to warn them that someone on their cruise had tested positive.

The company waited until March 28 — nearly two weeks after first learning of a possible infection — to warn the crew still on board of their exposure and isolate them. At least 14 crew members have tested positive.

Similarly, Norwegian Cruise Line encouraged crew on its Norwegian Encore ship, docked at PortMiami, to take advantage of activities normally off limits to workers like passenger buffets and pools and gyms, even as more people fell ill. Meanwhile on land, city governments and public health officials warned the public to stay in their homes.

One crew member who was able to leave the Encore tested positive for COVID-19 the next day.

Some crew members will never make it home.

As of publication, at least eleven crew members have died from COVID-19 — four of them in South Florida hospitals.

Twenty-seven year old Pujiyoko, a Royal Caribbean housekeeper from Indonesia, became the youngest person in South Florida at the time to die from COVID-19 on April 12.

Andrew Fernandes, 48, from India, who worked as a security guard on Carnival’s Costa Favolosa cruise ship, which had at least 58 people test positive, died alone at Larkin Community hospital in Hialeah on April 4. He was a father of four.

Citing continued COVID-19 infections and hospitalizations among crew who remain on cruise ships, on April 9 the CDC extended the halt on cruise operations in U.S. waters until late July, or until the COVID-19 pandemic is over, and required the industry to implement a plan to immediately mitigate outbreaks on ships.

Industry says it's unfairly being singled out

For this story, the Miami Herald asked all affected cruise companies for the number of COVID-19 cases linked to each ship in their fleets.

Carnival Corp. and MSC Cruises responded; Royal Caribbean Cruises Ltd. declined to provide any information, including whether its ships now have testing kits.

Most of those contacted did not respond, including Norwegian Cruise Line Holdings, Disney Cruise Line, Genting Cruise Lines (parent of U.S.-based Crystal Cruises and two Asian lines), TUI Cruises, Aurora Expeditions, Fred Olsen Cruise Line and Phoenix Reisen Cruises.

Carnival Corp. was by far the most transparent, wrangling data from its nine cruise brands that operate 104 ships to provide to the Herald. Still, the company provided an undercount.

“There is not a strong mechanism or feedback loop that has been put in place to date for governments, especially internationally, to report back to cruise lines once the guests leave the ship,” said company spokesperson Roger Frizzell. “We largely have looked to government’s health authorities to capture and manage this data as part of its oversight role.” He said the company has only recently started to use testing kits on board one of its ships, the Zaandam; it does not have tests on the others.

MSC, which operates 17 cruise ships, also provided information. A company spokesperson said other forms of transmission for people who tested positive after disembarking cannot be ruled out. All of the company’s ships now have COVID-19 tests on board, she said.

CLIA said cruise ships have stringent reporting requirements compared to other industries and criticized the CDC’s April 9 no-sail order.

“We are … concerned about the unintended consequences the No Sail Order issued on April 9 has in singling out the cruise industry, which has been proactive in its escalation of health and sanitation protocols and was one of the first industries to announce a voluntary suspension of operations,” the statement said. “It would be a false assumption to connect higher frequency and visibility in reporting to a higher frequency of infection.”

Dr. Martin Cetron, the director of the CDC’s Division of Global Migration and Quarantine, said in an interview that cruise ships have a higher risk of infectious disease spread than arenas, theaters and restaurants.

“It’s intuitive and it’s obvious and it’s been borne out looking at the science of the attack rates,” he said. “It’s especially challenging.”

Cruise ships have medical centers on board, but their facilities are easily overwhelmed during an outbreak because resources are finite. At a meeting with Broward County Commissioners on March 31, Carnival Corp. Chief Maritime Officer Bill Burke said the Zaandam ship, which carries more than 2,000 passengers and crew, had intensive care capabilities for just one or two ventilated patients.

The diverse population of passengers and crew contained on the ship for several days, mixed with limited access to hospitals from remote areas of the ocean, make cruise ships especially vulnerable.

“When you realize the impact the virus is having on the cruise ship in that kind of environment, it’s an environment that has unique challenges,” Cetron said. “A single case can amplify to an outbreak extremely quickly. … The opportunities for amplification and spread in this kind of setting are really challenging.”

A spokesperson for the CDC said quarantine and isolation measures are difficult to implement on cruise ships and only occur after an infection has been identified, minimizing their effectiveness.

Earlier this month, Genting Cruise Line announced it is preparing for a host of post-pandemic changes when cruises resume. Those include requiring a doctor’s note from passengers over 70, infrared fever detectors on gangways, face masks for all passenger-facing crew members, and common-area disinfecting as frequently as every two hours.

Rockford Weitz, director of the Maritime Studies Program at Tufts University’s Fletcher School, said these kinds of changes to cruising are necessary to keep infection rates in check.

“It’s going to be expected by the customer base that the industry is doing more than they did before to maintain a sanitary environment,” he said. “This can be an opportunity. The old procedures were based on the fact that there was not a social acceptance to wear a mask and gloves and do the kind of disinfecting that is the best practice. COVID-19 has changed social norms.”

Lack of transparency

The true number of people who have been infected with COVID-19 on cruise ships may never be known.

Crew members experiencing symptoms say they have not been tested and are waiting out the sickness in isolated cabins. Some passengers and crew have not been able to get tested after disembarking. And countless others may have the disease but experience no symptoms, spreading it to those around them unknowingly.

Thousands of crew members still trapped on ships experiencing outbreaks say companies aren’t being forthcoming about the number of COVID-19 cases on board. The companies aren’t providing everyone with masks and gloves, they say, or allowing them to follow social distancing protocols. Those who have been able to leave the ships say they were never warned about their exposure.

“I’m worried we’ve been lied to this whole time by management,” said a Norwegian Encore crew member who was able to leave the ship. “It is reckless behavior on their part, in my opinion, and endangering. I could have endangered my family.”

Cruise passengers and their families say they would have foregone their vacations if the companies had told them about how many people were experiencing COVID-19 symptoms on ships.

Among them is Tom Sheehan, from Sarasota. When he boarded Carnival’s Costa Luminosa in Fort Lauderdale on March 5, his family said he had no idea that Jamaica had barred Italian passengers from getting off the ship on a previous cruise, or that a passenger, who later died of COVID-19, had been medically evacuated in the Cayman Islands.

Sheehan, 69, died in a Sarasota hospital on March 30; his kids said goodbye to him over speakerphone.

“If the ship had told everyone what was going on, my dad and stepmom would have gotten off in Puerto Rico and flown home,” said his son Kevin Sheehan. “But they didn’t tell them. So they stayed on the ship.”

Miami Herald growth editor Forrest Milburn contributed to this report.

©2020 Miami Herald

Visit Miami Herald at www.miamiherald.com

Distributed by Tribune Content Agency, LLC.

