MIAMI - Dozens of Americans aboard a cruise ship that docked last weekend in Miami with coronavirus cases still waited Monday to disembark, delayed by new federal rules requiring cruise companies to bring them directly home to avoid more infections.

Two passengers died before the Coral Princess docked in Miami and a third passenger, a man, died at a hospital. It is not clear if the deaths were caused by COVID-19. Officials say 24 critically ill patients have been taken from the ship to hospitals for immediate care, including the man who died.

Foreign passengers were allowed to disembark after passing a medical screening and have been taken to the Miami international airport, where charter planes awaited them for flights abroad. But many of the 250 Americans aboard the Princess Cruises ship continued to await instructions, two days after their arrival in Miami.

“With the Americans, it is taking a little longer because they have to find more charters because of the requirements,” Miami-Dade Mayor Carlos Gimenez said during a video conference.

Gimenez said several Florida residents were able to leave the ship because the cruise line arranged ground transportation. Relatives of passengers from other states said they had yet to receive any news on when their loved ones would disembark.

The Centers for Disease Control and Prevention on Saturday updated its recommendations for cruise lines requiring them to take travellers directly to their homes with charter flights and ground transportation. The federal agency said commercial flights and public transportation were not allowed amid the global pandemic.

For a cruise ship that arrived in South Florida on Thursday, passengers were flown to flight hubs where they could transfer to shorter commercial flights to their home cities.

Federal, state and local authorities have made arrangements with cruise lines to screen and disembark passengers from cruise ships, instructing them to wear masks and isolate at home for 14 days. But there are more than 35 cruise ships with 35,000 crew members aboard in U.S. waters around Florida.

Usually, the U.S. Coast Guard can be called for emergencies aboard vessels but the agency last week directed cruise ships in the district that covers Florida, Georgia, South Carolina and Puerto Rico to prepare to treat any sick passengers and crew on board. It warned that foreign-flagged vessels should try to first medically evacuate the very sick to those countries.

Many cruises ships in South Florida are registered in the Bahamas.

Evacuations that are absolutely necessary have to be approved now by a Coast Guard flight surgeon, the agency ordered. Then cruise lines are responsible for arranging on-shore transportation and hospital beds.

Last weekend, the agency oversaw the medical evacuation of three crew members with COVID-19-like symptoms in two cruise ships in Miami and St. Petersburg.

For most people, the coronavirus causes mild or moderate symptoms, and the vast majority survive. But for others, especially older adults and people with existing health problems, it can cause pneumonia or death.

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