NEW YORK (NYTIMES) - A waiter in the crowded cruise ship passageway approached the isolated passenger with a tray of food, two glasses of juice, plastic gloves on his hands - and a white table napkin across his face.

The napkin, tied over his mouth like a bandanna on a bank robber in an old western, was presumably supposed to protect the crew member aboard the Costa Luminosa from the spread of the coronavirus, which had already sickened three passengers. This was on Sunday (March 15), the first day that the crew began wearing gloves and shields over their mouths.

A picture snapped by a passenger and circulating on social media encapsulated the missteps by a cruise company that seemed to be improvising its coronavirus response, even after the high-profile disasters that left hundreds sickened on two other ships, the Diamond Princess and the Grand Princess, owned by its corporate parent, Carnival Cruises.

"We kept saying, 'They'll do better. They'll see what happened on the Diamond and the Grand, and they'll do better for us.' But what they did was way worse - and they lied as well," said Mrs Kelea M. Edgar Nevis, 57, of Arizona, who was on the ship with her 80-year-old husband. "It was ridiculous."

A week passed between the time the first passenger in whom coronavirus was suspected, an Italian woman, took ill and the moment that Costa Cruises instituted sanitary protocols, which included isolating everyone in their cabins, taking their temperatures daily and making employees wear protective gear. Another passenger who later tested positive for the coronavirus had been taken off the ship a week before her for other health reasons.

As the Costa Luminosa headed across the Atlantic with more people getting sick, another Carnival ship, the Grand Princess, finally docked in Oakland, California, with 21 infected passengers on board after being stranded for days.

Citing ship logs, the Miami Herald reported on Wednesday that at least 24 crew members and 50 passengers on the Costa Luminosa were classified as sick. On Thursday, Carnival said that only seven people, including two crew members, were showing symptoms, and that the logs included people who were close contacts of the sick.

The ship is now docked in Marseille, France, and French health authorities have boarded to conduct health checks. Americans on board have been told that a chartered plane will take them to Atlanta. Various government agencies are involved in figuring out what to do with them next, and some US states may allow them to isolate at home, as some people who sailed on the Grand Princess did, the Centres for Disease Control and Prevention said.

When cruise lines decided to suspend US sailings last week, 40 ships carrying tens of thousands of passengers were in the middle of their voyages.

On at least three of them, passengers got Covid-19 while cruise ship companies, port officials, governments and international health organisations scrambled to determine whose rules applied.

Thousands of people were at sea, sometimes confined to tiny cabins, but also enjoying the bar, serving themselves from the buffet and enjoying festivities while more people contracted the disease and the ship captains tried to figure out what to do.



In a photo from social media, a waiter in the crowded cruise ship passageway is seen with a tray of food, two glasses of juice, plastic gloves on his hands and a white table napkin across his face. PHOTO: REUTERS



The Braemar, a ship operated by Fred. Olsen Cruise Lines, was denied entry by four countries when a guest, four crew members and two passengers who had been on the ship tested positive. Cuba opened its port to them, and about 700 mostly British passengers took chartered flights home to England on Wednesday.

Also on Wednesday, nearly 100 passengers who had been in quarantine - with six infected passengers aboard the Silver Explorer cruise off the coast of Chile - were flown out of that country on charter flights, according to Chilean officials.

Meanwhile, passengers aboard the Silver Shadow were close to completing a week in quarantine in the port of Recife in northern Brazil over coronavirus fears that are so far unfounded. Both the Silver Explorer and Silver Shadow are operated by Silversea Cruises, which is owned by Royal Caribbean.

The Costa Luminosa, a 295m-long ship built in 2009, is owned by the Crociere Group, Italy's biggest tour operator. Headquartered in Genoa, the company has 27 ships in service that offer trips from the Mediterranean to South America.

The company, which is part of the Carnival Corp, came under fire in 2012, when its Costa Concordia ran aground off Tuscany, killing 32 people. The captain was sentenced to 15 years for manslaughter.

The Costa Luminosa first left Fort Lauderdale, Florida, for a cruise around the Caribbean on Feb 24. But the coronavirus was raging in Italy, and Jamaica did not let the Italians disembark as scheduled on Feb 28. The next day, one of the ship's passengers, a 68-year-old Italian man, was evacuated on Grand Cayman Island after having two heart attacks.

The ship returned to Fort Lauderdale to drop some passengers off and pick more up. Destination: Venice. It was to be a grand affair with stops in Antigua; Puerto Rico; Malaga, Spain; the Canary Islands and Marseille.

"We had planned a bucket list trip - 30-night cruise and 30 around Europe, as my husband had spent 40 nights in the hospital back in October and November," Mrs Nevis, who was on the ship with her 80-year-old husband, said in an e-mail.



Employees of Costa Luminosa wearing protective masks work on a cruise ship on March 16, 2020. PHOTO: REUTERS



Mrs Kelly D. Edge, 60, a former HGTV decorator who lives in Miami, booked the cruise at the last minute with her husband, Mr Woody Edge, 65. Rates on the Costa Cruises itinerary were already so appealing - starting at US$350 (S$505) a person for a windowless cabin - that the couple booked a suite for US$1,250 a person.

After the epidemic, Mrs Edge wanted her money back, but the company wasn't giving refunds. She packed a roll of paper towels and disinfectant wipes.

When they arrived for their sailing on March 5, Costa sent them an e-mail saying that the US wouldn't let the ship go to Italy, so their final destination would be Marseille, instead. They got a US$500 shipboard credit.

"So we committed and went on," Mrs Edge said. "So we felt manipulated from the beginning." The ship was only half full.

By March 7, two days after the ship left Fort Lauderdale, a 68-year-old Italian woman who had already gone to the ship's doctor for a headache returned to the doctor with "worsening respiratory conditions", a Costa spokesman, Ms Rossella Carrara, said. An earlier communique from the company said she had cold symptoms.

She was evacuated in Puerto Rico on March 8, while the more than 1,400 passengers, including 168 Italians and 233 Americans, spilled out to the streets of Old San Juan to enjoy a day of leisure.

Her close contacts were isolated, Ms Carrara, a company vice-president, stressed.

The protocol was strict and the reaction swift, Costa Cruises said. "We underline that the patient had already been placed in isolation on board," the company said in a statement.

The next day, Antigua refused the ship entry, and the man who had the heart attacks in the Cayman Islands and had stayed behind in the hospital there started to develop a dry cough, so the doctors there tested him for the coronavirus.

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By then, the Costa Luminosa's sailing had turned into a trans-Atlantic cruise to nowhere, with Antigua and Spain turning the vessel away, while the employees in charge minimised the situation on board and gave passengers misleading information. The gym stayed open and the Ping-Pong contests continued.

On March 11, the cruise stopped group activities like lounge and pool parties.

Mrs Edge, who had taken advantage of the cheap cruise, was feeling worried.

"If we make it the next six days to Tenerife with no illness, my attitude will most likely change," she wrote in an e-mail. "But now it feels scary. Real or imagined."

On March 12, three days after the Cayman Islands patient's coronavirus test was taken, it came back positive for Covid-19.

It is unclear if the cruise line was ever notified. The casino, piano bar, pool, karaoke and gym stayed open, passengers said. The bands kept playing.

"The bar stools were cheek to cheek," Mrs Nevis said.

A day later, at about 9pm last Friday - five days after the sick woman was evacuated during the ship's Puerto Rico stop - the governor of Puerto Rico gave a news conference announcing that the woman had tested positive. So had her husband.

The news swept through the ship as passengers read about it on social media and news reports. But Costa Cruises took no further significant action, though serving utensils were taken away from the buffet, passengers said.

At 2.15pm the following afternoon, the cruise company told The New York Times that it still had not received official word from local health authorities.

"However, we are aware that unofficial information is circulating on the alleged positivity of the 68-year-old lady of Italian nationality who has been hospitalised in Puerto Rico on March 8," the company said in an e-mail.

"I did show our waiter in the restaurant the tweet about the positive test, and it was definitely the first he'd heard about the results, so the crew is also kept in the dark as far as I can tell," said Morgan Battisti, a 51-year-old retiree from Oregon who was on board.

Asked about the Costa Luminosa last Saturday, Carnival's chief medical officer, Dr Grant Tarling, said: "What ship?" The Costa Luminosa was being handled in Europe, he said.

Passengers were not allowed to disembark in the Canary Islands that day. However, three sick passengers, two with respiratory problems and one with a fever, were evacuated. The remaining passengers took photos of the ambulances and the men in hazardous materials suits outside.

Hours later that same night, even worse news came. The man who had the heart attacks in the Cayman Islands had died of the coronavirus.

Late on Sunday, the company instituted the established protocol for an outbreak on board.

People were to have their temperatures taken every day, and all 1,421 passengers were isolated to their rooms. Food was delivered to the cabins. The crew started wearing masks and gloves, and eventually even gowns over their clothes.

People with inside rooms were moved to cabins with balconies.

"The organisation of all of this, of course, required some time, as you can imagine," Ms Carrara, the company spokesman, said.

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She stressed that the company had introduced "rigid pre-boarding screening", which included temperature checks for everyone and restrictions for people coming from hard-hit areas.

She did not answer questions about whether the ship had been notified about the Cayman Islands man's illness, or why the cruise line waited for official notification from health authorities before instituting stricter health protocols.

"Every situation is unique, as you know, but there continues to be broad coordination, guidance and learning provided from medical and maritime at our sister brands and the corporation," she said.

One of the notable issues that the ship faced was the lack of clarity about who was in charge of official notifications that would trigger ship protocols. World Health Organisation protocols, for example, call for passengers who test positive and their close contacts to disembark and not be allowed to travel internationally. Social distancing is encouraged, such as eliminating the buffet. But what happens when the test results take days?

"One of the questions I heard was 'Who has authority over us?' It's a good question," Battisti said. "Costa? Italy? The US, or your home country? When you're out in international waters rather than on home soil, the answers get murky."

Mr Roger Frizzell, a senior vice-president at Carnival, noted that 10 other ships across the company were "disrupted for testing and all 10 were negative".

"Princess is documenting the entire account in both cases and will be sharing learnings with our other brands, the industry and others to help everyone better prepare and better combat the virus," he wrote in an e-mail.

Many passengers disembarked in Marseille on Thursday and were put on buses, with little information about how they were getting home. It is unclear whether they will be required to quarantine, and where. In exchange for the interruptions on the cruise, they were offered a US$50 credit to spend on board for every port they were turned away from, and a refund credit to use for another voyage within the year.

At a news conference on Thursday, US President Donald Trump suggested that Carnival cruise ships might be put into service as hospitals.