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Cruise Vacation With COVID-19 Safe Management
No matter why you slice, dice, or spin it, throughout 2020, the leisure cruise industry is facing an unprecedent global crisis brought on by the COVID-19 pandemic.  After being hammered by the bad publicity, the industry is looking forward to restarting leisure cruises in 2021.  Singapore which has seen relatively good result in tackling the coronavirus is taking incremental steps to allow leisure cruises with COVID-19 safety measures.  A false alarm soon after the pilot program was launched provided good lessons for cruise lines and passengers alike.


The Coronavirus Threat
COVID-19 can spread in any setting where people come together to socialize like restaurants, hotels, and movie theatres. It also spreads in the transportation sectors if people are in close contact with others who are infected, such as passenger aircraft, trains, public transport buses and ride share vehicles.  However, cruise ships suffer badly from the misperception perpetuated by the early reports of COVID-19 outbreaks on cruise ships. The infection rate on a cruise ship is probably high because many people are accommodated in close quarters and there are many common that touching surfaces that can be contaminated with the coronavirus. The drama of cruise ships being refused port entry by many countries also did not help. COVID-19 infections spread easily on cruise ships not just because of the ship environment.  In recent years, passengers aged 50 and above have come to form the core customer base for leisure cruises.  Indeed, many of the cruise tour passengers are in the over-70s age group.  The high proportions of older people who tend to be more vulnerable to the coronavirus contributed to the high infection rate.
In the first known case on 1 February 2020, a passenger who had disembarked from the Diamond Princess cruise ship days earlier in Hong Kong tested positive for the COVID-19. The ship with 3,711 passengers and crew members on board, was promptly quarantined after it entered Japanese waters on 3 February 2020. Over the next few weeks, over 700 would be tested positive and in the end, 9 people succumbed to the infection. The fate of the passengers and the response of the Japanese authorities dominated both the mainstream media and online social media.
Since the Diamond Princess outbreak, at least 25 other cruise ships have reported confirmed COVID-19 cases.  Soon the media started to refer to ships as “floating Petri dishes”. There was wide news coverage of cruise ships being turned away from ports and left to sail aimlessly on the high seas while thousands of passengers are stranded on board. With all these bad publicities, it was unsurprising that cruise ship operations quickly grinded to a halt worldwide.
Late in 2020, there came the news of potential COVID-19 vaccines with several companies reporting trial results of up to 95% efficacy.  Even with this good news, it is a long way to go before the pandemic can be contained. So, the cruise industry is no doubt still at sea. It will be months before the vaccines are approved and widely available.  It will be many more months before people regain enough confidence in taking cruise holidays and some normality return to cruise industry.

CruiseSafe Pilot Program
In the light of these development, it is interesting to see how Singapore is gingerly re-opening its holiday cruise sector. In November 2020, Singapore piloted a scheme called CruiseSafe with COVID-19 safety protocols.  Two cruise ships, one each from the Royal Caribbean International and Genting Cruise Lines, whose home ports are in Singapore, can carry Singapore residents as passengers on roundtrips with no ports of call at a maximum passenger load of 50 per cent of the maximum capacity.  The vessels are installed with upgraded ventilation and air conditioning system, which will supply filtered air from outside the ship to replace used air on-board. The ships’ crew members on these cruises are subjected to stringent measures beyond Singapore’s prevailing requirements for cross-border travel.  Crew members from outside of Singapore must first undergo 14 days’ isolation in their home country and must produce a negative test result for COVID-19 before entering Singapore.  They will be tested again on arrival in Singapore and serve a 14-day stay-home notice. They will be tested a third time at the end of the stay-home notice period.  During the voyage, all crew members will be subjected to routine COVID-19 tests.
Prior to sailing, the cruise vessels must obtain the Singapore CruiseSafe certification, which requires an independent assessment by a third-party certification firm.  The CruiseSafe standards are developed by the Singapore Tourism Board in consultation with the industry and is benchmarked against global health and safety standards. The standards set out stringent hygiene and safety measure requirements throughout the passenger journey – from prior to boarding, to after disembarkation.  The standards cover the following preventive measures:
  1. Infection control measures at every stage of a passenger’s journey, including a mandatory COVID-19 test prior to boarding
  2. Strict and frequent cleaning and sanitization protocols onboard
  3. Safe management measures aligned with prevailing national policy at the time of sailing such as mask-wearing and the 1metres safe distancing.
  4. Ensuring 100 per cent fresh air throughout the ship
  5. Reducing passenger load to enable sufficient safe distancing
  6. Implementing on-board measures to dissuade close contact and inter-mingling between groups
In addition, there must be emergency response plans for incidents relating to COVID-19 such as isolation of infected passenger. A compliance audit will be conducted by an appointed certification firm prior to sailing.
There will be regular inspections conducted onboard to ensure compliance.  Non-compliance with the CruiseSafe standards will subject the cruise lines to severe penalties including fines, suspension of sailings and revocation of CruiseSafe certification.
The cruise ships will have the equipment to conduct COVID-19 tests on board.  If a passenger is sick, testing will be conducted. If there is a confirmed COVID-19 case detected, the affected person, as well as their close contacts, will be isolated immediately. Deep cleaning of the common areas on board the ship will be carried out, and all leisure activities on-board will cease.  The ship will return to Singapore immediately.
Facing the COVID-19 Infection Test
The scheme faced a test within weeks of commencement. On 9 Dec 2020, the Royal Caribbean’s Quantum of the Seas ship returned to port a day ahead of schedule after an 83-year-old passenger tested positive for COVID-19 during the cruise. Although it was subsequently found to be a false alarm, the episode is instructive in term of the precautions taken and responses to COVI-19 infection during a cruise.  This is something that the cruise industry will be studying closely as it seeks to rebound from the pandemic.
Countries such as New Zealand and Singapore which have been successfully in containing the spread of COVID-19 applied a similar strategy.  This involves a strict lockdown to suppress any transmission within the community, followed by extensive testing and contact tracing to prevent any subsequent outbreaks. This strategy can be similarly applied to a cruise ship.  The false alarm on Royal Caribbean cruise ship, Quantum of the Seas demonstrated how the strategy panned out.

COVID-19 Safe Management Measures During Cruise 
The preventive measures of wearing masks and safe distancing are strictly enforced.  Passengers must always wear masks except during certain activities such as eating or sports.  Royal Caribbean also adhered to the restrictions enforced by the Singapore authorities pertaining to social activities and sports. For example, karaoke singing, and dancing are not permitted and there is a cap on the maximum number of people for events or within a certain area. Passengers must also use a contact tracing App, TraceTogether which is checked by the ship crew at random. TraceTogether is a Bluetooth-based App which records all mobile phones which have the App enabled and in proximity for an extended time.  This allow for the fast and effective contact tracing when a COVID-19 infection is confirmed.  Privacy is ensured by having no record of location and personal information.  Any record is automatically deleted after 25 days. This is complemented using the room pass to record the location of the passengers as they enter and leave rooms.
Prior to boarding, all passengers must take and pass a polymerase chain reaction (PCR) test within the past three days. The passengers would undergo mandatory COVID-19 antigen testing before leaving the cruise terminal as part of the post-arrival protocols. Passengers from different cruise ships will also be kept separated as they embark or disembark.
Some passengers rued the absence of their favourite activities such as the nightly singing and dancing.  However, there are enough entertainment and dining options to keep the passengers happy as nobody complained even when the cruise was cut short by a day.
 The ship also has an on-board capability to process PCR test.  Passengers who had to see the ship doctor were given a swab test.  This is what triggered the false alarm. The passenger who tested positive for COVID-19 was given a swab test after reporting to the cruise ship's medical centre for diarrhoea.

Emergency Response to COVID-19 Infection 
Once there is a confirmed case of COVID-19, the ship swung into ‘lock down’ mode.  All activities were suspended, and passengers asked to stay in their cabins while the ship immediately returned to port.
The protocols to return the cruise ship to Singapore even when a single case was detected offered an assurance of safe harbour, for it will be a long while before the spectre of cruise ships stranded on the high seas like the Diamond Princess cruise ship fade from memory.
For the rest of the passengers, they were subjected to the COVID-19 antigen test while disembarking.  The whole process of clearing immigration to taking the antigen test took about 10 to 15 minutes for each passenger.  The results of the antigen test will be available in an hour.  The Ministry of Health (MOH) also issued an advisory to the passengers, instructing them to monitor their own health closely for the next 14 days as a precautionary measure. All passengers also must take another PCR test after 14 days although they can resume normal activities within the community including going to back to work or school. Only close contacts of the suspected COVID-19 case were sent to a designated government quarantine facility. 
To prevent any intermingling at the cruise terminal with passengers for another cruise ship that was setting sail, the passengers on board the Royal Caribbean's Quantum of the Seas cruise were only allowed to disembark about 12 hours after docking
The original test sample of the suspected COVID-19 case was re-tested at the National Public Health Laboratory (NPHL) and came back negative for COVID-19 infection.  A second and third fresh sample were subsequently tested by NPHL before the case was declared as a false alarm. 
Royal Caribbean International cancelled the follow-on cruise by the Quantum of the Seas in an overabundance of caution to review its processes despite the confirmation that it was a false alarm.  Earlier, it had decided to set sail as planned after ensuring that proper cleaning and sanitization was completed.  The ship’s PCR sample testing process was under investigation at the point of publication.

Major Public Relation Disaster Averted 
In rolling out the cruise-to-nowhere, Royal Caribbean International provided "COVID-19 protections" to their customers, including 100 per cent credit towards a future cruise should a passenger or any member of their travel party test positive for COVID-19 during the three weeks prior to their booked cruise. Full refunds will be provided if a passenger, or any member of their travel party, tests positive during the cruise.
Royal Caribbean International will also cover COVID-19 related costs up to S$25,000 per person in the travel party for on-board medical expenses, quarantine cost and the subsequent travel home.
Royal Caribbean International did well to manage the issue.  Few passengers were particularly upset by the shortened cruise as all passengers were given compensation in the form of credits that can be used for future cruises.  Early in the mini-crisis, Royal Caribbean International also announced that they will cover the expenses for the additional PCR testing for all passengers.  By keeping the passengers well informed as the situation unfolds and pre-emptively allaying any fears and concerns, there was no disgruntlement voiced to the media.  This is one major public relation disaster averted.

Moving Forward
At the present moment, COVID-19 vaccination using Pfizer-BioNTech's vaccine have started. Britain was the first country in the world to roll out injections on Dec 8, 2020 with the United States following suit on Dec 16.  However, it will take months or even years before enough people around the world are vaccinated to end the pandemic.  Singapore’s CruiseSafe program has given us a look at the new norms for cruise vacations. The cruise industry must review the lesson learnt and quickly adapt to recover.