This week, Dr. Stephen Ostroff said he is comfortable unmasked, indoors, circulating among 2,608 other (mostly) unmasked people.
This is not what one expects to hear from a 20-plus-year veteran of the CDC who specialized in emerging infectious diseases and who also served as the chief scientist at the Food and Drug Administration (stepping in as acting director twice).
But there is a very special circumstance that makes the doctor feel comfortable without a mask, indoors, among thousands of people: Every single one of them is certified to have been vaccinated and has had a negative Covid test before joining him inside.
"Inside" is within the confines of the Encore, the first Norwegian Cruise Line ship to sail from a U.S. port since the pandemic was declared.
A self-described "vaccination zealot," Ostroff served on the Healthy Sail Panel of experts put together by Norwegian Cruise Line Holdings (NCLH) and Royal Caribbean Group that came up with 74 recommendations to minimize onboard health risks.
That was prior to widespread availability of the Covid-19 vaccine. Today, Ostroff sits on a successor panel, NCLH's SailSAFE Global Health and Wellness Council, a post-vaccine committee that continues to provide health and sanitization guidance to NCLH in order to minimize the risks of cruising during a pandemic.
The CDC has offered two choices to cruise ships sailing from U.S. ports: Either sail with at least 95% of guests and crew vaccinated, with no obvious restrictions for guests, or sail with lower rates of vaccinated guests and crew and then layer on protocols that will noticeably impact the cruise experience.
But, Ostroff told media aboard the Encore, "there's a difference between 100% and 95%. One hundred percent ought to be the standard for cruise ships, plain and simple. This is the [safest you can be], other than locking yourself into your house."
NCL president Harry Sommer elaborated, using the Encore as an example. "In a ship this size, with only 95% vaccinated, you could have 200 unvaccinated passengers and 100 unvaccinated crew. We won't be in that situation."
Ostroff cited three standards he feels are necessary to sail safely, even with 100% vaccinated guests and crew: First and foremost, keep the virus from getting on the ship. Second, if it does get aboard, make sure opportunities for it to spread are minimized. And third, minimize the likelihood that if someone picks up the virus they become severely sick, and if they do, take care of them.
Vaccinations and testing are needed for No. 1. Testing is particularly crucial, he said, because the best of the vaccines is only 95% effective.
Advanced air filtration, disinfectants and contact tracing address No. 2 (applying facial recognition software to scan the ship's ubiquitous video feed speeds contact tracing).
And free medical care for respiratory issues, an onboard ICU, isolation cabins and a policy of prorated refunds support No. 3.
"We've come pretty close to creating a bubble," Ostroff said. "If the unvaccinated are present, you can't accomplish these three things to the same degree. The delta variant focuses like a laser on the unvaccinated. Even if there are only a small number of them, it will find them."
During the sailing, the absence of children under 12 was noticeable, especially on a ship with so many attractions designed with kids in mind. Ostroff said he anticipates that in "late fall," children 6 and over will begin to be vaccinated.
The Encore is the second cruise ship that I've been on with 100% of the guests and crew vaccinated (the first was on Silversea's Silver Moon, sailing the Greek isles). On both sailings, I've felt that I was seeing a glimpse of an idealized future, one where Covid is eliminated.
But in reality, it's more like a glimpse into the not-too-distant past. Former FDA commissioner Dr. Scott Gottlieb, another member of the SailSAFE council, has said that Covid is likely here to stay, possibly as a seasonal threat.
The news that NCL had won a preliminary injunction against the state of Florida to allow it to require proof of vaccination from cruises departing Florida ports was handed down during the cruise. Having experienced the feeling of freedom and peace of mind that a fully vaccinated cruise allows, it seems odd to me that Florida Gov. Ron DeSantis is going to the mat to forbid this option when there is nothing in NCLH's victory that would prevent another cruise line from sailing with lower numbers of vaccinated guests. (NCLH is the only one of the big four cruise companies to steadfastly maintain it will only sail with 100% vaccinated passengers.)
Perhaps as an indication of just how safe a 100% vaccinated cruise is versus, well, anywhere else, Ostroff said there is a circumstance in which he would don his mask on the ship: as he prepares to leave for a shore excursion.
Being on a 100% vaccinated ship, he asserted, "shows you what's possible."