Fine print with a huge impact: Ports struggle with CDC terms

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Ships at Charlotte Amalie's cruise port on St. Thomas before the pandemic.
Ships at Charlotte Amalie's cruise port on St. Thomas before the pandemic.

The mayor of Skagway, Alaska, knows that his small town is in dire need of a cruise ship season: Cruise ship tourism supports 95% of the city's economy.

But even if Canada were to drop its cruise ban and the CDC enabled cruising to resume under the restrictions and protocols of its current Conditional Sailing Order (CSO), it would still be unlikely that Skagway would welcome any cruise ships this year.

As it is currently written, the CSO requires that ports be able to care for, house and evacuate infected passengers and crew should a shipboard outbreak occur.

"Well, we don't have a hospital," said Skagway's mayor, Andrew Cremata. "That's impossible to implement."

The small-print requirements of the CSO have gone largely unnoticed amid the broader frustration around the CDC's reluctance to permit cruising to resume.

Skagway mayor Andrew Cremata and his dog Rufus.
Skagway mayor Andrew Cremata and his dog Rufus.

But for destinations like Skagway, those details could result in their exclusion from the itineraries of the first sailings if cruising resumes with the CSO still in force.

And it's not only small ports that are concerned.

In order for a ship to obtain a Conditional Sailing Certificate, the CSO requires that cruise lines enter into agreements with shoreside healthcare entities and port authorities regarding the care and evacuation of patients and also be able to isolate and quarantine Covid-19 cases and their close contacts.

Even in large ports, where such conditions may make compliance possible, many hospitals may have spent the last year overwhelmed by Covid outbreaks, with additional waves possible.

"You hear that ports like Seattle or Los Angeles are trying to comply with these things and they're having issues," said Mark Ittel, senior vice president of ports and maritime for the architecture and engineering firm Bermello Ajamil & Partners. "How do they go to a hospital in L.A. and say they have to guarantee so many beds for cruise when, a couple of months ago, everything was full in L.A. They had real issues.

"It is problematic," he added. "It's difficult ... for any port right now to put together the medical care agreement side of it." 

The Norwegian Bliss at the Port of Los Angeles in 2019.
The Norwegian Bliss at the Port of Los Angeles in 2019. Photo Credit: Courtesy of the Port of Los Angeles

Like many other parts of the CSO, the directive that patients be housed lacks clarity and detail.

"Basically you're talking about a hotel," Ittel said. "Well, how much [room] do you need? There's really no technical guidelines to direct what that means, so I think everybody is just speculating what kind of volume that is."

For a large city, it may be a little bit easier to fulfill the housing requirement, but for smaller towns, he said, "they can't really do it."

Cremata said that being able to quarantine more than just a few people would become very problematic for Skagway. 

"What if there was an outbreak of 35 people while they're in port? We can't handle that," he said. "And then what? State requirements are that they're not allowed to travel on the ferry. So are they getting medevaced out, one at a time? It's impossible to implement."

As far as Cremata is concerned, if those obligations remain in place, cruise ships won't be able to call at Skagway.

"It puts us in a bind," he said. "We need them to come to save our community and so we have an economy. But ... the reality of the situation is, we can't do those things."

Joseph Boschulte, Virgin Islands tourism
Joseph Boschulte, Virgin Islands tourism

Joseph Boschulte, the U.S. Virgin Islands' commissioner of tourism, also said that the island would have difficulty handling an outbreak on a 3,000-passenger ship.

"That is an area that is still of concern to us as a relatively small destination in terms of infrastructure and airlift," he said. "It would be very difficult to move 3,000 passengers off the island efficiently."

The CSO's requirement that the cruise line and "port authority" determine how many ships be allowed at one time so as not to overburden the public health response in the event of an outbreak is also a lot to expect from some of the entities that regulate cruise ship visits, given that it is a question that goes beyond what port operators would be expected to know, such as hospital bed capacity, air transportation levels, etc.

"Some places have port authorities, some are just the city, some are maybe even private operators that have long-term leases," Ittel said. "[How are they] supposed to determine the right number of cruise ships that are in port on a given day without overburdening the public health response?"

And if the acceptable number is one or two, it may not be worth it for some ports to open for a cruise season.

"That doesn't work in Alaska," Ittel said, where a small number of destinations are trying to fit dozens of cruise ships into a short summer season. 

Boschulte said another unknown is what the ship capacity levels would be.

"Will it be half? 25%? The numbers can change, and that's part of the struggle right now with the CDC and the industry and destinations," he said. "I can tell you that if a ship sailed to us at 25%, we'd feel much better from a health perspective, because clearly that is fewer people than a ship that is 75% or 100% full."

Like the rest of the CSO, these requirements do not take into account the subsequent CDC approval of Covid-19 vaccines. Written in October, the document only mentions vaccines twice, and in both cases it is in reference to there not being any vaccines yet approved in the U.S. As Boschulte said, ships requiring passengers to be vaccinated changes the equation when it comes to a destination's ability to handle a potential outbreak for a simple reason: "That mitigates the risk." 

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