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Test cruises will start in U.S. waters this month after the Centers for Disease Control and Prevention stopped large cruise ships from sailing due to the COVID-19 pandemic more than a year ago.

But just because cruises are restarting with a slew of protocols in place to prevent the spread of the coronavirus that causes COVID-19, including vaccination requirements on some ships, that doesn’t mean that sailing is without risk.

And evidence that the risk is present has already been made clear on a Celebrity Cruises sailing from St. Maarten that departed June 5 on a Caribbean cruise not regulated by the CDC. Two passengers tested positive on the Celebrity Millennium, which was billed as a “fully vaccinated” sailing by the cruise line, with the exception of a handful of children under the age of 12.

It’s still possible to test positive for the coronavirus even after getting vaccinated, experts say, and the CDC has said it can take weeks for a person’s body to build up immunity after getting vaccinated.

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What will happen if COVID-19 cases are detected on cruises?

CDC spokesperson Caitlin Shockey told USA TODAY in a statement Friday that “cruising safely and responsibly during a global pandemic is very challenging.”

It’s not possible for cruising to be a “zero-risk activity” in terms of COVID-19 spread, she added, noting that vaccines play a “critical role” in safely allowing cruising to return. “CDC recommends that all travelers (passengers and crew) get a COVID-19 vaccine.”

There may be nuances by cruise line, but most cruise ships will have a similar response based on three key pillars, according to Brian Salerno, senior vice president of maritime policy for Cruise Lines International Association, the leading trade organization for the industry: prevention, detection and response.

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“Nobody is under the illusion that there will never be a case of COVID on a cruise ship,” Salerno said, though CLIA members are following protocol laid out by the CDC in case of COVID-19 cases emerging on board.

That protocol varies by ship and the kind of sailing it’s embarking upon.

Test cruises

In its guidance on test cruises, the CDC states that “a simulated voyage must be designed and conducted insofar as practicable to test the efficacy of the cruise ship operator’s ability to mitigate the risk of COVID-19 on board a cruise ship.”

Test cruises may be halted by the CDC and may be required to take other actions to protect the health and safety of crew and passengers if a certain threshold of COVID cases is reached. Test cruises are required to have a minimum itinerary of two days, and many are scheduled to conduct test cruises at that minimum.

When a threshold of 1.5% of passengers or 1% of crew are infected with COVID-19, the CDC will begin investigating what happened on board and will consider factors, including how many passengers and crew are vaccinated and epidemiological links between cases.

The minimum number of volunteer passengers for each test sailing, per the CDC’s guidelines, must be 10% of the maximum passenger capacity for the first two sailings with paying passengers. So if a ship plans to carry 1,000 passengers for a sailing with paying passengers, there must be at least 100 passengers on a test cruise. In that situation, the threshold would be met with two or more passengers testing positive for COVID-19.

The CDC added that the threshold is subject to change based on lessons learned on test cruises, the pandemic’s evolution and other factors. If the voyage ends early, the cruise operator will be required to conduct another test cruise at a later date.

If a case of COVID-19 is identified on board, affected passengers or crew members must be transferred from cabins into isolation rooms.

The volunteer passengers must also agree to inform the ship’s crew if they are experiencing symptoms or test positive for COVID-19 after disembarking so that contact tracing may be carried out.

Sailings with paying passengers

As for sailings with paying passengers, the requirements for COVID-19 outbreaks are not yet clear – though the first CDC-approved paid sailing is scheduled to depart on June 26 on Celebrity Cruises’ Celebrity Edge.

“CDC is currently evaluating thresholds of COVID-19 cases on restricted cruise ship voyages that would require actions to protect the health and safety of passengers and crew, such as ending the voyage,” Shockey told USA TODAY Thursday.

Protocols on cruises in other parts of the world are minimizing COVID outbreaks, industry says

Protocols adopted by cruise lines on their ships are working, according to Salerno, and what happened on the Celebrity Millennium is proof of that.

“The two individuals that tested positive were not even aware – they were asymptomatic,” he said. After the routine test, the passengers were placed in isolation, and contact tracing was conducted immediately.

“The end result is the disease did not spread, and the cruise was able to continue,” Salerno said noting the sequence was similar to what cruise lines have done since resuming operations abroad last summer – without vaccine requirements.

Royal Caribbean Group, parent company to Celebrity, echoed that sentiment in a statement released at the time COVID-19 cases emerged on board. “This situation demonstrates that our rigorous health and safety protocols work to protect our crew, guests and the communities we visit.”

Some people are worried about getting on board

Nan Palmero, a marketing professional, told USA TODAY that though he’s vaccinated against COVID-19, the news of Celebrity Millennium passengers testing positive for COVID gave him pause and will likely prevent him from getting on board a cruise ship in the near future.

He’s also concerned about being in close quarters with passengers traveling from around the globe.

“The thing that makes cruise ships wonderful is the people from all over. Unfortunately, we can all be carriers of different strains of ailments globally,” Pamero said. “I would likely reconsider my position as vaccinations increase globally with the ongoing proof that they are effective on new strains of COVID.”

While the risk of contracting COVID-19 is nerve-wracking to some, others are nervous about the potential of finding themselves in a situation similar to what happened on Princess Cruises’ Diamond Princess, on which passengers were quarantined as the pandemic began. More than 700 COVID cases were tied to the Diamond Princess outbreak, and more than a dozen died, according to Johns Hopkins data.

“My No. 1 fear with cruises currently is a repeat of Diamond Princess in terms of being turned away from ports and countries enforcing at-sea quarantines if there is a COVID outbreak,” Leona Bowman, a travel blogger currently based in the UK, told USA TODAY.

Bowman added that if she was forced to quarantine in a cruise cabin, it may be difficult to entertain her two young children.

Salerno said that he doesn’t believe getting stuck is an issue passengers need to worry about anymore given measures put in place by cruise lines.

“What we’ve seen in places where cruises have resumed and cases have emerged, (passengers) haven’t been stuck because the management strategies for dealing with (COVID-19) are so far superior to what we had 15 months ago so that it can be contained and not spread throughout the ship,” Salerno said.

While Palmero is nervous about contracting a COVID variant, he seconded Salerno’s sentiment.

“We have a better understanding of how COVID spreads now and better precautions, compared to early on where much less was known and a greater abundance of caution was required,” he said.

This article originally appeared on USA TODAY: Cruise ships will sail soon in US. What if there’s a COVID outbreak?

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