Last month, a 77-year-old woman made a fatal decision: She boarded a Carnival cruise in Galveston, Texas, set for sunny Belize.
The cruise required vaccination, and approximately 96% of all 4,336 passengers and crew were reportedly vaccinated, but nobody was required to present a negative Covid test before boarding. After four days on the water, the ship reported a 27-person Covid outbreak spanning both passengers and crew. One of the passengers, the 77-year-old, died 10 days later — the first such reported death since cruises restarted in the United States in June.
The tragic incident begs the question: Is traveling on a cruise safe right now?
Predictably, Carnival says yes. In recent weeks, the company has mandated pre-boarding negative Covid tests for all passengers and released a statement to the Washington Post saying that the woman who died "almost certainly did not contract COVID on our ship." Notably, when she boarded the ship on July 31, testing procedures were not in place.
Medical experts are unconvinced. Travel of any kind is currently a very high-risk activity, explains Dr. Luis Ostrosky, division chief for infectious diseases at UT Health, part of the University of Texas, Houston. Cases are "completely out of control," he says. "And we don't have the level of vaccination we need to assure that people are going to survive if they happen to get [Covid]."
And even with safety measures in place, cruises come with residual risks that can't be ignored, like unavoidable close quarters and potential for breakthrough infections.
Here's why those risks are particularly dangerous, especially compared to other forms of travel — and what can be done to make cruises safer:
Even on a good day outside of the pandemic, cruises are challenging environments from an infection-control standpoint, Ostrosky says.
On a cruise, you often spend time in shared common areas. You eat and drink indoors at buffet restaurants with large communal tables, attend shows in theaters and touch all kinds of surfaces, from railings to casino games. If an outbreak happens at sea, you're restricted to the boat, which can make the outbreak harder to contain and treat.
"It's just a recipe for transmission," Ostrosky says. That's why it's common to see outbreaks of other contagious respiratory or gastrointestinal viruses, like norovirus, aboard cruises.
Cruises are even particularly risky when compared to other types of travel, like driving or flying, because they present more opportunities for prolonged exposure. "Frankly, the risk on a two-hour flight where everyone is masked and airflow is good is [lower] than being on a cruise ship for five days straight," says Dr. Preeti Malani, chief health officer at the University of Michigan.
Several cruise companies, including Disney Cruise Line and Norwegian Cruise Line, are cracking down on vaccine requirements. It's a good start, experts say — but not enough.
While being fully vaccinated significantly reduces your risk of hospitalization or death from Covid, Ostrosky notes, the delta variant's increased transmissibility means vaccination "no longer guarantees that you're not going to acquire the infection, or be able to transmit it." That means any vaccine mandates need to be paired with other safety measures, like wearing masks and maintaining social distance.
"We can try to do cruises as safely as possible, but we are going to have breakthrough cases," says Ostrosky.
Another factor to keep in mind: The level of community spread in the place where you live — or, in this case, where a cruise is departing from — significantly affects your risk level. "When spread is extensive in the community, like it is in Florida right now, every everything becomes risky," Malani says. "The idea of going on a cruise is that much riskier."
Some of the cruise companies are fighting another battle, too — against state governments that have passed laws or executive orders aimed at stopping vaccine mandates. On Wednesday, Texas Gov. Greg Abbott passed an executive order banning any state or local mandates requiring Covid vaccination. In Florida, home to multiple popular cruise departure ports, Gov. Ron DeSantis signed an executive order in May prohibiting vaccine passports statewide.
Norwegian Cruise Line sued Florida's top health official in July, requesting a preliminary injunction to let the company implement its vaccine mandate for all passengers and crew. The company won the case earlier this month, with U.S. District Judge Kathleen Williams writing that Norwegian "demonstrated that public health will be jeopardized if it is required to suspend its vaccination requirement."
If you don't quarantine for two weeks before your pre-boarding Covid test, the test is "basically irrelevant," Ostrosky says.
To make cruises genuinely safe, he says, companies would need to require mandatory two-week quarantines for each passenger and crew member, negative Covid tests 24 to 48 hours before boarding and another negative Covid test immediately after boarding. That's an onerous process, and difficult to organize and pull off, especially in the middle of a passenger's vacation.
It could be a while before it's truly safe to board a cruise. Dr. Anthony Fauci, the nation's leading expert on infectious diseases, recently said that he thinks the country will have control over Covid and regain a sense of normalcy by spring 2022. But even then, travel and cruises will likely be high-risk activities.
"We look forward to a future when more people are vaccinated and the numbers are lower, perhaps we're over the delta variant," Ostrosky says. "That'll be a much safer time to travel."
If your heart is set on going on a cruise before then, you should get vaccinated when you're eligible, Malani says. Then, look for cruises that require vaccination proof and only allow reduced capacity — the lower, the better. While on the cruise, pick activities and excursions that are lower-risk, she says, like always dining outdoors. And of course, board the ship with the understanding that no matter what happens, you're taking a risk.
The Centers for Disease Control and Prevention (CDC) gives cruise ships a color-coded safety status — green, yellow, orange and red — based on reports of cases of Covid or Covid-like illness. The agency also indicates when there are investigations into outbreaks on ships. You can check the CDC's website for a ship's Covid status before planning or boarding a cruise.