Crusing risk management

Cruising in the US: The return to service

Kevin Byers, (left) Project Engineer, Marine Practice and Kirsten Hoedlmoser, (right) Technical Lead, Environmental and Industrial Hygiene Group, at forensic consulting and engineering services group, Envista Forensics, explain what the cruise sector is doing to return to normal after a tough few years in the pandemic

The latter half of 2021 saw a return to cruising out of the US, with the largest cruise lines returning more than 50% of their ships back to service. To do so in a safe and effective manner, the US Center for Disease Control’s (CDC) Framework for Conditional Sailing Order for cruise ships established guidelines for a phased resumption of cruise ship passenger operations. Additionally, many cruise lines have implemented operational restrictions and technical changes to their engineering systems to go above and beyond these requirements.

At the onset of the pandemic in March 2020, cruise ships were in the headlines for uncontrolled COVID-19 outbreaks, closed ports, and stranded crews and passengers.

The initial No Sail Order issued by the CDC on March 14, 2020, was maintained through the end of 2020 and well into 2021, with the first paid-passenger cruise departing Port Everglades in June of this year. From that point, resumption of cruising in the US states has accelerated with major lines expected to have all ships back in service by mid-2022.

COVID-19 PROTOCOLS

The Framework for Conditional Sailing Order requires cruise ships to adhere to a minimum set of standards which aim to mitigate COVID-19 risk to passengers and crews, prevent community spread, and protect public health and safety.

Requirements range from testing and vaccinations prior to boarding a cruise, efforts to mitigate spread on the ship and during shore excursions, and planning and preparation for controlling an outbreak and evacuating a person who requires immediate medical attention not available on board.

This includes designation and preparation of guest and crew cabins specifically for quarantine and isolation for people who

“The initial No Sail Order issued by the CDC on March 14, 2020, was maintained through the end of 2020 and well into 2021, with the first paid-passenger cruise departing Port Everglades in June of this year.’’

display COVID-19-like symptoms. Simulated cruises with non-paying guests for each ship have been conducted prior to returning to service to demonstrate that these measures are implemented appropriately. Once approved to sail by the CDC, many cruise ships have reduced passenger capacities as low as 50% to provide additional space and comfort for their guests. For crew onboard, who are integral to the experience and often interact closely with guests throughout the cruise, the CDC requires vaccinations, physical distancing, increased hand hygiene and face masks. Passenger requirements vary by cruise line, but in general require proof of COVID-19 vaccination (if eligible) and a negative test prior to boarding. Masks and social distancing are encouraged, especially during the boarding process and pre-departure drills where queues are likely to form. These requirements for individuals aboard cruise ships work in tandem with a host of operational sanitation measures.

Behind the water slides, staterooms and restaurants, many cruise lines have also improved ventilation and sanitation systems to control the spread of infectious disease.

Even before the start of the pandemic, cruise lines were keenly aware of the risks of improper sanitation with respiratory infections, GI infections and varicella (chickenpox) outbreaks having made headlines in years past.

INDUSTRIAL HYGIENE PERSPECTIVE

From an industrial hygiene perspective, these engineering changes represent tier-three on the hierarchy of controls – a system used to determine effective and feasible solutions, often relating to the control of occupational hazards that workers may be exposed to.

The tiers of the hierarchy are arranged such that the most effective controls are to be considered first, whereas the less effective controls are considered and implemented last. Quite often, as many individual controls are not 100% effective in managing a hazard, a control strategy will involve several tiers from the hierarchy to control occupational exposures to hazards.

The first two tiers on the hierarchy, and thus the most effective controls, are elimination of the hazard and substitution of the hazard, wherein the hazard is removed or replaced with a less harmful alternative. The remaining tiers, listed in decreasing order of effectiveness, include engineering controls, administrative controls and personal protective equipment (PPE).

In the case of COVID-19, elimination of the hazard is not reasonably achievable by the cruise ship industry alone. Vaccine mandates could arguably be considered an elimination tool, although breakthrough infections can still occur.

Substitution of COVID-19 for a less harmful disease is also not something the cruise industry reasonably can do. This leaves the balance of the control tiers available for implementation where feasible.

As noted above, improvements to the ventilation systems represent an engineering control, where the control is intended to isolate people from the hazard. Administrative controls, where the manner in which people interact is changed, is reflected in physical distancing and quarantine requirements, and the wearing of masks and face coverings represents the use of PPE controls.

In an effort to reduce occupant exposures to infectious droplets and aerosols, operators have implemented a variety of ventilation system changes. These changes include increased ventilation and air changes per hour and upgraded filters within the ventilation system.

Unpublished data from ventilation assessments on a cruise ship has reportedly indicated that, through a combination of six or greater air changes per hour and the use of MERV-13 filters, the dispersion of airborne contaminants could not be detected in less than an hour outside of the room in which they were released. The findings indicated that air management strategies can reduce the transmission of infectious aerosols.

Other recommendations made to cruise operators includes air is not to be recirculated and is to be exhausted to the outdoors. Typically, a cruise ship is designed to prevent recirculation of air between spaces. Air intake and exhaust are positioned in a manner to prevent recirculation via pressure differentials. Where this is not possible because of design constraints of the ventilation system, air is recirculated through MERV-13 filters.

Additionally, it has been recommended that isolation rooms be kept under negative pressure to prevent the migration of infectious aerosols to surrounding areas, have between 6-12 air changes per hour, and exhaust air to the exterior of the ship. Where needed, portable HEPA filtration systems may be used to augment other ventilation control strategies.

These engineering control strategies, used in combination with physical distancing and PPE, as well as other administrative controls, provide a blended hazard control strategy. In this blended strategy, when implemented consistently, the various components work together to reduce the transmission of COVID19 and other infectious aerosols on cruise ships.

CONCLUSION

As cruise ships continue to return to service, the travel industry has building momentum and pent-up demand for vacations. The health and safety of crew members and guests will continue to be at the forefront and the preparation and reaction to infectious disease outbreaks onboard ships will remain a priority. Moving forward, expect smaller ships, new technologies (ie, touchless payments and keycards), and private destination islands to lead the way.

22 March 2022 22 March 2022

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Tuesday 22 March 2022 All times are in Greenwich Mean Time (GMT) Tuesday 22 March 2022 All times are in Greenwich Mean Time (GMT)

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