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Back Interim Guidance for Ships on Managing Suspected or Confirmed Cases of Coronavirus Disease 2019 (COVID-19) | Quarantine | CDC

Key Concepts

  • Preventive measures, including physical distancing and wearing well-fitting masks, are essential to maintaining ship operations during the COVID-19 pandemic.
  • After a COVID-19 case is identified on a non-cruise ship, all persons on board are considered contacts because of the close living and working conditions.
  • Cleaning and disinfection protocols may reduce transmission of COVID-19 on ships.

Who this Guidance Is for

This document provides guidance for ships originating from or porting in the United States to help prevent, detect, report, and medically manage suspected or confirmed COVID-19 cases. As ships travel worldwide, ship management and medical staff need to be aware of and respond to local jurisdictional requirements. Important points to be aware of:

[1] U.S.-flagged cruise ships may follow CDC’s COVID-19 program for cruise ships at the cruise ship operator’s discretion.

Purpose

This document provides guidance for preventing the spread of COVID-19 during and after a voyage, including personal protective measures, management of sick or exposed persons on board, reporting suspected or confirmed cases, and cleaning and disinfection recommendations for common areas on the ship and areas previously occupied by individuals with suspected or confirmed COVID-19. CDC will update this interim guidance for ships as needed and as additional information becomes available.

Planning and Prevention

Plans to Mitigate COVID-19 on Board Ships

Ship companies should develop, implement, and operationalize an appropriate, actionable, and robust plan to prevent, mitigate, and respond to the spread of COVID-19 on board ships. The Occupational Safety and Health Administration’s webpage, Protecting Workers: Guidance on Mitigating and Preventing the Spread of COVID-19 in the Workplaceexternal icon, provides ways to prevent workplace exposures to persons with COVID-19. Plans should include the following components:

  • Training of all crew on COVID-19 prevention and mitigation
  • On-board monitoring of crew and non-crew for signs and symptoms of COVID-19
  • COVID-19 testing (onboard or onshore)
  • On-board isolation, quarantine, and physical distancing
  • Adequate medical staffing (this can include telehealth or telemedicine providers)
  • Maintaining sufficient quantities of Personal Protective Equipment (PPE), oxygen, and other supplies, and the ability to obtain additional resources, if needed
  • COVID-19 outbreak management and response information
  • Medical arrangements for onshore evaluation and hospitalization
  • Screening of embarking or disembarking crew and non-crew
  • A system to notify respective national, state, and local public health authorities

Preventive Measures for Ship Operators

Shipping involves the movement of people from different geographic areas in settings with inevitable close contact. Like other close-contact environments, ships may facilitate transmission of respiratory viruses from person to person through exposure to respiratory droplets or small particles that contain the virus or contact with contaminated surfaces.

To reduce spread of respiratory infections including COVID-19, CDC recommends that ship operators take the following actions:

  • Explore options to keep crew up to date on their COVID-19 vaccines, which includes booster doses if eligible. This includes encouraging crew to get a COVID-19 vaccine and working with local authorities to make arrangements for crew to get vaccinated while the ship is at port. Ship operators should keep records of the vaccination status of all crew.
  • Encourage crew to wear masks in indoor areas (unless work duties prevent their safe use or necessitate personal protective equipment for hazardous reasons) or when interacting with port personnel.
  • Educate all persons on board about the signs and symptoms of COVID-19.
  • Assign crew to single-occupancy cabins with private bathrooms, if possible.
  • Implement physical distancing of persons when working or moving through the ship (maintaining at least 6 feet [2 meters] from others).
  • Modify meal service to facilitate physical distancing if one or more cases are identified on board (e.g., reconfigure dining room seating, stagger mealtimes, encourage in-cabin dining).
  • Eliminate self-serve dining options at all meals.
  • Minimize shore leave; if shore leave occurs, preventive measures are recommended.
  • Discourage handshaking and instead encourage the use of non-contact methods of greeting.
  • Promote hand hygiene and cough etiquette.
  • Place hand sanitizer (containing at least 60% alcohol) in multiple locations and in sufficient quantities to encourage hand hygiene.
  • Ensure handwashing facilities are well-stocked with soap, paper towels, and a waste receptacle or air dryer.
  • Place posters that encourage hand hygiene and physical distancing to help protect yourself and others pdf icon[PDF – 1 page] in high-trafficked areas.
  • Educate workers that use of cigarettes, e-cigarettes, pipes, or smokeless tobacco can lead to increased contact between potentially contaminated hands and their mouths, and that avoiding these products may reduce their risk of infection.
  • Because of how easily COVID-19 spreads in the close quarter environment on board ships, ship operators should consider having embarking crew quarantine for 10 days immediately before or upon boarding the ship to prevent introduction of the virus on board. If testing is feasible, crew members, regardless of vaccination status, should be tested using a viral COVID-19 test with a result available prior to boarding.

Preventive Measures for Persons on Board the Ship

CDC recommends that all crew stay up to date with their COVID-19 vaccine, which includes booster doses if eligible.

Crew should do the following to protect themselves and others:

  • Avoid sharing personal items with other persons, such as blankets, laptops, video games, tablets, and other hand-held devices.
  • Wear a well-fitting mask indoors (unless work duties prevent their safe use or necessitate personal protective equipment for hazardous reasons) and when outside of individual cabins.
  • Maintain distance from others when working or moving through the ship. Note: If a distance cannot be maintained in narrow corridors, then allow persons to pass completely before entering.
  • Avoid physical contact with other people, including shaking hands, giving hugs, and cheek kissing.
  • Avoid touching eyes, nose, and mouth with unwashed hands.
  • Wash hands often with soap and water for at least 20 seconds.
  • Use hand sanitizer (containing at least 60% alcohol) if soap and water are not available.

CDC has free, simple posters available to download and print, some of which are translated into different languages. The Help Protect Yourself and Others pdf icon[PDF – 1 page] is also available in Spanish pdf icon[PDF – 1 page].

COVID-19 Vaccinations

CDC recommends that people remain up to date with their COVID-19 vaccines, which includes booster doses if eligible. For more information, please see CDC’s COVID-19 Vaccine Booster Shots. For the purposes of this guidance, those that are not fully vaccinated are referred to as unvaccinated.

As the majority of non-cruise ships are flagged in other countries, for the purposes of this guidance, maritime crew members on board a non-cruise ship are considered fully vaccinated for COVID-19 if they have received the appropriate series of a vaccination authorized by a national government authority (this may include booster doses, as applicable). While booster doses for COVID-19 vaccines approved or authorized by the Food and Drug Administration are widely available for those eligible in the United States, many other countries do not offer booster doses because of limits on available vaccines. If the maritime crew member disembarks the non-cruise ship at a U.S. port, CDC’s guidance for persons up to date with their COVID-19 vaccines [2] will apply.

[2] Up to date with COVID-19 vaccines means a person has received all recommended COVID-19 vaccines, including any booster dose(s) when eligible. For more information: https://www.cdc.gov/coronavirus/2019-ncov/vaccines/stay-up-to-date.html.

Pre-Boarding Procedures for Ships

Before anyone boards the ship, conduct verbal or written screening in appropriate languages and in a private environment to determine whether persons have had signs or symptoms of COVID-19 or a known exposure (close contact) to a person with COVID-19 within the past 14 days. In addition, temperature checks should be used to identify any person with a temperature of 100.4°F (38°C) or greater.

Persons with signs or symptoms of COVID-19: Persons with signs or symptoms of COVID-19 who intend to board the ship should be denied boarding, regardless of vaccination status. These symptomatic persons should be assessed by medical personnel and either be determined not to have COVID-19 or complete isolation for COVID-19 before they are allowed to board.

Close Contacts:

Ship operators, at their discretion, may deny boarding to crew who were exposed to a person with COVID-19 until they complete a 10-day quarantine period and have tested negative.

  • If boarding is allowed, the following options should be considered:
    • 10-day quarantine period, or
    • 10-day “working” quarantine [3] period wearing a well-fitting mask any time they are around others and monitoring their health until 10 days after their last exposure. If viral COVID-19 testing is available, testing before the end of quarantine is recommended.
  • People who recovered from COVID-19 in the past 3 months do not need to quarantine or be tested after an exposure but should wear a well-fitting mask any time they are around others and monitor their health until 10 days after their last exposure. If they develop symptoms, they should isolate until COVID-19 testing can be conducted and results are available.

Anyone who develops symptoms of COVID-19 after an exposure should isolate until COVID-19 testing can be conducted and results are available according to the Isolation or Quarantine Procedures section below.

[3] For a “working” quarantine, crew are permitted to work but must observe activity restrictions while off duty. These crew must have in-cabin dining and properly wear a well-fitting mask at all times when outside of their cabin (indoors and outdoors). They must also wear a well-fitting mask inside their cabin if any other person (e.g., a crew member) enters the cabin.

Testing for COVID-19

If testing is feasible, crew members, regardless of vaccination status, should be tested using a viral COVID-19 test. Please see the following infographics for additional information on COVID-19 testing for crew: COVID-19 Testing: What You Need to Know pdf icon[PDF – 1 page] and COVID-19 Testing: Information for Crew on Ships pdf icon[PDF – 1 page].

Crew who are self-testing for COVID-19 using “home tests,” “at-home tests,” or “over-the-counter (OTC) tests”, should review CDC’s Self-Testing At Home or Anywhere webpage.

Isolation or Quarantine Procedures

Isolation Basics

Isolation is used to separate people with confirmed or suspected COVID-19 from those without COVID-19. Persons with symptoms of COVID-19, regardless of vaccination status or previous recovery from COVID-19, should be isolated using the same procedures as a person with confirmed COVID-19 until testing can be conducted and results are available. Sick persons, regardless of vaccination status or previous recovery from COVID-19, should self-isolate immediately and inform the Captain or medical designee if they develop a fever (100.4°F / 38°C or higher), begin to feel feverish, or develop acute respiratory symptoms (cough or difficulty breathing) or other symptoms of COVID-19. Please see table below for isolation options for crew on non-cruise ships.

Quarantine Basics

Quarantine is a strategy used to prevent transmission of COVID-19 by keeping people who have been in close contact with someone with COVID-19 apart from others. Quarantine of unvaccinated persons without symptoms who are identified as close contacts of sick persons (until COVID-19 test results are available) or confirmed cases is also needed to minimize on-board transmission. On non-cruise ships, all crew members are considered close contacts if a person with known or suspected COVID-19 is on board or disembarked within the past 10 days. Please see table below for quarantine options for crew on non-cruise ships.

The following procedures are recommended for both isolation and quarantine onboard a ship:

  • Isolate or quarantine persons in single-occupancy cabins, with private bathrooms, with the door closed, if possible. Persons should wear a well-fitting mask or respirator, any time they are outside of isolation or quarantine.
  • Isolated or quarantined persons should have no direct contact with other persons except for medical designee.
  • Designated ship medical personnel or the Captain should communicate with each person in isolation or quarantine at least once per day to check on their status.
  • Designated ship medical personnel or other personnel should wear proper personal protective equipment (PPE) when in proximity to isolated or quarantined persons. Breaches in PPE or any potential exposures should be reported to the appropriate medical designee.
  • Meals should be delivered to individual cabins with no face-to-face interaction during this service.
  • To the extent possible, cabins housing isolated or quarantined persons should not be cleaned by other persons. Supplies such as paper towels, cleaners, disinfectantsexternal icon, and extra linens can be provided to isolated or quarantined persons so they can clean their own cabin as necessary.
  • Food waste and other garbage should be collected and bagged by the isolated or quarantined person and placed outside the cabin during designated times for transport to the garbage/recycle room for incineration or offloading.
  • Soiled linens and towels should be handled by the isolated or quarantined person and placed outside the cabin in labeled bags during designated times for transport to the laundry room.
  • Ship medical personnel and telemedicine providers should reference CDC’s COVID-19 website, Information for Healthcare Professionals, for the latest information on infection control, clinical management, collecting clinical specimens, evaluating patients who may be sick with or who have been exposed to COVID-19, and identifying close contacts.

Isolation Discontinuation

If isolated on board the non-cruise ship:

  • Isolation may be discontinued for symptomatic crew with suspected or confirmed COVID-19 after 10 days from symptom onset, if:
    • they are fever-free for 24 hours without the use of fever-reducing medication, and
    • their other symptoms have improved (loss of taste and smell may persist for weeks or months after recovery and need not delay the end of isolation).
  • Isolation may be discontinued for asymptomatic crew with confirmed COVID-19 after 10 days from their first positive viral test.
  • If isolated off the ship (i.e., post-disembarkation) in the United States: Travelers should follow the isolation guidance for the general population. See additional information about air travel. Note: the isolation guidance for the general population does not apply to crew who are transferring to another ship or reembarking the same ship (i.e., these crew would need to isolate until 10 days after symptom onset/positive test shoreside or on the ship).

Quarantine Discontinuation

  • Due to the high risk of secondary transmission onboard ships, CDC recommends a 10-day quarantine for crew members, regardless of vaccination status.
  • People who recovered from COVID-19 in the past 3 months do not need to quarantine or be tested after the last close contact with someone with COVID-19 (the date of last close contact is considered day 0) but should:
    • wear a well-fitting mask when outside of cabin (indoors and outdoors),
    • wear a well-fitting mask inside their cabin if any other person (e.g., a crew member) enters the cabin, and
    • monitor their health until 10 days after their last exposure.
  • If the crew member is disembarked in the United States, then the person should follow CDC’s quarantine guidance for the general population (including testing at least 5 days after last exposure). See additional information about air travel and other public conveyances (e.g., buses, trains).
  • If a non-cruise ship cannot maintain minimum safe manning because crew members are in quarantine, then the ship may consider a “working quarantine” (i.e., crew perform job duties then return to cabin quarantine) for essential crew to ensure the safety of ship.
    • The ship should prioritize crew who are up to date with their COVID-19 vaccines (which includes booster doses if eligible) over those who are not.
    • Crew in working quarantine should:
      • wear a well-fitting mask when outside of cabin (indoors and outdoors [unless working alone in an outdoor area]),
      • wear a well-fitting mask inside their cabin if any other person (e.g., a crew member) enters the cabin,
      • eat their meals in-cabin (i.e., instead of the crew mess),
      • monitor their health until 10 days after their last exposure, and
      • isolate and get tested if they develop COVID-19 symptoms.

Options for Managing Non-Cruise Ships with One or More Confirmed Cases of COVID-19

The following table provides management options for non-cruise ships and their crew after a confirmed case of COVID-19 is identified. Decisions regarding the best option for managing an individual ship and exposed crew on board should take into account various factors (e.g., the industry, seaport location, itinerary, and the availability of alternate crew).

Note: The ship should be allowed to come into port for all disembarkations, disinfection, and embarkations. There is an increased safety risk, to the crew and port partners, associated with embarking or disembarking a ship while at anchorage (i.e., keeping the ship at sea). In addition, quarantine of crew while the ship is at anchorage can be difficult due to the increased number of essential crew needed to safely maintain ship operations at anchor (i.e., operations are minimized on a ship while it is at a dock, which allows crew to quarantine more safely).

Entire content available on: https://www.cdc.gov/quarantine/maritime/recommendations-for-ships.html


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Guidelines/Recommendations/Technical Instructions

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Covid-19 Prevention Preparedness

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