Trick or Treat? With the CDC It’s All Tricks!

My last article presented the extraordinary steps cruise lines are taking to reduce the risk of COVID-19 on their ships. From enhanced screening that includes mandatory testing and temperature checks, to enhanced sanitation and rigid quarantine protocols, cruise lines are doing as much as they can to keep anyone from bringing the virus onboard with them and potentially seeding an outbreak. Does that make it safe to cruise? “Safe” is a relative term. COVID-19 will be with us even after a vaccine is widely available. It will find its way onto cruise ships, that’s a fact. But the steps the cruise lines are taking will reduce that risk and will greatly reduce the risk of anyone contracting the virus when it does find its way aboard. As I noted in my last article, the decision to cruise is a personal risk decision that you must make as an individual.

The CDC has shut down the cruise industry since March over this question of risk and it will remain shut down until at least the end of October. Cruise lines haven’t brought in a single dollar of passenger revenue since the CDC’s no sail order (NSO) went into effect in March, yet they are bleeding money. One of the biggest cruise lines in the world is spending $160 million dollars per day to keep their ships at anchor in and around U.S. waters as they await the OK to resume passenger operations. The European Union has already given the OK for cruise ships to resume sailing in their waters, so what is the CDC waiting for?

Following the CDC’s no sail order back in March, all major cruise lines scrambled to line up funding and lines of credit so that they would have enough liquidity to meet expenses for the next 12-18 months. If the NSO is extended to February as the CDC proposes, most of the cruise lines will have burned through the bulk of their reserves. What then? In my view, the CDC is treating cruise lines with arrogance and bureaucratic laziness. They deserve better.

There is no simple solution here. Keeping the cruise ships at anchor won’t keep COVID-19 away. Nor will allowing them to sail provided they implement solid risk plans. As a good friend of mine noted, no matter how effective the cruise lines are with their risk plan implementation, there will always be that drunk in the bar who removes his mask, gets up in your face and talks loudly as drunks do. For that and other reasons this latest extension may be warranted. I don’t think so, but what I know is that the CDC has failed to justify it, at least to me.

I noted in my last article that as a travel advisor and a cruise lover I am a cheerleader for the cruise industry…I won’t make any apologies for that. As a critical thinker I am also a stickler for data and data driven decisions, even if it goes against the cruise industry, and I won’t make any apologies for that either. That is the prism through which I read both the “Recommendations from the Healthy Sail Panel” and the CDC’s latest no sail order (NSO) extension. To cut to the chase, the cruise lines have answered the mail…the CDC has failed miserably.

I looked forward to reading the CDC’s NSO extension expecting it to present examples of where the cruise lines did not comply with specific CDC objectives and why therefore they could not be allowed to return to sailing. But as I discovered, unlike their colleagues in Europe who did provide concrete steps for the cruise lines to take, the CDC has yet to produce even one specific requirement for the cruise lines to meet before allowing them to return to sailing.

No Sail Order Extension
To me, the CDC’s most recent no sail order extension is sloppily written and poorly justified. It reads like a point by point rebuttal of the Healthy Sail Panel’s report, which it may well be. I suppose I could be wrong about that. Could be the CDC and the Healthy Sail Panel were totally in synch, held hands and sang Kum Ba Yah as they each released their respective reports. Could be…but somehow, I don’t think it went down like that. Maybe because the American Society of Travel Advisors (ASTA), the largest trade organization representing travel advisors, is considering legal action against the CDC if they continue to extend their no sail order. They, like me, have characterized the CDC’s action as arbitrary.

Ground Rules
I will present verbatim extracts from the CDC’s latest NSO extension, to include subheadings to help keep everything organized, and I’ll note them with quotes. My comments and opinions will follow each verbatim extract and will be clearly marked as such. They are informed by extensive research on the subject as well as comments from senior executives representing several of the major cruise lines serving the U.S. market. There are more examples than I am presenting in this article of how the CDC’s NSO extension used misleading and inaccurate information and conclusions to justify extending their NSO…many more. I am focusing on just a few.

Executive Summary
Quoting from the CDC’s NSO extension now, “Cumulative CDC data from March 1st through September 28th, 2020, show a total of 3,689 confirmed cases of COVID-19 or COVID-like illness cases on cruise ships and 41 deaths. These data have also revealed a total of 102 outbreaks on 124 different cruise ships, meaning more than 82% of ships within U.S. jurisdiction were affected by COVID-19 during this time frame…Recent outbreaks on cruise ships overseas continue to demonstrate that reduced capacity alone has not diminished transmission.”

My comment and opinion: Very early on in the Excutive Summary the CDC opens with a statement that is pejorative and not accurate. The CDC includes cases of what they describe as “COVID-like illnesses” along with laboratory confirmed cases. You have to dig deep into a footnote to discover what that means. If you do, you’ll discover it refers to diseases and conditions like the flu, pneumonia (from a number of root causes) and the common cold, all of which have symptoms in common with COVID-19. They also have a wide window for considering a case of COVID-19 to be caused by infection aboard a cruise ship, counting cases that are diagnosed a week or longer after someone has disembarked from a cruise. They gave no consideration to the possibility that those cases could have been contracted after disembarkation.

Independent researchers have reported COVID-19 case counts that are almost half of what the CDC is reporting. They aren’t including COVID-like illnesses, nor are they counting cases that are diagnosed long after disembarkation which were likely contracted on land. Neither is accurate given the lack of test kits in the early days of the pandemic, but the CDC continues to include COVID-19 like illnesses in their count, in spite of the wide availability of test kits now. That results in numbers that represent an ongoing intentional over-count since more recent laboratory testing of COVID-like illnesses (diagnosis based on symptoms) reveals that at least some turn out not to be COVID-19. I can see no reason to include any COVID-19 cases at this point that are not laboratory confirmed, yet the CDC continues to do so resulting in a biased understanding of the problem’s scope, and potentially resulting in ongoing biased decision making.

The excerpt also refers to outbreaks without defining what constitutes an outbreak. When you consider that the first use of the term “outbreak” on a cruise ship referred to the 712 confirmed COVID-19 cases aboard the Diamond Princess, the use of the word outbreak here is pejorative. Particularly when applied to subsequent incidents of COVID-19 on cruise ships, most of which number in the single digits. Additionally, I can find no data to back up the claim that there have been 102 outbreaks on 124 ships, even if you include single cases in the count of “outbreaks.” The highest count I could come up with from independent sources is 86 ships, and one source reported outbreaks on just 37 ships. One reason for the discrepancy could be that the CDC is defining “outbreak” to be far fewer cases than most people would. It represents yet another form of bias. It is impossible to reconcile the CDC’s case count with the others since their NSO extension justification fails to list which ships they include in their count. You have to take their word for it. Having read the entire NSO extension text, I’m not prepared to take their word for anything.

The conclusion that “Recent outbreaks on cruise ships overseas continue to demonstrate that reduced capacity alone has not diminished transmission” troubles me in several ways. This statement is a direct rebuttal of one of the recommendations the Healthy Sail Panel made to the cruise lines. The CDC’s observation, while partially true, is meaningless and irrelevant. Set aside for a minute the fact that the “recent outbreaks” the CDC refers to occurred on ships that did not fall within their jurisdiction, as well as the fact at least one of the cruise ships involved admitted they failed to follow their own COVID-19 quarantine protocols, both of which points are problematic on their own. I have another issue with this statement. It is irrelevant. None of the cruise lines are planning to rely on any single factor, “…reduced capacity alone…” to reduce the risk of contracting COVID-19. As I noted in my previous blog article, the Healthy Sail Panel came up with 74 discrete recommendations which they intend to be fully implemented in their totality in a layered defense, not just one or two here and there. Reduced capacity is but one of the 74.

Challenges and Limitations in Testing Crew on Cruise Ships During the NSO
“While cruise ship operators have adhered to their NSO response plans during this time of suspended passenger operations, challenges remain. These challenges include the limitations of viral test results, including the possibility of false negative test results, the importance of crew quarantine in preventing disease spread, and concerns relating to reporting of symptoms by crew. Two specific cases help illustrate these challenges…”

My comment/opinion: I’m not including the details of the two cases cited here. They were representative of the impact false negative COVID-19 test results could have on cruise ship operations. I think we can all stipulate to false negative test results being a real and ongoing problem. Nothing is going to change that except advances in testing technology. The important thing is that pre-cruise testing is but one of many tools the cruise lines plan to use. Since neither of the cases cited resulted in onboard spread of COVID-19, they demonstrate the success of the multi-layered approach the cruise lines are taking to manage COVID-19 and specifically their quarantine protocols. The CDC is trying to use these two examples as evidence that testing alone is not effective at keeping COVID-19 off cruise ships, and for that reason that cruise lines should not be permitted to resume normal operations. The first part is true, but the second part is not because the cruise lines don’t plan to rely on one measure alone. What the CDC should have done rather than focusing on two false negatives is cited how many people testing positive for COVID-19 were kept from boarding ships since mandatory testing was implemented.

Dangers of Prematurely Resuming Passenger Operations on Cruise Ships
“There have been several recent instances of outbreaks of COVID-19 onboard cruise ships in those countries that have allowed passenger operations to resume, despite cruise ship operators implementing measures to control the disease.”

My comment/opinion: My first reaction…so what? As they do a number of times, the CDC is citing outbreaks of COVID-19 aboard cruise ships that do not fall within their jurisdiction. Why should cruise ships that do come under the CDC’s jurisdiction be painted with the same brush as cruise ships that don’t? My second reaction is that the phrase, “…despite cruise ship operators implementing measures to control the disease…” is not a factual statement. As the CDC notes in the details of this example, the cruise ship operators failed to follow the measures they implemented to control the disease. By their own admission, they failed to follow their established quarantine protocols, thereby allowing a single case to mushroom into a dozen or so.

The CDC listed more examples of what they presented as evidence that allowing cruise lines to resume regular operations would pose an unacceptable risk to public health. I looked at each example they presented, and it was clear to me the examples they chose reflected their attempt to refute the value of the Healthy Sail Panel’s report. The reason their approach isn’t valid is that in each case they cited, they chose cases where a single preventative or mitigating measure, on its own, could be ineffective. The Healthy Sail Panel knew that, which is why rather than providing a menu of individual recommendations for cruise lines to select from, they prescribed a list of 74 recommendations the cruise lines needed to take together, to form an effective layered defense against another COVID-19 outbreak on a cruise ship.

More Time Needed
“To gather more information regarding these industry-led efforts and solicit public input, on July 20, 2020, the CDC published a Request for Information (RFI) in the Federal Register related to cruise ship planning and infrastructure, resumption of passenger operations, and additional summary questions. The document had a comment period that ended on September 21, 2020 and almost 13,000 comments were received. In light of the number of submissions and high level of public interest, additional time is needed for CDC to review these comments, which may be used to inform future public health guidance and preventive measures…”

My comment/opinion: I’m not sure what the CDC’s point was in saying, “…these industry-led efforts.” Of course the industry led these efforts…the CDC certainly wasn’t providing any guidance or leadership here. Does that make the “industry-led efforts” any less valid? The larger question is why open the industry efforts up to public comment at all? Is the CDC, the nation’s premier health protection agency, incapable of determining their own criteria for permitting cruise lines to return to sailing in U.S. waters and for gauging compliance? I mean really…I was one of the 13,000 people that responded to the RFI, as were several non-profit groups who responded with petitions containing 50,000 signatures in pursuit of their own agenda. According to what I read, these non-profits were trying to keep cruise ships from returning to sail for environmental reasons. Last time I checked the CDC doesn’t have an environmental impact remit. I’m not arguing against the non-profits, but without a doubt the CDC’s RFI is the wrong forum for such a debate. Take it up with the EPA. Surely the CDC has much more expertise on the subject than me or most of the 13,000 respondents. I don’t get this.

Still, the CDC issued the RFI in July with a closing date of September 21st for an NSO that expired on September 30th. This is yet another example of the CDC being bureaucratically lazy and arrogant. Rather than building in sufficient time to consider the RFI inputs they gave themselves just one week to do so. Either they assumed they would rip through the inputs quickly, or if not no worries…they would just issue yet another extension. But even then they didn’t need to extend the NSO through mid-February which was their original position. The extension through the end of October, which is ultimately what the White House pushed them to accept, should be more than adequate. I can see where the task of going through the 13,000 responses to their RFI from the public may take more than the week the CDC allowed themselves for the review, but I wonder how many of those inputs were relevant or were from people qualified to pass judgement on the cruise lines’ plans? That was an avoidable problem of their own making and should not result in a continued financial burden on the cruise industry. Particularly since the European Union has already permitted cruise ships to resume normal operations after they adopted many of the same steps the cruise lines are planning to implement for cruise ships operating in U.S. waters. Of course, the EU told the cruise lines back in July what they needed to do to get the OK to resume sailing. Seven months after the CDC issued their initial NSO, the CDC has yet to do what the EU did back in July.

Findings and Immediate Action
“Accordingly, and consistent with 42 CFR §§ 70.2, 71.31(b), and 71.32(b), the Director of CDC (“Director”) continues to find that cruise ship travel exacerbates the global spread of COVID-19, that the scope of this pandemic is inherently and necessarily a problem that is international and interstate in nature, and such transmission has not been controlled sufficiently by the cruise ship industry or individual State or local health authorities. As described in the March 14, 2020, Order, cruise ship travel markedly increases the risk and impact of the COVID-19 disease epidemic within the United States. If unrestricted cruise ship passenger operations were permitted to resume, infected and exposed persons disembarking cruise ships would place federal partners (e.g., Customs and Border Protection and the U.S. Coast Guard), healthcare workers, port personnel, and communities at substantial unnecessary risk. Additionally, persons infected on cruise ships would be likely to transmit COVID-19 to U.S. communities by traveling interstate after cruising. Accordingly, under 42 CFR § 70.2, the Director determines that measures taken by State and local health authorities regarding COVID-19 onboard cruise ships are inadequate to prevent the further interstate spread of the disease.”

My comments and opinion: Wow. I don’t even know where to begin with the statement, “…infected and exposed persons disembarking cruise ships would place federal partners (e.g., Customs and Border Protection and the U.S. Coast Guard), healthcare workers, port personnel, and communities at substantial unnecessary risk.” According to data from the FAA as of September 21st, 2020, 2.9 million passengers take to the air in the U.S. every day. Flying involves being in an enclosed environment for hours with no social distancing possible. Unlike the cruise industry, not one airline requires any of those 2.9 million people to present a negative COVID-19 test result before boarding or disembarking, nor are they monitored with enhanced screening. If that doesn’t present the CDC’s federal partners with “substantial unnecesary risk” I don’t see how cruise passengers would. With the CDC’s position on the risk to federal partners by cruise ship passengers as articulated in this passage, I am surprised anyone is permitted to fly. Yet air travel continues pretty much unimpeded by any bureaucratic process such as the CDC is imposing on the cruise lines. That is one of many reasons why I feel the CDC is acting arbitrarily against cruise lines, singling out one segment of the travel industry for significantly more harsh treatment than any of the others.

Just because the Director of the CDC says it’s so doesn’t make it so. The only portion of the above extract that is factual is the part that says, “…the scope of this pandemic is inherently and necessarily a problem that is international and interstate in nature…” Everything else is unsupported or just plain wrong. The statement that says, “…and such transmission has not been controlled sufficiently by the cruise ship industry…” is subjective since they never define what they mean by “sufficiently.” Not to mention the fact that with no ships under the CDC’s jurisdiction sailing since March, the statement is flat out untrue. The only way the CDC can justify it is by including ships that aren’t within their jurisdiction, which as I’ve noted several times already is bureaucratically lazy.

The statement “If unrestricted cruise ship passenger operations were permitted to resume…” may actually be true, except such resumption would not be unrestricted. The CDC would require cruise lines to conform to the risk mitigation plans they submitted. Anywhere the CDC finds something that needed to be tweaked, or where there is non-compliance, they have recourse short of re-instituting the no sail order for all cruise ships operating within their jurisdiction.

“The Director also continues to find evidence to support a reasonable belief that cruise ships are or may be infected or contaminated with a quarantinable communicable disease…As a result, persons on board or seeking to board cruise ships may likely be or would likely become infected with or exposed to COVID-19 by virtue of being on board at a time when cases of COVID-19 continue to be reported in increasingly increasing numbers globally.”

My comments and opinion: A cruise ship is an inanimate object incapable of being infected with a quarantinable communicable disease so I don’t agree that it is a “reasonable belief.” The only explanation I could come up with for this final statement is that it originated from early studies of the Diamond Princess showing the COVID-19 virus remained detectable in the cabins of infected passengers for days after they disembarked. Later studies refuted that, noting the traces of the virus that were detected were fragments that were incapable of infecting anyone. Especially a cruise ship.

Summary
As noted from the outset, this latest CDC NSO extension is (in my view) sloppily written and poorly justified. Their lack of specific guidance to the cruise industry after ordering them to cease operations for the past seven months, and their inclusion of Catch-22 traps in what little guidance they have given are shameful. This has not been the CDC’s finest hour.

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