Hospital Ships, Residential Ships, and Quarantine Ships Oh My!

[gatour]

51 minutes ago, rimmit said:

You are missing the argument.  The previous poster was stating that resorts aren’t denied access to hospitals, why should cruise ships be denied.   It’s not the passengers being denied access to hospitals. It’s the passengers being denied access to the country.    Big difference.  Once in the country, most likely the country would assist the passengers on a healthcare front whether they are a Citizen or not and sort the bill out later.  However, they are being blocked at the gate.

 

They aren’t being denied healthcare, they are being denied either coastguard, naval, or other extraordinary assistance.  If they got to the US they wouldn’t be denied healthcare.  This issue is getting into the US as since these are foreign flagged boats the US is not so eager to let them dock with a ship full of infected people and ports are closing to cruise ships whether people are infected or not. 

At this point the people who boarded the boat knowingly during a pandemic are knowingly subjecting themselves to a high level of risk and possible quarantine.  The CDC is basically saying at this point, unless you abide by our rules we aren’t bailing you out anymore.  The issue at hand is that cruise ships are drawing a lot of resources every time they require quarantine and repatriation which is becoming incredibly common place and cruise ships are banking on the USN and USCG to continually bail them out when Covid strikes their ships.

I am not missing the argument.

 

By the CDC/Coast Guard denying ships carrying UNITED STATE's passengers to dock.  They are denying UNITED STATE's passengers access to health care.  Remember these are tax paying citizens.

[bluesea321]

11 minutes ago, chengkp75 said:

And, if you read above this in the order, it defines the term "operations", which I then quoted.  Significantly, while it lists several "operations" it does not list merely sitting at a dock or at anchor as an "operation", and it also makes a distinction between arriving at port ("making port") and leaving port, and only "making port" is restricted.  The two paragraphs you mention have reference to "free pratique", which is the process where a ship declares itself healthy and requests clearance to enter port, or move within a port.  Ships that are already in a US port, have received pratique, and therefore unless they wish to "shift berths, move to anchorage, or embark or disembark passengers or crew", they do not need to apply for pratique again.

 

Why do you feel the need to argue?  The CDC Order speaks for itself.  There are many cruise ships anchored off S. Florida or the Bahamas and some of these ships have been coming into port and departing, both into Miami and Fort Lauderdale.  They would have to comply with the CDC Order by tomorrow to "make port". 

[MoniMommy]

  Is this for the foreseeable future even after the pandemic ends? If this is how it will be post pandemic it will be the end of cruising for me and I will have to forfeit my $900 FCC. If I am critically ill, I want to be medivaced to a US hospital. This is why I always purchase insurance. I am healthy, and don't expect to need it, but if I do I want to be taken care of in my own country. If there aren't enough ventilators or other necessary medicine and equipment, who gets treated first?  suite guest? or casino high rollers? No thank you. If you see a flaw in my logic, please tell me because I really LOVE crusing. Perhaps you can explain why I'm overreacting and put my mind at ease thereby saving our $900.

Edited April 15, 2020 by MoniMommy

[rimmit]

37 minutes ago, gatour said:

I am not missing the argument.

 

By the CDC/Coast Guard denying ships carrying UNITED STATE's passengers to dock.  They are denying UNITED STATE's passengers access to health care.  Remember these are tax paying citizens.

 

You are using a transitive property in this situation so if you want to make it transitive, passengers are being denied a lot more than access to just healthcare (which in the US is a privilege, not a right)  by being blocked from entering a country.  You are also being denied access to your home, your car, your kids, etc. by being denied from being allowed back in the country, and they are not denying you entry. They are denying the ship docking privileges.  Again transitive.  They are repatriating people to get them home.  They just don't want the ship to dock.

 

However, the point is at this point if you chose to go on a ship, despite all the warnings and everything that has happened, it's basically go at your own risk, no country whether it be the US, Chile, Australia wants anything to do with cruise ships, and that's even if the cruise ships were allowed to operate, which is just not happening for a LOOONG time.

Edited April 15, 2020 by rimmit

[rimmit]

5 minutes ago, MoniMommy said:

If this must be implemented, this will be the end of cruising for me and I will have to forfeit my $900 FCC. If I am critically ill, I want to be medivaced to a US hospital. This is why I always purchase insurance. I am healthy, and don't expect to need it, but if I do I want to be taken care of in my own country. If there aren't enough ventilators or other necessary medicine and equipment, who gets treated first?  suite guest? or casino high rollers? No thank you. If you see a flaw in my logic, please tell me because I really LOVE crusing. Perhaps you can explain why I'm overreacting and put my mind at ease thereby saving our $900 FCC.

 

I do not foresee the USN/USCG abandoning cruise ships if they follow CDC recs or wait until Covid is gone.  As long as cruise lines are willing to play by the rules that is just not happening.  However, if they decided to take off today with a ship full of pax, I can honestly see the US saying, "We ain't bailing you out.  You left despite EVERYONE saying don't do it.  You're on your own."

[MoniMommy]

1 minute ago, rimmit said:

 

You are using a transitive property in this situation so if you want to make it transitive, passengers are being denied a lot more than access to just healthcare (which in the US is a privilege, not a right)  by being blocked from entering a country.  You are also being denied access to your home, your car, your kids, etc. by being denied from being allowed back in the country.  

 

However, the point is at this point if you chose to go on a ship, despite all the warnings and everything that has happened, it's basically go at your own risk, no country whether it be the US, Chile, Australia wants anything to do with cruise ships, and that's even if the cruise ships were allowed to operate, which is just not happening for a LOOONG time.

I can't see cruises resuming until there is a vaccine or effective treatment. I think this order is just to make sure that cruise lines don't try to start up again any time soon. No way they can comply with all of this.

[chengkp75]

23 minutes ago, bluesea321 said:

 

Why do you feel the need to argue?  The CDC Order speaks for itself.  There are many cruise ships anchored off S. Florida or the Bahamas and some of these ships have been coming into port and departing, both into Miami and Fort Lauderdale.  They would have to comply with the CDC Order by tomorrow to "make port". 

Because you stated that they would have to leave US waters if the action plans were not submitted and put in operation.  That is not the case.  While you are correct that the "supply runs" would likely end, the ships do not have to leave US waters.

[Biker19]

7 minutes ago, MoniMommy said:

Perhaps you can explain why I'm overreacting and put my mind at ease thereby saving our $900 FCC.

Wait about 2 months when things should be a bit clearer what will happen with the cruise industry and RCI in particular. Currently, only wild speculation is happening.

[rimmit]

1 minute ago, MoniMommy said:

I can't see cruises resuming until there is a vaccine or effective treatment. I think this order is just to make sure that cruise lines don't try to start up again any time soon. No way they can comply with all of this.

 

Yep, you hit the nail on the head.  

 

They basically wrote that order such that it was nearly impossible for cruises to take off until Covid had a vaccine as I don't see a fleet of medical ships materializing anytime soon.

[rimmit]

12 minutes ago, Biker19 said:

Wait about 2 months when things should be a bit clearer what will happen with the cruise industry and RCI in particular. Currently, only wild speculation is happening.

Wild speculation based on a current 100 day CDC no sail order and CDC requirements for cruising to restart in the US (and likely the world).

Edited April 15, 2020 by rimmit

[Jobeth66]

Note that the order does not mandate 'hospital ships' or 'quarantine ships' or 'residential ships' - I believe those were ideas floated by CLIA which were actually rejected by the CDC.

 

What the CDC requires is actually much, much more stringent.  If you go to the published document, pages 6-8, you'll see what the ships have to do.

 

https://www.cdc.gov/quarantine/pdf/No-Sail-Order-Cruise-Ships_Extension_4-9-20-encrypted.pdf

 

Highlights:

Must have onboard surveillance of passengers & crew with acute respiratoy illnesses, influenza-like illnesses, pneumonia & COVID-19 including reporting to HHS/CDC on a weekly basis on overall case counts, methods of testing, and number of persons requiring hospitalization or medical evacuation.

 

Protocols for testing, including details relating to shore-side lab work if onboard work is not feasible

 

Onboard isolation, quarantine and social distancing protocols 

 

Onboard medical staffing and equipment to provide a HOSPITAL LEVEL OF CARE (eg ventilators, facemasks, PPE) for the infected without need for hospitalization onshore  (So EACH SHIP must have, essentially, a fully stocked ICU along with trained physicians for COVID-19 patients - not a general 'hospital ship in the area', though such a ship could potentially be used for evacuation purposes)

 

Must have contracts in place with shore-side hospitals in advance of sailing that will agree to take any potential evacuated patients, and those patients must be evacuated and transported to those facilities via contracted carrier - relying on the USCG is not an option

 

Detailed logistical planning for evacuating and repatriating US citizens and foreign nationals to their respective communities and home countries via foreign government or industry-chartered private transport and flights, including the steps the cruise ship operator will take to ensure those involved in the transport are not exposed (use of commercial flights to evacuate or repatriate within or from the US Is PROHIBITED - so you cannot be taken to the local airport and booked on a commercial flight, they MUST charter flights for passengers to be returned home)

 

I don't see any cruise line being able to meet these requirements anytime soon.

 

[bluesea321]

35 minutes ago, chengkp75 said:

While you are correct that the "supply runs" would likely end, the ships do not have to leave US waters.

 

So they don't have to leave US waters but they cannot make supply runs.  Are the ships just going to sit out there until the crews run out of supplies?  Surely not.  And are they going to comply with all of the following by tomorrow?  I don't see how so what are they going to do from tomorrow forward?

 

An appropriate plan is one that adequately prevents, mitigates, and responds to the spread of COVID-19 on board cruise ships and that, at a minimum, must address the following elements:

 

a. Onboard surveillance of passengers and crew with acute respiratory illnesses, influenza-like illnesses, pneumonia, and COVID-19, including reporting to HHS/CDC on a weekly basis on overall case counts, methods of testing, and number of persons requiring hospitalization or medical evacuation;
b. Reports on the number of persons onboard the cruise ship and any increase in the numbers of persons with COVID-19 made to HHS/CDC and USCG on a daily basis for as long as the cruise ship is within waters subject to the jurisdiction of the United States.
c. Onboard monitoring of passengers and crew through temperature checks and medical screening, including addressing frequency of monitoring and screening;
d. Training of all crew on COVID-19 prevention, mitigation, and response activities;
e. Protocols for any COVID-19 testing, including details relating to the shore-side transport, administration, and operationalization of laboratory work if onboard laboratory work is not feasible;
f. Onboard isolation, quarantine, and social distancing protocols to minimize the risk of transmission and spread of COVID-19;
g. Onboard medical staffing, including number and type of staff, and equipment in sufficient quantity to provide a hospital level of care (e.g., ventilators, facemasks, personal protective equipment) for the infected without the need for hospitalization onshore;
h. An outbreak management and response plan to provision and assist an affected cruise ship that relies on industry resources, e.g., mobilization of additional cruise ships or other vessels to act as “hospital” ship for the infected, “quarantine” ship for the exposed, and “residential” ship for those providing care and treatment, including the ability to transport individuals between ships as needed;
i. Categorization of affected individuals into risk categories with clear stepwise approaches for care and management of each category;
j. A medical care plan addressing onboard care versus evacuation to on-shore hospitals for critically ill individuals, specifying how availability of beds for critically ill at local hospitals will be determined in advance and how the cruise ship operator will ensure acceptance at local medical facilities to treat the critically ill in a manner that limits the burden on Federal, State, and local resources and avoids, to the greatest extent possible, medivac situations. If medical evacuation is necessary arrangements for evacuation must be made with commercial resources (e.g., ship tender, chartered standby vessel, chartered airlift) and arrangements made with a designated medical facility that has agreed to accept such evacuees. All medical evacuation plans must be coordinated with the U.S. Coast Guard;
k. Detailed logistical planning for evacuating and repatriating, both U.S. citizens and foreign nationals, to their respective communities and home countries via foreign government or industry-chartered private transport and flights, including the steps the cruise ship operator will take to ensure those involved in the transport are not exposed; (the use of commercial flights to evacuate or repatriate individuals, both within or from the United States, is prohibited);
l. The projected logistical and resource impact on State and local government and public health authorities and steps taken to minimize the impact and engage with these authorities; all plans must provide for industry/cruise line management of suspected or confirmed cases of COVID-19 without resource burden on Federal, State, or local governments;
m. Plan execution in all U.S. geographical areas – all plans must be capable of being executed anywhere in international, interstate, or intrastate waterways subject to the jurisdiction of the United States; and

n. Cleaning and disinfection protocols for affected cruise ships.

Edited April 15, 2020 by bluesea321

[bluesea321]

12 minutes ago, Jobeth66 said:

Note that the order does not mandate 'hospital ships' or 'quarantine ships' or 'residential ships' - I believe those were ideas floated by CLIA which were actually rejected by the CDC...

...

I don't see any cruise line being able to meet these requirements anytime soon.

 

While I agree with you that cruise lines will likely not be able to mee the CDC requirements, the Order of 4/9 does mention the use of "hospital and quarantine" ships.  Please see Section h above (underlined).

[Jobeth66]

3 minutes ago, bluesea321 said:

 

While I agree with you that cruise lines will likely not be able to mee the CDC requirements, the Order of 4/9 does mention the use of "hospital and quarantine" ships.  Please see Section h above (underlined).

Right - but those would be /in addition/ to having the full hospital facilities on every ship.  Not in place of.  CLIA's idea appears to have been just the floating evacuation ships, which is what the CDC rejected.

[MoniMommy]

The evacuation part seems easy. Passengers can have insurance. It can be required. 

[rimmit]

6 minutes ago, Jobeth66 said:

Note that the order does not mandate 'hospital ships' or 'quarantine ships' or 'residential ships' - I believe those were ideas floated by CLIA which were actually rejected by the CDC.

 

What the CDC requires is actually much, much more stringent.  If you go to the published document, pages 6-8, you'll see what the ships have to do.

 

https://www.cdc.gov/quarantine/pdf/No-Sail-Order-Cruise-Ships_Extension_4-9-20-encrypted.pdf

 

Highlights:

Must have onboard surveillance of passengers & crew with acute respiratoy illnesses, influenza-like illnesses, pneumonia & COVID-19 including reporting to HHS/CDC on a weekly basis on overall case counts, methods of testing, and number of persons requiring hospitalization or medical evacuation.

 

Protocols for testing, including details relating to shore-side lab work if onboard work is not feasible

 

Onboard isolation, quarantine and social distancing protocols 

 

Onboard medical staffing and equipment to provide a HOSPITAL LEVEL OF CARE (eg ventilators, facemasks, PPE) for the infected without need for hospitalization onshore  (So EACH SHIP must have, essentially, a fully stocked ICU along with trained physicians for COVID-19 patients - not a general 'hospital ship in the area', though such a ship could potentially be used for evacuation purposes)

 

Must have contracts in place with shore-side hospitals in advance of sailing that will agree to take any potential evacuated patients, and those patients must be evacuated and transported to those facilities via contracted carrier - relying on the USCG is not an option

 

Detailed logistical planning for evacuating and repatriating US citizens and foreign nationals to their respective communities and home countries via foreign government or industry-chartered private transport and flights, including the steps the cruise ship operator will take to ensure those involved in the transport are not exposed (use of commercial flights to evacuate or repatriate within or from the US Is PROHIBITED - so you cannot be taken to the local airport and booked on a commercial flight, they MUST charter flights for passengers to be returned home)

 

I don't see any cruise line being able to meet these requirements anytime soon.

 

It does not mandate those ships, but they “need an outbreak management and response plan To provision and assist

an affected ship that utilizes industry resources.”  They go on to suggest quarantine, hospital and residential ships.    Given they are not building rigs in the ocean for “hospital”, “residential”, and “quarantine” purposes ships are the most likely and really only option that would be mobile enough and available as again they are not in the rig business.  Ultimately,  this is just semantics.  
 

Yes I read the whole thing over the weekend.  I typically don’t feel like quoting the whole article, but see the on the on the ocean outbreak and response as the biggest barrier.  There are planes galore they could charter these for repatriation flights as so many are grounded these days.
 

The reason I only quote the medical ships is that logistically it is by far the most difficult of the requirements for the cruiselines to meet and really emphasizes to someone who has not read it just how much is required Of the cruiselines.  Lab equipment, vents, Med staffing can all be obtained reasonably quickly once the current surge has abated.  

[rimmit]

4 minutes ago, Jobeth66 said:

Right - but those would be /in addition/ to having the full hospital facilities on every ship.  Not in place of.  CLIA's idea appears to have been just the floating evacuation ships, which is what the CDC rejected.

No one would ever say it was in place of.  If you go through all my comments,  I have specifically mentioned the logistics of having a full hospital onboard.  It would require at minimum two intensivists, an increase in nurses, an RT and buying many vents, along with having negative pressure isolation rooms.  This is much more doable than coming up with hospital, quarantine and residential ships.

[Jobeth66]

3 minutes ago, rimmit said:

It does not mandate those ships, but they “need an outbreak management and response plan To provision and assist

an affected ship that utilizes industry resources.”  They go on to suggest quarantine, hospital and residential ships.    Given they are not building rigs in the ocean for “hospital”, “residential”, and “quarantine” purposes ships are the most likely and really only option that would be mobile enough and available as again they are not in the rig business.  Ultimately,  this is just semantics.  
 

Yes I read the whole thing over the weekend.  I typically don’t feel like quoting the whole article, but see the on the on the ocean outbreak and response as the biggest barrier.  There are planes galore they could charter these for repatriation flights as so many are grounded these days.
 

The reason I only quote the medical ships is that logistically it is by far the most difficult of the requirements for the cruiselines to meet and really emphasizes to someone who has not read it just how much is required Of the cruiselines.  Lab equipment, vents, Med staffing can all be obtained reasonably quickly once the current surge has abated.  

 

There are planes galore they COULD charter, the question is - do they have the funds to do so?  Because it seems to me that the order puts all the costs on the cruise line.  They are responsible to get evacuated passengers where they need to be - nothing that says they can charge for it.  So if you have to be evacuated off the ship to a shoreside hospital?  The cruise line must make that happen.  Then if the passengers have to be repatriated?  The cruise line has to charter planes to do that.  

 

I see nothing allowing them to pass those charges back, and I doubt they'd be able to.  I'm sure their insurance carriers wouldn't pick up those costs, either.

[rimmit]

3 minutes ago, Jobeth66 said:

 

There are planes galore they COULD charter, the question is - do they have the funds to do so?  Because it seems to me that the order puts all the costs on the cruise line.  They are responsible to get evacuated passengers where they need to be - nothing that says they can charge for it.  So if you have to be evacuated off the ship to a shoreside hospital?  The cruise line must make that happen.  Then if the passengers have to be repatriated?  The cruise line has to charter planes to do that.  

 

I see nothing allowing them to pass those charges back, and I doubt they'd be able to.  I'm sure their insurance carriers wouldn't pick up those costs, either.

I one hundred percent agree,  but I have mainly been talking logistics.  Finances are a whole bother ball game.  The discussion has revolves around if this is even feasible. 
 

we could talk days for days about financing.  Is it feasible financially to pull half your fleet to be used as medical facilities?  Is it feasible Financially to hire a bunch of docs and nurses so you can have a hospital on your ship?  This isn’t just about planes if we are talking finances. The charter flights would be pocket change compared to having billion dollar ships only be used as hospitals and for quarantines.

[LMaxwell]

1 hour ago, gatour said:

I am not missing the argument.

 

By the CDC/Coast Guard denying ships carrying UNITED STATE's passengers to dock.  They are denying UNITED STATE's passengers access to health care.  Remember these are tax paying citizens.

 

I do not believe the Coast Guard is denying Americans access to health care; that said though this is why they are requiring the cruise lines to have these plans in place.  

 

Tax payer dollars have paid for every single USCG rescue, escort, inspection...the cruise lines aren't billed for rescues or armed escorts in and out of ports. That's tax payer money. Keeping tax payers secure. 

[Jobeth66]

Just now, rimmit said:

I one hundred percent agree,  but I have mainly been talking logistics.  Finances are a whole bother ball game.  The discussion has revolves around if this is even feasible. 
 

we could talk days for days about financing.  Is it feasible financially to pull half your fleet to be used as medical facilities?  Is it feasible Financially to hire a bunch of docs and nurses so you can have a hospital on your ship?  This isn’t just about planes if we are talking finances. The charter flights would be pocket change compared to having billion dollar ships only be used as hospitals and for quarantines.

 

Very, very true.  Which is why I think the no-sail will stand as long as the CDC keeps extending it - the lines are never going to be able to live up to the requirements to get waivers.  Obviously, someone higher up in the government could come down and remove all these precautions and restrictions, but it only takes one outbreak on one ship to do a lot of damage.

[MoniMommy]

2 minutes ago, LMaxwell said:

 

I do not believe the Coast Guard is denying Americans access to health care; that said though this is why they are requiring the cruise lines to have these plans in place.  

 

Tax payer dollars have paid for every single USCG rescue, escort, inspection...the cruise lines aren't billed for rescues or armed escorts in and out of ports. That's tax payer money. Keeping tax payers secure. 

This is especially important since they don't pay to the federal government. After the pandemic if Royal is still around, I wanr to know that I can use my vacation insurance policy to get medivaced home if necessary. Hopefully that doesn't change.

[rimmit]

1 minute ago, Jobeth66 said:

 

Very, very true.  Which is why I think the no-sail will stand as long as the CDC keeps extending it - the lines are never going to be able to live up to the requirements to get waivers.  Obviously, someone higher up in the government could come down and remove all these precautions and restrictions, but it only takes one outbreak on one ship to do a lot of damage.

Exactly.   Basically the CDC has said, “You can’t possibly come up with a plan that meets what we want.  You aren’t going anywhere till we can get a vaccine and make it semi safe to be on a cruise ship again.”

 

If large events like concerts and sports are likely canned till there is a vaccine, and that is on land, there is no way that cruise ships are getting the ok to be stranded out on the ocean.

[MoniMommy]

3 minutes ago, Jobeth66 said:

 

Very, very true.  Which is why I think the no-sail will stand as long as the CDC keeps extending it - the lines are never going to be able to live up to the requirements to get waivers.  Obviously, someone higher up in the government could come down and remove all these precautions and restrictions, but it only takes one outbreak on one ship to do a lot of damage.

If the requirements are waived, cruises will have very little sympathy from the general population when (not if) there is an outbreak.

[MoniMommy]

1 minute ago, rimmit said:

Exactly.   Basically the CDC has said, “You can’t possibly come up with a plan that meets what we want.  You aren’t going anywhere till we can get a vaccine and make it semi safe to be on a cruise ship again.”

 

If large events like concerts and sports are likely canned till there is a vaccine, and that is on land, there is no way that cruise ships are getting the ok to be stranded out on the ocean.

So much for those summer cruise. We're looking at Fall 2021 at the earliest. Will the cruise lines last that long?