Anyone strongly discouraged from going to medical for Covid symptoms?

[GrapevineTx_Cruiser]

1 minute ago, ChiefMateJRK said:

Thanks.  Wow.  Would you do the same again or just self-isolate and try your best to enjoy your cruise?  That security procession, complete with fogging, borders on insulting.

I would probably still go to the medical center. I was pretty sick the first couple of days until the meds started kicking in.

 

We also didn’t want to risk my wife getting sick later in the cruise before we started hitting ports every day. Luckily I only missed the first two ports (Azores and Lisbon). We also had five days in Rome booked after the cruise and didn’t want to risk that with one of us having Covid when we got to Civitavecchia.

[pcakes122]

5 hours ago, MoCruiseFan said:

You were merely given honest facts about the situation.  No one tried to make you select any particular option for how to proceed.

Only they were not honest facts. Just experienced Covid in October on the Joy. Had all the tests in Medical and received meds and multiple nebulizer breathing treatments for the shortness of breath. Total bill was $989 (My private health insurance paid everything but $50 and my travel insurance paid the remaining $50.)

 

There is no maritime law requiring $6,000 worth of testing for Covid symptoms. It's not only NOT honest, it's the worst kind of dishonest. What kind of medical professional discourages someone from seeking medical treatment? (It's this kind of thing that makes me wonder if some of the doctors and nurses get jobs on cruise ships because they were unsuccessful or unemployable on land.)

[ExpatBride]

3 hours ago, pcakes122 said:

(It's this kind of thing that makes me wonder if some of the doctors and nurses get jobs on cruise ships because they were unsuccessful or unemployable on land.)

You could be onto something here. My ex had a medical emergency onboard an NCL ship and it was an absolute nightmare from the crew to the medical centre staff. I had to tell them what needed to be done (and what didn't). The bill was astronomical and they were clearly doing things to jack it up even more. We were about to remove the IV ourselves so we could get out of there. We joked that our on-board doctor was an ex-prison doctor.

[Notamegagirl]

I was on the spirit last month (april) out of sydney; everyone was vaccinated and had to test 24 hrs prior to boarding. 

 

 I caught covid onboard. It was mild. However; due to other pasengers and crew safety; thought I should report my positive self test. The medical center really tried to discourage me to go there. They kept saying they consider me negative until I pay a lot of fees for consultation and tests. I could move freely and do whatever I wanted. I did not think that was right.

So I went down to medical; they did consultation and pcr test. I refused chest xray and other treatments; because those would be unnecessary for my symptoms. You can say no to dr that want tests you are not comfortable with. He prescribed antibiotics which cdc and who do not recommend for covid and Tylenol. At first I said no to antibiotics; then he was going to have me sign a form saying I refused medical treatment;  far from it! so instead of arguing, I paid for antibiotics ($620 total medical bill) and went back to my balcony cabin; were I  quarantined for 5 days until tested negative.

It was a tough 5 days, seeing fiji and south pacific from my cabin was sad. Once tested negative and released; had to wear MASK indoors and out; except when eating for 5 days. I was one of the only people onboard with a mask and felt self conscious, covid cootie person.

Something to consider: The room service menu is very limited. Since I reported myself; had free room service and when main dinning room was open could order off their menu. 

 

 I spoke to others that visited medical center; it is a mixed bag. Glad there for life saving emergencies.

it was a dream trip; however, would of been much more comfy at home with covid. 

 

Been vaccinated/boosted and since then have caught covid twice on cruises(each time in balcony cabin for fresh air and mindful of hand washing/touching)....healthy and no underlying health conditions. 

 

 

 

 

[ExpatBride]

4 minutes ago, Notamegagirl said:

He prescribed antibiotics which cdc and who do not recommend for covid and Tylenol. At first I said no to antibiotics; then he was going to have me sign a form saying I refused medical treatment;  far from it! so instead of arguing, I paid for antibiotics ($620 total medical bill) and went back to my balcony cabin; were I quarantined for 5 days until tested negative.

 

Since I reported myself; had free room service and when main dinning room was open could order off their menu. 

 

 

 

 

 

Antibiotics for a virus? I think he needs to go back to pre-med 🤦‍♀️ 

I'm surprised they gave you free room service. After our medical emergency, I asked if it would be possible for NCL to waive the RS service charge, and they wouldn't. Our holiday was clearly ruined at that point and a little kindness would've gone a long way. That was last time I'll sail with NCL. 

[BirdTravels]

On 5/22/2023 at 12:53 AM, insearchofsun said:

Mostly just looking for other’s experiences. Also folks should know that people are being told that everything is back to normal and that when one discloses Covid, there is nothing done to prevent spread.  No one wants to go back to early pandemic days, but I would expect them to treat it the way they do norovirus. 

First and foremost, the WHO and the President of the United States have determined that COVID emergency is over. You can’t get free tests, vaccines, or treatment as of a few weeks ago. 
 

As the medical center says, it is just another illness. If you want treatment, it is all costs out of pocket. And from the perspective of the cruise line, I would expect them to do a full “new patient” history and run a battery of tests. The have to assess your total physical condition. The Medical Center can’t dispense you a sea sick pill without an exam (just like your doctor at home))… but you can get free pills from guest services. 

 

If it were me, I would pay whatever they wanted to get the Paclovid antiviral prescribed since I am old and can’t afford to end up in a hospital. Health first. No need for money if you are dead. 
 

We have been on 9 post pandemic cruises. We caught COVID on one cruise earlier this year. Could have been at the airport/plane, on shore or on the ship. We tested positive at home and had the antiviral an hour later. 

[Homosassa]

11 hours ago, pcakes122 said:

Only they were not honest facts. Just experienced Covid in October on the Joy. Had all the tests in Medical and received meds and multiple nebulizer breathing treatments for the shortness of breath. Total bill was $989 (My private health insurance paid everything but $50 and my travel insurance paid the remaining $50.)

 

There is no maritime law requiring $6,000 worth of testing for Covid symptoms. It's not only NOT honest, it's the worst kind of dishonest. What kind of medical professional discourages someone from seeking medical treatment? (It's this kind of thing that makes me wonder if some of the doctors and nurses get jobs on cruise ships because they were unsuccessful or unemployable on land.)

The OP wanted Paxlovid.

 

Paxlovid has a long list of contraindications in patients with certain conditions such as heart,  kidney and liver problems.  There is a long list of interactions with commonly prescribed prescription drugs.

 

To safely prescribe  Paxlovid to an unknown patient walking into the medical center for the first time, there would be a battery for tests to screen for  all  known contraindicated medical conditions'

 

They would be costly to the patient and then there is the actual cost of Paxlovid itself.

 

Keep in mind that for any expenses in the medical center on board, it is an out of pocket expense that must be paid by the passenger before disembarking the ship.

 

Any recovery of costs through available insurance is on the passenger to file for and receive after the cruise.

 

It is  entirely understandable that the medical center warned someone who wanted Paxlovid of the costs of the required testing and the cost of the drug.

 

Six thousand dollars to cover all testing (ECG, kidney and liver function, etc) and the cost of the drug itself is reasonable and to be expected.

[pcakes122]

8 minutes ago, Homosassa said:

The OP wanted Paxlovid.

 

Paxlovid has a long list of contraindications in patients with certain conditions such as heart,  kidney and liver problems.  There is a long list of interactions with commonly prescribed prescription drugs.

 

To safely prescribe  Paxlovid to an unknown patient walking into the medical center for the first time, there would be a battery for tests to screen for  all  known contraindicated medical conditions'

 

They would be costly to the patient and then there is the actual cost of Paxlovid itself.

 

Keep in mind that for any expenses in the medical center on board, it is an out of pocket expense that must be paid by the passenger before disembarking the ship.

 

Any recovery of costs through available insurance is on the passenger to file for and receive after the cruise.

 

It is  entirely understandable that the medical center warned someone who wanted Paxlovid of the costs of the required testing and the cost of the drug.

 

Six thousand dollars to cover all testing (ECG, kidney and liver function, etc) and the cost of the drug itself is reasonable and to be expected.

You didn't fully read my post. I got the tests AND the meds 😊. All under $1K.

 

Also when you go to the Medical Center, they evaluate you to determine what tests they want/need to do and they provide you with a WRITTEN estimate in hand before you make a decision to proceed with treatment. And then you can even choose what you want or don't want. They don't tell you over the phone that it's going to be xx dollars and discourage you to come in. (Unfortunately, I have too much experience going to the Medical Center on ships.)

 

I've recently got Paxlovid from my primary care doctor with just a phone call the last time I had Covid. She didn't even suggest running any tests (at that point I hadn't had blood work in 5 months, hadn't had an EKG in probably four years and had not seen her in person since before the pandemic.) I don't know where you live that requires such thorough testing before administering Paxlovid, but I'm in New Jersey and even pharmacists can prescribe it here (obviously without any prior testing.)

 

The $6K estimate for a Covid exam and meds was completely out of whack and unreasonable.

[Homosassa]

38 minutes ago, pcakes122 said:

You didn't fully read my post. I got the tests AND the meds 😊. All under $1K.

 

Also when you go to the Medical Center, they evaluate you to determine what tests they want/need to do and they provide you with a WRITTEN estimate in hand before you make a decision to proceed with treatment. And then you can even choose what you want or don't want. They don't tell you over the phone that it's going to be xx dollars and discourage you to come in. (Unfortunately, I have too much experience going to the Medical Center on ships.)

 

I've recently got Paxlovid from my primary care doctor with just a phone call the last time I had Covid. She didn't even suggest running any tests (at that point I hadn't had blood work in 5 months, hadn't had an EKG in probably four years and had not seen her in person since before the pandemic.) I don't know where you live that requires such thorough testing before administering Paxlovid, but I'm in New Jersey and even pharmacists can prescribe it here (obviously without any prior testing.)

 

The $6K estimate for a Covid exam and meds was completely out of whack and unreasonable.

I did read your post.

 

You stated that you received "meds," non specified.

 

The medical centers on board ship have routinely provided medication such as acetaminophen and cough syrup for Covid and other treatments for symptoms (such as nebulizer). 

 

Did you receive Paxlovid?

 

If so, I am surprised that screening was not done and that the cost for all treatments were only  approximately $1000.

 

As for you receiving a prescription for Paxlovid from your primary care physician, you received the prescription from a physician who knows your medical history and can prescribe Paxlovid without carefully screening for any contraindications.  At the time, the cost of the drug in the US was also still being subsidized by the US government. You are probably unaware of the unsubsidized  cost of the drug as it would be charged on a cruise ship.

 

I would expect my primary care doctor  (and possibly my local pharmacist who also knows my prescription drug use history) to do the same (although she, the pharmacist  and I all know that while I could probably take Paxlovid without a problem, it would not be a needed treatment given my health  status).

 

[pcakes122]

1 hour ago, Homosassa said:

I did read your post.

 

You stated that you received "meds," non specified.

 

The medical centers on board ship have routinely provided medication such as acetaminophen and cough syrup for Covid and other treatments for symptoms (such as nebulizer). 

 

Did you receive Paxlovid?

 

If so, I am surprised that screening was not done and that the cost for all treatments were only  approximately $1000.

 

As for you receiving a prescription for Paxlovid from your primary care physician, you received the prescription from a physician who knows your medical history and can prescribe Paxlovid without carefully screening for any contraindications.  At the time, the cost of the drug in the US was also still being subsidized by the US government. You are probably unaware of the unsubsidized  cost of the drug as it would be charged on a cruise ship.

 

I would expect my primary care doctor  (and possibly my local pharmacist who also knows my prescription drug use history) to do the same (although she, the pharmacist  and I all know that while I could probably take Paxlovid without a problem, it would not be a needed treatment given my health  status).

 

Yes, I received Paxlovid and it really helped. It was the last day of the first leg of a back-to-back cruise and I nixed the second leg and went home. I tested negative on the third day.

 

You should do some more research on Paxlovid. The only screening even the manufacturer recommends is to determine what other medications the patient is taking. There's no medical (or maritime lol) requirement or recommendation for any kind of pre-testing for Paxlovid use.

 

Without proper education, it seems you might easily get taken for $6,000 should you wind up needing Paxlovid on a cruise (or some other medical treatment.) Everyone should be well informed and be diligent about being their own advocate - medically and financially!

[ChiefMateJRK]

34 minutes ago, pcakes122 said:

It was the last day of the first leg of a back-to-back cruise and I nixed the second leg and went home. I tested negative on the third day.

Why did you do this?  It sounds like you would have been just fine for the second leg.

[NCruiser2012]

To the original poster: we had a similar situation on a cruise in January 2023.

 

Even though I wore a mask the entire cruise, I started to feel sick and had a fever towards the end of the cruise. I had brought some Covid tests with me in my carry on since I had read that this is the safest way to carry the tests. I took a Covid test and it immediately showed positive. I called the Medical Center, and the nurse I spoke to was very nice, but he said those tests tend to show false positives and Covid is not that bad anymore. He said I could come down but only if I wanted to. I did go down the the Medical Center where they took my vitals and the nurse gave me another test which looked exactly like my home test. He barely swabbed my nose and showed me the negative result much earlier than the 15 minute wait time. He said that they could do further testing or I could see the doctor.

 

I decided that I had done my duty reporting my illness, and if they were not concerned, I should not be concerned. My husband became sick the next day. Fortunately, we had two sea days and we skipped one of the ports. We both wore masks and ordered room service for a couple days until the fever broke. We continued to wear the masks the rest of the trip, at the airport, and on the plane.

 

It was not too bad being sick on a cruise. We were able to get room service with chicken soup. We sat out on the balcony. Fortunately, I had brought a lot of over the counter medication and neither one of us was that sick.

 

I was very disappointed in NCL's response. I thought they should have taken me much more seriously.

 

 

 

 

 

 

Edited May 23, 2023 by NCruiser2012

[pcakes122]

23 minutes ago, ChiefMateJRK said:

Why did you do this?  It sounds like you would have been just fine for the second leg.

Only problem is I didn't know that at the time. I was feeling pretty sick and was really short of breath (received nebulizer treatments in Medical) which is kind of scary. Two days at home and I was kicking myself for giving up a Haven casino comp (they are not giving those out as easily as they used to!)

[SimplyAlbert]

DH and I both avoided COVID for three years.  The day after we got back from our cruise in February Dh came down with it and I got it three days later.  Both of us had mild symptoms.

 

I just had a norovirus over the weekend and that was way worse than COVID.

[DaisyGoldberg]

On 5/22/2023 at 11:21 PM, pcakes122 said:

Only they were not honest facts. Just experienced Covid in October on the Joy. Had all the tests in Medical and received meds and multiple nebulizer breathing treatments for the shortness of breath. Total bill was $989 (My private health insurance paid everything but $50 and my travel insurance paid the remaining $50.)

 

There is no maritime law requiring $6,000 worth of testing for Covid symptoms. It's not only NOT honest, it's the worst kind of dishonest. What kind of medical professional discourages someone from seeking medical treatment? (It's this kind of thing that makes me wonder if some of the doctors and nurses get jobs on cruise ships because they were unsuccessful or unemployable on land.)

My mom had covid in January on the Getaway - we got the "it's $3000 for a covid workup" warning over the phone, but she was quite ill and she needed evaluation. Ivs, chest xray (beginnings of pneumonia), nebulizer treatments for the next three days, paxlovid, the works.  $11,000 by the end (and you pay now and hash it out with your insurance company later).

 

I thought her care was equivalent to what she would have gotten on land (superior if you count the much reduced wait time). The doctors and nurses were efficient and skilled. I felt comfortable knowing she was not getting worse, as she had been before we left, and that we weren't looking at a medical evacuation (would it have come to that if she just suffered in the cabin without intervention?)

 

We went back and forth to the room without anybody tracking us or following us with a fogger. We were explicitly told that those of us who weren't sick (my sister and I had both tested negative) were free to move about the ship, which we thought was ridiculous. Stayed in our cabin, got room service. Fortunately we had a Haven suite and just relaxed and tended to Mom. Not the cruise we thought we were going to get, and months later we're still working to get the $ back from insurance, but it certainly was interesting!

 

I definitely felt like the pre-visit phone call spiel was to serve as a warning not to come if you were going to object to the cost. We spent several hours each day in the clinic and I listened to the poor woman working the desk take constant abuse from passengers who "just" wanted this or that, or who were shocked at their bill. When our bill was broken down, it was really quite reasonable - an xray for $38? Can you imagine what the cost would be at home? The paxlovid was $800, which was a hit, considering it was free at home. But it did make her feel better very quickly.

[pcakes122]

58 minutes ago, DaisyGoldberg said:

My mom had covid in January on the Getaway - we got the "it's $3000 for a covid workup" warning over the phone, but she was quite ill and she needed evaluation. Ivs, chest xray (beginnings of pneumonia), nebulizer treatments for the next three days, paxlovid, the works.  $11,000 by the end (and you pay now and hash it out with your insurance company later).

 

I thought her care was equivalent to what she would have gotten on land (superior if you count the much reduced wait time). The doctors and nurses were efficient and skilled. I felt comfortable knowing she was not getting worse, as she had been before we left, and that we weren't looking at a medical evacuation (would it have come to that if she just suffered in the cabin without intervention?)

 

We went back and forth to the room without anybody tracking us or following us with a fogger. We were explicitly told that those of us who weren't sick (my sister and I had both tested negative) were free to move about the ship, which we thought was ridiculous. Stayed in our cabin, got room service. Fortunately we had a Haven suite and just relaxed and tended to Mom. Not the cruise we thought we were going to get, and months later we're still working to get the $ back from insurance, but it certainly was interesting!

 

I definitely felt like the pre-visit phone call spiel was to serve as a warning not to come if you were going to object to the cost. We spent several hours each day in the clinic and I listened to the poor woman working the desk take constant abuse from passengers who "just" wanted this or that, or who were shocked at their bill. When our bill was broken down, it was really quite reasonable - an xray for $38? Can you imagine what the cost would be at home? The paxlovid was $800, which was a hit, considering it was free at home. But it did make her feel better very quickly.

Happy to hear your Mom recovered quickly! I was also on the Getaway for my Covid experience! I was not discouraged to come in on the phone, but I will say that I did not accept all the testing that was suggested (e.g., they had an EKG, heart enzyme test and lots of other crazy tests (kidney function?) on the estimate ("Why do I need that?" "To rule out a heart attack." "But I'm not having heart attack symptoms." "But you said you had chest pain." "What you asked was if it hurt when I cough and I said I was sore - I don't have any pain." "Ok, then fine.") And I was not charged for the actual Paxlovid pills, but I was charged for administering the pills lol. Reading your story, I hesitate to think of what my bill would have been if I had just accepted everything on the proposed treatment plan. Luckily, I only had one day of treatment and disembarked in the morning.

 

I was actually shocked that my personal health insurance reimbursed me within a week via direct deposit. The extra $50 from the travel insurance took about a month.

[Viajera7]

On 5/22/2023 at 7:42 PM, GrapevineTx_Cruiser said:

I too had avoided Covid for three years and came down with it the third day of our recent Gem TA. 
Was feeling off second day and woke up the next day with a fever of 101 feeling pretty bad. 
 

Concierge called medical center for us and they wanted to see both me and my wife. I tested positive and she was negative. I was prescribed Paxlovid and my wife took it prophylactically as a preventative measure. I was required to isolate in the cabin for five days and she had to wear a mask outside the cabin. Was released from isolation after five days and a negative test. It was quite the procession to get me back to the cabin from the medical center.  Returned as far as possible through the crew are with security clearing the way flowed by nurse, then me then somebody fogging behind me. I found out after the fact that my key card had been flagged in case I tried to go anywhere or leave the ship.

 

The medical center fee for evaluation, antigen test, PCR test, Paxlovid and follow up antigen test was $1,318.00 dollars. Her bill was $1,223.00. So far my personal insurance is covering $245.00 each ( cost of the tests) and the rest is pending with AON trip insurance. Should have their answer on coverage of the balance in a couple weeks.

 

The only issue I had with the medical center was that they took no vitals (BP, pulse ox, temp, etc.) but when I went back to the medical center a few days later to pick up the final paperwork, it magically had vital signs filled in.

I was on the Gem with my cousin on the following cruise 4/30 to 5/6/23. We met a mother and adult daughter who we saw a few times during the cruise. The mother sent an e- mail to my cousin after the cruise to let us know that she and her daughter had Covid. My cousin and I tested for Covid but we were negative. I wonder how many other people got Covid on the Gem.

[ChiefMateJRK]

3 hours ago, Viajera7 said:

I was on the Gem with my cousin on the following cruise 4/30 to 5/6/23. We met a mother and adult daughter who we saw a few times during the cruise. The mother sent an e- mail to my cousin after the cruise to let us know that she and her daughter had Covid. My cousin and I tested for Covid but we were negative. I wonder how many other people got Covid on the Gem.

I'm guessing that other people did have Covid after the cruise.  What's the point?  Covid is everywhere now, and (fortunately) it's just a normal thing.

[Viajera7]

22 minutes ago, ChiefMateJRK said:

I'm guessing that other people did have Covid after the cruise.  What's the point?  Covid is everywhere now, and (fortunately) it's just a normal thing.

Read it again to see my point.

[Turtles06]

On 5/23/2023 at 3:28 PM, NCruiser2012 said:

I called the Medical Center, and the nurse I spoke to was very nice, but he said those tests tend to show false positives

Just the opposite of what is true. It’s usually several days of symptoms before there’s enough viral load in your body to be detected by home antigen tests, making false negatives a concern with those tests. 

[DaisyGoldberg]

14 hours ago, pcakes122 said:

Happy to hear your Mom recovered quickly! I was also on the Getaway for my Covid experience! I was not discouraged to come in on the phone, but I will say that I did not accept all the testing that was suggested (e.g., they had an EKG, heart enzyme test and lots of other crazy tests (kidney function?) on the estimate

 

My mom's 86 with heart disease and kidney disease and was pretty severely ill, so I was glad they did the kidney function tests before the treatments. Paxlovid can really do a number on people with poor kidney function. 

[pcakes122]

8 minutes ago, DaisyGoldberg said:

 

My mom's 86 with heart disease and kidney disease and was pretty severely ill, so I was glad they did the kidney function tests before the treatments. Paxlovid can really do a number on people with poor kidney function. 

Luckily I had blood work that was only 10 days old so I didn't have to spend the money for a lot of those tests. Hope your insurance kicks in soon! Good on your mom for continuing to travel despite her age and medical conditions! I have a lot going on medically as well, but I don't let it stop me either. 😊 (That's why I always see a doctor, get blood work and get a check up before every trip.)  Even so, I've now had Covid on ships three times. 🤦‍♀️ It is what it is.

 

[Homosassa]

19 minutes ago, DaisyGoldberg said:

 

My mom's 86 with heart disease and kidney disease and was pretty severely ill, so I was glad they did the kidney function tests before the treatments. Paxlovid can really do a number on people with poor kidney function. 

Yes, FDA approved labeling for Paxlovid includes the statement that a doctor-patient relationship should exist where the doctor knows the liver and kidney functions of the patient.  If unknown, tests for liver and kidney functions should be done before use of the drug.

 

The approved labeling also includes a long list of drugs that are contraindicates the use of Paxlovid.

Many of the drugs are used by heart patients where Paxlovid interferes with the metabolic pathway of the  different medications which can lead to life threatening drug interactions.

 

HIV positive patients are another group that need careful evaluation.

 

Paxlovid is a drug that should only be used in limited circumstances after a thorough medical evaluation by a physician.

 

A primary care physician that knows the patient's history would not need to prescreen for the contraindicated conditions and medications. 

 

A physician meeting a patient for the first time who does not have access the patient's medical history, needs to screen for liver and kidney function  plus all the drugs that contraindicate use of Paxlovid (many for heart disease and HIV positive patients).

 

For some, including some cardiac patients, patients need to be closely monitored while on the drug.

 

There is a good reason why a ship doctor may wish to do prescreening tests before prescribing Paxlovid. 

 

It is surprising. IMO,  that any ship's doctor would consider providing Paxlovid considering all the possibilities of problems with administration of the drug.

 

For those who may wish to educate themselves on the use of Paxlovid, I have linked the FDA package insert below. Please note the restriction on pharmacists  prescribing Paxlovid. 

 

https://www.fda.gov/media/155050/download

[Turtles06]

24 minutes ago, Homosassa said:

Yes, FDA approved labeling for Paxlovid includes the statement that a doctor-patient relationship should exist where the doctor knows the liver and kidney functions of the patient.  If unknown, tests for liver and kidney functions should be done before use of the drug.   ***

 

Your well-written comment above also helps explain why many doctors, including my own, will not prescribe Paxlovid to their patients "just in case" they need it on a trip.  Too many variables, some of which could be very serious.   Also, if I'm not mistaken, a positive covid test is required in order for Paxlovid to be prescribed. 

[sanger727]

This wasn't NCL but I had a very opposite experience on a cruise last december. It was a river cruise on a small ship - the company still required everyone onboard to be vaccinated but did not require a pre-cruise test. Our trip was a combined land tour/river cruise. Someone had cough/sinus symptoms the first day of the tour and they rapidly spread throughout the group. A few days into our cruise our cruise director decided that everyone who was sick should take a rapid covid test. Out of 10-15 people that were clearly sick, 4 tested positive. The real kicker of the situation is that my roommate and I were both sick - I tested positive and she tested negative. The cruise line had no idea of how to handle this situation. They allowed her to move to a different room and continue on with the tour while I was quarantined in my room. Two days later, when we docked they arranged for all of the "positives" to have a PCR test - and we all tested negative. It was a really terrible experience to have the midst of a wonderful vacation.