-Cruises are not built for social distancing.
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Buffets, pools, theaters are all layered on top of each other.
The size of an average cabin
ranges from 150 to 200 square feet,
about the same as a one-car garage.
And the rooms are stacked like Tetris blocks.
-You couldn't ask for a better incubator for infection.
-Yet as the coronavirus outbreak
was spiraling into what became a pandemic
and cruise ships began to report confirmed exposures --
-This has 3,600 people on board.
-Thousands of tourists continued to visit
one of the most popular cruise destinations --
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the Caribbean.
The $100-billion cruise industry
transports some 30 million passengers
around the world every year,
an industry trade association said,
with nearly a third of all cruise ships in the Caribbean.
That's a fraction of those who travel by air,
a major factor in the spread of the virus.
But public-health experts
said cruise ships create unique opportunities
for infectious diseases to spread.
In February and March of 2020, as cruise ships,
some carrying ill passengers, sought to dock,
the Caribbean faced difficult choices
on whether to close ports
to avoid the possibility of infections.
Epidemiologists at Yale's Public School of Health
modeled different scenarios of what could happen
if a passenger infected by the novel coronavirus
left a cruise ship and entered a port city
where there were no previous cases.
-Once we have three or five or seven
infectious passengers leaving a ship,
we believe that almost all of the time,
we'd see a sustained transmission in the port city.
-The "Washington Post" mapped the travel
of five passenger cruise ships in the Caribbean
from February 20th to March 18th
that transported someone
who later tested positive for coronavirus.
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This is the story of one of those ships.
The Costa Luminosa, operated by the Italy-based Costa Cruises,
can carry up to 2,826 passengers and 1,050 crew members.
♪♪
On February 28th,
the Costa Luminosa reached Ocho Rios, Jamaica,
but Jamaican authorities refused to allow Italian passengers
on the Costa Luminosa to disembark.
The government had recently set up guidelines
that banned passenger entry from countries with known outbreaks.
-To now include Italy, South Korea,
Singapore, and Iran.
-Unable to unload passengers,
the Luminosa left Jamaica and sailed on to George Town,
the capital of the Cayman Islands.
Upon arrival, a 68-year-old Italian man suffering a stroke
was rushed from the docked ship to a hospital.
He was left on the island after the ship departed later that day
to undergo treatment.
The Costa Luminosa finished the rest of the journey
and arrived in Fort Lauderdale on March 5th,
where some passengers left
and the ship prepared for its next trip.
In the early hours of the following day,
it departed with new passengers but the same crew.
-Bye! Going on the plank.
-Jennifer Catrun was a passenger on that trip.
She logged her experiences in daily videos.
-So excited.
Going on.
-Activities on the ship were going on as usual
at a time when Catrun said
she was aware of the illness spreading in the world.
-This is one of those times, March 7, 2020,
just in case somebody's looking at this later on,
in the midst of the coronavirus scare.
-While the Costa Luminosa
was sailing to San Juan, Puerto Rico,
cruise-line executives and Jamaican government officials
met in Miami to discuss guidelines
for port entry to islands,
Jamaican officials told the "Post."
On March 8th, the Costa Luminosa docked in San Juan, Puerto Rico.
-So pretty. So pretty, so pretty.
-Along with other footage of the island,
including scenes from a local gathering,
Catrun filmed an ambulance leaving the Costa Luminosa.
The president of this ambulance company is Carmen Cruz.
-As soon as we get a call,
we are on alert for symptoms associated with the pandemic,
which in Puerto Rico, there still hadn't been a single case.
-Cruz said the call came from a port agent in San Juan
that dispatches requests from cruise ships.
-They described it saying, no, that this was pneumonia,
and she had a history of respiratory issues.
But when they gave us the details that she was from Italy,
had been on the ship for 16 days,
we prepared ourselves as if it was a case of COVID-19.
-Cruz said they were told
that the passenger had shown symptoms for two days.
A representative of the dispatcher
said that the company facilitates communications
between a ship's medical staff and the local hospital,
but that those parties
discuss the particulars of a medical case.
-By 8:00 in the morning already all the crew and tourists
had disembarked on the island to go shopping
and take their normal trip
without knowing that there was an infected person.
We took the patient with her mask,
which was the only thing she had on.
The nurses on the cruise ship delivered the patient to us,
and they did not have any type of protection.
A hospital near the pier agreed to accept the patient.
-Costa Cruises disputed the idea that ship officials
had dismissed the possibility of the virus,
saying that before the sick woman disembarked,
the ship's doctor requested
that she be tested for the coronavirus in Puerto Rico,
even though the local hospital
said it was not likely a COVID-19 case,
according to the company.
The couple remained in San Juan for care.
The Costa Luminosa left the Caribbean the next day
for a week-long journey across the Atlantic.
-People are a little nervous about the COVID-19 panic
that's going on throughout the world.
Had messages on Cruise Critic this morning
that someone was taken off the ship yesterday
with respiratory illnesses.
I don't think that's true.
I saw the ambulance leaving. They were not even --
There was no masks on the people that were working.
None of that was going on.
-Remember the passenger
that was dropped off in the Cayman Islands
on the ship's previous voyage?
Well, on March 12th,
officials announced the coronavirus test results
for five suspected cases,
one of which was the Costa Luminosa passenger
who had disembarked on February 29th.
-The patient is a visitor
who was transferred from a cruise ship
for a critical cardiac issue.
-By the time he was diagnosed with coronavirus,
the country's first confirmed case,
he had already unknowingly exposed
more than 40 healthcare workers and their families,
according to hospital officials.
Six confirmed positive cases were tied to the passenger,
officials said.
The hospital was partially shut down for two weeks
as it moved to contain the virus.
Back on the Costa Luminosa, passengers were sent a letter,
a copy of which was obtained by "The Post,"
stating there were no suspected COVID-19 cases on board,
but acknowledge that a passenger
had been hospitalized in Puerto Rico.
-And we got word last night that there was nobody on board
that had suspected cases of the virus,
and although there's a lot of people coughing on board,
nobody has been severe enough to go into the infirmary.
So that is a huge deal.
-On March 13th, the Puerto Rican government
announced the COVID-19 test results
for the couple who had disembarked the Costa Luminosa
on March 8th.
-The results of the first cases that came under suspicion
and were subject to the analysis just a few hours ago,
we confirmed the first three positive coronavirus cases
in Puerto Rico.
-Passengers on the Costa Luminosa
were told about the two confirmed cases
the next day, on March 14th.
Costa told "The Post" it learned of official results
between March 14th and March 15,
as they were at sea on the Atlantic.
-We are on quarantine in our rooms.
-After facing port closures and quarantines,
the cruise line eventually canceled the rest of the trip
and was able to evacuate more sick individuals
in Spain's Canary Islands
before disembarking passengers in France and Italy.
Catrun got off the Costa Luminosa on March 19th
and flew from France to Atlanta.
The Centers for Disease Control and Prevention
met the passengers at the airport
and, after taking their temperatures,
allowed them to fly back home.
Catrun said she was ill as of April 16th
with an unknown virus,
but was not able to get a COVID-19 test
because she does not have typical symptoms.
Puerto Rico officials announced on March 21st
that the Italian woman
who was evacuated from the Costa Luminosa
had passed away.
-Our condolences to the family of this patient from Italy.
-As of April 20th, at least 145 crew members and 48 passengers
who were aboard the Luminosa
had tested positive for the coronavirus,
according to Costa Cruises.
Costa Cruises said it passed along information
to passengers as soon as the ship received it
and said that while the woman was still in the hospital,
Luminosa officials isolated
those who were in close contact with her
and then took further measures
when it got the result of her test.
It also noted that company
voluntarily paused all cruises on March 13th,
the same day it said it received notice
that the first passenger had tested positive.
The Costa Luminosa wasn't the only ship
that health officials tied to coronavirus cases.
The Costa Favolosa left off passengers in three countries
who officials said later tested positive --
13 cases in the Dominican Republic,
52 in Trinidad and Tobago, and 2 in Martinique.
A passengers on the British cruise ship MS Braemar
traveling the Caribbean in the Americas
disembarked on March 8th in Cartagena, Colombia,
and was the city's first confirmed case,
local health officials said.
Fred Olsen Cruise Lines, the owner of the Braemar,
said the guest was not displaying
any known COVID-19 symptoms at the time.
[Indistinct speaking]
In statements to "The Post,"
cruise lines said they followed all international regulations
to prevent the spread of disease and took voluntary measures,
such as temperature checks and intensive sanitation measures.
They disputed the idea that their ships
brought the coronavirus into the region,
saying that, while Caribbean residents
who sailed on their ships have tested positive,
there is not proof they contracted the virus on board.
On April 16th, Carnival CEO Arnold Donald
held a conference call with reporters
and defended the company's response
to the COVID-19 outbreak.
-There was very little knowledge, you know,
starting early on in fabulous and March and whatnot.
We aggressively managed it, as we do any illness on board.
-We spoke to the director of the Pan American Health Organization
that helps countries in the Americas combat diseases
about the burden a large-scale coronavirus outbreak
would place on the region.
-So, the very tiny ones,
particularly those of the Eastern Caribbean --
they have limited capacities,
limited number of healthcare workers,
limited number of beds,
limited number of the equipment that is necessary,
particularly ventilators, et cetera.
-The best way to protect a port city
is to prevent any seeding events from taking place.
-The Yale epidemiologists found to effectively prevent cruises
from causing infections in port cities,
cruise ships would need to prevent all passengers
from disembarking once a single person
is found to be symptomatic or infected.
About a week before Donald's call,
the CDC extended a nearly month-old No Sail Order
for cruise ships in US waters for as long as 100 days.
The CDC said that cruise-ship travel
exacerbates the global spread of COVID-19
and that the pandemic had not been controlled sufficiently
by the cruise-ship industry.
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