April Updated No Sail Order

U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES
CENTERS FOR DISEASE CONTROL AND PREVENTION (CDC)
ORDER UNDER SECTIONS 361 & 365
OF THE PUBLIC HEALTH SERVICE ACT (42 U.S.C. 264, 268) AND
42 CODE OF FEDERAL REGULATIONS
PART 70 (INTERSTATE) AND PART 71 (FOREIGN):
MODIFICATION AND EXTENSION OF NO SAIL ORDER
AND OTHER MEASURES RELATED TO OPERATIONS

Previous Order and Incorporation by Reference
This Order renews the No Sail Order and Other Measures Related to Operations signed by the
CDC Director on March 14, 2020—subject to the modifications and additional stipulated
conditions as set forth in this Order. This Order shall continue in operation until the earliest of
(1) the expiration of the Secretary of Health and Human Services’ declaration that COVID-19
constitutes a public health emergency; (2) the CDC Director rescinds or modifies the order based
on specific public health or other considerations; or (3) 100 days from the date of publication in
the Federal Register. The findings and other evidence relied upon in issuing the March 14, 2020
Order are incorporated herein by reference. Any ambiguity between the March 14, 2020 Order,
as modified by the current Order, shall be resolved in favor of the current Order.
Statement of Intent
This Order shall be interpreted and implemented in a manner as to achieve the following
paramount objectives:
•
•
•
•
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Preservation of human life;
Preventing the further introduction, transmission, and spread of COVID-19 into and
throughout the United States;
Preserving the public health and other critical resources of Federal, State, and local
governments;
Preserving hospital, healthcare, and emergency response resources within the United
States; and
Maintaining the safety of shipping and harbor conditions, including safety of personnel.

Applicability
This Modification and Extension of No Sail Order and Other Measures Related to Operations
shall apply only to the subset of carriers 1 described below and hereinafter referred to as “cruise
ships:”
1

Carrier is defined by 42 CFR § 71.1 to mean, “a ship, aircraft, train, road vehicle, or other means of transport,
including military.”
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All commercial, non-cargo, 2 passenger-carrying vessels operating in international,
interstate, or intrastate waterways and subject to the jurisdiction of the United States with
the capacity to carry 250 3 or more individuals (passengers and crew) with an itinerary
anticipating an overnight stay onboard or a twenty-four (24) hour stay onboard for either
passengers or crew. 4
This Order shall additionally apply to any cruise ship that was previously excluded from the
March 14, 2020 Order, by virtue of having voluntarily suspended operations.
“Operations” for purposes of this Order means any action by a cruise ship operator to bring or
cause a cruise ship to be brought into or transit in or between any international, interstate, or
intrastate waterways (e.g., shifting berths, moving to anchor, discharging waste, making port, or
embarking or disembarking passengers or crew) subject to the jurisdiction of the United States.
“Operator” for purposes of this Order means the Master of the vessel (cruise ship) and any other
crew member responsible for cruise ship operations and navigation, as well as any person or
entity (including a corporate entity) that authorizes or directs the use of a cruise ship (e.g., as
owner, lessee, or otherwise). A cruise ship operator may be either the cruise ship captain or the
cruise line to which the cruise ship belongs, or both. The term “Operator” as used in this Order
further incorporates the terms “company,” “designated person,” and “responsible person” as
defined in 33 CFR. § 96.120.
Events Since the Issuance of March 14, 2020 Order
On March 14, 2020, the CDC Director issued a No Sail Order and Other Measures Related to
Operations directing cruise ships not voluntarily suspending operations to comply with measures
outlined by the CDC and U.S. Coast Guard. This followed a March 13, 2020, announcement by
Cruise Lines International Association (CLIA), the leading industry trade group, that its
members would voluntarily suspend cruise ship operations. On March 17, 2020, CDC issued a
Level 3 Travel Warning that all travelers defer cruise travel worldwide based on widespread
ongoing transmission of COVID-19. 5 The suspension of a global tourism industry, such as the
2

Given the substantial risk of person-to-person transmission of COVID-19, as opposed to transmission via indirect
contact, this Order is currently limited to passenger, non-cargo vessels.
3
Based on substantial epidemiological evidence related to congregate settings and mass gatherings, this Order
suspends operation of vessels with the capacity to carry 250 individuals or more. Evidence shows that settings as
small as nursing homes or movie theaters can proliferate the spread of a communicable disease. As the numbers of
passengers and crew onboard a ship increases, certain recommended mitigation efforts such as social distancing
become more difficult to implement. In light of the demonstrated rapid spread of this communicable disease in
current cruise ship settings, application of this Order to vessels carrying 250 or more individuals is a prudent and
warranted public health measure. Moreover, the management of current coronavirus cases in addition to existing
seasonal care needs (e.g., influenza) has placed an extreme burden on the public health and healthcare systems and
this Order will help avoid further stressing those systems.
4
This order shall not apply to vessels operated by a U.S. Federal or State government agency. Nor shall it apply to
vessels being operated solely for purposes of the provision of essential services, such as the provision of medical
care, emergency response, activities related to public health and welfare, or government services, such as food,
water, and electricity.
5
CDC, Traveler’s Health, COVID-19 and Cruise Ship Travel, at:
https://wwwnc.cdc.gov/travel/notices/warning/coronavirus-cruise-ship (originally posted, March 17, 2020).
2

cruise line industry, does not happen instantaneously or easily. During the suspense of
operations, the cruise line operators worked with both Federal, State, and local governments to
disembark of over 250,000 passengers from more than 120 vessels. The cruise line operators
continue discussions with Federal, State and local governments regarding the 114 vessels with
over 93,000 crew either in or near U.S. ports. However, COVID-19 clusters and outbreaks
continue to occur on and in connection with cruise ships.
There are a number of recent incidences of reported COVID-19 spread onboard cruise ships
including the Costa Magica, Costa Favolosa, Celebrity Eclipse, Disney Wonder, Holland
America Zaandam, and Celebrity Coral Princess. The Costa Magica and the Costa Favolosa,
reported at least 88 ill crew members on board with respiratory symptoms of COVID-19. On
March 26, 2020, in coordination with U.S. Coast Guard and public health personnel, four
infected crew members were evacuated off the Magica and seven from the Favolosa for lifecritical care at Jackson Memorial Hospital in Miami, Florida. The Zaandam cruise ship reported
illness consistent with COVID-19 in at least 250 persons onboard – guests and crew members;
76 of these persons remain symptomatic. Four passengers onboard the Zaandam have died (one
for non-COVID-19 related reasons). 6 As of April 1, 2020, four crew members onboard the
Eclipse have tested positive for COVID-19, three of whom remain on the ship. One passenger
onboard the Eclipse required emergency medical evacuation and is currently hospitalized in San
Diego, California after having tested positive for COVID-19. The Wonder reported four crew
members who have tested positive for COVID-19. Two of the four are now hospitalized, the two
others are isolated on the ship; an additional three former passengers (from the last voyage who
disembarked) are also positive. Most recently, the Coral Princess reported 12 persons (seven
passengers and five crew members) onboard who are confirmed positive for COVID-19 and an
additional 43 suspected cases in persons with influenza-like illness. As of April 3, 2020, there are
four patients on oxygen in the ship’s medical center.
There are approximately 50 cruise ships that remain at sea off the East Coast of the United States
and in the Bahamas with an estimated 47,800 crew onboard; off the West Coast and Gulf Coast
there are approximately 45 cruise ships with an estimated 32,000 crew onboard. Some of these
crew are not critical to maintain the seaworthiness or basic safe operation of the cruise ships;
many are part of the hotel and hospitality crew. CDC is currently aware of 15 cruise ships at port
or anchorage in the United States with known or suspected COVID-19 infection among the crew
who remain onboard. CDC is currently tracking two cruise ships with passengers that are
expected to make port in the United States.
There are several public health concerns when crew members become ill while onboard these
ships and the cruise lines seek the aid of the United States in disembarking them, as has already
occurred on numerous occasions. The intensive care requirements for infected crew in need of
life-critical care greatly stresses an already overburdened healthcare system facing shortages of
masks, test kits, beds, and ventilators needed to respond to COVID-19. The addition of further
COVID-19 cases from cruise ships places healthcare workers at substantial increased risk.
Moreover, safely evacuating, triaging, and repatriating cruise ship crew involves complex
6

“President of Holland America cruise line pleads for compassion while Florida debates allowing ships to dock,”
Fox News, March 31, 2020, available at: https://www.foxnews.com/travel/zaandam-holland-america-cruisepresident-florida-debate.
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logistics, incurs financial costs at all levels of government, and diverts resources away from
larger efforts to suppress or mitigate COVID-19.
Critical Need for Further Cooperation and Response Planning
CDC and other Federal agencies engaged with CLIA representatives in early March. On March
13, 2020, CLIA and their associated members announced that all member cruise lines would
voluntarily suspend cruise ship operations from U.S. ports of call for 30 days as public health
officials and the Federal government continue to address COVID-19. Several cruise lines
followed CLIA’s example and similarly voluntarily suspended operations.
CLIA also drafted a response plan, “On Course: Cruise Industry COVID-19 Response and
Protocols” (hereinafter, “On Course”). The plan proposed “industry management of suspected or
confirmed cases of COVID-19 without burden on the U.S. government.” 7 CLIA stated that it
could implement this plan within 7 days. 8 In response to a suspected or confirmed case of
COVID-19, “industry would be responsible for transporting the [exposed or infected] individuals
in appropriate buses, cars, or ambulances.” 9 Furthermore, CLIA averred that, “contracts for
predesignated facilities though Global Rescue [a firm with purported experience and expertise in
mass medical incidents] [would] receive COVID-19 patients, including arrangements [that] will
be executed following plan approval.” 10 CLIA further stated that it had planned for “multiple
redundancies” in its response efforts. Specifically, “CLIA commits to making five ships
available for temporary housing purposes. They would be tasked with sailing to any affected ship
and taking affected guests and crew aboard for the self-isolation period.” 11
On April 3, 2020, CLIA drafted a new response plan, “Framework: For Cruise Industry Care of
Crew and other Persons on Board while Ships Remain Idle during the Global COVID-19
Pandemic” (hereinafter, “Framework”). The Framework plan must go further to reduce industry
reliance on government and shoreside hospital resources. For example, while the Framework
states that a ship will maintain its medical staff, it must provide further details of how the
industry will provide for the acute care needs of the critically ill. The Framework must also
address industry assistance to COVID-19 affected cruise ships by deploying additional ships for
cohort separation of those who are exposed, infected, and in need of hospitalization.
Furthermore, laboratory sampling and testing, onboard mitigation and prevention strategies,
disinfection protocols, personal protective equipment, repatriation of foreign nationals, and
onshore transportation, including through contract medivac helicopter, must be addressed in
further detail, including how the industry proposes to acquire, staff, and operationalize this plan,
with minimal burden on Federal, State, or local government entities or the healthcare system.
Findings and Immediate Action

7

(On Course, pages 1, 10).
Id. at 2.
9
Id. at 1-2.
10
Id. at 7.
11
Id. at 13.
8

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Accordingly, and consistent with 42 CFR §§ 70.2, 71.31(b) and 71.32(b), the Director of CDC
(“Director”) finds that cruise ship travel exacerbates the global spread of COVID-19 and that the
scope of this pandemic is inherently and necessarily a problem that is international and interstate
in nature and 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 outbreak within the United States. If
unrestricted cruise ship passenger operations were permitted to resume, infected and exposed
cruise ship cases would place healthcare workers at substantial increased risk. Specifically, these
cases would divert medical resources away from persons with other medical problems and other
COVID-19 cases, consuming precious diagnostics, therapeutics, and protective equipment.
Ongoing concerns with cruise ship transmission would further draw valuable resources away
from the immense Federal, State, and local effort to contain and mitigate the spread of COVID19. Further, the current ongoing non-passenger operation of cruise ships has not sufficiently
abated the public health concern, as ship crew become sick and require medical care drawing on
otherwise engaged Federal, State, and local resources. As operators of non-U.S. flagged vessels
sailing in international waters, it is imperative that the cruise ship industry and cruise lines
themselves take responsibility for the care of their crew and do not further tax limited U.S.
resources during a public health emergency.
The Director also finds evidence to support a reasonable belief that cruise ships are or may be
infected or contaminated with a quarantinable communicable disease. 12 This reasonable belief is
based on information from epidemiologic and other data regarding the nature and transmission of
COVID-19 on cruise ships, including the information described in the March 14, 2020 Order and
evidence from the Costa Magica, Costa Favolosa, Eclipse, Wonder, Zaandam, Coral Princess,
and other cruise ships. As a result, persons onboard cruise ships may be infected with or exposed
to COVID-19 by virtue of being onboard at a time when cases of COVID-19 are being reported
in increasingly significant numbers globally 13 and specifically on cruise ships, when testing is
available.
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.
This Order is not a rule within the meaning of the Administrative Procedure Act (“APA”), but
rather an emergency action taken under the existing authority of 42 CFR §§ 70.2, 71.31(b) and
71.32(b). In the event that this Order qualifies as a rule under the APA, notice and comment and
a delay in effective date are not required because there is good cause to dispense with prior
public notice and comment and the opportunity to comment on this Order and the delay in
effective date. 14 Considering the public health emergency caused by COVID-19 based, among
other things, on its continued spread on board cruise ships, it would be impracticable and
12

COVID-19 is a communicable disease for which quarantine is authorized under Section 361 of the Public Health
Service Act (42 U.S.C. § 264) and 42 CFR §§ 70.1, 71.1, as listed in Executive Order 13295, as amended by
Executive Orders 13375 and 13674.
13
Since the March 14, 2020 Order, the number of global cases of COVID-19 reported by the World Health
Organization (WHO) has risen from 142,534 to 1,051,635 as of April 4, 2020, with 56,985 deaths. See Situation
Reports, WHO, https://www.who.int/emergencies/diseases/novel-coronavirus-2019/situation-reports.
14
See 5 U.S.C. §§ 553(b)(B), (d)(3).
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contrary to the public health, and by extension the public interest, to delay the issuance and
effective date of this Order. Similarly, if this Order qualifies as a rule per the definition in the
APA, the Office of Information and Regulatory Affairs has determined that it would be a major
rule, but there would not be a delay in its effectiveness as the agency has invoked the good cause
provision of the APA.
If any provision in this Order, or the application of any provision to any carriers, persons, or
circumstances, shall be held invalid, the remainder of the provisions, or the application of such
provisions to any carriers, persons or circumstances other than those to which it is held invalid,
shall remain valid and in effect.
In accordance with 42 U.S.C. § 264(e), this Order shall supersede any provision under State law
(including regulations and provisions established by political subdivisions of States), that conflict
with an exercise of Federal authority, including instructions by U.S. Coast Guard (USCG) or
HHS/CDC personnel permitting ships to make port or disembark persons under stipulated
conditions, under this Order.
This Order shall be enforceable through the provisions of 18 U.S.C. §§ 3559, 3571; 42 U.S.C. §§
243, 268, 271; and 42 CFR §§ 70.18, 71.2.
Therefore, in accordance with Sections 361 and 365 of the Public Health Service Act (42 U.S.C.
§§ 264, 268) and 42 CFR §§ 70.2, 71.31(b), 71.32(b), for all cruise ships for the period described
below, it is ORDERED:
1. As a condition of obtaining controlled free pratique to continue to engage in any cruise
ship operations in any international, interstate, or intrastate waterways subject to the
jurisdiction of the United States, cruise ship operators shall immediately develop,
implement, and within seven (7) days of the signing of this Order operationalize, an
appropriate, actionable, and robust plan to prevent, mitigate, and respond to the spread of
COVID-19 on board cruise ships.
2. As a condition of obtaining controlled free pratique to continue to engage in any cruise
ship operations in any international, interstate, or intrastate waterways subject to the
jurisdiction of the United States, the cruise ship operator shall make the plan described in
paragraph 1, above, available to HHS/CDC and USCG personnel within seven (7) days
of the signing of this Order.
3. 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
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c.
d.
e.

f.
g.

h.

i.
j.

k.

l.

m.

basis for as long as the cruise ship is within waters subject to the jurisdiction of
the United States.
Onboard monitoring of passengers and crew through temperature checks and
medical screening, including addressing frequency of monitoring and screening;
Training of all crew on COVID-19 prevention, mitigation, and response activities;
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;
Onboard isolation, quarantine, and social distancing protocols to minimize the
risk of transmission and spread of COVID-19;
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;
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;
Categorization of affected individuals into risk categories with clear stepwise
approaches for care and management of each category;
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;
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);
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;
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
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n. Cleaning and disinfection protocols for affected cruise ships.
4. An appropriate plan shall be designed to minimize, to the greatest extent possible, any
impact on U.S. government operations or the operations of any State or local government,
or the U.S. healthcare system.
5. The cruise ship operator shall further ensure that the plan is consistent with the most
current CDC recommendations and guidance for any public health actions related to
COVID-19. Where appropriate, a cruise ship operator may coordinate the development,
implementation, and operationalization of a plan with other cruise ship operators,
including an industry trade group.
The terms and conditions of the No Sail Order and Other Measures Related to Operations signed
on March 14, 2020, as modified and extended by this ORDER, SHALL REMAIN IN
EFFECT. Consequently, it remains ORDERED:
1. Cruise ship operators shall not be allowed to disembark passengers and crew members at
ports or stations, except as directed by the USCG, in consultation with HHS/CDC
personnel and, as appropriate, as coordinated with Federal, State, and local authorities.
2. Cruise ship operators shall not reembark any crew member, except as approved by
USCG, in consultation with HHS/CDC personnel, until further notice.
3. Cruise ship operators shall not embark any new passengers or crew, except as approved
by USCG, or other Federal authorities as appropriate, in consultation with HHS/CDC
personnel.
4. Cruise ship operators shall not commence or continue operations (e.g., shifting berths,
moving to anchor, or discharging waste), except as approved by USCG, in consultation
with HHS/CDC personnel, until further notice.
5. While in port, the cruise ship operator shall observe health precautions as directed by
HHS/CDC personnel.
6. The cruise ship operator shall comply with all HHS/CDC, USCG, and other Federal
agency instructions to follow CDC recommendations and guidance for any public health
actions relating to passengers, crew, ship, or any article or thing on board the ship, as
needed, including by making ship’s manifests and logs available and collecting any
specimens for COVID-19 testing.
7. This order does not prevent the periodic reboarding of the ship by HHS/CDC personnel
and/or USCG and/or other Federal, State, or local agencies or the taking on of ships’
stores and provisions under the supervision of HHS/CDC personnel and/or USCG.

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8. This order does not prevent the ship from taking actions necessary to maintain the
seaworthiness or safety of the ship, or the safety of harbor conditions, such as movement
to establish safe anchorage, or as otherwise directed by USCG personnel.
This Order is effective upon publication in the Federal Register and shall continue in operation
until the earliest of (1) the expiration of the Secretary of Health and Human Services’ declaration
that COVID-19 constitutes a public health emergency; (2) the CDC Director rescinds or modifies
the order based on specific public health or other considerations; or (3) 100 days from the date of
publication in the Federal Register.
In testimony whereof, the Director, Centers for Disease Control and Prevention, U.S.
Department of Health and Human Services, has hereunto set his hand at Washington, D.C., this
9th day of April, 2020.

Robert R. Redfield, MD
Director
Centers for Disease Control and Prevention

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