​Background

The COVID-19 pandemic led to multiple outbreaks of COVID-19 aboard cruise ships around the world in early 2020. In some cases, there were very high levels of transmission of COVID-19 aboard cruise ships. There were also difficulties identifying on-shore resources needed to manage these outbreaks. 

CDC initially implemented a No Sail Order to prevent further outbreaks among ships in US Territorial waters and has now instituted a Conditional Sail Order (CSO) to permit ship voyages to resume. As part of the CSO, CDC requires that cruise ship operators enter into Local Agreements with local health jurisdictions (LHJs) and local port authorities. These Agreements must be approved by CDC and have multiple requirements as outlined in CDC's Cruise Ship Guidance: Technical Instructions for Local Agreements.

Objective

Provide a minimum set of recommended elements consistent with CDC's CSO across California for Local Agreements between LHJs, local port authorities, and cruise ship operators. Having a consistent and coordinated approach will facilitate development of those agreements and enhance the safety of travelers and communities in California. 

Scope

This document provides recommended standards for Local Agreements executed in California, while allowing for flexibility for LHJ local needs. 

Minimum recommended standards for Local Agreements in California under CDC's CSO

CDPH recommends that all Local Agreements executed in California as part of CDC's CSO include the following minimum elements consistent with CDC requirements:

1. Cruise ship operators should attempt to achieve a vaccination level of 95% of all crew and passengers eligible for COVID-19 vaccination. If an operator is unable to meet the 95% threshold, CDC's CSO requires adherence to certain additional protocols. As of July 2021, persons 12 years of age and older are eligible. Persons with prior history of COVID-19 are also eligible for vaccination. Persons should be fully vaccinated against COVID-19 with either a US Food and Drug Administration (FDA)-authorized vaccine or a vaccine product that has received emergency use listing from the World Health Organization (WHO) at all times while on board (including during sailing) if they are embarking or disembarking at a California port. A person is considered fully vaccinated if 2 weeks have elapsed since completing the final injection for the full schedule of the vaccination received (can be 1 or 2 doses, depending on the vaccine).

2. Consistent with CDC requirements, the full name, date of birth, sex, home address, phone number, email address, and vaccination status for each crew member and passenger should be maintained by the operator whenever a traveler is on board and provided to the LHJ as well as CDPH Traveler Team (CovTravelEpi@cdph.ca.gov) upon request, via a secure method that protects confidential health information. Vaccination status should indicate if the individual is:

   a. fully vaccinated, OR
   b. not fully vaccinated with documentation of recovery from COVID-19 within the prior 90 days, OR
   c. not fully vaccinated without documentation of recovery from COVID-19 within the prior 90 days of each traveler

3. Pursuant to CDC requirements, cruise ship operators should document fully executed contracts for shoreside services in the Local Agreements. Local health departments, in partnership with the cruise ship operators may consider the level of vaccination coverage agreed upon to determine any thresholds for the number of persons who can be served by such contracts, if applicable.
   

As these are minimum recommended standards, LHJs can implement additional and more stringent standards in their Local Agreements.