possible mandatory COVID testing for Caribbean cruises

[Gracie115]

Just now, sanger727 said:

 

Ok, so if you take a mid cruise test that comes back in 15 minutes it's the same issue... And I'm not sure when that technology will be readily available and reliable. This just occurred on one of the first Alaska cruises where the person embarked and didn't get their results back until mid cruise....

 

The technology is already available.  I am certain that the lines will have protocols in place for how to deal with a positive result before any of them really start sailing again.  I am trying to be POSITIVE about this, obviously the best thing is for a vaccine to happen that is effective but even then there is always a chance of someone getting it because rarely are vaccines more than 70% effective.  I will be the first in line for that vaccine whenever it happens and will get on a ship as soon thereafter as I can.  

[sanger727]

1 hour ago, Gracie115 said:

 

The technology is already available.  I am certain that the lines will have protocols in place for how to deal with a positive result before any of them really start sailing again.  I am trying to be POSITIVE about this, obviously the best thing is for a vaccine to happen that is effective but even then there is always a chance of someone getting it because rarely are vaccines more than 70% effective.  I will be the first in line for that vaccine whenever it happens and will get on a ship as soon thereafter as I can.  

 

I am the covid liaison with the health department for my workplace. I gather information about all people who are exposed, symptomatic and tested. I have seen one person get test results the same day and many strings were pulled to make that happen. Everyone else is taking anywhere from 3-10 days to get test results back. If the technology is already so "available" then why is testing time still an issue? I don't think that a leisure activity like travel will be able to purchase enough tests to test everyone as a preventative; when someone who is symptomatic with possible covid is still waiting a week to get test results. 

[Fouremco]

This FDA webpage provides an excellent overview of current testing methodologies and their time requirements: https://www.fda.gov/consumers/consumer-updates/coronavirus-testing-basics 

[Gracie115]

1 hour ago, sanger727 said:

 

I am the covid liaison with the health department for my workplace. I gather information about all people who are exposed, symptomatic and tested. I have seen one person get test results the same day and many strings were pulled to make that happen. Everyone else is taking anywhere from 3-10 days to get test results back. If the technology is already so "available" then why is testing time still an issue? I don't think that a leisure activity like travel will be able to purchase enough tests to test everyone as a preventative; when someone who is symptomatic with possible covid is still waiting a week to get test results. 

I have been tested twice, once the results were 2 days, the other 36 hours.

But there ARE tests that take as little as 15 minutes as Fouremco  posted in his link.  How readily available they are I don't know.

[npcl]

16 minutes ago, Gracie115 said:

I have been tested twice, once the results were 2 days, the other 36 hours.

But there ARE tests that take as little as 15 minutes as Fouremco  posted in his link.  How readily available they are I don't know.

The question is more how accurate are they.  The problem even PCR tests (the gold standard) is false negatives.  The other faster tests are even worse. A single negative result even with PCR does not mean that much with the error rate (according to a John Hopkins study) of at least 20% depending upon stage of the infection.  38% on first day of symptoms for example.

 

https://khn.org/news/abbott-rapid-test-problems-grow-fda-standards-on-covid-tests-under-fire/

[Gracie115]

31 minutes ago, npcl said:

The question is more how accurate are they.  The problem even PCR tests (the gold standard) is false negatives.  The other faster tests are even worse. A single negative result even with PCR does not mean that much with the error rate (according to a John Hopkins study) of at least 20% depending upon stage of the infection.  38% on first day of symptoms for example.

 

https://khn.org/news/abbott-rapid-test-problems-grow-fda-standards-on-covid-tests-under-fire/

 

Which is why a vaccine is important....also believe that as time goes by testing will get better (ok, so I'm optimistic😅)

[npcl]

12 minutes ago, Gracie115 said:

 

Which is why a vaccine is important....also believe that as time goes by testing will get better (ok, so I'm optimistic😅)

I am more confident about a potential vaccine or therapeutic than I am about testing.  The problem is that this virus hides well, even when someone is experiencing symptoms, If a PCR cannot detect the virus reliably, it is difficult to think of another technology that will.  To improve testing they will need to find another marker that shows active infection or another way to sample the virus that is much more reliable.  Doing that in a way that can be used for mass rapid testing is quite a challenge.

[markeb]

35 minutes ago, npcl said:

The question is more how accurate are they.  The problem even PCR tests (the gold standard) is false negatives.  The other faster tests are even worse. A single negative result even with PCR does not mean that much with the error rate (according to a John Hopkins study) of at least 20% depending upon stage of the infection.  38% on first day of symptoms for example.

 

https://khn.org/news/abbott-rapid-test-problems-grow-fda-standards-on-covid-tests-under-fire/

 

And even worse when you're trying to use a diagnostic test as a screening tool. You really need a very high negative predictive value test, which means you accept false positives on screening, but false positives are rare. And accepting false positives means potentially excluding more passengers dockside, unless you have a follow up plan for confirmation, also onsite...

 

If you adjust your inclusivity/exclusivity and call criteria on PCR, and allow more near neighbors to be called positive, it "might" be a better screening tool, but you're going to be calling a lot of suspects rather than confirmed. And a negative dockside just means "no virus detected".

 

6 minutes ago, Gracie115 said:

 

Which is why a vaccine is important....also believe that as time goes by testing will get better (ok, so I'm optimistic😅)

 

The testing may get better, but it's limited by the biology of the virus. It's got to be there when you test for it, and it's there in highest quantities when you're actually sick. So I don't know what the limits of testing will be, and especially the limits of testing to exclude rather than to diagnose.

[npcl]

6 minutes ago, markeb said:

 

And even worse when you're trying to use a diagnostic test as a screening tool. You really need a very high negative predictive value test, which means you accept false positives on screening, but false positives are rare. And accepting false positives means potentially excluding more passengers dockside, unless you have a follow up plan for confirmation, also onsite...

 

If you adjust your inclusivity/exclusivity and call criteria on PCR, and allow more near neighbors to be called positive, it "might" be a better screening tool, but you're going to be calling a lot of suspects rather than confirmed. And a negative dockside just means "no virus detected".

 

 

The testing may get better, but it's limited by the biology of the virus. It's got to be there when you test for it, and it's there in highest quantities when you're actually sick. So I don't know what the limits of testing will be, and especially the limits of testing to exclude rather than to diagnose.

You indicated you were DOD.  Fort Detrick by chance?

 

It is amazing how infectious this virus is, how well it escapes detection, the incubation times, the medical care required.  Amazing how many characteristics this virus has for one that just jumped from an animal to humans.  Certainly unique.

[markeb]

1 hour ago, npcl said:

You indicated you were DOD.  Fort Detrick by chance?

 

Never stationed there. Worked with them for parts of 20 years. Was in the old building before it became a prison and the slammer while it was still the slammer.

 

Was in positions (being a little cryptic as I kind of become identifiable because not many people did what I did for as long as I did...) where I had to know their business, sometimes inside and out, both in the lab and the acquisition side. It's amazing what you learn if you just listen to people, especially if you turn around and explain it to people who actually have money...

[boom_boom]

I agree with the thoughts of other here, I don't object to tests, social distancing or masks, but I sure do not want to be stranded somewhere if, mid-cruise, some folks test positive and we are all now in quarantine. IMO, without a vaccine, I'm most likley to be shore-bound for the nest year or so.

[WonderMan3]

On 8/11/2020 at 3:39 PM, hcat said:

"COVID-19 testing for all, only MSC excursions

The new procedures include COVID-19 testing for all passengers and crew prior to embarkation. During the initial phase of operations, passengers will go ashore only as part of an organized MSC Cruises’ excursion.

A redesigned embarkation procedure with digital check-in processes will be implemented. Universal health screening includes a temperature check, a health questionnaire and a COVID-19 swab test. Depending on the results and according to the passenger's medical/travel history, a secondary health screening or COVID-19 test will take place. Anyone testing positive, displaying symptoms or presenting a temperature will be denied boarding."

Following guidelines from the European Center for Disease Prevention and Control, travelers from countries categorized as high risk will be required to take a molecular RT-PCR test within 72 hours before joining the ship. All crew will be tested for COVID-19 prior to embarkation and regularly during their contract."

  

These plans seem to me to be impractical to near impossible for most travelers,   AND if denied  boarding , they could be left without any options to return home or be subject to quarantine at the place they are rejected,.. many plans  look great on paper but do not work well in the real world.  If X goes this route hope we can  cancel our bookings and be refunded what will become a useless fcc..

 

yes,  we want to be safe but these requirments are not workable in our opinion.

 

If Celebrity was to implement a policy like this I would cancel my cruise. I like to book with outside tour operators or just wander around on my own in a port. I book maybe one cruise line excursion per cruise.

[Gracie115]

1 hour ago, WonderMan3 said:

 

If Celebrity was to implement a policy like this I would cancel my cruise. I like to book with outside tour operators or just wander around on my own in a port. I book maybe one cruise line excursion per cruise.

 

 

I do too but in the short term I completely agree with this protocol and sure wouldn't keep me off a ship.

[cangelmd]

8 hours ago, markeb said:

 

And even worse when you're trying to use a diagnostic test as a screening tool. You really need a very high negative predictive value test, which means you accept false positives on screening, but false positives are rare. And accepting false positives means potentially excluding more passengers dockside, unless you have a follow up plan for confirmation, also onsite...

 

If you adjust your inclusivity/exclusivity and call criteria on PCR, and allow more near neighbors to be called positive, it "might" be a better screening tool, but you're going to be calling a lot of suspects rather than confirmed. And a negative dockside just means "no virus detected".

 

 

The testing may get better, but it's limited by the biology of the virus. It's got to be there when you test for it, and it's there in highest quantities when you're actually sick. So I don't know what the limits of testing will be, and especially the limits of testing to exclude rather than to diagnose.

Honestly, I have a hard time thinking of an infectious disease where we are asking so much of testing. HIV and hepatitis in blood products, for example - we have relatively rapid NAAT (which is another term/type of PCR) testing for blood products, but even with that, the samples are screened in large pools, then the products from a positive pool are sequestered until the actual positive sample is identified. The donor who is showing up positive would then get tested at least twice more to confirm that he actually had the virus, not a false positive. This is an example of screening for a very rare instance in a large population.

At the othEr end of the spectrum is antibody testing for a virus. We most commonly use that to confirm vaccination status. Before someone is hired on at a hospital, for example, we would antibody test them for hepatitis B, rubella, etc to confirm immunity. In this setting almost everyone is positive from vaccination, so antibody tests are done first, then PCR only to confirm a negative, or in the case of hepatitis or HIV, confirm an active infection.

 

Basically, we are asking Covid testing to do both at the same time, and lab tests just don’t work that way. Even Hep B and HIV tests, which are done on blood samples not respiratory swabs, have a negative window - a period of time where the NAAT test is negative, but the patient is infected and potentially infectious. 
 

The antigen tests and this new epidemiological saliva test, which is probably an antigen test, may be the only tests that come close to being useful in the way described. And there would still need to be masking and social distancing especially on a ship.

[markeb]

10 minutes ago, cangelmd said:

Honestly, I have a hard time thinking of an infectious disease where we are asking so much of testing.

 

That's probably the bottom line, isn't it? How the testing started and evolved, all over the news and social media, should really be studied when we all come up for air. From the clinical provider to the public health system to the policy makers to the understanding of the general public.

[npcl]

28 minutes ago, markeb said:

 

That's probably the bottom line, isn't it? How the testing started and evolved, all over the news and social media, should really be studied when we all come up for air. From the clinical provider to the public health system to the policy makers to the understanding of the general public.

The biggest problem with the focus on testing is that for many people unless they test positive there is no reason to isolate or take any special measures.  To them no need to do anything while waiting, no concern about a false negative.

 

To me the test is too confirm clinical diagnosis and to potentially backup contact tracing.  The error rates are just not reliable. The tests provide information but are not an absolute proveyor of wisdom and truth.

 

With COVID if you have any COVID like symptoms you should assume you have it and act accordingly until resolved. If you have come in contact with someone you should isolate.  In general behavior you should assume you might have and social distance accordingly, and you should assume that anyone you come in contact with might have it and social distance accordingly.

 

 

The tests are a tool not a panacea.  Unfortunately with COVID it is a very limited tool.

Edited August 13, 2020 by npcl

[WonderMan3]

14 hours ago, Gracie115 said:

 

 

I do too but in the short term I completely agree with this protocol and sure wouldn't keep me off a ship.

It’s a bit ridiculous though. You are going to be forced to be crowded into some group excursion where social distancing will be nearly impossible as opposed to leaving the ship on your own where you control your social distancing and could stay away from most people or can join a private tour where it is just you and your companions and one guide. I get what they’re trying to do here (although let’s not think they don’t have a money motivation here forcing people to pay for ship excursions in order to be able to leave the ship in port) but it doesn’t make total sense.

[K.T.B.]

On 8/11/2020 at 8:35 AM, ipeeinthepool said:

If testing becomes a reality, I wonder how they will end dealing with false positives?   Will insurance cover your losses if you end up covering negative a couple of days later? 

 

I also wonder when the CDC will lift the Level 3 travel advisories for many of the ports?  I know I won't have health insurance for any Covid issue if I sail before these advisories are lifted.

 

Focusing on the part I highlighted in red:

 

There are 2 tests.  One you get back quickly, but is only about 80% accurate.  Good example of its inaccuracy is what happened to Matthew Stafford when he had a false positive.  The test that is 100% accurate takes many days to come back.  So if they do want to test, they'll need to deal with the outcomes of passengers who get false positives and appropriately reimburse any and all losses.

 

IMO, what they should do is have the passengers get tested by their own doctor prior to the cruise and have the passenger provide documentation upon check-in that they're covid free.

Edited August 13, 2020 by K.T.B.

[cruisequeen4ever]

The problem I’m seeing with pre-testing is that 2 pax on 2 different ships have tested negative pre-cruise but ended up testing positive after being aboard a few days. 

[C-Dragons]

15 hours ago, Gracie115 said:

 

 

I do too but in the short term I completely agree with this protocol and sure wouldn't keep me off a ship.

Agreed. 😊
Right now, I would be happy just staying on the ship.

The Captain could do doughnuts in the middle of the Ocean, never touch a port, and I would enjoy every minute of the cruise.

[Gracie115]

1 hour ago, WonderMan3 said:

It’s a bit ridiculous though. You are going to be forced to be crowded into some group excursion where social distancing will be nearly impossible as opposed to leaving the ship on your own where you control your social distancing and could stay away from most people or can join a private tour where it is just you and your companions and one guide. I get what they’re trying to do here (although let’s not think they don’t have a money motivation here forcing people to pay for ship excursions in order to be able to leave the ship in port) but it doesn’t make total sense.

Well we have NO idea how they are doing excursions at this point.  I would bet there would be fewer people on each bus, I would also bet they control where you go and how much (if any) interaction there would be with anyone not on the ship or with the cruise line. I also believe it will cost more than normal.    

 

Doing it this way they control the scenario, they knew where you've been and who you have seen.  Makes perfect sense to me.

[Gracie115]

8 minutes ago, C-Dragons said:

Agreed. 😊
Right now, I would be happy just staying on the ship.

The Captain could do doughnuts in the middle of the Ocean, never touch a port, and I would enjoy every minute of the cruise.

 

YES YES YES!!!!!  I am right there with you........ happy to sail to nowhere and back!!!!😁

[npcl]

19 minutes ago, K.T.B. said:

 

Focusing on the part I highlighted in red:

 

There are 2 tests.  One you get back quickly, but is only about 80% accurate.  Good example of its inaccuracy is what happened to Matthew Stafford when he had a false positive.  The test that is 100% accurate takes many days to come back.  So if they do want to test, they'll need to deal with the outcomes of passengers who get false positives and appropriately reimburse any and all losses.

 

IMO, what they should do is have the passengers get tested by their own doctor prior to the cruise and have the passenger provide documentation upon check-in that they're covid free.

What test are you referring as being 100% accurate.  The most accurate test out there at detecting active disease is PCR based and the best it can do is a 20% false negative rate depending upon stage of disease.  False positive rates for PCR are less systemic and often involve issues with lab procedures, cross contamination, sample collection and handling, etc.

[hcat]

I would be nervous  everytime someone came close to me or sneezed in an enclosed area.  Sil was tested a few days ago...he had to isolate but good news today..test was negative. 

 

But of course he could be infected today, tom or the next day if he were travellibg to a cruise!  Testing is not the final answer.

[Gracie115]

20 minutes ago, hcat said:

I would be nervous  everytime someone came close to me or sneezed in an enclosed area.  Sil was tested a few days ago...he had to isolate but good news today..test was negative. 

 

But of course he could be infected today, tom or the next day if he were travellibg to a cruise!  Testing is not the final answer.

 

No, but it's a good start, along with wearing masks in public areas, social distancing, having fewer people on board, regulating how many can get on an elevator, making sure that ASSIGNED check in times are adhered to (no more 10AM arrivals), sanitizing regularly, washing your hands frequently, etc etc etc......  It will take a combined approach by both the ship staff AND the passenger and anyone who doesn't want to play by the rules is off the ship.