No Sail Order and Suspension of Further Embarkation; Notice of Modification and Extension and Other Measures Related to Operations, 21004-21008 [2020-07930]
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[FR Doc. 2020–07943 Filed 4–14–20; 8:45 am]
BILLING CODE 6820–EP–P
DEPARTMENT OF HEALTH AND
HUMAN SERVICES
Centers for Disease Control and
Prevention
No Sail Order and Suspension of
Further Embarkation; Notice of
Modification and Extension and Other
Measures Related to Operations
Centers for Disease Control and
Prevention (CDC), Department of Health
and Human Services (HHS).
ACTION: Notice.
AGENCY:
The Centers for Disease
Control and Prevention (CDC), a
component of the Department of Health
and Human Services (HHS), announces
a modification and extension of the No
Sail Order and Other Measures Related
to Operations that was previously
issued on March 14, 2020—subject to
the modifications and additional
stipulated conditions set forth in this
Order. The Order shall continue in
operation until the earliest of the
expiration of the Secretary of Health and
Human Services’ declaration that
COVID–19 constitutes a public health
emergency; the CDC Director rescinds or
modifies the order based on specific
public health or other considerations; or
100 days from the date of publication in
the Federal Register.
DATES: This action is effective on April
15, 2020.
SUMMARY:
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FOR FURTHER INFORMATION CONTACT:
Jennifer Buigut, Division of Global
Migration and Quarantine, Centers for
Disease Control and Prevention, 1600
Clifton Road NE, MS V18–2, Atlanta,
GA 30329. Phone: 404–498–1600.
Email: dgmqpolicyoffice@cdc.gov.
SUPPLEMENTARY INFORMATION:
On March 14, 2020, the Director of the
Centers for Disease Control and
Prevention (CDC) issued a No Sail Order
and Other Measures Related to
Operations. CDC published a notice
announcing that Order on March 24,
2020 (85 FR 16628). The March 14, 2020
Order was scheduled to expire April 13,
2020. This notice announces the
renewal of 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 adopted
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.
A copy of the order is provided below
and a copy of the signed order can be
found at https://www.cdc.gov/
quarantine/cruise/.
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
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Federal Register / Vol. 85, No. 73 / Wednesday, April 15, 2020 / Notices
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:
• 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
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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:’’
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
1 Carrier is defined by 42 CFR 71.1 to mean, ‘‘a
ship, aircraft, train, road vehicle, or other means of
transport, including military.’’
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.
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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 cruise line
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).
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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 life-critical
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
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-cruise-president-floridadebate.
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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
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
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
9 Id.
at 1–2.
at 7.
11 Id. at 13.
7 (On
Course, pages 1, 10).
8 Id. at 2.
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10 Id.
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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
COVID–19. 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
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.
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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 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
14 See
5 U.S.C. 553(b)(B), (d)(3).
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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 basis for as long as the
cruise ship is within waters subject to
the jurisdiction of the United States.
c. Onboard monitoring of passengers
and crew through temperature checks
and medical screening, including
addressing frequency of monitoring and
screening;
d. Training of all crew on COVID–19
prevention, mitigation, and response
activities;
e. Protocols for any COVID–19 testing,
including details relating to the shoreside transport, administration, and
operationalization of laboratory work if
onboard laboratory work is not feasible;
f. Onboard isolation, quarantine, and
social distancing protocols to minimize
the risk of transmission and spread of
COVID–19;
g. 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;
h. An outbreak management and
response plan to provision and assist an
affected cruise ship that relies on
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21007
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;
i. Categorization of affected
individuals into risk categories with
clear stepwise approaches for care and
management of each category;
j. A medical care plan addressing
onboard care versus evacuation to onshore 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;
k. 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);
l. 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;
m. 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
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
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Federal Register / Vol. 85, No. 73 / Wednesday, April 15, 2020 / Notices
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.
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
VerDate Sep<11>2014
18:22 Apr 14, 2020
Jkt 250001
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.
Authority
The authority for these orders is
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).
Robert K. McGowan,
Chief of Staff, Centers for Disease Control
and Prevention.
[FR Doc. 2020–07930 Filed 4–10–20; 4:15 pm]
BILLING CODE 4163–18–P
DEPARTMENT OF HEALTH AND
HUMAN SERVICES
Centers for Disease Control and
Prevention
Statement of Organization, Functions,
and Delegations of Authority
Part C (Centers for Disease Control
and Prevention) of the Statement of
Organization, Functions, and
Delegations of Authority of the
Department of Health and Human
Services (45 FR 67772–76, dated
October 14, 1980, and corrected at 45 FR
69296, October 20, 1980, as amended
most recently at 84 FR 65981, dated
December 12, 2019) is amended to
reorganize the Center for Preparedness
and Response, Deputy Director for
Public Health Service and
Implementation Science, Centers for
Disease Control and Prevention.
Section C–B, Organization and
Functions, is hereby amended as
follows:
Delete in its entirety the titles and
functional statements for Division of
State and Local Readiness (CBCB) insert
the following:
Division of State and Local Readiness
(CBCB). The Division of State and Local
Readiness (DSLR): (1) Provides program
support, technical assistance, guidance,
technical integration, and capacity
building of preparedness planning
across public health, healthcare, and
emergency management sectors; and (2)
provides fiscal oversight to state, local,
tribal, and territorial public health
department Cooperative Agreement
PO 00000
Frm 00035
Fmt 4703
Sfmt 4703
recipients for the development,
monitoring, and evaluation of public
health capabilities, plans, infrastructure,
and systems to prepare for and respond
to terrorism, outbreaks of disease,
natural disasters, and other public
health emergencies.
Office of the Director (CBCB1). (1)
Provides national leadership and
guidance that supports and advances
the work of state, local, tribal, and
territorial public health emergency
preparedness programs; (2) coordinates
the development of guidelines and
standards for programmatic materials
within the division to provide technical
assistance and program planning at the
state, local, tribal, and territorial level;
(3) represents and communicates the
interests and needs of the state, local,
tribal, and territorial jurisdictions on
state and local preparedness and
response issues; (4) develops and
ensures effective partnerships with
national stakeholders and preparedness
and response partners; (5) provides
oversight and management of division
contracts, recipient awards and fiscal
accountability; and (6) manages the IT
strategy and infrastructure to support
recipient programmatic and fiscal
activities.
Program Implementation Branch
(CBCBB). (1) Provides consultation,
technical assistance, and training to
state, territorial, tribal, and local health
departments in management and
operation of activities to support public
health emergency preparedness
programs and recovery, including the
infrastructure and systems necessary to
manage and use deployed medical
countermeasure assets; (2) facilitates
partnerships between public health
preparedness programs at federal, state,
and local levels to ensure their
consistency, sharing of promising
practices, and integration; (3)
collaborates with and supports other
divisions in CPR and other national
centers across CDC to ensure high
quality technical assistance is available
to the grantees on preparedness
capabilities; (4) monitors programmatic
activities of cooperative agreements of
state, local, tribal, and territorial
organizations to assure program
objectives and key performance
indicators are achieved, including
reviews of Cities Readiness Initiative
response plans; (5) provides assistance
to state and local governments and
public health agencies to prepare for
effective responses to large scale public
health events; (6) evaluates and
identifies gaps in jurisdictional
operational readiness and facilitates
plans and develops tools to address
identified gaps; (7) maintains an
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[Federal Register Volume 85, Number 73 (Wednesday, April 15, 2020)]
[Notices]
[Pages 21004-21008]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 2020-07930]
=======================================================================
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DEPARTMENT OF HEALTH AND HUMAN SERVICES
Centers for Disease Control and Prevention
No Sail Order and Suspension of Further Embarkation; Notice of
Modification and Extension and Other Measures Related to Operations
AGENCY: Centers for Disease Control and Prevention (CDC), Department of
Health and Human Services (HHS).
ACTION: Notice.
-----------------------------------------------------------------------
SUMMARY: The Centers for Disease Control and Prevention (CDC), a
component of the Department of Health and Human Services (HHS),
announces a modification and extension of the No Sail Order and Other
Measures Related to Operations that was previously issued on March 14,
2020--subject to the modifications and additional stipulated conditions
set forth in this Order. The Order shall continue in operation until
the earliest of the expiration of the Secretary of Health and Human
Services' declaration that COVID-19 constitutes a public health
emergency; the CDC Director rescinds or modifies the order based on
specific public health or other considerations; or 100 days from the
date of publication in the Federal Register.
DATES: This action is effective on April 15, 2020.
FOR FURTHER INFORMATION CONTACT: Jennifer Buigut, Division of Global
Migration and Quarantine, Centers for Disease Control and Prevention,
1600 Clifton Road NE, MS V18-2, Atlanta, GA 30329. Phone: 404-498-1600.
Email: [email protected].
SUPPLEMENTARY INFORMATION:
On March 14, 2020, the Director of the Centers for Disease Control
and Prevention (CDC) issued a No Sail Order and Other Measures Related
to Operations. CDC published a notice announcing that Order on March
24, 2020 (85 FR 16628). The March 14, 2020 Order was scheduled to
expire April 13, 2020. This notice announces the renewal of 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 adopted 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.
A copy of the order is provided below and a copy of the signed
order can be found at https://www.cdc.gov/quarantine/cruise/.
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
[[Page 21005]]
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:
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.''
---------------------------------------------------------------------------
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\
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\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.
---------------------------------------------------------------------------
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. Sec.
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 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.
---------------------------------------------------------------------------
\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).
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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 life-
critical 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\
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\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-cruise-president-florida-debate.
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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
[[Page 21006]]
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 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\
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\7\ (On Course, pages 1, 10).
\8\ Id. at 2.
\9\ Id. at 1-2.
\10\ Id. at 7.
\11\ Id. at 13.
---------------------------------------------------------------------------
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
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 COVID-19.
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.
---------------------------------------------------------------------------
\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.
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Accordingly, under 42 CFR 70.2, the Director determines that
measures taken
[[Page 21007]]
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 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.
---------------------------------------------------------------------------
\14\ See 5 U.S.C. 553(b)(B), (d)(3).
---------------------------------------------------------------------------
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 basis for as long as the cruise ship is within waters
subject to the jurisdiction of the United States.
c. Onboard monitoring of passengers and crew through temperature
checks and medical screening, including addressing frequency of
monitoring and screening;
d. Training of all crew on COVID-19 prevention, mitigation, and
response activities;
e. 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;
f. Onboard isolation, quarantine, and social distancing protocols
to minimize the risk of transmission and spread of COVID-19;
g. 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;
h. 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;
i. Categorization of affected individuals into risk categories with
clear stepwise approaches for care and management of each category;
j. 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;
k. 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);
l. 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;
m. 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
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
[[Page 21008]]
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.
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.
Authority
The authority for these orders is 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).
Robert K. McGowan,
Chief of Staff, Centers for Disease Control and Prevention.
[FR Doc. 2020-07930 Filed 4-10-20; 4:15 pm]
BILLING CODE 4163-18-P