March 8 (UPI) -- U.S. citizens, particularly those with "underlying health issues," are urged not to travel by cruise ship during the coronavirus outbreak, the U.S. State Department and the Centers for Disease Control and Prevention recommended Sunday night.
The guidelines come after two cruise ships were prevented from docking on both U.S. coasts after another cruise ship was quarantined in Japan for weeks.
Another Princess cruise ship, the Regal Princess, was held up for 14 hours off the southeast coast of Florida on Sunday as it awaited tests for coronavirus from two crew members transferred from the Grand Princess. The crew members didn't exhibit symptoms of the virus and the tests returned negative Sunday night.
With more than 3,800 deaths and nearly 110,000 cases worldwide, including 21 fatalities in the United States and more than 500 cases, the two agencies are urging Americans to avoid cruise travel. Their messages included similar wording.
"U.S. citizens, particularly travelers with underlying health conditions, should not travel by cruise ship," the State Department said. "While the U.S. government has evacuated some cruise ship passengers in recent weeks, repatriation flights should not be relied upon as an option for U.S. citizens under the potential risk of quarantine by local authorities."
The State Department said it is relying on guidance from the CDC.
"Recent reports of COVID-19 on cruise ships highlight the risk of infection to cruise ship passengers and crew," the CDC said. "Like many other viruses, COVID-19 appears to spread more easily between people in close quarters aboard ships.
"It has become clear that people with underlying conditions such as heart disease, chronic lung disease, diabetes, and other conditions that cause suppression of immune system particularly among the older adults, are at a high risk of serious disease if infected with the novel coronavirus.
"To best protect these vulnerable individuals, we recommend that such individuals avoid situations that increase their risk of acquiring infections. This entails avoiding crowded places, avoiding non-essential travel such as long plane trips, and especially avoiding embarking on cruise ships."
The State Department notes "this is a fluid situation" and "passengers with plans to travel by cruise ship should contact their cruise line companies directly for further information and continue to monitor the Travel.state.gov website and see the latest information from the CDC."
Carnival Cruise Line, which owns the Princess brand, said it will continue to offer cruises.
"Our brands have enhanced their health screening protocols, which includes thermal scans, temperature checks as well as other actions, both prior to boarding and onboard our ships," the company said in a statement.
"We are currently in discussions with the CDC, World Health Organization and other health officials, and we met as a cruise industry Saturday, March 7, with U.S. Vice President Mike Pence on an aggressive industry-wide response plan. The health and safety of our guests and crew is our highest priority, and cruising remains one of the most attractive vacation options available. "
Pence, who leads the White House Coronavirus Task Force, said new screening and quarantine protocols will be put into effect in a few days, and didn't mention avoid going on cruises.
"The American people value our cruise line industry," Pence, who leads the White House Coronavirus Task Force, said at a roundtable discussion with Florida Gov. Ron DeSantis in Fort Lauderdale. "American people value our cruise line industry, it brings great joy and great entertainment value for Americans. We want to ensure Americans can continue to enjoy the opportunities of the cruise line industry."
Passengers who require medical treatment and hospitalization will disembark first, followed by California residents, who will undergo a health screening before being sent to a federal facility in the state for further testing and isolation.
Guests from outside California will be transported to facilities in other states, and the crew will be quarantined and treated aboard the ship, according to initial plans.
The disembarkation process will take several days, Princess Cruises said in an emailed statement to UPI.
Once all passengers have left the ship, it will continue on to San Francisco, it said, adding that plans for crew to be quarantine at its final distination are still being discussed.
U.S. Rep. Joaquin Castro, D-Texas, wrote on Twitter that the Trump administration has decided to quarantine some of the passengers from the Grand Princess at Lackland Air Force Base in San Antonio, where 230 people have already been quarantined while calling for more tests in the state.
"Many of us have expressed to the Trump administration serious concerns with how the administration has handled the quarantine and treatment of infected patients," Castro wrote. "For example, we still do not have the testing kits we need to truly determine community spread."
Meanwhile, Canada said Sunday it will be repatriating its citizens from the vessel.
Global Affairs Canada said it has chartered a flight for the evacuation but did not state when it will occur.
"This decision was made following a request for assistance from the government of the United States to repatriate Canadians," it said in a statement.
Due to the possibility of COVID-19 transmission among the vessel's passengers, Canadians evacuated from the cruise will be quarantined upon their return to a Canadian Forces base in Trenton, Ontario.
Another Princess cruise ship, the Regal Princess, was held up off the southeast coast of Florida on Sunday as it awaited tests for coronavirus from two crew members who were transferred from the Grand Princess. The ship was scheduled to pull into the port at 8 a.m. EDT.
The Coast Guard delivered testing kits to the ship from a small boat Sunday morning. The cruise line canceled the next cruise from Port Everglades in Fort Lauderdale.
Six deaths have been associated with the Diamond Princess cruise ship that traveled to Wuhan, China, and was docked in Yokahama, Japan, for several weeks. Around 700 of the 3,711 guests have been stricken, including 46 Americans.
Surgeon General Jerome Adams urged elderly Americans to avoid traveling, including on cruise ships, on Sunday.
"We now know more about who is at risk. Average age of death for people from coronavirus is 80," Adams said on CNN's State of the Nation.
"Average age of people who need medical attention is age 60. We want people who are older, people who have medical conditions, to take steps to protect themselves, including avoiding crowded spaces, including thinking very carefully about whether or not now is the time to get on that cruise ship, whether now is the time to take that long haul flight."
The death toll grew by two Sunday with two fatalities in the state of Washington for a total of 18. The other deaths are two in Florida and one in California. The first death was eight days ago -- in Kings County, Wash.
Washington State has 132 cases, New York has the second most with 106 and California at 98.
"This news is concerning for all Oregonians, but my resolve and that of my administration to address this public health crisis is unchanged," Brown said.
"This emergency declaration gives the Oregon Health Authority and the Office of Emergency Management all the resources at the state's disposal to stem the spread of this disease. We will do everything it takes, within our power and in coordination with federal and local officials to keep Oregonians safe."
State emergencies were previously declared in California, Florida, Kentucky, Maryland, New York, Washington and Utah.
Puerto Rico officials announced Sunday its first presumptive case of the virus after a passenger of a cruise ship from Ft. Lauderdale, Fla., began experiencing symptoms on arrival in San Juan. The tests will be sent off to the CDC for confirmation.
The Puerto Rico Department of Health confirmed the patient to be a 68-year-old woman from Italy, which is dealing with Europe's largest and growing cluster of COVID-19.
The department said the woman had received medical treatment for pneumonia symptoms while on the vessel.
"Her husband, who we also ordered the test, does not show any symptoms," the department said in a statement.
In response, Gov. Wanda Vasquez Garced ordered all cruise ships to certify that no passengers are experiencing symptoms or have a travel history to hotspots when docking on the Caribbean island, the Executive Branch of Puerto Rico said via Twitter.
Iowa on Sunday evening confirmed its three presumptive cases among former passengers of an Egypt cruise ship, two of whom suffer from underlying health conditions.
"While these are the first cases, it may not be the last and it's why Iowans must continue to practice safe habits like hand washing and staying home from work when said," Gov. Kim Reynolds said in a statement.
Virginia health officials also announced a second presumptive case of coronavirus in the state, an 80-year-old Fairfax resident who traveled on a similar Nile River cruise linked to three positive tests in Maryland. Presumptive positive cases refer to patients who have tested positive for the virus but have not yet been confirmed by the CDC.
Anthony Fauci, head of the National Institute of Allergy and Infectious Diseases, said that the U.S. government could shut down some sections of the country due to outbreaks of COVID-19.
Fauci, a member of the White House Coronavirus Task Force, told Fox News that "anything is possible" in regards to measures widespread lockdowns in areas affected by the coronavirus could take place in the United States.
"I don't think it would be as draconian as nobody in or nobody out but if we continue to get cases like this particularly at the community level there will be what we call 'mitigation,' where we have to essentially do social distancing, keep people out of crowded places, take a look at seriousness, do you really need to travel and I think it's particularly important among the most vulnerable," he said.
The first case was on U.S. soil was Jan. 21.
President Donald Trump on Sunday responded to criticism of his administration's handling of the outbreak, writing on Twitter that the White House has a "perfectly coordinated and fine-tuned" plan for the virus.
"We moved VERY early to close borders to certain areas which was a Godsend. V.P. is doing a great job. The Fake News Media is doing everything possible to make us look bad. Sad!" Trump wrote.