Testing for SARS-CoV-2 among cruise ship travelers repatriated to the United States, February to March 2020

Waltenburg, M. A.; Pomeroy, M. A.; Hughes, L.; Gold, J. A. W.; Mayer, O.; Vang, A.; Hallowell, B. D.; Foster, L.; Xu, K.; Espinoza, R.; Hsieh, K.; Pieracci, E. G.; Wuyke, G.; Da Silva, J.; McClung, R. P.; Steinberg, J.; Westercamp, M.; Vallabhaneni, S.; Li, J.; Valderrama, A. L.; Grimes, G. R.; Harvey, R. R.; Nett, R. J.; Stokes, K.; Lindstrom, S.; Miller, A. D.; Griggs, E. P.; Milucky, J. L.; Bjork, A.; Albrecht, V.; Kuhnert, W. L.; Gould, C. V.; Knight, N. W.; Nelson, N. P.; Honein, M. A.; Barton Behravesh, C.; CDC COVID-19 Investigation Team,; Dubray, C. L.; Marx, G. E.

Background: In early 2020, an outbreak of coronavirus disease 2019 occurred among passengers and crew of the Diamond Princess cruise ship. During February 16 and 17, some US citizens, residents, and their partners voluntarily repatriated to the US from Japan. Methods: We conducted a retrospective, longitudinal evaluation of repatriated travelers where the outcome of interest was a positive test for SARS-CoV-2. Travelers who tested positive for SARS-CoV-2 were isolated in hospitals or at home under county isolation orders and underwent serial testing by real-time reverse transcription polymerase chain reaction (RT-PCR) approximately every other day, as contemporaneous US guidance required two consecutive negative tests collected greater than or equal to 24 hours apart and symptom improvement before release from isolation. Results: Among quarantined repatriated travelers, 14% tested positive for SARS-CoV-2. One-fifth of infected travelers initially tested negative but were identified on subsequent testing. All infected travelers remained asymptomatic or developed mild symptoms during isolation. Many travelers remained in prolonged isolation because of persistent viral detection based on contemporaneous policies. Conclusion: Our findings support testing within 3-5 days after possible SARS-CoV-2 exposure to comprehensively identify infections and mitigate transmission and lend support to symptom- and time-based isolation recommendations, rather than test-based criteria.