Article Text

Download PDFPDF

COVID-19: in the footsteps of Ernest Shackleton
  1. Alvin J Ing1,
  2. Christine Cocks2,
  3. Jeffery Peter Green3
  1. 1 Faculty of Medicine, Health and Human Sciences, Macquarie University, Sydney, New South Wales, Australia
  2. 2 Oncology Trials Unit, Sunshine Coast University Hospital, Sunshine Coast, Queensland, Australia
  3. 3 Royal Australian College of General Practitioners, East Melbourne, Victoria, Australia
  1. Correspondence to Professor Alvin J Ing, Faculty of Medicine, Health and Human Sciences, Macquarie University, Sydney, NSW 2109, Australia;{at}


We describe what we believe is the first instance of complete COVID-19 testing of all passengers and crew on an isolated cruise ship during the current COVID-19 pandemic. Of the 217 passengers and crew on board, 128 tested positive for COVID-19 on reverse transcription–PCR (59%). Of the COVID-19-positive patients, 19% (24) were symptomatic; 6.2% (8) required medical evacuation; 3.1% (4) were intubated and ventilated; and the mortality was 0.8% (1). The majority of COVID-19-positive patients were asymptomatic (81%, 104 patients). We conclude that the prevalence of COVID-19 on affected cruise ships is likely to be significantly underestimated, and strategies are needed to assess and monitor all passengers to prevent community transmission after disembarkation.

  • viral infection
  • clinical epidemiology
  • ARDS
  • pneumonia
  • respiratory infection

This article is made freely available for use in accordance with BMJ’s website terms and conditions for the duration of the covid-19 pandemic or until otherwise determined by BMJ. You may use, download and print the article for any lawful, non-commercial purpose (including text and data mining) provided that all copyright notices and trade marks are retained.

Statistics from


  • Contributors AJI wrote the manuscript and collated the data. CC collated the data and reviewed the manuscript. JPG collated the data and reviewed the manuscript and was also the ship physician.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Provenance and peer review Not commissioned; internally peer reviewed.

  • Addendum Following online publication of the paper, a query was raised regarding the difference between the number of tests conducted (217) and the number of passengers and crew believed to be on board ship at the time (221). The authors wish to clarify that testing took place on Day 20. All passengers and crew received written confirmation of their tests by Day 24. The data from ATGen-Diagnostica and testing on the 2 evacuated passengers by Day 20 records a total of 217 individual test results. The authors feel this is an accurate portrayal of the denominator as the testing methodology was strict and are confident everyone on board at the time was tested.

Request Permissions

If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.

Linked Articles