A cruise line didn't provide a COVID test to a symptomatic passenger. After disembarking, she tested positive.

Morgan Hines
USA TODAY

Alicia D'Amico knew something wasn't right. D'Amico, who has lupus, was sailing on Royal Caribbean International's Symphony of the Seas, the ship on which 48 people tested positive for COVID-19 before disembarking in Miami on Saturday.

It was Thursday, and she hadn't been feeling well all day. Initially, she chalked it up to a lupus flare-up and exhaustion after an asthma attack earlier in the day. But things got worse.

"As the night progressed, so did my body fatigue, coughing and wheezing," the 40-year-old Tampa, Florida, resident told USA TODAY. 

D'Amico started calling the medical center. No nurse answered. 

Eventually, exhausted, she decided to try again in the morning. 

"I wound up in bed almost 15 hours and was not OK at all," D'Amico said, listing symptoms: "Deep dry hacking cough. Sore throat. All over body pains. Felt super feverish. Lungs hurting a little."

Alicia D'Amico and her daughter were on Symphony of the Seas. D'Amico tested positive for COVID-19 after the sailing.

While on Symphony of the Seas, people tested positive for COVID-19, according to the cruise line. Passengers told USA TODAY that the ship's crew and medical staff seemed "overwhelmed," an assertion Royal Caribbean denies. 

D'Amico started calling again in the morning. After an hour of redialing, success. A nurse picked up.

She explained to the nurse that she knew what was happening to her was more than a lupus flare-up and asked about an appointment with the ship's doctor. She was told an appointment would not be available until Friday night and would come with a $160 charge and not include a coronavirus test.

Upon learning that a test wouldn't be included in the appointment, D'Amico told the nurse she expected testing to be free – especially since she was reporting COVID-19 symptoms per Royal Caribbean's guidance. 

"She was silent," D'Amico said.

"They never mentioned a test," she continued. “Never recommended a test. Nothing."

►'Everything was so confusing':48 people test positive for COVID on Royal Caribbean Symphony of the Seas ship

►Royal Caribbean's newest ship:Odyssey of the Seas, makes brief return to port due to COVID

The nurse agreed to "at least" take D'Amico's temperature, at her request. D'Amico's daughter took her to the infirmary in a wheelchair, and the nurse took her temperature. She told D'Amico she didn't have a fever.

"I was burning up," D'Amico said. "Then (the nurse) said 'just keep wearing your mask and enjoy your cruise.'"

D'Amico was shocked.

"My test should have been mandatory," D'Amico said. "I was extremely symptomatic, and I was not only not being tested but being told that I could just wander around the ship putting other people at risk of exposure to my germs." 

Too exhausted to push for more, nervous about being ill at sea without a full evaluation and unsure of what to do, D'Amico gave up, retreating with the knowledge she could take a test on dry land in less than 24 hours when the ship disembarked in Miami. 

Royal Caribbean Symphony of the Seas Cruise ship which is the world's largest passenger liner is seen docked at PortMiami after returning to port from an Eastern Caribbean cruise as the world deals with the coronavirus outbreak on March 14, 2020, in Miami.

D'Amico "mostly self-quarantined" for the remainder of the trip and when she went out, she said, she informed the crew she was sick and double-masked, hand-washed and sanitized surfaces she touched.

Later Friday evening, the captain made an announcement that a few passengers had tested positive and were asymptomatic, she said. 

"I about lost my mind," D'Amico said. 

"Here I was filled with symptoms and not even being tested," she continued

On Sunday, at 2:30 p.m. after leaving the ship, D'Amico took a PCR test. 

On Monday evening, her answer finally came.

D'Amico was positive for COVID-19, she said, sharing a screenshot result from CVS with USA TODAY. She called the situation "infuriating."

Her daughter, identified as Rowena D’Amico Scott, 25, also tested positive after the cruise.

"They didn’t take me seriously and put others at risk," D'Amico said.

Lyan Sierra-Caro, spokesperson for Royal Caribbean, told USA TODAY early Tuesday that the cruise line is unable to comment on a passenger's specific medical history.

Sierra-Caro continued that "if a guest is feeling symptoms we ask them to contact the medical center and we follow the protocols."

Once passengers are off the ship, Royal Caribbean doesn't track if they test positive for COVID. "If guests test once they return home we do not have a way of monitoring that," Sierra-Caro said Sunday.

Royal Caribbean reported 48 cases of COVID-19 from cruise

The 48 cases on the recently disembarked cruise "were found as a result of immediately identifying close contacts after a guest tested positive," Royal Caribbean's Sierra-Caro said, noting each person was quarantined quickly. 

Initially, Royal Caribbean said that everyone who tested positive was asymptomatic. In the statement Monday morning, it said that "everyone who tested positive were asymptomatic or had mild symptoms, and we continuously monitored their health."

Six passengers disembarked earlier in the cruise and were transported home. The rest of the passengers were assisted Saturday at disembarkation in Miami, Sierra-Caro said.

Passengers say Royal Caribbean was overwhelmed

Connor O'Dell, 29, from Orlando, Florida, was traveling with a party of 12 on the Symphony of the Seas sailing that wrapped up Saturday. Six of his traveling companions tested positive for COVID-19. Everyone in their group was fully vaccinated and most had had a booster shot, O'Dell said.

O'Dell and his fiancé, James Johnson, 36, tested negative, he said. 

The first person who tested positive in their group was Johnson's aunt, who is 66 and at high risk for COVID-19, O'Dell said. She was symptomatic and reported her symptoms to Royal Caribbean on Thursday during the cruise.

"She was very symptomatic," O'Dell said, noting she had a bad cough and sore throat, and that neither a doctor nor nurse gave her an in-depth physical exam or asked her about preexisting conditions. "We all knew the risks of going on the ship – the problem is that we were promised a set of protocols (or) adequate medical staffing, and they were never adhered to."

It took around four hours for a nurse to come to administer a coronavirus test and get a result. Johnson's aunt was then quarantined for the rest of the trip.

Johnson said he attempted to contact medical staff and, after several tries, reached a nurse who told him that they were understaffed. He asked if the ship's medical team could check on his aunt. His aunt received a call the next day.

Out of their party, she was the only one who was checked on by the cruise line at all, even after five others tested positive, Johnson said.

Johnson and O'Dell self-quarantined but later were told that they could leave their stateroom after the positive test came back on Johnson's aunt, even though they had been spending time together as a group.

"We kept asking 'are you sure we can leave?'" Johnson said. After half an hour, O'Dell said that they were asked by crew members to isolate again.

Johnson said that they received conflicting results, with his cousin being told she tested positive, then later that it was actually her boyfriend who was positive. 

"They were so overwhelmed," Johnson said. "They just kept saying something (and then) changing what they were saying. Everything was so confusing," he said. 

When asked to comment on whether staff was overwhelmed and if the protocol wasn't followed properly, Sierra-Caro said that wasn't the case.

"Our staff was able to handle all the cases on board and we followed all of our protocols for testing and quarantine," Sierra-Caro said Sunday.

Will passengers cruise again after the experience?

O'Dell won't be sailing with Royal Caribbean again after this last trip on Symphony of the Seas.

"I detest cruises but it’s the only vacation I can get my dad to go on. If we do another one in the future, will definitely be seeking another cruise operator given there’s plenty of them," he told USA TODAY Tuesday.

D'Amico said she didn't think she would be hesitant to sail with the line again.

"I believe a specific set of employees that ran our ship made poor decisions that did not follow protocol," she said. "I would most likely sail with (Royal Caribbean) again."

►As omicron spreads:Norwegian Cruise Line, Royal Caribbean International update onboard mask requirement

►COVID on a cruise:How a breakthrough case sent one couple from an ocean view balcony to the 'dungeon'