Number of sick soars on coronavirus-stricken cruise ship turned away by multiple ports

The number of passengers and crew who are sick on a Holland America ship in the midst of a coronavirus outbreak soared over the weekend to 189.

The Seattle-based line on Monday said 73 passengers on board the Zaandam had reported influenza-like symptoms, which are similar to COVID-19 symptoms. In addition, 116 crew members -- nearly 20% of the total number on board -- are exhibiting symptoms.

That adds up to nearly 40% more cases of illness since Friday, when Holland America said 53 passengers and 85 crew members had reported influenza-like symptoms. The line on Friday said two of the passengers had tested positive for the new coronavirus.

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Four passengers have died on board the vessel since the outbreak began. The line hasn't said if the four deceased passengers had been tested for the new coronavirus.

"Our thoughts and prayers are with their families, and we are doing everything we can to support them during this difficult time," Holland America said on Friday in a statement about the deaths.

Zaandam is one of more than a dozen cruise ships that have been stuck at sea in recent weeks as countries around the world have closed to outsiders. The 61,396-ton vessel was sailing near the southern tip of South America when Holland America suspended operations two weeks ago and has been unable to find a place to dock since.

Related: 2 of the world's biggest cruise lines extend shutdown into May

Zaandam has been heading northward toward the United States in recent days, as the U.S. is one of the few countries that has remained open to returning cruise vessels. Late on Sunday, the ship transited the Panama Canal from the Pacific to the Caribbean on a routing that would allow it to reach Fort Lauderdale, Florida, by later this week.

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The transit came after the Panama Canal initially said on Friday that Zaandam would not be allowed through the canal due to the coronavirus cases on board. The canal reversed its decision on Saturday, and Zaandam began the transit well after dark on Sunday.

With the situation on board Zaandam becoming more dire, Holland America over the weekend transferred groups of still-healthy passengers from Zaandam to another Holland America ship, Rotterdam, that was sent to rendezvous with the vessel.

Rotterdam arrived in the vicinity of Zaandam late Thursday and began transferring medical supplies and additional medical staff to the ship.

In the wake of the transfers, there now are just 446 passengers on Zaandam, down from 1,243 on Friday. The ship has 602 crew aboard.

The remaining 797 passengers now are on Rotterdam, along with 645 crew members. Rotterdam did not have any passengers on board when it was sent to Zaandam's aid.

The transfer allowed passengers who had been restricted to windowless "inside" cabins for a week to move into cabins with balconies where they can get fresh air. It also was designed to relieve the crew of Zaandam as more of them fall ill.

"The primary purpose of the transfer was to balance the workload between the two ships and to provide immediate relief to the service staff on Zaandam, which has fewer crew members working at this time," Holland America said Monday in a statement.

Holland America on Friday said there were four doctors and four nurses on Zaandam. Another two doctors and four nurses are aboard Rotterdam.

The two ships will remain together for the rest of the journey, the line said.

Nobody has been off Zaandam since March 14, when it was docked at Punta Arenas, Chile.

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As recently as Friday, Holland America said Zaandam was heading to Fort Lauderdale's Port Everglades, the port in Florida that it normally uses as its base when in the region. But by Monday morning, the line had grown more vague about its destination.

In a statement that noted the "humanitarian consideration and the compassion" shown by Panama in allowing Zaandam through the Panama Canal, the line suggested it still was in the process of securing a final docking place for the ship.

"We are still finalizing the details for where and when our guests will disembark, and are asking for the same compassion and humanity to be extended for our arrival," the line said.

Local leaders in Fort Lauderdale have grown increasingly alarmed about the idea of Zaandam arriving in the city. Fort Lauderdale Mayor Dean Trantalis on Sunday suggested the ship should instead head to a U.S. Navy base.

"We cannot add further risk to our community amid our own health crisis here with thousands of people already testing positive for the deadly and contagious COVID-19 virus in the tri-county area," Trantalis said in a tweeted statement.

In a Sunday tweet, Port Everglades suggested it had not yet given Zaandam permission to dock.

"Holland American must submit a plan prior to arrival that addresses a long list of Unified Command requirements for entry into a Port," the tweet said.

The Port Everglades Unified Command is made up of representatives from the U.S. Centers for Disease Control and Prevention (CDC), the Florida Department of Health in Broward County, the U.S. Coast Guard, U.S. Customs and Border Protection (CBP), Port Everglades Pilots Association, Broward Sheriff's Office Departments of Law Enforcement and Fire Rescue, Broward County Emergency Management and the Broward County Port Everglades Department.

While a number of other vessels have experienced coronavirus outbreaks in recent weeks, the situation on Zaandam is unusual in that passengers have died while the ship still is at sea.

For now, it's unclear if the four passengers who died were suffering from COVID-19, as Holland America has not released information about the causes of their deaths.

Holland America sailings often draw a large number of older travelers who would fall into the group most at risk for becoming seriously ill from coronavirus.

Additional resources for traveling during the coronavirus outbreak:

• Can I cancel or postpone my cruise due to coronavirus?
• How coronavirus is impacting airline award availability
• How coronavirus has left the travel industry reeling
• Airlines scale back inflight offerings due to coronavirus
• How to ward off coronavirus in your hotel room
• Guide to traveling during the coronavirus outbreak