At least 13 crew members who were displaying respiratory symptoms consistent with pneumonia and bronchitis have been evacuated from two cruise ships near Florida, according to Miami-Dade County government.
Four passengers have died aboard a cruise ship stranded at sea carrying 247 Canadians as worldwide ports remain closed fearing the coronavirus pandemic.
The Zaandam embarked from Buenos Aires in Argentina on 7 March with 1,243 passengers and 586 crew on board.
"Our thoughts and prayers are with their families and we are doing everything we can to support them during this hard time", a statement read.
Holland America sent another cruise liner, the Rotterdam, carrying COVID-19 test kits, supplies and relief staff to meet the Zaandam in Panamanian waters.
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"Only those who have not been ill will be moved, and health screenings will be conducted before transferring", Holland America wrote in a statement.
The assistance operation "was requested in support of human beings who are on board with symptoms of a cold and seeks to be able to transfer medical supplies from the Holland America Company to them", the AMP explained.
All crew and passengers now ill or in isolation because of close contact with an ill person, will remain on Zaandam. The administrator for the Panama Canal, however, said the Zaandam would not be allowed to pass through and that passengers would have to be quarantined. On Zaandam there are four doctors and four nurses.
The cruise line also confirmed the death of four "older guests", though Holland America did not say where they were from, or whether the two positive COVID-19 cases were among them.
While the onward plan for both ships is still being finalized, the company said it will continue to work with the Panamanian authorities on approval to transit the Panama Canal for sailing to Fort Lauderdale, Florida.
The ship was trying to get to Fort Lauderdale in the United States after being denied permission to dock at its original destination of Chile a week ago. No one has been off the ship since March 14 in Punta Arenas, Chile, where guests were initially told they could disembark for flights but were not permitted to.