People come out to watch the new Carnival Cruise Line ship Mardi Gras on its maiden voyage, a seven-day cruise to the Caribbean from Port Canaveral, Florida on July 31, 2021.

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The Centers for Disease Control and Prevention extended until January the restrictions on the cruise industry due to expire next week, citing concerns about the highly contagious Delta variant and groundbreaking cases among vaccinated travelers.

Since October 2020, the CDC has allowed cruise ships to operate under conditions that, among other safety precautions, require masks on board and vaccinations or tests on passengers and crew members. Although the agency planned to cancel the order by November 1, the extension will become a voluntary measure for cruise lines on Monday starting January 15.

“The procedures put in place to resume passenger operations have successfully averted an overload of medical facilities on board and a strain on hospital resources on land,” the CDC said in a statement on Monday. “However, the CDC has decided to temporarily extend the contract due to the continued spread of the Delta variant.”

All foreign-flagged cruise ships carrying at least 250 passengers must adhere to the order and, upon request, grant the CDC access to their ships and passengers’ health records to ensure compliance. Cruise ships that do not receive a Covid-19 Conditional Sailing Certificate from the CDC will be banned from operating in US waters.

To receive a certificate, cruise lines must train their crews in Covid prevention tactics and implement their own testing and quarantine standards. They must also “provide hospital care” by equipping their ships with ventilators, masks and other protective equipment for Covid patients “without having to rely directly on a hospital stay on land,” the regulation says.

The CDC’s conditional cruise order also requires cruise lines to test passengers and staff for Covid prior to embarkation, prohibit suspected Covid patients from boarding, and isolate those infected from other travelers and employees. Cruise lines must also allow adequate social distancing while eating and entertaining, and comply with all state sanitary standards for masking and sanitation.