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Four elderly passengers on board Holland America's MS Zaandam have died on the cruise ship that is stuck in limbo during the coronavirus pandemic.

The ship is currently carrying 138 people who have complained of flu-like symptoms, which are similar to coronavirus symptoms. Two people have tested positive for 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 Line said of the four who had died of undisclosed causes in a statement shared by spokesperson Erik Elvejord.

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Elvejord added that Holland America Line is not at liberty to share whether those passengers had reported coronavirus symptoms due to privacy regulations.

Those sick include 53 passengers and 85 crew members. There are 1,243 passengers and 586 crew members on the ship, including 305 Americans.

Zaandam was named after the city of Zaandam located in the Dutch province of Noord Holland (North Holland), the main city in the municipality of Zaanstad. Zaandam, the city, was once a small settlement built on the river Zaan near a dam. Ms Zaandam is the third ship in HAL history to bear the name Zaandam and also the third ship of the four.

The ship did not have coronavirus tests available on board until Thursday evening when it rendezvoused with Holland America's MS Rotterdam for additional supplies and medical personnel.

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On board the Zaandam there are four doctors and four nurses, and the Rotterdam is carrying two doctors and four nurses, the cruise line said.

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Thursday, an unspecified number of patients with 'respiratory symptoms' were tested for COVID-19, two of which came back positive. Flu and respiratory symptoms and coronavirus symptoms are similar, so the cruise line 'out of an abundance of caution' told passengers to stay in their staterooms on Sunday.

Passengers will be separated based on their condition between the two ships.

'Today we announced a plan to transfer groups of healthy Zaandam guests to Rotterdam, with strict protocols for this process developed in conjunction with the U.S. Centers for Disease Control and Prevention (CDC),' Holland America's statement said. 'Only those who have not been ill will be moved, and health screenings will be conducted before transferring.'

Passengers over 70 will be transferred first, and quarantine will continue on board both the Zaandam and the Rotterdam until disembarkation. Anyone who has come in contact with an ill person will also remain on the Zaandam. All on board were provided with face masks when the ships met.

The two ships received permission to anchor off the coast of Panama to meet and transfer supplies and passengers. However, the plan for disembarkation is not yet finalized.

'While the onward plan for both ships is still being finalized, we continue to work with the Panamanian authorities on approval to transit the Panama Canal for sailing to Fort Lauderdale, Florida,' the line said in the statement.

No one has been off the ship since March 14 when it was in Punta Arenas, Chile.

The Zaandam began its South American voyage from Buenos Aires, Argentina, on March 7 and was originally scheduled to end the sailing in San Antonio, Chile, March 21.

However, Holland America Line, along with major cruise lines worldwide, announced March 13 it would suspend cruise operations for at least 30 days and end its cruises in progress.

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The Zaandam stopped in Valparaiso, Chile, at the end of last week and has food and fuel for the remainder of the ship's intended journey to the U.S., the line said.

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Holland America Line is offering complimentary counseling services over the phone with their partner, Empathia, for passengers and crew members.

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