The World Health Organization (WHO) has declared COVID-19 (coronavirus disease 2019) as a pandemic. While ships can be considered the safest place right now in light of the increasing cases of COVID-19 worldwide, the fact that our vessels call ports in affected areas puts our seafarers at the risk of contracting the disease.
“The seafarers themselves are now the barriers against COVID-19. Their main task is to avoid getting sick and bringing the disease on board. If someone on board gets it, there's a high chance everybody will get it."
Torger Trige, VP Maritime Personnel
Gard has advised the development of a written plan for disease outbreak management, preferably in close contact with a medical service supplier, covering the following:
- How to identify a suspected case of COVID-19
- An isolation plan describing the location/s where suspected cases should be temporary individually isolated until disembarkation
- Hygiene rules for the isolation room including use of personal protective equipment (PPE), cleaning and disinfection procedures and waste management
- Options for onboard treatment and medical equipment inventories
- Management of close contacts
Affected areas
WHO defines affected areas as the countries, provinces, territories or cities experiencing ongoing local transmission of COVID-19. Local transmission occurs when the source of infection is within the reporting location, e.g. people contracting the disease despite having no history of travel. The latest situation report lists 88 countries having local transmission, including the territories of Guam and the occupied Palestinian Territory.
Symptoms
The thing about COVID-19 is that not everyone who contracts the disease develops any symptoms. But when they do show, the most common symptoms include fever, tiredness and cough. Other reported symptoms are aches and pains, nasal congestion, stuffy or runny nose, sore throat or diarrhea. Shortness of breath is also reported in more severe cases.
Click on the image to download a printable PDF.
Another notable thing about COVID-19 is that the majority who become seriously ill are the elderly and those with underlying conditions like high blood pressure, heart problems and diabetes.
Identifying a ‘suspected case’ of COVID-19 onboard
The WHO’s guidance on how to define a ‘suspected case’ of COVID-19 is available in the document Global Surveillance for human infection with coronavirus disease (COVID-19). Case definitions in this document are based on what is currently known about the clinical and epidemiological profile of cases of COVID-19 presenting to date and may be revised as new information is collected. The 14-day period is based upon what is currently known to be the upper time limit of the incubation period.
Since the symptoms of COVID-19 are non-specific and very similar to those of the common cold and flu, the patient's exposure history during the 14 days prior the onset of symptoms needs to be assessed:
- Has the seafarer visited an affected area?
- Has the seafarer been in close contact with someone sick or suspected to be sick with COVID-19?
- Has the seafarer provided care (mostly applies to on-signers) to someone sick or suspected to be sick with COVID-19?
Managing a suspected case onboard
Gard outlined a very detailed approach on how to manage a suspected COVID-19 case on board:
- Isolate the patient immediately, in a predefined isolation ward, cabin, room or quarters, with the door closed.
- Instruct the patient to wear a medical mask, follow respiratory etiquette and regularly wash hands with soap and water and use alcohol-based hand rub.
- Make sure all persons entering the isolation room wear proper personal protection equipment, such as gloves, impermeable gown, goggles and medical masks, and wash their hands immediately after leaving the patient’s room.
- Limit the number of persons entering the isolation room and maintain an entry log.
- Regularly clean and disinfect medical facilities and cabins occupied by the patient and otherwise maintain a high level of cleanliness onboard the ship.
- Handle laundry, food service utensils and waste from the patient and identified close contacts as if infectious.
Treatment of an ill seafarer
As no cure has been developed for COVID-19, medical attention should be given on the clinical symptoms of the patients. Gard suggests the administration of supportive care:
- Make sure the patient drinks enough clear fluids (not alcohol).
- If the patient develops a bothersome cough, use cough suppressants available in most ships’ medicine chests.
- Use paracetamol in normal dosages (500-1000 mg every 6-8 hours) to control fever and pain.
- Observe the patient regularly and monitor the patient’s temperature, heart rate and respiratory frequency (number of breaths per minute).
- Seek telemedical advice if the patient develops a breathing problem or feels very ill. Be alerted if the respiratory frequency is above 20 when the person is resting, or if the person has a moderately to severely reduced general condition.
- If the patient develops a severe breathing problem, urgent treatment in a hospital will be necessary.
- Limit the movement and transport of the patient from the isolation room for essential purposes only. If transport is necessary, the patient should wear a medical mask and any surfaces touched by the patient should be cleaned and disinfected.
Managing ‘close contacts’ onboard
Gard advises immediate contact tracing after a suspected case is identified on board, without waiting for any laboratory results. While all persons on board should be assessed for their risk of exposure, the following may be considered close contacts:
- Crew member/s who stayed in the same cabin
- Crew member/s who worked in the same area
- Crew member/s who provided health care to the suspected case
- Crew member/s who engaged in common activities with the suspected COVID-19 case
All close contacts should be asked, to the extent possible, to stay in their cabins and do passive self-monitoring of any symptoms.
Going to port
Gard offers this step-by-step process to ensure safe and efficient disembarkation of the patient:
- The Master should report any suspected diagnosis of COVID-19 as soon as possible to the next port of call so relevant authorities may prepare and assist.
- Disembarkation of the patient should take place in a controlled way to avoid any contact with other persons on board the ship and the patient should wear a medical mask. Personnel escorting the patient during the medical evacuation should wear suitable PPE. All equipment used for transporting the patient must be cleaned and disinfected after use.
- As soon as the patient has been removed from the ship, the cabin or quarters where the suspected case of COVID-19 was isolated and managed should be thoroughly cleaned and disinfected by staff using PPE and who are trained to clean surfaces contaminated with infectious agents.
- The port health authority will conduct a risk assessment and all contacts of the suspect case should be identified and follow the instructions of the public health authorities, until the laboratory results of the suspect case are available. If the laboratory examination of the suspect case is positive for COVID-19, then all close contacts are likely to be quarantined for 14 days according to instructions from the competent authorities.
Strengthen the barrier
As Trige said, the seafarers – and practically everyone in the world – now serve as barriers against further spread of COVID-19. The disease is highly contagious, and doing our utmost to avoid it is preventing several other people from getting it.
The key is literally in our hands: practicing good hand hygiene, keeping distance from one another, and these preventive measures (click on the image to download the printable file):
“Let us face the challenges in a calm and collected way. The mitigating actions are already being done globally and we can do our part by meticulously abiding by the rules set by the relevant authorities.”
Torger Trige, VP Maritime Personnel
