Managing suspected COVID-19 cases onboard

What happens in the unfortunate event that a seafarer onboard is positively tested, keeping in mind that the vessel is navigating the seas and does not have the option to transfer the crewmember on a hospital ashore?

Seafarers work in close contact environments likely to facilitate transmission of COVID-19. An outbreak onboard is a concern for safety and wellbeing of the crew and may affect the safe operation of the ship.

Risk Analysis

WHO advises that the risk analysis for suspected COVID-19 cases should include four zones:

-Potentially contaminated zones: these are areas where suspected cases can be isolated, such as in the ship’s medical accommodation, and all other areas that are potentially contaminated but have not been disinfected;

-Zones where only crew interact (e.g. mess rooms, bridge, communal toilets, etc.);

-Zones or activities where crew interact with shore personnel;

-Zones where no interaction takes place among crew members or among crew members and shore personnel (e.g. single cabins).

Pathway for identifying and treating suspected cases onboard

• Screening and ongoing monitoring: The outbreak management plan should be activated if ongoing screening or monitoring activities determine that there is a crewmember with symptoms onboard.
• Isolation of suspected cases: The suspected case should immediately be placed in isolation in a designated area and anyone else entering this area should wear respective equipment.
• Implementing infection prevention and control measures: The crew should practice appropriate infection prevention and precautions under the plan.
• Assessing severity and risk factors: Risk factors for severe disease include age > 60 years, underlying noncommunicable diseases and smoking.
• Determining if the case be managed onboard: Refer to pre-established criteria to determine whether the suspected case can be treated onboard or requires shoreside medical care.

Treatment of an ill person

After isolating the suspected COVID-19 case, due to the lack of specific treatment, it is helpful to follow the steps below:

• 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 breathing problems 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.

In the meantime, don’t forget the importance of hand hygiene and physical distance!