The World Health Organization declared the COVID-19 as a global pandemic; Thus, early detection, prevention and control of any possible case onboard the vessel has to become the number one priority to protect the health of the crewmembers and prevent the transmission of the virus.
The rapid increase of COVID-19 cases is seen in countries all over the world, with the exemption of Antarctica, with Europe being the centre of the virus. Therefore, Gard advises all ships conducting international voyages to develop a written plan for disease outbreak management, preferable in close contact with a medical service supplier, covering issues such as:
- identifying a suspected case
- 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; and
- management of close contacts.
Up to now, industry stakeholders and organizations have issued guidelines to support operators and crews on how to deal with a suspected case onboard ships.
Gard provides a summary of some key recommendations:
- What is considered an ‘affected area’?
WHO defines “affected areas” as those countries, provinces, territories or cities experiencing ongoing local transmission of COVID-19, in contrast to areas reporting only imported cases.
- Recognising the symptoms of COVID-19
To remind, the symptoms of coronavirus are
- Fever
- Cough
- Shortness of breath
Also, it is important to distinguish the symptoms of the flu on the contrary to the coronavirus, so you are able to control any case.
- Identifying a ‘suspected case’ of COVID-19 onboard
Identifying and isolating passengers and crew with possible symptoms of COVID-19 as soon as possible is necessary to minimise transmission of this virus.
However, because the signs and symptoms of COVID-19 are non-specific, Gard highlights that it is also important to carry out a detailed assessment of the patient’s exposure risk, i.e. if he or she has visited an affected area, or been in close contact with someone sick with COVID-19, during the 14 days prior to the onset of the symptoms.
Also, the ICS launched guidance on how to define a ‘suspected case’ of COVID-19 and a ‘close contact’ person.
- Managing a suspected case onboard
To manage a possible COVID-19 case onboard, the WHO has published guidance, according to which it is important to isolate the patient immediately, in a predefined isolation ward, cabin, room or quarters, with the door closed and:
- 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.
- 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.
- Treatment of an ill person
Despite the fact that there is no specific treatment for the time being, supportive care can be really helpful and effective for a patient with symptoms.
Consequently, it is recommended to
- 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.
- Medical supplies and equipment
While the carriage of medical supplies is regulated by Flag States, the Club encourages ship operators to review the need for any additional equipment onboard their ships and ensure plentiful supplies of all equipment considered essential in order to prevent spread of the virus. This could include handwashing supplies, alcohol-based sanitizers, PPE and other medical supplies to meet day-to-day needs.
Specifically, the ICS launched the “Guidance for Ship Operators for the Protection of the Health of Seafarers” contains a useful list of supplies and equipment required in a situation involving COVID-19.
- When going to port
In the event of a suspected diagnosis of COVID-19 onboard, the master should report the event as soon as possible to the next port of call, to allow the competent authority at the port to arrange, depending on the situation, medical evacuation or special arrangements for disembarkation and hospitalization of the patient and laboratory diagnosis.
The ship may be asked to proceed to another port in close proximity if this capacity is not available, or if warranted by the critical medical status of the suspect case of COVID-19.
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.
