Accordiing to WHO onboard coronavirus management guidelines you have to take note of the following things when there’s a coronavirus suspected infection onboard your ship.
What is a suspected case?
But now know first let us know what a suspected case means.
A suspected case is:
A. a patient with severe acute respiratory infection (that is, fever and cough requiring
admission to hospital) AND with no other aetiology that fully explains the clinical
presentation AND a history of travel to or residence in China or in another country
with established community transmission1 of COVID-19 disease during the 14 days
prior to symptom onset
OR
B. a patient with any acute respiratory illness AND at least one of the following during
the 14 days prior to symptom onset: (a) contact with a confirmed or probable case of
COVID-19 disease or (b) working in or visiting a healthcare facility where patients with
confirmed or probable COVID-19 disease were being treated.
Activating the outbreak management plan
If it is determined that there is a suspected case of COVID-19 disease on board, the outbreak management plan should be activated.
- The suspected case should be immediately instructed to wear a medical mask, follow cough etiquette and practice hand hygiene;
- the suspected case should be isolated in a predefined isolation ward, cabin, room or quarters, with the door closed.
- Infection control measures should be applied in accordance with WHO guidance
- The disembarkation and transfer of the suspected case to an onshore healthcare facility for further assessment and laboratory testing should be arranged as soon as possible in
cooperation with the health authorities at the port. - In addition to the medical personnel providing health care, all persons entering the isolation area should be appropriately trained prior to entering that area, should apply standard precautions and contact and droplet precautions as described in WHO’s guidance for infection control
Obligations of ship owners
In accordance with the IHR (2005), the master of the ship must immediately inform the port health authority at the next port of call about any suspected case of COVID-19 disease .
- For ships on an international voyage, the Maritime Declaration of Health should be completed and sent to the port authority in accordance with local requirements at the port of call.
- Ship owners must facilitate the use of health measures and provide all relevant public health information requested by the health authority at the port. Ship operators shall provide to the port health authorities all essential information (that is, PLFs, the crew list, and the passenger list
- to conduct contact tracing when a confirmed case of COVID-19 disease has been
identified on board or when a traveller who has been on board and possibly was exposed
during the voyage is diagnosed as a confirmed case after the end of the voyage.
Disembarkation of suspected cases
During the disembarkation of suspected cases, every effort should be made to minimize the
exposure of other persons and environmental contamination.
- Suspected cases should be provided with a surgical mask to minimize the risk of transmission.
2. Staff involved in transporting suspected cases should apply infection control practices by following. These practices are summarized below.
• When loading patients into the ambulance, transport staff, including medical staff,
should routinely perform hand hygiene and wear a medical mask, eye protection
(goggles or a face shield), a long-sleeved gown and gloves.
• Personal protective equipment (PPE) should be changed after loading each patient
and disposed of appropriately in containers with a lid and in accordance with national
regulations for disposing of infectious waste.
• The driver of the ambulance must remain separate from the cases (keeping at least 1
m distance). No PPE is required if distance can be maintained or a physical separation
exists. If drivers must also help load the patients into the ambulance, they should
follow the PPE recommendations in the previous point.
• Transport vehicles must have as high a volume of air exchange as possible (for
example, by opening the windows).
• Transport staff should frequently clean their hands with an alcohol-based hand rub or
soap and water and ensure that they clean their hands before putting on PPE and
after removing it.
• Ambulances and transport vehicles should be cleaned and disinfected, with particular
attention paid to the areas in contact with the suspected case.
Cleaning should bedone with regular household soap or detergent first and then, after rinsing, regularhousehold disinfectant containing 0.5% sodium hypochlorite (that is, equivalent to5000 ppm or 1 part bleach to 9 parts water) should be applied.
Notification and reporting requirements for WHO State Parties
The authority at the port must inform immediately its IHR NFP if a suspected case of COVID19 disease has been identified. When the laboratory testing has been completed and if the suspected case is positive for the virus that causes COVID-19 disease, then the IHR NFP shall inform WHO.
The IHR NFP will pay attention to IHR Article 43 that concerns additional health measures,
which states that State Parties implementing any additional health measure that significantly interferes with international traffic (such as refusal of entry or departure of international travelers and/or ships, or their delay for more than 24 hours) shall provide to WHO the public health rationale for and relevant scientific information about it.
Managing contacts
In order to avoid delays in implementing health measures, contact tracing should begin
immediately after a suspected case has been identified on board without waiting for
laboratory results. Every effort should be made to minimize the exposure of other travellers
to and on-board environmental exposures of the suspected case, and close contacts must be separated from other travellers as soon as possible.
All persons on board should be assessed for their risk of exposure and classified either as a
close contact with a high risk of exposure or as having a low risk of exposure.
Definition of close contacts on board a ship (high-risk exposure)
A person is considered to have had a high-risk exposure if they meet one of the following
criteria:
• they stayed in the same cabin as a suspected or confirmed COVID-19 case;
• they had close contact (that is, they were within 1 m of) or were in a closed
environment with a suspected or confirmed COVID-19 case −
- for passengers, this may include participating in common activities on
board the ship or while ashore, being a member of a group travelling
together, dining at the same table; - for crew members, this includes the activities described above, as applicable, as well as working in the same area of the ship as the suspected or confirmed COVID-19 case, for example, cabin stewards who cleaned the cabin or restaurant staff who delivered food to thecabin, as well as gym trainers who provided close instruction to the case;
• they are a healthcare worker or another person who provided care for a
suspected or confirmed COVID-19 case.
Follow-up with close contacts
If a large outbreak occurs as a result of ongoing transmission on board the ship, both crew
members and passengers should be assessed to determine whether they were exposed to the suspected or confirmed case.
If it is difficult to identify the close contacts and if widespread transmission is identified, then all travellers (that is, passengers and crew) on board the ship could be considered close contacts who have had a high-risk exposure.
Until the laboratory result for the suspected case is available, all travellers who fulfil the
definition of a close contact should be asked to complete the PLF (Annex 2) and remain on
board the ship in their cabins or, preferably, at a specially designated onshore facility (if
feasible and when the ship is at the turnaround port where the embarkation or disembarkation of passengers or discharge or loading of cargo and stores takes place), in
accordance with instructions received from the port health authorities.
- If the laboratory result is positive, then all close contacts should be quarantined in specially
designated onshore facilities and not allowed to travel internationally, unless this has been
arranged following WHO’s advice for repatriation, which also discusses quarantine measures. - Persons in quarantine who had close contact with a confirmed case should immediately
inform health services if they develop any symptom within 14 days of their last contact with the confirmed case. - If no symptoms appear within 14 days of their last exposure, the contact is no longer considered to be at risk of developing COVID-19 disease.
- The implementation of these specific precautions may be modified depending on the risk assessments for individual cases and their contacts as conducted by the public health authorities.
- If the laboratory result is positive, then all other travellers who do not fulfill the definition of a close contact will be considered as having had a low-risk exposure; they should be requested to complete the PLF with their contact details and the locations where they will be staying for the following 14 days. The implementation of these precautions may be modified depending on the risk assessments conducted by the public health authorities.
- Further instructions may be given by the health authorities. Travellers considered to have had a low-risk exposure should be provided with information and advice about :
• the symptoms of COVID-19 disease and how it can be transmitted;
• the need to self-monitor for COVID-19 symptoms for 14 days from their last
exposure to the confirmed case, including fever of any grade, cough or
difficulty breathing;
• the need to immediately self-isolate and contact health services if any
the symptom appears within the 14 days.
If no symptoms appear within 14 days of their last exposure, the traveller is no longer considered to be at risk of developing COVID-19 disease.
WHO’s guidance about quarantine measures can be found on the web pages about COVID-19 (https://www.who.int/health-topics/coronavirus).
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Source: WHO
