[Answer] What Measures You Need To Take Onboard Coronavirus Infected Ships?

As the Coronavirus pandemic gripples the world and countries announce lockdown, ships are still at sea and the lives of the people working in the shipping industry are in jeopardy.

In such a scenario, WHO has announced a detailed guideline on how to tackle onboard COVID19 infections. So, here’s the measures you need to take on board ships in view of recent global health concerns.

Onboard Measures

In the event that the affected ship calls at a port other than the turnaround port, the port
health authority should conduct a risk assessment and may decide in consultation with the
ship’s owner to end the cruise.

The ship should be inspected according to Article 27 of the (2005), which discusses affected conveyances, and then health measures (such as cleaning and disinfection) should be applied based on the findings of the inspection.

Detailed guidance from WHO is available in the Handbook for inspection of ships and
issuance of ship sanitation certificates . For more details about the inspection, see the
section on environmental investigation in this document.

• Infectious waste should be disposed of in accordance with the port authority’s procedures.
• Health measures implemented on the ship should be noted in the Ship Sanitation Certificate.
• The next voyage can start after thorough cleaning and disinfection have been completed.
• Active surveillance should take place on board the ship for the following 14 days.
• Additionally, the ship’s owner could explore the possibility of starting the next voyage with a new crew onboard, if this is feasible.

Cleaning and disinfection

In accordance with WHO’s guidance about infection prevention and control during health
care when COVID-19 infection is suspected, medical facilities, cabins and quarters occupied by patients and close contacts of a confirmed case with COVID-19 disease should be cleaned and disinfected daily, and cleaning and disinfection should be carried out after they have disembarked.

The remainder of the ship should also be cleaned and disinfected, particularly when an outbreak occurs.

Detailed information about cleaning and disinfecting cabins can be found in WHO’s interim guidance about home care for patients with suspected COVID-19 infection and how to manage their contacts .

• Laundry, food service utensils and waste from the cabins of suspected cases and their contacts should be handled as if infectious and according to the outbreak management plan provided on board for other infectious diseases (for example, for norovirus gastroenteritis).
• It is essential that the ship remains at the port for the time required to thoroughly clean and disinfect it.
• A ship that is considered to have been affected shall cease to be regarded as such when the port health authority is satisfied with the health measures undertaken and when there are no conditions on board that could constitute a public health risk

Outbreak investigation

Efforts to control the COVID-19 epidemic focus on containing the disease and preventing new cases. Onboard ships it is essential to identify the most likely mode or modes of transmission and the initial source or sources of the outbreak. Because the outbreak may have international ramifications, on large ships, including cruise ships that carry nationals from many countries or areas, the outbreak investigation requires coordinated efforts.

Article 6 of IHR (2005) provides that a State Party shall communicate to WHO all timely,
accurate and sufficiently detailed public health information available to it about the notified
event (such as case definitions, laboratory results, source and type of the risk, number of cases and deaths, conditions affecting the spread of the disease, and the health measures
employed) and report, when necessary, the difficulties faced in responding to the public
health emergency of international concern and the support needed

Epidemiological investigation

The field investigation team should take all necessary precautions and use PPE appropriately to avoid becoming infected.

For close contacts, the analyses should consider the following risk factors, where applicable:

• who shared cabins,
• their companions,
• groups travelling together,
• and their participation in onshore activities;
• the restaurants and bars they attended,
• seating arrangements at meals based on reservation lists,
• buffet service seating locations (schematics);
• participation in onboard events or in the ship’s public areas (such as the gym, theatre, cinema, casino, spa, recreational water facilities);
• the deck of the cabin where the cases and contacts stayed; and
• the fire zone and air handling units.

Records to be reviewed and considered in the investigation are the ship manifest, the ship schematics, cabin reservation lists, activities reservation lists, records of vomiting incidence, accidental faecal release records for pools, dining reservation lists, medical logs of passengers and crew with gastrointestinal issues, cabin plans, the cabin stewards assigned to each cabin and their shifts, and any records about the demographic characteristics of the travellers.

The minimum data requirements that should be collected are included in the Public Health Passenger/Crew Locator Form (Annex 2).

Environmental investigation

• A focused inspection should be conducted to assess whether the isolation procedures and other measures on board the ship were applied properly, sufficient PPE supplies were available and staff were trained in the use of PPE.
• Housekeeping, cleaning and disinfection procedures (such as protocols, products, concentrations, contact times, use of PPE, mixing processes) and the frequency of cleaning and disinfection (especially of areas that are frequently touched) should be checked during the inspection.
• The focused inspection should also determine whether any crew might have been working while symptomatic, including food handlers, housekeeping staff and spa staff.
• If feasible, samples from environmental surfaces and materials could be collected and sent toa laboratory for testing both before and after the cleaning and disinfection procedures are completed.
• Staff should be trained to use PPE to avoid becoming infected.

Environmental Samples Needed To Be Collected

The following 8 environmental samples could be collected:

1. surface swabs from cabins where cases stayed,
2. frequently touched surfaces in public areas, and food preparation areas, including pantries close to the cabins of affected travellers;
3. air from cabins where cases stayed and medical rooms where cases were isolated;
4. air from the sewage treatment unit exhaust and engine exhaust;
5. air ducts;
6. air filters in the air handling units of the cabin;
7. sewage tanks
8. recreational water buffer tanks.

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Source: WHO

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