WHO tips for COVID-19 outbreaks aboard ships

The World Health Organization (WHO) has published some interim considerations for the handling of the 2019 coronavirus (previously named 2019-nCoV, now designated COVID-19) disease. Their target audience is any authority involved in the public health response to a COVID-19 public health event onboard a ship, including International Health Regulations (IHR), National Focal Points (NFPs), port health authorities, and local, provincial and national health surveillance and response systems, as well as port operators and ship operators. Here is an excerpt of that document.

Outbreak-management plan for COVID-19 disease

Ships sailing on an international voyage are advised to develop a written plan for disease outbreak-management that covers the definitions of a suspected case of COVID-19 disease, the definition of close contacts, and an isolation plan. The outbreak-management plan should include descriptions of the following:

- The location or locations where suspected cases will be isolated individually until disembarkation and transfer to a healthcare facility.

- How the necessary communications between departments (for example, medical, housekeeping, laundry, room service) about persons in isolation will be managed.

- The clinical management of suspected cases while they remain onboard.

- Cleaning and disinfection procedures for potentially contaminated areas, including the isolation cabins or areas.

- How close contacts of the suspected case will be managed.

- Procedures to collect passenger/crew locator forms.

- How food service and utensils, waste management services and laundry will be provided to the isolated travellers.

Staff onboard should have knowledge of the outbreak-management plan and should implement it as required.

Education

Shipowners should provide guidance to the crew about how to recognise the signs and symptoms of COVID-19 disease. Crew should be reminded of the procedures that are to be followed when a passenger or a crew member onboard displays signs and symptoms indicative of acute respiratory disease. Country-specific guidance for crew members about prevention measures should also be made available. Additional guidance is available in WHO’s interim guidance about home care for patients with suspected COVID-19 infection who have mild symptoms and how to manage their contacts, and about the use of medical masks. Healthcare staff onboard ships should be informed and updated about the outbreak of COVID-19 disease and any new evidence and guidance available for healthcare staff.

Managing a suspected case onboard a ship

If it is determined that there is a suspected case of COVID-19 disease onboard, the outbreak-management plan should be activated. The suspected case should be immediately instructed to wear a medical mask, follow cough etiquette, and practise 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 healthcare, 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.

Shipowners 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.

Notification and reporting requirements for WHO State Parties

The authority at the port must inform immediately its IHR NFP if a suspected case of COVID-19 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 travellers 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.

Measures on board the ship

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 IHR (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 (10). 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 onboard 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 on board, if this is feasible.

More on this document is available online from the World Health Organization’s news and media pages.