Simple measures can decrease the risk of infection onboard

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The more contact there is between ships and land, the greater is the risk for corona infections on board. However, there are simple measures for decreasing this risk: using paper towels, holding meetings outdoors on the deck and being thorough with hand hygiene.

The corona pandemic has severely affected maritime transport, especially ferry services where several ships have been laid up or used for goods traffic only, with many under notice or made redundant as a result. The cargo segment has also been affected by declining volumes and problems with signing on and off. This not only creates worry about jobs and future prospects, but there is also a fear that the disease might come onto the ships themselves. One of those who has noticed this concern is Andreas Hein, a doctor at the Sahlgrenska University Hospital in Gothenburg. He is the medical director at TMAS (Telemedical advice services) which assists the maritime sector with medical advice at a distance.

“We receive a number of phone calls from worried crewmembers who ask what they should do when someone gets a fever and has symptoms in their nose and throat,” he says. “We give the same recommendations to them as for patients ashore: self-isolate as much as possible and take it easy. If the situation becomes worse, especially in the case of breathing problems, they should get medical care quickly.”

Since the pandemic started, there have been reports from several ships affected by COVID-19. Most attention has been directed at international cruise ships, which have had large numbers of ill passengers and even a number of deaths. But there are also simple steps that people can take to reduce the risk of infection on board according to David Edberg, an A&E doctor at Varberg hospital who works with COVID-19 patients and who was also in the medical team on the East Indiaman Götheborg II during her maiden voyage.

Infection paths via objects

“The most important action to prevent the spread of infection is good hand hygiene,” he says. “Washing your hands thoroughly, especially before and after eating, makes a lot of difference. The virus is also extremely sensitive to alcohol, so if you have access to hand disinfectant on board it is a very good idea to use it.”

David Edberg recommends avoiding physical contact with others on board as much as possible. When it is necessary to meet people from outside the ship, such as pilots, agents, port state representatives and so on, the risk of infection can be substantially reduced by not shaking hands and keeping a distance.

“The virus spreads via small droplets when people cough, sneeze or spit. The droplets that come out of the mouth or nose sink to the ground rather quickly and if you keep to the recommended separation of 2 metres you can be fairly sure of being safe,” says David Edberg.

The ability of the virus to survive outside a host’s body is still not known in detail, but research suggests that people can become infected by touching objects that have been contaminated by the new coronavirus. On its website the Swedish public health agency refers to a study carried out in the field of health services, which shows that there are traces of the virus on surfaces and objects in rooms where COVID-19 patients are isolated. On the other hand, you do not become infected just by having the virus on your skin.

“No, you are only infected when the virus enters the body through mucous membranes,” says David Edberg. “That is why it is so important to avoid touching your mouth, eyes or nose without thoroughly washing your hands first.”

Normal cleaning procedures are sufficient

He is doubtful whether it is worth spending time cleaning surfaces onboard after a pilot or other people from outside have boarded the ship. He thinks that all extra work and actions must be assessed in terms of the possible gain.

”Following normal cleaning procedures should be quite sufficient,” he says. “On the other hand, it may be good to wipe over surfaces that many people touch such as buttons, binoculars and handles. Holding meetings on the deck instead of inside the ship, to the extent that this is possible, may also reduce the risk of spreading the disease.”

Another preventive measure which may help, according to David Edberg, is to replace cloth towels next to shared wash basins with paper towels. We should also keep a safe distance from each other in the day room and messes. As far as meals are concerned, there is no evidence that anyone has become infected by eating food or drinking water. It should also be acceptable to serve food as a buffet, as long as there is sufficient social distancing in the queue for the buffet.

“People should also be extra thorough with hand hygiene in the context of eating, and should wash their hands before and after meals,” says David Edberg.

With regard to signing on and off during the corona pandemic, shipping companies have chosen different solutions. Some of them have stopped changeovers completely, while others continue to replace crews, even though it requires some planning and changes to procedures. David Edberg is cautious about commenting on whether crews should be changed or not but says that a complete stop can only be a short-term solution.

“You have to ask whether it is not more reasonable to let the crews go home. They can’t stay on board forever and maybe it is better instead to do what is possible to reduce the risk of spreading infection on board.”

Risk factors:

Most people who are infected with COVID-19 only have mild symptoms, but scientists have identified several risk factors that can cause some to become seriously ill. These are:

• Old age, over 70

• High blood pressure

• Cardiovascular diseases

Pulmonary diseases (not asthma)

• Severe obesity

• Diabetes

In addition to these risk factors, it is possible that people that are already ill or undergoing medical treatment which affects the immune system may be at increased risk of becoming seriously ill. Some studies indicate that smokers are overrepresented among those who become seriously ill with COVID-19, but the quality of the studies is uncertain and there are few such studies. Knowledge about pregnant women and COVID-19 is also very limited.

Linda Sundgren

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