What to do during a quarantine

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Given the recent parotitis outbreak affecting twenty-five sailors and marines aboard the USS Fort McHenry, resulting in the ship being quarantined at sea for two months, and the potential spread of infection during the ship’s early port calls, outbreak plans and quarantine measures remain key to crew health and wellbeing. Safety at Sea spoke with Liz Baugh, the lead medical consultant at Red Square Medical, about procedures shipowners and crews can put in place to reduce the spread of infection.

Medical tests and vaccinations

Pre-employment medical checks screen for pre-existing conditions to reduce the possibility of seafarers who are medically compromised working onboard vessels. Sophia Bullard, the crew health programme director at the UK P&I Club, told SAS the most common illnesses that cause crew to fail medicals tend to be conditions such as hypertension, diabetes, abnormal liver function and gallbladder disease brought about by lifestyle.

“Infectious diseases are less commonly found at PEME, but where they do occur it is more commonly pulmonary tuberculosis and this remains the sole reason 10% of crew are found unfit after being screened at our approved medical clinics,” she said.

As a result, the UK P&I Club follows an enhanced medical format that incorporates screening for hypertension, tuberculosis, diabetes, kidney and liver function, eyesight, hearing, lung function and hepatitis A, B and C as these are most often listed as claims filed with them.

Medical checks serve an important purpose as seafarers, by sheer dint of what they do, are more exposed to contagious diseases. In order to alleviate some of the issues faced, a series of vaccinations are recommended to the contraction of certain preventable diseases.

Liz Baugh pointed out that although there has been a rise in reports of malaria and tuberculosis in seafarers, both can be prevented through adequate measures taken. Vaccination against tuberculosis is now available, and preventative measures for malaria involves medication and bite avoidance. “Education is key and early recognition of the signs and symptoms is essential to stop it from becoming life-threatening should seafarers contract it,” she said.

Stopping the spread of disease

Exposure to any virus, bacteria, or other causative agent may lead to the crew member developing symptoms over the period of either a few hours or a few days. For example, a gastrointestinal virus would tend to show symptoms such as nausea, vomiting, and diarrhoea; or a respiratory infection would offer cold and flu symptoms, which may also involve coughing up sputum.

Recognising these issues as symptoms would be important and following procedures to limit the spread of infection would help reduce risk to crew.

Speaking of the measures a crew member should follow, Baugh noted, “Ideally, they should return to their cabin and report this immediately to the designated medical person on board. The idea is to isolate anyone that may have a contagious disease so as not to spread it further.”

Potentially everything that a crew member touches can leave traces of the causative agent and can spread an infection if others come into contact with it.

“In both instances the crew member should carefully note down where they have been, what they have been doing, what they have eaten and drunk both on board and ashore and who they were with,” said Baugh. “These are all useful pieces of information that can help establish whether we may be dealing with an outbreak.”

Commonly shared spaces such as crew recreational areas, toilets, sinks, handrails, door handles, and high traffic areas like the galley and crew mess areas are often sites for the spread of infection.

Theorising the event of a contagious disease outbreak, she stated that crew that appear to be infected would have to be isolated until the cause is proven or until evacuation can take place.

Additional sanitation measures and personal protective equipment should be used by those caring for the infected person and the authorities should be notified. Should the case be so severe that the ship’s master feels it necessary to arrange to send them to shore, evacuation and transport to a local hospital would need to be carefully planned so as not to infect any other crew or receiving medical staff.

The length of quarantine procedures onboard would depend on the disease itself. In all likelihood, quarantine would be enforced until all crew members are symptom-free, no new cases have occurred, and the incubation period for that disease has passed.

Procedures for an outbreak

Baugh holds that a robust outbreak plan that is specific to the vessel in question is needed to reduce risk to crew members, and that many companies have begun to put these in place.

She urged all senior management teams onboard to ensure that this involved educating the crew on methods they could use to minimise the spread of infection, and steps they need to follow once they suspect they have come into contact with an infectious disease.

Robust outbreak policies would ideally involve different levels of outbreak readiness, allowing crew to follow a carefully drawn up plan should there be a suspected versus confirmed outbreak.

A good outbreak policy would need to have clear levels of vessel sanitation, crew/passenger education, increased use of personal protective equipment and clear reporting procedures both to the management company and the appropriate health authorities.

Information about outbreaks onboard would need to be shared with relevant onshore health authorities so as to construct an accurate image of the pattern of outbreaks and deal with the spread of disease. This information would allow authorities to target affected areas to help reduce the number of cases or, if possible, eradicate the spread of the disease altogether. Thus, if previous ports were to see a similar spread of infection, it would be taken into consideration by these bodies.

For vessels seeking to avoid areas where infection and the risk of requiring quarantine is high, Baugh suggests checking websites such as www.cdc.gov or www.who.int as they offer up to date information on the regional spread of contagious diseases and risk factors.

Diagnosis and medical services

It is worth noting that ship medical stores could do with some updating to deal with current needs.

“The Maritime and Coastguard Agencies Merchant Shipping Notice of 1768 – Ships Medical Stores provides a range of anti-sickness medication, anti-diarrhoeal medication and respiratory medication which cover the most common types of outbreak on board. These medications tend to be broad spectrum though and won’t necessarily deal with the cause,” said Baugh.

By treating symptoms rather than the cause, there remains the possibility that underlying factors may remain unresolved for long periods until the seafarers are shoreside.

Not all vessels may have medical professionals such as doctors onboard to assist with a formal diagnosis, as they may fall outside of the guidelines requiring this and/or having a ship’s doctor onboard may not be financially viable.

In such cases, Baugh noted that, “The Proficiency in Medical Care course, which is the STCW course to prepare chief mates and masters to gain their Certificate of Competency, provides the learner with multiple opportunities to discuss contagious diseases and should cover how to write and implement a good outbreak plan. If this is supported by the management company, then in our experience the senior crew are normally well placed to manage a potential outbreak.”

Telemedicine also offers an alternate solution and may prove more accurate in certain cases as this would involve a qualified medical practitioner, unlike the ship’s master, who would attempt to accurately diagnose the ailment based on the patient’s assessment of their condition.