Coronavirus protocols and best practice for captains, crew, owners and guests
The coronavirus outbreak has thrown the maritime industry into turmoil, with no vaccine or treatment available for the time being, and testing not yet universally available. It’s fair to say that yachting has some unique challenges with COVID-19 on the scene.
We asked some specialist maritime medical experts how captains can mitigate the risks of cruising with owners or chartering with guests. Specifically, what steps can captains take to minimise the health risk to crew in the day-to-day operation of their yacht?
Dr. John Ross is an emergency physician at the Halifax Infirmary, Nova Scotia, Canada, and serves as medical director of Praxes Medical Group, a private sector telemedicine provider to remote sites around the world, and as provincial advisor on emergency care to the Deputy Minister of Health. He is a Fellow of the Royal College of Physicians of Canada (FRCPC) in emergency medicine and is a professor of emergency medicine at Dalhousie University, with a focus on acute airway management. He also works as a trauma team leader, teaching rural trauma team development courses throughout the Maritimes.
Michelle Currie is Operations Manager for Praxes Medical Group. Michelle is an avid sailor and has specialised in healthcare and telemedicine since 2004.
21 May 2020
Estela Superyacht Agency:
In general, what steps can captains take to minimise the health risks to crew in the day to day operations of the yacht?
“We’re trying to do things that we consider normal, in the midst of a global pandemic, which is really a big stretch. So, this is probably a loaded, multipart question.”
“Firstly, it’s an education piece. There are quite a few younger folks who perceive this as an old person’s problem. They feel bulletproof, that they’re not vulnerable. “That [perception] is incorrect. Infections are skewed a little bit towards the older age group, but younger people are getting it too.”
“There’s an element of responsibility that younger people need to embrace, in order to keep safe people who are older, or who have underlying health problems. So, whoever’s responsible for the crew’s general knowledge and attitude, needs to meet with each crew member face to face, so they understand that this is a serious business.”
What protocols or best practice do you recommend for owners coming on board?
“Ideally, the crew ideally has been properly isolated, so we know what they’re doing, where they’re going, how they’re behaving. For fourteen days. This period is not negotiable. That fourteen day period is one where we now know for sure that the crew have not provided any symptoms and the vessel is definitely virus free.”
“For owners, we don’t know what owners and guests do prior to arrival. But if they’re out in clubs and doing all sorts of things prior to arrival, they are then the virus vectors that are going to be bringing it on board.”
“I think a key part is to try and have a conversation with the people that are anticipated coming on board to get a sense of, what is their acceptance? How concerned are they about this? Are they the kind for preparing appropriately? Ideally, it would be nice to know that the person has led a COVID-free life for the prior fourteen days.”
For charter yachts, many of them have high turnover of guests, sometimes even changing over on the same day. Is there any way that yachts can mitigate the risks?
“Charter companies probably need to think hard around their current chartering programme. It might be that daily switchovers are just not appropriate. It might be that you need to look at longer engagements as being kind of the limit.”
“The higher the turnover, the less you know about the people coming on board. That puts your asset and crew at risk, so management companies, the charter brokers, need to give that some thought.”
What about testing?
“There are two types of tests and I have to warn people right off the bat. There are a number of companies out there making tests and claiming how wonderful they are, but mostly they’re simply not true.”
“There’s more than 120 different antibody tests, almost like pregnancy tests, or ‘point of care’ tests. However, many of them don’t perform well, they’re just false. Secondly, only when the immune system has been woken up after contracting the virus and has created some antibodies, can I actually measure them in my bloodstream.”
“So it’s not a screening test that you can use to say, okay, can you come on board the ship or not? It’s a retrospective test to give you a sense of the prevalence of illness in the past, but not the present.”
“Right now (May 2020), point of care tests are in development, but they do not yet exist, so do not be sold on that.”
“Part of the complication is that the concentration in your nasal passage area, where you take the sample, is going to be variable. There are also potential processing problems along the way, and then there’s the delay between getting the infection, starting to viral shed to others and getting a positive test. Then you have lab-dependency too, where one lab here is very, very good and then you move and the boat’s now having to work with this lab over there. And with some (health) systems, it’s hard to get test access sometimes.”
“Remember, a positive test can be useful, while a negative test is not reassuring. It doesn’t necessarily mean anything and it really needs to be held in context.”
If it’s possible to take swabs in a mobile setting, can private medics on board submit swabs to a lab?
“Yes, but the person has to know how to do it properly first. It’s not hard, but it should be done by somebody who’s qualified. Secondly, one would have to pre-establish a relationship with the processing lab, in order for them to agree to accept this in a timely fashion and give a result back. These relationships and processes can take time to develop.”
I guess they can work with a telemedicine company, like Praxes?
“I hate to be opportunistic, but I think you’re right. There’s an element of hubris if you’re thinking you can do this on your own. You want to be talking to somebody who keeps on top of developments and can steer you correctly.”
“Point of care tests are incredibly compelling, but if they don’t meet the requirement, then you’re not actually doing something that’s legitimate. There’s nothing concrete about this virus, the way it presents, the way it behaves. It’s a moving target.”
Yachts going from place to place are continually taking on provisions. What are your thoughts around that, in terms of keeping movements limited and cleaning everything?
“I think if I was the captain of a yacht, going into various ports, I would like to know something about my suppliers and what they are like. I mean, do they get the concern about the virus or not? Knowing your suppliers is an important part, making sure that the culture and understanding of procedures at their end is going to be as clean as possible.”
“My initial threshold would be that I would get some disinfectant and clean the packaging of supplies on the outside. If suppliers or their delivery people are potentially COVID positive and handling goods, there could be virus particles on the outside. So, I think cleaning of materials is a good idea.”
“With regard to shopping, try not doing it on a very frequent basis, if possible, so load up for a longer period of time. If you designate one or two crew members as responsible for shopping and bringing provisions, you’re not sending the entire crew ashore to wander around.”
Are marine air conditioning systems a potential risk for infection?
“This is not an aerosol-carried virus, per se. Unless there’s a lot of vigorous coughing or sneezing or screaming or singing, it tends to come out of one’s mouth or nose, and it does a downward trajectory, because it’s usually attached to a drop. It’s a droplets-spread virus.”
Are the risks of infection different from those on planes?
“Viruses will spread on airplanes, but it’s more the aerosolized smaller viruses, like influenza or the cold common cold. COVID tends to be less that way. Depending on the ventilation and flow patterns, and a fan is blowing air across me, anyone downstream of me is going to be in my slipstream and catching the virus. Whereas the people that are upwind are less likely to get it.”
What protocols should be put in place in case guests or crew members become symptomatic?
“Captains need to pre-think their isolation process and they do need to isolate this person. Ideally what we do is we put them in an isolation area, check their temperatures and provide food and symptom relief. The goal would be to try and get them off the ship as soon as possible.”
“If doing a long crossing, we now need to give it our best and keep our fingers crossed. Remembering that 80-85% of people with COVID are going to be fine. About 15-20% will have a more severe illness. Again, the risk groups are the people who are older, who have other underlying health problems, heart, lung, immune system compromise. So if someone in that kind of risk group was to start developing COVID-like symptoms, then I’m going to be taking them off as quickly as I can.”
On what basis will countries, health systems, take in passengers who have fallen ill?
“It really depends on the governance for the country. An understanding of the ongoing situation where you are, and an awareness of the potential ports of call that you could divert to if something did come along, and their receptivity to you being able to come in and offload a patient, are important considerations.”
Apart from the obvious PPE, Is there any other equipment that you recommend to be carried on board specifically for COVID or for antiviral protection?
“Aside from masks, goggles or shields and gloves, a disposable gown or suit of some sort are all important pieces. I think the suit part and the more protective covering comes when you do actually have someone who you suspect could have COVID, and you’re going to be moving them from one place to another.”
“You don’t have to have the N95 masks, just regular surgical masks are fine. Unless someone is aerosolizing and coughing and coughing and coughing, in which case, the more filtered kind of mask would be appropriate.”
“In terms of other things, diagnostic kit so you can get some blood pressure and oxygen saturation levels should be absolutely part of anyone’s kit that they need to have. Proper, vital signs-obtaining equipment. After that, in terms of other special treatments, there really isn’t anything.”
“There is no prevention medicine. Yes, work on ways of boosting your immune system, get plenty of rest, eat well, exercise and vitamin D if you’re living in high latitude climates. But otherwise really, there is no specific treatment or antibiotics that will treat this.”
“One more thing to mention is that it might be helpful to pick up a few extra items for the medical kit, such as extra thermometers. Or, if you have a digital thermometer, that you have one with a disposable protective covering, so you’re not sharing it with multiple people.
Do ‘point and shoot’ infrared thermometers work as well?
“They do work and we are using them, but you need to be very careful that they’re being used indoors. Ideally they would be used inside when it’s at a nice room temperature. You wouldn’t want to take the temperature of someone who might have a hat on and is sweating, or who has just been sitting in front of an air conditioner and their skin is quite cool.”
So, as they come on board, but ideally not on the passerelle?
Yes, that’s right. You just want to have them in an area where they’re not overheated or not too cool. And if you do have one, we’d recommend that you compare it to a standard, digital thermometer, because sometimes those [infrared] thermometers tend to register on the low side.”
Yachts maintain very high standards on board, which means a lot of refreshing of bed linen, clothing, uniform, all these things. Do you have any special suggestions around laundry, dry cleaning?
“The key thing is the handling of linens and clothing. Ideally, crew members can take care of their own cabins and make their own beds and do all that kind of stuff.”
“Trying to reduce the touch of other people’s stuff is a good practice. And when it gets down to on-board or off-board cleaning, I think as long as you take off the sheets and pillowcases directly into a bag of some sort, then it’s going to be handled by as few people as possible.”
“The person handling laundry should have gloves on and a mask, in case there’s some aerosolization as you’re shaking things around. And then, minimal handling, soap and water does the trick. So once it gets into the washing machine, it should just fall apart very, very quickly.”
“Anything that’s been touching us, whether it’s bed linens, whether it’s clothing, just needs to be handled in kind of a hazardous material fashion. Until 14 days have passed for the crew with no guests coming on board.”
Do UV or ozone have any role to play in disinfecting?
“You know what, probably not. What works for sure, that’s soap and water or basic cleaning agents. All those things work with disinfectants. Once you start getting into the “look how fast I can wave a UV thing over the surface”, I would be very cautious with that.”
“It’s the same with ozone. I mean, what’s the penetration of the ozone? Is it getting to all the nooks and crannies of whatever you’re trying to treat? It sounds like charlatan material.”