7 April 2020

Updated 24 July 2020

COVID-19 mechanism of transmission and the clinical signs of the disease

Cases of pneumonia caused by a new coronavirus (SARS-CoV-2) were detected in China in December 2019. The disease is often referred to as the COVID-19 infection. The new coronavirus is mainly spread as a droplet infection when an infected person coughs or sneezes.

The disease can also be transmitted in close contact with people through contact transmission, such as when an infected person coughs into their hands and touches another person.  When a person coughs or sneezes, very small droplets can also form in addition to larger droplets, which can remain in the air for a while in aerosol form. However, according to current knowledge, the risk of airborne infection is low.

The virus can also be transmitted through contact with surfaces that have recently been exposed to the respiratory secretions of an ill person.  However, according to current knowledge, the number of infections caused by contact with an infected surface is not significant. For the time being, there are no known cases of infection via food or items.

The incubation period of the disease is estimated at 2–14 days, with an average of about 4–5 days. An infected person may spread the coronavirus infection for 1–2 days before the symptoms start. An asymptomatic person may also spread the infection.

The symptoms of the coronavirus disease may include a cough, fever, shortness of breath, muscle pain, fatigue, runny nose, nausea or diarrhoea. The symptoms described also include impairment of taste and smell. The majority of those infected with coronavirus have a mild illness and they recover well. However, some people may experience serious symptoms. The majority of patients who have experienced serious symptoms have been elderly, and many of them have also had underlying illnesses.  The Finnish Institute for Health and Welfare’s information page on the symptoms and treatment of the coronavirus disease.

Mild symptoms – do as follows

If the symptoms of the disease are mild and the person does not belong to any risk group, a diagnosis made by a doctor is generally not required, and the person can recover on board. Mild symptoms include runny nose, cough, sore throat, muscle aches or fever. However, the patient’s condition should be monitored and certain symptoms require immediate treatment.

The patient’s condition should be monitored 2–3 times per day until they have recovered from the disease. Take the patient’s temperature and measure their heart rate and respiration rate. If a crew member has symptoms consistent with a coronavirus infection or if there are other grounds for suspecting that they might have a coronavirus infection, they must be directed to occupational health services or their own health centre for a coronavirus test upon returning to a Finnish port. In foreign ports, adhere to the instructions of local health authorities

Serious symptoms – do as follows

If the patient develops severe symptoms, such as shortness of breath, or trouble breathing, and if their general condition weakens, ask for guidelines through the TMAS system (link to guidelines on when to seek treatment THL)

Many other microbes can also cause respiratory track infections with symptoms similar to those caused by the new coronavirus, meaning they cannot be distinguished on the basis of clinical symptoms alone.
See THL’s home care guidelines).

Risk groups

If people belonging to the risk groups (THL) work on board, it is recommended that, where possible, they would be moved to ships sailing near the coasts to ensure access to medical care as soon as possible.

Due to the current COVID-19 pandemic, when sailing on European waters, we must also bear in mind that country-specific medical care resources have changed dramatically, concerning the seriously ill.

General protection measures on ships

  • No-one should to work when sick. Adherence to general hygiene guidelines on board ships is particularly important because the staff spend long periods of time in the same premises, both at work and in their free time, which increases the risk of spreading infectious diseases.
  • Close contact should be avoided in dining and relaxations areas, and breaks should be scheduled in such a way that as few people as possible occupy the areas at the same time.

Respiratory track infections are best avoided by adhering to hygiene guidelines regarding hand washing and coughing and sneezing. It is important to thoroughly clean hands with soap and/or disinfectant.

Guidelines in case of illness on board

Measures in the event of a crew member suffering from a mild respiratory infection on board. The infection may be COVID-19 or another respiratory tract infection.

  • The patient should avoid close contact with others. They must stay in their cabin. Either a TMAS doctor or the health authorities of the next port of entry should be consulted with regard to the length of the isolation period and further actions. A respiratory tract infection usually clears up by resting for about one week.
  • If an isolation period compliant with the guidelines provided cannot be realised without jeopardising the on-board operations, for instance (the infected person’s work contribution is absolutely necessary for ensuring safe on-board operations and navigation) and the infected person has been asymptomatic for a minimum of 2 days, the recovered employee can return to their work duties earlier. This is possible only if the employee wears a surgical mask all the time when working.
  • When you are sick, it is important to rest and drink adequate amounts of water. Fever and pain can be relieved with medicine available from the ship’s pharmacy.
  • Follow hygiene guidelines regarding hand washing and coughing and sneezing.
  • If it is necessary for the sick person to move outside their cabin on board, they should use a mouth and nose mask (whenever possible).
  • A separate bathroom and toilet should be reserved for the infected person. If this is not possible, the infected person should be provided with a separate towel.
  • The patient’s condition should be monitored and, if necessary, a doctor should be consulted.
  • The number of people in contact with the infected person should be limited to 1–2 persons.
  • When visiting the patient’s cabin, try to maintain a distance (of more than 1 metre) and ensure good hand hygiene.
  • Protective equipment such as that used for protecting the mouth and the nose, or FFP2/3 respirators, should be reserved for those caring for a sick crew member and for those who have been instructed in the use of protective equipment. As far as possible, a surgical mask and protective gloves should be used in the treatment of an infected person.
  • A maritime declaration of health must be submitted before entering port in accordance with the requirements of the port or country concerned.

When should a doctor be consulted?

A doctor should be consulted if the sick person belongs to a risk group (THL) or if they develops severe symptoms, such as shortness of breath and/or their general condition weakens. Please note that microbes other than the coronavirus can also cause serious infections. The doctor will make a risk assessment and decide whether the sick person should be evacuated from the ship.

Cleaning, laundry and housekeeping

Cleaning guidelines are available on FIOH’s website.

Measures to be taken when a respiratory tract infection is confirmed as a case of COVID-19

If a respiratory tract infection is confirmed while a member of the crew affected by COVID-19 is on board, proceed in the same manner as described above under “Guidelines in Case of Illness on Board”.

A maritime declaration of health must be submitted for the case in accordance with the requirements of the port or country concerned before entering the port. Local health authorities will decide on further action.

If the respiratory tract infection is confirmed as a case of COVID-19 after the sick crew member has been evacuated from the ship, a maritime declaration of health must be submitted before entering the port in accordance with the requirements of the port/country.

Local health authorities will decide on further action.. The cabin used by the sick crew member must be cleaned in accordance with FIOH’s cleaning guidelines.

The Finnish Border Guard has guidelines on crew changes and the crew’s onshore visits during border-crossing restrictions (link to the guidelines)

https://shipowners.fi/wp-content/uploads/2020/03/Miehist%C3%B6nvaihdot-ja-merimiesten-maissa-k%C3%A4ynti-rajanylitysliikenteen-rajoitusten-aikana_.pdf

Further information: viestinta@ttl.fi.

The guidelines of the Finnish Institute of Occupational Health (FIOH) are drawn up together with the Ministry of Social Affairs and Health (SMAH) and the Finnish Institute for Health and Welfare. We also follow the publications of the European Centre for Disease Prevention and Control (ECDC) and the World Health Organization (WHO).

European Centre for Disease Prevention and Control (ECDC), COVID-19

World Health Organization (WHO), coronavirus