FOM-10.20	Fleet Operations Manual FOM Covid – 19 Outbreak Management Plan	Doc No.: FOM 10.20 Revision: 01 Date: 15 Oct 2024 Issued by: DPA Approved by: MD

1. OBJECTIVE

This document is a supplement to the FOM 10.21 Infectious Disease Outbreak Management to specifically address the event of an outbreak, or suspected outbreak, of Covid-19 onboard our vessels.

2. SCOPE

This document is to be used by the Shore CMT and the vessels to support their efforts to manage an outbreak of Covid-19 onboard.

This document shall be updated as required to ensure that only the latest verified information and actions are communicated to all relevant parties.

3.1 Suspect Case

• A patient with acute respiratory illness (fever and at least one sign/symptom of respiratory disease (e.g., cough, shortness of breath), AND with no other etiology (i.e. cause of a disease) that fully explains the clinical presentation AND a history of travel to or residence in a country/area or territory reporting local transmission (See latest WHO situation report here) of COVID-19 disease during the 14 days prior to symptom onset.
• OR
• A patient with any acute respiratory illness AND having been in contact with a confirmed or probable COVID-19 case (see definition of “contact” below) in the last 14 days prior to onset of symptoms;
• OR
• A patient with severe acute respiratory infection (fever and at least one sign/symptom of respiratory disease (e.g., cough, shortness breath) AND requiring hospitalization AND with no other etiology that fully explains the clinical presentation.

3.2 Probable Case

A suspect case for whom testing for COVID-19 is inconclusive.

• Inconclusive being the result of the test reported by the laboratory

Definitions of suspect, probable and confirmed case taken from WHO Situation Report and Contact and Close Contact on board taken from Operational considerations for managing COVID-19 cases and outbreaks on board / Ships Interim guidance, 24 February 2020

3.3 Confirmed Case

A person with laboratory confirmation of COVID-19 infection, irrespective of clinical signs and symptoms.

• Information regarding laboratory guidance can be found here.

3.4 Contact

A contact is a person involved in any of the following:

• Providing direct care to a patient with COVID-19 disease, visiting patients or staying in the same environment as a COVID-19 patient;
• Working in close proximity to or sharing a cabin or room with a patient with COVID-19 disease;
• Traveling with a COVID-19 patient in any kind of conveyance;
• Living in the same household as a patient with COVID-19 disease within 14 days after the patient’s onset of symptoms.

3.5 Close Contacts on Board a Vessel (High Risk Exposure)

A person is considered to have had a high-risk exposure if they meet one of the following criteria:

• They stayed in the same cabin as a suspected or confirmed COVID-19 case;
• They had close contact (that is, they were within 1 m of) or were in a closed environment with a suspected or confirmed COVID-19 case:
• for passengers, this may include participating in common activities on board the ship or while ashore, being a member of a group travelling together, dining at the same table;
• for crew members, this includes the activities described above, as applicable, as well as working in the same area of the ship as the suspected or confirmed COVID-19 case, for example, cabin stewards who cleaned the cabin or restaurant staff who delivered food to the cabin;
• They are a healthcare worker or another person who provided care for a suspected or confirmed COVID-19 case.

4. COVID-19 SYMPTOMS

The most common symptoms of COVID-19 are fever (37.5°C and above), tiredness, and dry cough. Some patients may have aches and pains, nasal congestion, runny nose, sore throat or diarrhoea. These symptoms are usually mild and begin gradually. People with fever, cough and difficulty breathing should seek medical attention.

5.MODES OF TRANSMISSION 3

People can catch COVID-19 from others who have the virus. The disease can spread from person to person through small droplets from the nose or mouth which are spread when a person with COVID-19 coughs or exhales. These droplets land on objects and surfaces around the person. Other people then catch COVID-19 by touching these objects or surfaces, then touching their eyes, nose or mouth. People can also catch COVID-19 if they breathe in droplets from a person with COVID-19 who coughs out or exhales droplets. This is why it is important to stay more than 1 meter (3 feet) away from a person who is sick.

WHO Q&A on Coronaviruses

6. OUTBREAK MANAGEMENT PLAN ACTIVATION

This plan shall come into effect the moment one or more suspect cases are detected.

7. ONE OR MORE SUSPECTED/CONFIRMED CASES ONBOARD

Objective: Expedite the suspected crew for shore based medical attention.

The following must be done:

7.1 Crisis Management Team (CMT) – Shore Actions

CMT shall ensure the following is done as a minimum:

Person in-charge	Responsibilities
Marine Manager	Identify nearest safe port. Contact CIRM. (Marine Manager to tell Master) A risk assessment shall be carried out to supplement these actions both in office and on-board so as to mitigate any hazards that are unique to that particular event.
Crewing Manager	Liaise with local authorities to ensure access to port not denied and medical assistance assured. Notify the family of the affected crew. Map crew’s health status in terms of likelihood of illness severity (e.g. above 60, diabetes, lung or heart conditions), use in grouping of crew (see point below). Plan new crew for standby. If crew change not possible then exemption from Flag will be required if crew member/s are part of the safe manning.
DPA	Notify Flag; ask for assistance with exemptions/ dispensations, if required.
Insurance Manager	Notify P&I
Fleet Group Manager (Tech Director)	Vessel instructed to cease all non-essential work. Communicate at least once daily with all identified stakeholders.
Incident Commander (Tech Superintendent)	Orders are “sail to identified safe port”. (Coordinate with Owners) Obtain regular feedback with the vessel and update the response as deemed necessary.

7.2 On-board Actions

7.2.1 Isolation

• The suspected case should be immediately instructed to wear a medical mask, follow cough etiquette and regularly wash hands with soap and water and use alcohol-based hand rub.
• The suspected case should be isolated in a predefined isolation ward, cabin, room or quarters, with the door closed and portholes/windows open if possible and when safe to do so.

Note:
Single cabin with its own water closet shall be used as a primary means of isolation.

• For multiple suspected cases and when single rooms are not available, patients should be grouped together, and all patients’ beds should be placed at least 1 m apart.

Note:
The hospital, gym or other large areas may be designated for this purpose.

• Limit the number of persons entering the isolation room/s and maintain an entry log.

WHO, “Infection prevention and control during health care when novel coronavirus (nCoV) infection is suspected”, 25 January 2020

7.2.2 Splitting of Crew into Teams

Use the information in the crew health status update to divide the crew into 4 teams viz. sick/suspected cases, those well, caregivers and key personnel.

Table 1 Team Groupings Guidelines

Team	Responsibilities	Additional details
Key personnel	To ensure the integrity of the vessel and its ability to navigate to safe port. Report status to Emergency Response Team – Shore on a regular basis. Navigational team to be organized into two teams, taking a 6-6 watch pattern. Senior-most member of the team to decide watch keeping schedule and team pairings. Twice-daily announcements to be made by senior-most member of the key personnel to all crew. The announcement shall remain positive and give information on progress made towards safe port and likely ETA. Any information given by FFM to be related to crew in these announcements. Note: caution against detailing numbers of ill crewmembers onboard. Engine team to maintain UMS watch keeping schedule. Schedule and shift pattern to be decided by the senior-most engineer among the engineering key personnel. Catering team to ensure food is available at regular mealtimes. Chief Cook to decide mealtimes schedule for when crew get to take their meals. Catering team to follow guidance in terms of handling food utensils as given by WHO/ICS/CDC. Appointed member of key personnel shall take the twice-daily “roll call” of all crew to monitor spread of illness and conditions of crew, e.g. collect temperature readings. Follow same procedures as ill crew members and confine themselves to their cabin when not performing watch keeping duties.	See table 2 below for Key Personnel grouping.
Caregivers	Food distribution to the sick or quarantined individuals. Collection of used utensils. Administration of medication. Keeping record of the medical fundamentals of those ill. Taking roll call of all crew on board; at 0800 and 1700 hrs. Wearing of correct PPE at all times. Caregivers are to self-isolate when not performing caregiving duties.	The caregivers shall themselves not be ill or have a key position. A team is to be appointed with a team lead. The team lead shall be responsible for organising the care, setting up a shift rotation to ensure 24/7 caregiving as needed. The team lead shall ensure all caregivers follow the guidance given by WHO/ICS/CDC. The number of team members should be as minimum as possible to reduce the risk of exposure, also to conserve the PPE. Example caregiving team: Chief Officer – caregiver team lead to provide necessary guidance to caregivers and care givers to provide the care to the sick crew. Ensure WHO&ICS guidelines adhered to: 1 Engine Room or Deck Rating
Sick or suspected cases	Maintain proper hygiene. Comply with isolation requirements. Comply with Caregiver instructions.
Those well	Cleaning duties	These are crew that are well but not performing caregiving duties. Shall be organised in teams of 2 for the performing of cleaning duties in the accommodation. Note: This is to keep crew that are not sick occupied with useful tasks, to fill the day and to alleviate concerns of those who are performing duties. This means that this instruction can be dropped or amended as found appropriate in the given circumstances.

Table 2 Key Personnel Grouping

For safe navigation		For engine management
Primary	Back-up	Primary	Back-up
Master	Chief Officer	Chief Engineer	2nd Engineer
2nd Officer	3rd Officer	3rd Engineer	Other Engineers / Engine Rating
AB	OS
For catering
Primary	Back-up
Chief Cook	Messman	Note: Master to identify if any other personnel on-board has cooking capabilities to assist the Chief Cook and Messman.

7.2.3 Managing Contacts

It is advised that contact tracing activities begin immediately after a suspected case is identified on board without waiting for any laboratory results. All persons on board should be assessed for their risk of exposure. A close contact having had high risk exposure would typically be a person who has stayed in the same cabin, worked in the same area, provided health care to, or otherwise engaged in common activities with a suspected/confirmed case of COVID-19. All close contacts should be asked, to the extent possible, to stay in their cabins and do passive self-monitoring of any symptoms.

Depending on the type of ship and outbreak onboard, it may be difficult to identify who the close contacts are. In such cases, all persons on board could be considered as close contacts having had high risk exposure.

7.2.4 Infection Control

The following infection control measures should be applied in accordance with WHO interim guidance:

• Maintain a distance of at least 1 m from the ill person.
• Limit the number of caregivers. Ideally, assign one person who is in a good health and has no underlying chronic or immunocompromising conditions.

Caution:
Non-caregivers should not be allowed into the isolation area until the patient/s have completely recovered and have no signs and symptoms.

• Perform hand hygiene after any type of contact with patients or their immediate environment. Hand hygiene should also be performed before and after preparing food, before eating, after using the toilet and whenever hands look dirty. If hands are not visibly dirty, an alcohol-based hand rub can be used. For visibly dirty hands, use soap and water.
• When washing hands with soap and water, it is preferable to use disposable paper towels to dry hands. If these are not available, use clean cloth towels and replace them when they become wet.
• To contain respiratory secretions, a medical mask should be provided to the suspected case and worn as much as possible. Individuals who cannot tolerate a medical mask should use rigorous respiratory hygiene − that is, the mouth and nose should be covered with a disposable paper tissue when coughing or sneezing. Materials used to cover the mouth and nose should be discarded or cleaned appropriately after use (e.g., wash handkerchiefs using regular soap or detergent and water).
• Caregivers should wear a tightly fitted medical mask that covers their mouth and nose when in the same room as the patient. Masks should not be touched or handled during use. If the mask gets wet or dirty from secretions, it must be replaced immediately with a new clean, dry mask. Remove the mask using the appropriate technique – that is, do not touch the front, but instead untie it. Discard the mask immediately after use and perform hand hygiene.
• Avoid direct contact with body fluids, particularly oral or respiratory secretions, and stool. Use disposable gloves and a mask when providing oral or respiratory care and when handling stool, urine and other waste. Perform hand hygiene before and after removing gloves and the mask.

WARNING: Do not reuse masks or gloves.

• Use dedicated linen and eating utensils for the patient; these items should be cleaned with soap and water after use and may be re-used instead of being discarded.
• Clean and disinfect daily surfaces that are frequently touched in the room where the patient is being cared for, such as bedside tables, bedframes and other bedroom furniture. Regular household soap or detergent should be used first for cleaning, and then, after rinsing, regular household disinfectant containing 0.5% sodium hypochlorite (i.e., equivalent to 5000 pm or 1 part bleach to 9 parts water) should be applied.
• Clean and disinfect bathroom and toilet surfaces at least once daily. Regular household soap or detergent should be used first for cleaning, and then, after rinsing, regular household disinfectant containing 0.5% sodium hypochlorite should be applied.
• Clean the patient’s clothes, bed linen, and bath and hand towels using regular laundry soap and water or machine wash at 60–90 °C with common household detergent, and dry thoroughly. Place contaminated linen into a laundry bag. Do not shake soiled laundry and avoid contaminated materials coming into contact with skin and clothes.
• Gloves and protective clothing (e.g., plastic aprons) should be used when cleaning surfaces or handling clothing or linen soiled with body fluids. Depending on the context, either utility or single-use gloves can be used. After use, utility gloves should be cleaned with soap and water and decontaminated with 0.5% sodium hypochlorite solution. Single-use gloves (e.g., nitrile or latex) should be discarded after each use. Perform hand hygiene before and after removing gloves.
• Gloves, masks and other waste generated during at-home patient care should be placed into a waste bin with a lid in the patient’s room before being disposed of as infectious waste.
• Avoid other types of exposure to contaminated items from the patient’s immediate environment (e.g., do not share toothbrushes, cigarettes, eating utensils, dishes, drinks, towels, washcloths or bed linen).

WHO, “Home care for patients with suspected novel coronavirus (COVID-19) infection presenting with mild symptoms, and management of their contacts Interim guidance”, 04 February 2020

7.2.5 Treatment of Ill Crew (Patient)

Contact CIRM for medical advice on how to respond to each individual case. If CIRM cannot be contacted, the following supportive care measures should be considered:

• Make sure the patient drinks enough clear fluids (not alcohol).
• If the patient develops a bothersome cough, use cough suppressants available in most ships’ medicine chests.
• Use paracetamol in normal dosages (500-1000 mg every 6-8 hours) to control fever and pain.
• Observe the patient regularly and monitor the patient’s temperature, heart rate and respiratory frequency (number of breaths per minute).
• Contact CIRM if the patient develops a breathing problem or feels very ill. Be alerted if the respiratory frequency is above 20 when the person is resting, or if the person has a moderately to severely reduced general condition.
• If the patient develops a severe breathing problem, urgent treatment in a hospital will be necessary.

Gard, “Managing COVID-19 Cases Onboard”, 13 March 2020

7.2.6 General Instructions

Social Isolation

• No social contact between crew.
• Comply with Social Media Policy.
• No use of gym.
• Smoking can only be done in smoking rooms, one person at a time. The person shall use gloves when smoking. Packets of cigarettes to be kept personal.

Meals

• Meals by those well to be taken in groups no larger than 4 individuals sitting with a minimum of 1m distance.
• No buffet – a plated meal service only. “Lunchbox” provision for watch keeping personnel. Self-service is prohibited.
• Chief Cook to decide meal rotation times.

Regular Work Stopped

• ‘Keep propellers turning’
• Engine UMS

7.2.7 Disembarkation of Crew

During the disembarkation of suspected cases, every effort should be made to minimize the exposure of other persons and environmental contamination. Suspected cases should be provided with a surgical mask to minimize the risk of transmission. Staff involved in transporting suspected cases should apply WHO infection control instructions. These practices are summarised below.

• When transferring patients, routinely perform hand hygiene and wear a medical mask, eye protection (goggles or a face shield), a long-sleeved gown and gloves.
• Personal protective equipment (PPE) should be changed after loading each patient and disposed of appropriately in containers with a lid and in accordance with national regulations for disposing of infectious waste.
• Frequently clean their hands with an alcohol-based hand rub or soap and water and ensure that they clean their hands before putting on PPE and after removing it.

WHO, “Operational considerations for managing COVID-19 cases and outbreaks on board Ships Interim guidance”, 24 February 2020

8. OUTBREAK INCAPACITATING 50-100% OF CREW

Objective: Safely navigate vessel to port to expedite medical assistance to affected crew.

In this event, the CMT shall re-evaluate possibilities of arranging navigational assistance, tugs and tow and this will be based upon the number and ranks of crew incapacitated.

The course action taken will depend on the severity of the outbreak onboard. Given the high impact of this scenario, all necessary stakeholders shall be involved to ensure that the health & safety of the crew is prioritised.

9. VESSEL AT SAFE PORT

9.1 Evacuation of Patients

• Medivac of crew needing hospitalisation.
• Continued isolation of crew not requiring hospitalization.
• If possible, shore quarantine to be provided to enable new crew to board and take vessel out.

9.2 Disinfection of Whole Vessel

• To be done before new crew take possession of vessel cabins etc. If possible staged onboarding of crew.
• New linen to be provided for cabins. All plates and cooking utensils to be sterilised.

9.3 New Crew

• New crew to be screened prior to joining.
• Monitoring of crew health to be done in line with Circular 23/2020.

9.4 Ready for Next Voyage

• 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 on board the ship for the following 14 days.