The usefulness and practicality of the International Medical Guide for Ships.

BACKGROUND: The third edition of the International Medical Guide for Ships (IMGS) was published in 2007 and supported a main principle of the newly adopted International Maritime Labour Convention (MLC) 2006: to ensure that seafarers are given health protection and medical care as comparable as possible to that which is available to workers ashore. In 2021, the revisions and drafting of the fourth edition of the IMGS began. Taking the COVID-19 pandemic into consideration, it was decided that a stakeholder study was necessary to ascertain the usefulness and practicality of the guide as well as provide input for which new topics to include. MATERIALS AND METHODS: The study applied data triangulation, with respondents from a geographically broad sample of the International Maritime Organization's five regional areas of the world. The data was analysed using thematic analysis. RESULTS: The results show that the IMGS is widely known and used among persons involved in medical care on board ships, but the IMGS is not as practical as stakeholders would wish it to be. For the guide to be useful, it must be ensured that telemedical advice information is included and if possible, ensure there is one single and global medical guide. Also, there is a need for new medical information, and respondents pointed to pandemic information, medicines list, medical chest, mental health issues, a women's section, updated cardiopulmonary resuscitation instructions, human immune defect virus information (human immune defect-virus) and information on how seafarers may self-monitor and be monitored on board in relation to chronic diseases. CONCLUSIONS: Respondents understand a medicine chest on board is mandatory according to the MLC 2006, 98% are familiar with its content, and 86% use the IMGS.

Procedural aspects of COVID-19 vaccinations for seafarers on ocean-going vessels.

The increasing availability of safe and authorised coronavirus disease 2019 (COVID-19) vaccines for the first time provides the opportunity to vaccinate seafarers on board their ships while in port. Speedy vaccination of seafarers secures their health and serves to avoid the international propagation of COVID-19 virus variants via maritime traffic. As a port medical clinic, we will share our practical vaccination experience on board of merchant vessels in German/European ports with our esteemed coastal colleagues to stimulate their participation in this endeavour. You will have to adapt the procedure to your national particularities, otherwise please freely share the information with interested parties. Detailed guidance on COVID-19 vaccination in shipping and accompanying legal issues was published by the International Chamber of Shipping (www.ics-shipping.org).

Mental health of Filipino seafarers and its implications for seafarers' education.

This narrative review examines current academic literature on the mental health of Filipino seafarers working internationally, including the mental health effects of coronavirus disease 2019 (COVID-19). Framed within a rights-based approach, it aims to identify and analyse emerging themes on Filipino seafarers' mental health literature to understand what these studies potentially mean for the improvement of seafarers' education on mental health. Based on a broad selection criteria, 28 eligible papers demonstrate collectively three key findings: firstly, there is paucity in published research on seafarers' mental health; secondly, the majority of published studies are associated with a recent piracy crisis, where a significant number of mariners were attacked, taken as hostages, or killed; thirdly, three key areas emerged under which research on Filipino seafarers' mental health can be organized: the medical repatriation of seafarers, system of care for the mental health of seafarers including the diagnostic standards used, and seafarers' experiences and conceptions of mental health including the mental health effects of COVID-19. Though the bulk of the current understanding of the mental health problems is associated with piracy, several risk factors for which the quality of quantitative and qualitative evidence are patchy. The few sources of primary data to date lack focus on mental health needs which makes it difficult to grasp the extent of the problem. Developing policies and programmes for the promotion of mental health through mental health education among seafarers is important for a couple of reasons. Seafaring remains a dangerous and socially isolating occupation where work-related accidents are likely and will be potentially traumatic to mariners. Research on occupational stressors is increasingly providing evidence of their contributions to poor mental health outcomes among seafarers. Thus, mental health education of seafarers in the context of their work is important for proactive training and development.

Management of COVID-19 on board the mixed cargo ship Aranui 5.

BACKGROUND: During cruises, the management of coronavirus disease 2019 (COVID-19) infections poses serious organizational problems such as those encountered in 2020 by the Zaandam, the aircraft carrier Charles de Gaulle or the Diamond Princess. In French Polynesia, the mixed cargo ship Aranui 5 transports both tourists and freight to the Marquesas Islands. The purpose of this article is to show how COVID-19 infections were diagnosed and contained before and after passengers boarded a cruise. MATERIALS AND METHODS: On October 15, 2020, 161 passengers including 80 crew members embarked for a 13-day voyage from Papeete to the Marquesas Islands. Prior to boarding, all passengers underwent a reverse transcriptase-polymerase chain reaction (RT-PCR) test; the tests results were all negative. On Day 0, 3, 5, 8 and 11, Biosynex® rapid antigen diagnostic tests were carried out on all or some of the crew members and tourists who may have had contact with new positive cases. Each day, forehead or temporal temperatures were measured using an infrared thermometer and questions were asked concerning the subjects' health status. When a subject was positive, the person and their contacts were isolated in individual cabins. The infected person then left the vessel to be received in a communal reception centre on the nearest island. RESULTS: A total of 9 positive cases were observed, including two before departure (a tourist and a crew member). During the trip, 7 crew members tested positive. The patients and their contacts were isolated and then disembarked at the earliest opportunity. At the time of sampling, the subjects were asymptomatic. The patients and their contacts all became symptomatic within 24 to 48 hours after sampling. CONCLUSIONS: In total, the voyage could be completed without any transmission on board among the tourists and with a minimum transmission among the crew members, thus maintaining the tourist and economic activity of the islands during the times of COVID-19 pandemic.

[PROBLEMS OF REGULATORY AND LEGAL SUPPLY OF DRUGS CONTAINING NARCOTIC AND PSYCHOTROPIC SUBSTANCES OF OVERSEAS VESSEL].

In the context of the COVID-19 pandemic, the issue of protecting the vital functions of crew members on ship's board in conditions of a long voyage and stay in a confined space is urgent. In addition, excluding cases of infection with a new coronavirus infection, one must not forget about the readiness to provide first and subsequent medical assistance in case of urgent need to any crew member, and this can sometimes be done only by using drugs containing narcotic drugs and psychotropic substances in treatment or medical care. The analysis carried out indicates that there is no normative legal regulation of the composition of a first-aid kit in the Russian Federation, and many of the available international documents are for the most part advisory in nature. In this regard, the article carried out a detailed analysis of the regulatory framework governing the procedure for providing ships for overseas navigation with drugs, including those containing narcotic drugs and psychotropic substances, to protect the health of crew members of sea vessels in the context of the spread of COVID-19 and formulated the appropriate conclusions and recommendations.

[PROBLEMATIC ISSUES OF EQUIPPING SEA VESSELS IN TERMS OF STAFFING THE SHIP'S FIRST AID KIT IN THE CONTEXT OF THE NEW CORONAVIRUS INFECTION COVID-19].

Today, the presence of specifics in the organization of the work of sea cargo, fishing and passenger ships is indisputable, which affects the difficulties in providing qualified timely medical care in case of need. This issue is especially urgent in the context of the pandemic caused by the new coronavirus infection COVID-19. The article carried out a detailed analysis of the regulatory framework governing the formation of the list of ship's first aid kit and formulated the appropriate conclusions and recommendations. In addition, the article developed recommendations for supplementing the ship's list with drugs necessary for the treatment of COVID-19.

Outbreak of COVID-19 on an industrial ship.

BACKGROUND: People on ships are at high risk for outbreaks of infectious diseases including coronavirus disease 2019 (COVID-19). A rapid and well-coordinated response is important to curb transmission of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). We studied an outbreak on an industrial ship to improve outbreak control for ships and coordination between participating harbour partners. MATERIALS AND METHODS: Public Health Service (PHS) Rotterdam-Rijnmond performed an epidemiological investigation during the outbreak of COVID-19 among 77 seafarers on a ship in their port. The captain was interviewed about ship details and his experiences during the outbreak. The seafarers were asked to fill in questionnaires about symptoms suspicious of COVID-19 and date of symptom onset. Information about stakeholders involved in outbreak control was registered. RESULTS: The captain first contacted PHS about probable cases on March 31st 2020 via a physician ashore. One crewmember was hospitalised on April 8th and another died unexpectedly aboard on April 10th. Questionnaires distributed mid-April to the 75 remaining seafarers showed that 38 of 60 responders (63%) had had suspicious symptoms between February 15th and April 13th. None of them were tested but a total of 8 other crewmembers tested positive for COVID-19 after leaving the ship, including the hospitalised crewmember and the one who died aboard. On May 5th, the last case left isolation and the quarantine ended. Many different stakeholders were involved in the outbreak response and responsibilities were not always fully clear beforehand, causing coordination issues. CONCLUSIONS: Testing crew with COVID-19 symptoms underpins control measures and clarifies communication between stakeholders. Building a network beforehand to develop outbreak guidelines tailored to ships and local circumstances is essential to control future outbreaks on ships.

Prevalence and risk factors of depression symptoms among Chinese seafarers during the COVID-19 pandemic: a cross-sectional study.

BACKGROUND: To curb the spread of COVID-19, most countries have adopted measures such as banning shore leave at ports and placed restrictions on crew change. Seafarers may bear an excess pressure during the COVID-19 pandemic. This study aimed to investigate the prevalence and risk factors associated with depression symptoms among Chinese seafarers during the COVID-19 pandemic. DESIGN: Cross-sectional study. METHODS: This field survey-based study was conducted at Rongcheng Port, Shandong Province, China, from 10 June 2020 to 25 July 2020. Sociodemographic and occupational characteristics and health-related behaviours were collected through a face-to-face questionnaire. The Self-Rating Depression Scale was used to evaluate depression status during the preceding week. Logistic regression models were used to explore factors related to depression. RESULTS: 441 male Chinese seafarers were enrolled. Overall, the proportions of seafarers with low, moderate and severe depression symptoms were 23.35%, 9.30% and 9.07%, respectively. Compared with those with good self-rated health (SRH), seafarers with poor SRH had higher odds of depression (OR, 2.24, 95% CI 1.22 to 4.11). Less leisure time or physical exercise was associated with more severe self-reported depression symptoms (1-3 per week vs ≥4 per week: OR, 1.72, 95% CI 0.71 to 4.14; none vs ≥4 per week: OR, 3.93, 95% CI 1.67 to 9.26). Poor sleep quality was associated with higher likelihood of reporting severe depression (fair vs good: OR, 2.78, 95% CI 1.54 to 5.01; poor vs good: OR, 4.30, 95% CI 1.65 to 11.24). The more frequent seafarers worked overtime a week, the higher the likelihood of reporting severe depression symptoms (1-2 per week vs none: OR, 1.82, 95% CI 1.04 to 3.18; ≥3 per week vs none: OR, 2.49, 95% CI 1.05 to 5.92). Also, high perceived work stress was linked to higher odds of being depressed (intermediate vs low: OR, 2.06, 95% CI 0.78 to 5.46; high vs low: OR, 3.83, 95% CI 1.35 to 10.90). CONCLUSIONS: There is a high burden of depression associated with COVID-19 among seafarers. Special interventions that protect the mental health of seafarers are more critical than ever in the context of the pandemic.

Estimating the risk of outbreaks of COVID-19 associated with shore leave by merchant ship crews: simulation studies for New Zealand.

AIM: We aimed to estimate the risk of COVID-19 outbreaks in a COVID-19-free destination country (New Zealand) associated with shore leave by merchant ship crews who were infected prior to their departure or on their ship. METHODS: We used a stochastic version of the SEIR model CovidSIM v1.1 designed specifically for COVID-19. It was populated with parameters for SARS-CoV-2 transmission, shipping characteristics and plausible control measures. RESULTS: When no control interventions were in place, we estimated that an outbreak of COVID-19 in New Zealand would occur after a median time of 23 days (assuming a global average for source country incidence of 2.66 new infections per 1,000 population per week, crews of 20 with a voyage length of 10 days and 1 day of shore leave per crew member both in New Zealand and abroad, and 108 port visits by international merchant ships per week). For this example, the uncertainty around when outbreaks occur is wide (an outbreak occurs with 95% probability between 1 and 124 days). The combination of PCR testing on arrival, self-reporting of symptoms with contact tracing and mask use during shore leave increased this median time to 1.0 year (14 days to 5.4 years, or a 49% probability within a year). Scenario analyses found that onboard infection chains could persist for well over 4 weeks, even with crews of only 5 members. CONCLUSION: This modelling work suggests that the introduction of SARS-CoV-2 through shore leave from international shipping crews is likely, even after long voyages. But the risk can be substantially mitigated by control measures such as PCR testing and mask use.

Telemedical assistance at sea in the time of COVID-19 pandemic.

BACKGROUND: Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), the aetiological factor of COVID-19 infection, poses problems in providing medical assistance at sea. Ships are in an isolated environment, and most of the merchant ships do not carry medical personnel or medical supplies. Telemedicine offers a real possibility to provide reasonable quality medical assistance to seagoing vessels. The fact that ships may touch ports in affected areas, the difficulties for seafarers to be assisted ashore due to quarantine measures and the crews' lack of turnover make medical assistance at sea difficult. This study has compared maritime telemedical assistance data before and during the COVID-19 pandemic to propose prevention measures. MATERIALS AND METHODS: The study was based on the data from medical records of Centro Internazionale Radio Medico (C.I.R.M.) database of seafarers assisted from January 1 to June 30, in the years 2017-2020. The data were collected separately for each year. Age, sex, rank, and pathologies affecting the assisted seafarers were considered. Common signs of COVID-19 infection such as fever, cough, sore throat, shortness of breath, and other respiratory symptoms were analysed. RESULTS: From January 1, 2017, to December 31, 2019, C.I.R.M. assisted 15,888 patients on board ships. During the first 6 months of the years under evaluation, C.I.R.M. assisted 2,419 patients in 2017, 2,444 patients in 2018, 2,694 patients in 2019, and 3,924 in 2020. The number of assisted cases almost doubled in the first 6 months (from January to June) of 2020 compared to the same period of the previous years. Gastrointestinal disorders, injuries/traumas, and dermatological pathologies were the first, second, and third most often reported causes of illness on board over the 4-year study period. A higher number of seafarers with fever, cough, sore throat, and shortness of breath were assisted during the COVID-19 pandemic than before the coronavirus outbreak. Medical requests for fever increased significantly during the COVID-19 pandemic compared to the same period from 2017 to 2019. CONCLUSIONS: The requests for medical advice for fever, sore throat, and shortness of breath were significantly more common during the coronavirus epidemic. Close follow-up, regular health education on preventing coronavirus transmission, personal protective equipment, adequate environmental hygiene, and applying other standard precautions could help minimise the risk factors for the spread of COVID-19.

COVID-19 and French Medical Maritime Teleconsultation.

Introduction: The coronavirus disease 2019 (COVID-19) epidemic has impacted both land and maritime health services. The purpose of this study is to describe the calls received by the Tele-Medical Assistance Service (TMAS) in relation to this epidemic. Methods: From March 1 to 30 April 30, 2020, all records coded by TMAS doctors as "influenza due to an unidentified virus" were extracted. The following data were collected: patients' age, gender, nationality, role on board, type of ship, area of navigation, reason for the teleconsultation, patient's symptoms, whether or not a COVID test had been carried out, and treatment given. The data were analyzed in two groups, depending on the reason for the consultation: teleconsultation for suspected COVID patients and teleconsultation for non-COVID patients for whom the call was nevertheless related to the COVID pandemic. Results: Sixty-one records were included-51 for suspected COVID patients and 10 records for COVID-related problems (six patients whose treatment had stopped due to shortage of medication/one patient reporting a psychiatric problem associated with isolation, three patients followed up as contact cases). Forty-five patients presented with fever when the first call was made (88%) and 39 had a cough (76%). On closure of the medical records, 33 were receiving treatment on board (65%), 10 had disembarked (20%), 1 had been rerouted (2%), and 7 had been evacuated (13%). Discussion: TMAS was able to aid professional sailors as well as passengers/recreational sailors in terms of telemedicine (diagnosis and monitoring), logistics (barrier actions and isolation), and operations (evacuation and repatriation).

Wellbeing of a selection of seafarers in Eastern Adriatic Sea during the COVID-19 pandemic 2020.

BACKGROUND: Work-related stress among seafarers is well known but a suspected excess of work-related stress due to the COVID-19 so far has not been published. The aim of the study was to evaluate the well- -being of the seafarers during the outbreak of COVID-19 pandemic and their evaluation of the precautions taken by the shipping companies. MATERIALS AND METHODS: Seventy-two seafarers completed the General Health Questionnaire (GHQ12) with three extra questions on how the COVID-19 precautions were taken on board. RESULTS: The mean Likert score was 13.9 for the whole sample, corresponding to "no problems" while a subgroup of 40% had mean Likert sum scores of 16.1 (level 15-23) corresponding to "starting problems." In response to the extra items, 50% of the seafarers did not feel safe doing their job in relation to the epidemic and 60% did not think everything has been done to ensure their health at work in relation to the epidemic. Thirty per cent suffered of insomnia to the extent of becoming concerned and 26% had been unhappy and depressed during the latest tours of duty. CONCLUSIONS: The hypothesis that excess work-related stress has been put on the seafarers in this specific situation was confirmed and calls for prevention. A combination of person-focused and organisation-focused prevention approaches has been advocated as the most promising for alleviation of job stress in the workplaces at sea.