COVID-19 on board a cruise ship: medical management.

BACKGROUND: First, this analysis was conducted to study a coronavirus disease 2019 (COVID-19) cluster dynamic on a cruise ship in order to allow the ship physician to anticipate the duration and importance of the contaminations. Secondly, the author tries to find out if the closed environment on board allows specific conclusions about epidemic dynamics and preventative measures. MATERIALS AND METHODS: From a personal epidemiological compendium done by himself on board the author analysed different epidemic curves identified on board other ships and compared them to the epidemiologic data from the different COVID-19 contamination waves in France since 2020. All crew members were submitted to polymerase chain reaction tests on D2, D5, D8 and D15 and symptomatic cases were tested on on-board devices in the meantime. An excel file called "Log Covid" allowed for daily reporting to the ship-owner on the epidemic dynamics and the prospects on the end of crises in order to anticipate the resumption of the business in the best conditions. The jobs on board, age and geographic origin of the contaminated people were analysed, as well as their vaccination status. RESULTS: Out of a total of 118 crew members, 61 (52%) sailors were contaminated in 8 days. The symptoms were benign (pharyngitis, headaches, feverish state); no serious form of illness were reported. The passengers were repatriated to France at the earliest stage. The epidemic phase occurred in a 15-day window. The first 8 days corresponded to the ascending phase, then a faster phase of epidemic decrease of 7 days. Similarities emerged between the epidemic dynamics of this virus and other contaminations on cruise ships and epidemic phases on land in spite of important differences in numbers. CONCLUSIONS: This study can allow a ship's doctor to better understand the viral dynamics in case of a COVID- 19 cluster and to anticipate the exit of the crisis. Repeated tests during the active phase of the epidemic are necessary in case of a large cluster to know where to place oneself on a typical epidemic curve. Isolation and barrier measures advised by the ship's doctor remain the only weapons that can limit its magnitude.

Preliminary study after two years of use of Nausicaa system for seasickness management.

BACKGROUND: Seasickness is a set of clinical signs from which approximately 30% of the population suffers with a severity and frequency that varies according to the state of the sea and according to each individual susceptibility. The medical treatments are varied but may provide annoying side effects. Vestibular rehabilitation has all its advantages in cases of professional unfitness. The objective of this work is to validate the first results of rehabilitation of seasickness using the Nausicaa system developed at the HIA in Brest. MATERIALS AND METHODS: Retrospective study of the first 2 years of use of the Nausicaa system, from commissioning in November 2016 until December 2018. Twenty-eight patients were treated exclusively by the Nausicaa system with a minimum of 1 year of follow-up and a minimum of 90 days at sea per year. RESULTS: The average intensity of seasickness of these sailors decreased from 8.96 to 4.5 and the inability to hold one's post from 8.36 to 3.7 after 10 rehabilitation sessions using this system. The Graybiel and Miller score was markedly improved (decrease of 2 to 3 grades) in 62% of the patients, and partially improved (decrease of one grade) in 20% of the sailors. A total of 82% of rehabilitated patients were improved by this treatment without any side effects. CONCLUSIONS: The analysis of the results on a retrospective questionnaire describing clinical signs 1 year later is necessarily subjective. The use of visual analogic scales from 1 to 10 concerning the intensity of motion sickness and the inability to hold one's position seems to be an easy way to assess discomfort. The comparison with other series seems to show a slight superiority of the Nausicaa system compared to optokinetic rehabilitation or by visual simulator alone.