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Handling COVID-19 on ships
Planning and start-up of cruise/operation
Shipping companies/ companies responsible for vessels sailing along the Norwegian coast should establish a preparedness plan. The plan should include:
- A plan to ensure people do not bring COVID-19 onto the ship, including:
- Written routines for quarantine of the crew
- Written routines for giving information to and collecting information from passengers:
- Information on the ships’ COVID-19 measures
- Collection of information about possible exposure and symptoms for the past fortnight.
The shipping company should consider making agreements with ports of call to include:
- Plans for how people with symptoms, suspected or confirmed COVID-19 should be handled upon arrival.
- Plans for how suspected or confirmed outbreaks on board should be handled, including plans for isolating the sick/infected, quarantine of close contacts and whether these can be handled on land or on board.
Assessment and measures for vessels with suspected COVID-19 on board
Assessments and measures in case of illness on board are based on symptoms and information about potential exposure to COVID-19. Exposure to COVID-19 means a stay in a country / area covered by a quarantine obligation or contact with confirmed COVID-19 cases:
Anyone with symptoms of an infection should be handled as a possible case of COVID-19. You will find information about COVID-19 symptoms in the chapter When you suspect that you have COVID-19 disease
- If the person has a known exposure, the patient must be isolated alone in a cabin. The patient’s close contacts should be quarantined in separate cabins. The person with symptoms will be tested at the next port. The person and their close contacts should disembark there and be followed up by the local health and care services.
- If the person is unaware of possible exposure, they should be isolated alone in a cabin until they (passenger or crew) are examined and tested, and a negative result from a PCR test is available. The patient should be tested but can be isolated until they reach their destination port, and be followed up by the local health and care service there, if it is justifiable based on their condition.
If the health and care service considers that the patient must be followed up on land, or they have reached their destination, further isolation and follow-up can be carried out by the local health and care service
Notification of local and central authorities
The captain of a ship on an international voyage with suspected or confirmed COVID-19 on board is, according to the IHR regulations § 5, obliged to report the health status on board as soon as possible, at the latest upon arrival at the first arrival point in Norway:
- Regulations on notification of and measures in the event of serious incidents of significance to international public health. (IHR regulations - Lovdata - in Norwegian)
The duty to notify pursuant to section 5 is intended for vessels from abroad on arrival at their first point of call in Norway. Vessels that start their journey in a mainland port in Norway and only call at other mainland ports in Norway are not obliged to notify in accordance with the provision in section 5 of the IHR regulations, but are encouraged to follow the same routine.
The vessel's captain must notify the Norwegian Coastal Administration's maritime traffic centre in Vardø by telephone +47 78 98 98 98. In addition, an electronic notification must be completed at SafeSeaNet Norway. The Norwegian Coastal Administration can help the ship to notify the municipal medical officer in the relevant municipality if necessary, as well as contacting the municipal medical officer if the ship needs help to analyse samples. Notice in accordance with the IHR regulations § 4 shall be sent to the municipal medical officer in the port where the ship will land. If it is not possible to notify the municipal medical officer, the Infection Control Service at the Norwegian Institute of Public Health must be notified directly. The municipal medical officer must notify the Norwegian Institute of Public Health (and the County Governor).
Healthcare personnel on ships who are within the baseline and who suspect or confirm a COVID-19 case on board have a duty to notify pursuant to section 4 of the IHR regulations.
In connection with notification of the local health and care service, and especially if there is information about known exposure to COVID-19, it is important to discuss further handling, including whether the patient shall disembark and be followed up by the local health and care service. In addition, the need for testing and contact tracing among other passengers should be discussed.
Appropriate ports for handling COVID-19 outbreaks
In case of infection or suspected infection on board vessels that start in a mainland port in Norway and only call at other mainland ports in Norway, the ship shall follow its itinerary and seek necessary health care for handling suspected or confirmed COVID-19 outbreaks where the ship calls.
In the event of a major outbreak of COVID-19 and where the operation of the vessel may be affected, the Norwegian Directorate of Health / Coastal Administration recommend which port the ship should sail to. This will also have to take place in dialogue with the local health and care service in the municipality, represented by the municipal medical officer.
The Norwegian Directorate of Health designates which ports, airports and border crossing points are to carry out specific responsibilities in order to be able to handle serious incidents with significance for international public health. Designated ports are the ports of Oslo, Bergen and Tromsø. If the ship is relatively close to a designated port, it may, depending on the circumstances, be reasonable to expect that the vessel would sail to the designated port, see the IHR regulations § 19.
The municipality shall ensure that the designated port has access to the necessary premises, personnel and equipment during the COVID-19 outbreak. If a ship is redirected to an alternative port than planned, the municipal medical officers in the two affected municipalities should agree on how to handle the situation. If necessary, the Norwegian Directorate of Health can be contacted.
Advice to the health and care service in the municipality about handling suspected COVID-19 on ships
When there are sick people without known exposure to COVID-19 on board
- People on board ships who have symptoms of infection but do not have information on previous exposure to COVID-19 should be tested.
- Local health authorities will assess the health status and information on possible exposure, and decide on further follow-up.
- If the person does not need treatment and has not reached their destination, the person can be isolated on board until their test result is available. With a negative test result, isolation ceases. With a positive test result, isolation continues, and further follow-up is carried out as described below.
- If the person is taken ashore, the patient should be isolated in a suitable place and followed up further in accordance with the advice given in the chapter Follow-up of close contacts, quarantine and home isolation
- If the person is isolated on board and shall travel further, with a positive test result the doctor must notify the ship, the municipal medical officer / another doctor at the ship's next port of call, and the Norwegian Institute of Public Health.
When there are sick people with known exposure to COVID-19 on board
- People on board ships who have symptoms of infection and information on possible exposure to COVID-19 should be followed up by local health authorities in the relevant port (see section above on relevant ports).
- Local health authorities shall decide on further follow-up. In principle, the affected person should be isolated and followed up further in a suitable location on land.
- Based on an overall assessment, local authorities shall decide whether people in quarantine should continue their quarantine on land or on board, and whether the ship should be detained.
- This decision is based on an assessment of whether there may be an ongoing transmission on board. The municipal medical officer can consult the Norwegian Institute of Public Health.
- The ship cannot let passengers or crew disembark until this has been clarified with local authorities.
When there are confirmed cases of COVID-19 on board
On board for a short period (<1 day)
- If a person with COVID-19 has been on board for less than 24 hours during the contagious period, the situation is handled in line with follow-up of COVID-19 on public transport.
- An assessment is made of whether they were been infected while on board or whether they were infected before embarking and have been contagious during the voyage.
- If it is considered that they were infected on board, it will be necessary for contact tracing among the crew and to notify the other passengers. The Norwegian Institute of Public Health is responsible for co-ordinating the management of outbreaks that are / may be extensive and that include several municipalities or countries. Further follow-up is co-ordinated with the municipal medical officer in the port of arrival and NIPH.
- If it is considered that the person was infected before travel, but was contagious during the journey, contact tracing is performed among passengers and crew to identify who is defined as close contacts. Other passengers are notified, either directly or via a press release / web article.
- Contact tracing of close contacts is done for people who are considered to be travel companions and is relevant to other passengers and crew if the patient has used a pre-booked seat (seat or table in a defined area on the ship).
- The shipping company is contacted for a list of passengers who have had a seat booked on the affected journey, as well as a map indicating how the seats are distributed in the room.
- Passengers who have been closest to the patient and within 2 metres in all directions are defined as close contacts and are included in the contact tracing.
- In consultation with the shipping company, the municipal medical officer will assess whether crew working in the affected areas should be included in the contact tracing, and if so, follow up these by putting them in quarantine and testing them.
- NIPH can assist in co-ordinating contact tracing if it includes people who live or are staying in several municipalities.
- If it considered that the person was infected before embarking but was contagious during the journey, and it is considered likely that they had contact with several fellow passengers during the journey who cannot be identified, the shipping company should issue a warning to all passengers on the journey in question. This can be done either by text messages directly to people on the passenger lists and / or through a press release or on a website. The Norwegian Institute of Public Health can assist shipping companies with the format of text in notices or websites, and publishes information on NIPHs website.
- The ship can depart / maintain operations after an assessment of the infection situation by the municipal medical officer, unless an ongoing transmission is suspected among the crew. In that case, follow the advice below.
On board for more than 1 day or there is ongoing transmission among crew and / or passengers
- If it is considered that someone (passenger or crew) may have been infected on board the ship, the ship should sail to the nearest suitable port and be followed up by local health authorities, in consultation with NIPH.
- The ship should not travel further, and no-one should disembark (passenger or crew) without clarification from the municipal medical officer.
- Each situation is assessed individually both with regard to recommended infection control measures and restrictions or requirements from the municipality pursuant to the Infection Control Act. This should be co-ordinated with NIPH and the Norwegian Directorate of Health.