Interim Guidance for Ships on Managing Suspected or Confirmed Cases of Coronavirus Disease 2019 (COVID-19) | Quarantine




Key Concepts

  • Preventive measures, including hand hygiene, social distancing, and wearing facemasks or cloth face coverings, are essential to maintaining ship operations during the COVID-19 pandemic.
  • After a COVID-19 case is identified on a non-cruise ship, all persons on board are considered contacts because of the close living and working conditions. Due to the size and number of persons on board cruise ships, identification of contacts should be done on a case-by-case basis.
  • Cleaning and disinfection protocols may reduce transmission of COVID-19 on ships.

Who this Guidance Is for

This document provides guidance for ships originating from or porting in the United States to help prevent, detect, report, and medically manage suspected or confirmed COVID-19 cases. As ships travel worldwide, ship management and medical staff need to be aware of and respond to local jurisdictional requirements. Important points to be aware of:


1 All commercial, non-cargo, passenger-carrying vessels operating in international, interstate, or intrastate waterways and subject to the jurisdiction of the United States with the capacity to carry 250 or more individuals (passengers and crew) with an itinerary anticipating an overnight stay on board or a twenty-four (24) hour stay on board for either passengers or crew

Purpose

This document provides guidance for preventing the spread of COVID-19 during and after a voyage, including personal protective measures, management of sick or exposed persons on board, reporting suspected or confirmed cases, and cleaning and disinfection recommendations for common areas on the ship and areas previously occupied by individuals with suspected or confirmed COVID-19.

CDC will update this interim guidance for ships as needed and as additional information becomes available.

Plans to Mitigate COVID-19 on Board Ships

Ship companies should develop, implement, and operationalize an appropriate, actionable, and robust plan to prevent, mitigate, and respond to the spread of COVID-19 on board ships. CDC’s Interim Guidance for Businesses and Employers Responding to COVID-19 provides ways to prevent workplace exposures to COVID-19.  Plans should include the following components:

  • Training of all crew on COVID-19 prevention and mitigation
  • Onboard monitoring of crew and non-crew for signs and symptoms of COVID-19
  • COVID-19 testing (onboard or onshore)
  • Onboard isolation, quarantine, and social distancing
  • Adequate medical staffing (this can include telehealth or telemedicine providers)
  • Maintaining sufficient quantities of Personal Protective Equipment (PPE), oxygen, and other supplies and the ability to obtain additional resources, if needed
  • COVID-19 outbreak management and response information
  • Medical arrangements for onshore evaluation and hospitalization
  • Screening of embarking or disembarking crew and non-crew
  • A system to notify respective national, state, and local public health authorities

Pre-Boarding Procedures for Ships

Before boarding, conduct verbal or written screening in appropriate languages and in a private environment to determine whether persons have had signs or symptoms of COVID-19 or a known exposure to a person with COVID-19 within the past 14 days. In addition, temperature checks should be used to identify any person with a temperature of 100.4°F or greater. Deny boarding of a crew member or non-crew member who is suspected of having COVID-19 because they have symptoms, a temperature of 100.4°F or greater, or have had known exposure to a person with COVID 19 within the previous 14 days. Because the virus that causes COVID-19 can spread from persons without symptoms, ship operators should consider having embarking crew quarantine for 14 days immediately before or upon boarding the ship to prevent introduction of the virus on board.

Preventive Measures for Ship Operators

Shipping involves the movement of people from different geographic areas in settings with inevitable close contact. Like other close-contact environments, ships may facilitate transmission of respiratory viruses from person to person through exposure to respiratory droplets or contact with contaminated surfaces.

To reduce spread of respiratory infections including COVID-19, CDC recommends that ship operators take the following actions:

  • Educate all persons on board about the signs and symptoms of COVID-19.
  • Assign crew to single-occupancy cabins with private bathrooms, if possible.
  • Implement social distancing of persons when working or moving through the ship (maintaining at least 6 feet [2 meters] from others).
  • Instruct persons to wear a facemask or cloth face covering when outside of individual cabins (unless work duties prevent their safe use or necessitate personal protective equipment for hazardous reasons).
  • Modify meal service to facilitate social distancing (e.g., reconfigure dining room seating, stagger mealtimes, encourage in-cabin dining).
  • Eliminate self-serve dining options at all meals.
  • Minimize shore leave; if shore leave occurs, preventive measures are recommended.
  • Discourage handshaking and instead encourage the use of non-contact methods of greeting.
  • Promote hand hygiene and cough etiquette.
  • Place hand sanitizer (containing greater than 60% ethanol or 70% isopropanol) in multiple locations and in sufficient quantities to encourage hand hygiene.
  • Ensure handwashing facilities are well-stocked with soap, paper towels, and a waste receptacle, or air dryer.
  • Place posters that encourage hand hygiene and social distancing to help stop the spread in high-trafficked areas.
  • Educate workers that use of cigarettes, e-cigarettes, pipes, or smokeless tobacco can lead to increased contact between potentially contaminated hands and their mouths, and that avoiding these products may reduce their risk of infection.

Preventive Measures for Persons on Board the Ship

Persons without symptoms should do the following to protect themselves and others:

CDC has free, simple posters available to download and print, some of which are translated into different languages. The Stop the Spread of Germs poster pdf icon is available in Amharic pdf icon, Arabic pdf icon, Burmese pdf icon, Dari pdf icon, Farsi pdf icon, French pdf icon, Haitian Creole pdf icon, Kinyarwanda pdf icon, Karen pdf icon, Korean pdf icon, Nepali pdf icon, Pashto pdf icon, Portuguese pdf icon, Russian pdf icon, Simplified Chinese pdf icon, Somali pdf icon, Spanish pdf icon, Swahili pdf icon, Tigrinya pdf icon, Ukrainian pdf icon, and Vietnamese pdf icon.

Symptomatic Persons on Board the Ship

Identifying and isolating persons with possible symptoms of COVID-19 as soon as possible is essential to minimize transmission of the virus. Educate crew to watch themselves for symptoms of COVID-19. Sick persons should self-isolate immediately and inform the Captain or medical designee if they develop a fever (100.4°F / 38°C or higher), begin to feel feverish, or develop acute respiratory symptoms (cough or difficulty breathing) or other symptoms of COVID-19.

Ship medical personnel and telemedicine providers should reference CDC’s COVID-19 website, Information for Healthcare Professionals, for the latest information on infection control, clinical management, collecting clinical specimens, evaluating patients who may be sick with or who have been exposed to COVID-19, and identifying close contacts. On non-cruise ships, all crew members are considered close contacts if a person with known or suspected COVID-19 is on board or disembarked within the past 14 days.

Isolation of Sick Persons or Confirmed Cases and Quarantine of Close Contacts

Persons with symptoms of COVID-19 should be isolated using the same guidelines as a person with confirmed COVID-19 until COVID-19 testing can be conducted and results are available. All persons on board should be educated on and aware of the emergency warning signs for COVID-19. Quarantine of persons without symptoms who are identified as close contacts of sick persons (until COVID-19 test results are available) or confirmed cases is also needed to minimize on board transmission of SARS-CoV-2, the virus that causes COVID-19. On non-cruise ships, all crew members are considered close contacts. Please see table below for quarantine options for crew on non-cruise ships.

  • Isolate or quarantine persons in single-occupancy cabins, with private bathrooms, with the door closed, if possible. Persons should wear a facemask or cloth face covering any time they are outside of isolation or quarantine.
  • Isolated or quarantined persons should have no direct contact with other persons except for medical designee.
  • Designated ship medical personnel or other personnel should wear proper personal protective equipment (PPE) when in proximity to isolated or quarantined persons. Breaches in PPE or any potential exposures should be reported to the appropriate medical designee.
  • Meals should be packaged in disposable dining ware with single-use cutlery and delivered to individual cabins with no face-to-face interaction during this service.
  • To the extent possible, cabins housing isolated or quarantined persons should not be cleaned by other persons. Supplies such as paper towels, cleaners, disinfectantsexternal icon, and extra linens can be provided to isolated or quarantined persons so they can clean their own cabin as necessary.
  • Food waste and other garbage should be collected and bagged by the isolated or quarantined person and placed outside the cabin during designated times for transport to the garbage/recycle room for incineration or offloading.
  • Soiled linens and towels should be handled by the isolated or quarantined person and placed outside the cabin in labeled bags during designated times for transport to the laundry room.

Options for Managing Non-Cruise Ships with One or More Confirmed Cases of COVID-19

The following table provides management options for non-cruise ships and their crew after a confirmed case of COVID-19 is identified. Decisions regarding the best option for managing an individual ship and exposed crew on board should take into account various factors (e.g., the industry, seaport location, itinerary, and the availability of alternate crew).

Note: The ship should be allowed to come into port for all disembarkations, disinfection, and embarkations. There is an increased safety risk, to the crew and port partners, associated with embarking or disembarking a ship while at anchorage (i.e., keeping the ship at sea). In addition, quarantine of crew while the ship is at anchorage can be difficult due to the increased number of essential crew needed to safely maintain ship operations at anchor (i.e., operations are minimized on a ship while it is at a dock, which allows crew to quarantine more safely).

Options for Managing Non-Cruise Ships with One or More Confirmed Cases of COVID-19
  Recommendations for Non-Cruise Ships and Crew
Option 1: Crew Change Out
  • All crew disembark for 14-day shoreside quarantine*
  • Private company disinfects ship, then
  • New crew embark ship to resume operations
Option 2: Working Quarantine
  • Onboard 14-day “working” quarantine¥ of all crew without signs or symptoms
  • Crew or private company disinfects ship
  • Ship operations resumed with ship remaining close to shore (for potential medical evacuations of crew)
  • Any symptomatic crew to be isolated in their cabins§
Option 3: Temporarily Discontinue Operations
  • Onboard 14-day quarantine of non-essential crew
  • “Working” quarantine¥ of essential crew without signs or symptoms
  • Crew or private company disinfects ship
  • Ship operations suspended (i.e., ship stays at dock, berth, or anchorage)
  • Any symptomatic crew to be isolated in their cabins§

* Approval for quarantine facility required from local health department.

¥  For a “working” quarantine, follow the CDC Critical Infrastructure Guidance. Crew who have been exposed to COVID-19 but remain without symptoms may continue to work, provided they adhere to additional safety precautions.

§ If emergency medical evacuations are needed, U.S. Coast Guard (USCG) and/or Customs and Border Protection (CBP) should be notified.

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