By David Best, Director of Public Health

In the book The Old Man and the Sea, Ernest Hemingway wrote, “Now is no time to think of what you do not have. Think of what you can do with what there is.” Wise words, indeed, and perhaps advice that many maritime executives might consider in these uncertain times as they seek solutions to the undeniable question of the day: How can we best protect the public health and safety of those on board our ships?

Undoubtedly, we are living through a challenging period, but ingrained in nearly all challenges are opportunities for renewal and transformation. The good news for the maritime industry is the wheel doesn't necessarily need to be reinvented. While specific maritime segments might be oceans apart, they do share the same seas. There is ample opportunity to leverage the experiences, protocols and solutions implemented on cruise ships to help mitigate the risk of infectious disease transmission on all vessels.

Gains & Losses - COVID's Impact on the Maritime Industry

The public health impact that COVID-19 has had on society is unfathomable. With 260 million cases worldwide and counting, and over 5.1 million deaths, its legacy for future generations is guaranteed. Twenty-four months after the novel virus was first identified in the Chinese city of Wuhan, physical distancing, face masks, and vaccine certificates have become the norm. The financial repercussions have been extreme with the cruise industry feeling its blunt force. Losses are measured to the tune of $25 billion in 2020 with over $60 billion in debt reported by operating lines in the first quarter of 2021 alone.

Some maritime verticals have fared better than others. For example, the pandemic has opened the yachting landscape to a whole new wave of owners and charterers. Every size sector is witnessing growth with demand fueled in part by the culmination of a desire to be in a healthy and safe environment surrounded by people one cares about. Within the container shipping market, this year stimulus-induced consumer spending on retail goods has seen carriers desperate to get hold of additional ships. Q1 2021 was the busiest first quarter on record, with volumes reaching 42.9m TEU, a 10.7% increase on Q1 2020.

The sense of perceived public health risk in these industries is understandably different than it is for cruise ships; however, it is worth remembering that infectious microorganisms rarely make such distinctions on where to strike next. Correlations can be drawn to the cruise sector when taking into consideration prospective public health measures that could be scaled and applied to address actual risk. When it comes to maritime public health, cruising has the weight of history behind it.

The Whole of Maritime Public Health

What exactly does "public health" mean in this context? In 1975, the United States’ Centers for Disease Control and Prevention (CDC) established the Vessel Sanitation Program (VSP) as a cooperative endeavor with the cruise ship industry to prevent the introduction, transmission, and spread of communicable diseases into the US from a foreign country. A communicable disease is an infectious illness caused by the direct effect of a pathogen—a bacteria, virus, fungi, or parasite—that is capable of being spread from person to person through direct or indirect modes of transmission. Forty-six years later, the VSP Operations Manual is still the standard-bearer for cruise ship public health regulation worldwide.

As a result of media coverage throughout the pandemic, terminology such as health screening, surveillance, isolation, and quarantine are understood by most, if not all, while the whole of maritime public health encompasses much more than this.

1. Food safety, for example, is a huge component. Robust food safety protocols are critical to the success of any public health program. There are more than 250 foodborne illnesses that are the product of bacteria, viruses, parasites, or chemical contamination. An estimated 600 million people worldwide become sick after eating contaminated food and approximately 420,000 die every year. Foodborne outbreaks are well documented in the cruise industry (think Norovirus) due, in part, to specific communicable disease reporting requirements. However, it’s a fallacy to believe they are confined only to large passenger vessels. Cases of Acute Gastroenteritis (AGE) can be as serious on a yacht or a container ship, where a large outbreak within a smaller population could potentially threaten the continuation of a voyage.

2. There has been a dramatic increase in waterborne disease outbreaks associated with Recreational Water Facilities (RWFs) such as swimming pools, hot tubs, and whirlpools in recent decades. Various illnesses may be acquired causing diarrhea or skin, ear, eye, and upper respiratory infections. A reduction in disinfectant residual in these environments can provide opportunistic pathogens a chance to multiply to unsafe levels with other would-be infections occurring due to poor design or inadequate water quality and treatment. Consequences related to improper management of controls are also common. Effective water quality balance is essential to optimize the disinfection process and to protect equipment from corrosion.

Due to the presence of organic matter and elevated temperatures, hot tubs and whirlpools are often an ideal habitat for the proliferation of bacteria such as Legionella spp. while other equipment such as shower heads and air conditioning systems also present risk. Legionnaires’ disease is a potentially fatal type of pneumonia, contracted by inhaling airborne water droplets containing viable Legionella bacteria. Prevention is the best control. This can be achieved by properly maintaining all pipe work and tanks and ensuring there are no opportunities for water stagnation in your system. All taps and outlets should be regularly flushed, at least weekly. Hot water should be heated to at least 60°C (140°F) and distributed at 50°C (122°F) or higher, with cold water ideally stored and distributed below 20°C (68°F). Shower heads should be periodically cleaned, descaled and sanitized, with biofilm dispersant treatment carried out in Recreational Water Facilities such as whirlpools and hot tubs. It is well known that Legionella bacteria selectively grow under layers of biofilm, so keeping water systems biofilm free is of obvious importance.

3. A multi-layered approach to communicable disease prevention is always recommended. Risk management understands that all risk cannot be completely eliminated, but with appropriate contingency measures established, it can be substantially reduced. Having redundant layers of protection provides additional mitigation in the event any one particular strategy is not as effective or properly implemented as expected. Early detection of issues and contingency arrangements are paramount to reduce the risk while understanding what is operationally feasible and practical to implement is equally important. If mitigation strategies cannot be fully executed, they will not be as successful.

Broad Spectrum Public Health Policies

The importance of crew within maritime industries cannot be understated: crew retention is a principal consideration for most companies. It's not just about paying higher salaries; it's about incorporating an investment in crew sustainability programs to deliver tangible gains across the board. When implementing wide-ranging public health protocols, take responsibility for the health and wellbeing of staff. This easily translates into improved health and safety onboard which promotes a more engaged crew. Furthermore, it results in cost savings through minimized losses associated with absenteeism and “presenteeism” (working while ill) and, critically, a reduction in communicable illnesses. From the public health perspective, crew consideration is a principal objective behind the execution of effective and sustainable protocols.

Implementing broad-spectrum public health policies established today on cruise ships would neither be suitable nor necessary in all maritime sectors, but there are clear benefits to integrating lessons learned from it and other “concierge” industries. Consider how the airline industry managed to evolve their attitude towards risk management, switching from a reactive approach to a proactive one. There is opportunity in other industries’ experiences to all maritime businesses with the importance of creating a safety culture within an organization as critical.

This is where a company like VIKAND provides support. We anticipate and manage global medical and public health service solutions for the entire maritime industry, including cruise, yacht, superyacht, commercial shipping, fishing, and energy sectors. Our proven expertise and experience are demonstrated through a proactive and evidence-based approach, something we call the VIKAND Total Healthcare Solution which is coordinated with global regulatory agencies and industry associations. To learn more about how a partnership with VIKAND could work for you, click here.

In The Old Man and the Sea, Santiago also said, “Every day is a new day. It is better to be lucky. But I would rather be exact. Then when luck comes you are ready.”