It is hard to believe that we’re almost in the summer of 2020.
Everyone is feeling the toll of uncertainty and the cumulative effects of ongoing stress from the last few months.
Our clients in the maritime industry have done an excellent job in responding to the recent challenges, and the team at Discovery Health MD is proud of our ongoing collaborative efforts and the results we’ve achieved together.
So what is actually working?
A 14-day fitness-for-duty observation period is the best tool we have for keeping a vessel COVID-19 free. You may have heard this referred to as a “quarantine” period.
To assess for the development of fever or symptoms.
An employee who develops fever or symptoms during the observation period should not proceed to travel based on a negative test alone.
The employee should instead…
- be removed from the fitness for duty assessment
- be encouraged to seek medical care, and
- if appropriate, enter a return to work strategy based on a testing or time-based strategy.
We have validated a risk reduction strategy for high-risk “Closed System” environments.
We recommend the following risk-reduction strategy for:
- Operations that allow for a period of observation before reporting to work
- Workforces that operate in medically-austere environments, where introducing disease to local communities would be catastrophic or where the nature of the worksite would make stopping the spread of disease difficult
Process for Closed Systems
- All employees undergo a 14-day period of observation before reporting for work, at home or in a supervised setting. Preventing further potential exposure to the virus and observing for the development of fever or symptoms is the goal.
- The 14-day period includes testing for the virus with a highly-accurate validated test. PCR nasal swabs are an example of such a test. Testing could occur once, twice, or three times during this period. The role of antibody testing is not known at this time. If antibody testing is incorporated into a fitness for duty program, seek guidance which types of tests are appropriate. Fingerstick antibody tests are not recommended at this time.
- The employee reports to work with ongoing twice daily symptom and temperature monitoring at the end of the observation and testing period, if…
- the employee does not develop fever or symptoms
- the employee has negative PCR tests
“Aleutian Spray Fisheries and some other fishing companies have hired Discovery Health MD, a Seattle-based firm with long involvement with the maritime fleet, to conduct two rounds of shore-side screening at the beginning and end of quarantines. The protocol administers swab tests that identify active cases of COVID-19 as well as antibody tests that may indicate if a person previously was exposed to the virus that causes the disease.”Trawl fishing in the age of the coronavirus: First, you make it through quarantine – The Seattle Times
Over the past month we have found a 2% PCR positive rate at the beginning of the observation period, with a 2.5% PCR positive rate at the end.
All these cases claimed to be asymptomatic.
We obtained Venous IgG serology tests at the beginning and end of the observation period. Our theory was that a trend from negative to positive could identify a subacute, but still infectious case. Only one out of about 1000 tests demonstrated this pattern.
The utility of serologic tests in the fitness for duty process is still undefined.
Of almost 20% of the employees who participated in this process, surveillance testing demonstrated all negative PCR tests at 2-3 weeks after completion of the isolation and testing period.
Based on our data, we now believe that the above process offers the greatest risk reduction for high-risk Closed Systems.
What About Ongoing Testing?
There is not yet a defined role for surveillance testing of asymptomatic workers.
There is Still More To Learn
So much is still unknown about COVID-19, and there’s much uncertainty around how to safely return people to work. We have, however, made great strides in our understanding of the importance of a 14-day observation period to identify symptomatic workers, and testing to identify asymptomatic but infectious workers.
The lessons we’ve learned while devising closed-system fitness-for-duty algorithms may apply to open systems as well, with some modifications.
Discovery Health MD and our partners continue to find solutions for these challenges in the Maritime Industry and beyond.
We look forward to working with you to keep your crews & employees safe and healthy.