The present pandemic of Covid-19 continues escalating rapidly, and it seems that there is little that will prevent further spread other than stringent restriction and social distancing control.

Unfortunately, there is nothing that can be done in terms of treating the virus directly, and there is no accurate test for the virus that can be performed outside hospital.

However, there are two practical things that can be done to mitigate the risks presented by Covid-19:

• Early identification of ‘Red Flag’ symptoms and signs that may indicate the onset of disease caused by Covid-19;

• Early oxygen therapy whilst arrangements are made for transfer to a medical facility.

Early identification of ‘Red Flag’ symptoms and signs

The most serious complication of Covid-19 infection is shortness of breath and subsequent respiratory failure. Identifying any deterioration at an early stage will enable timely and effective introduction of supportive measures, and planning for transfer to a definitive medical facility in good time.

This is all about knowing about ‘Red Flags’ – and spotting them early. The main ones are an increased respiratory rate, lowered oxygen blood levels, and raised temperature.

The new edition of the Ship Captain’s Medical Guide for the MCA , which was published in the autumn of 2019 provides some good reference points. An underlying principle of the new guide are algorithms to guide immediate targeted  treatment, incorporating Red Flags as part of recognising serious medical and trauma problems early.

The algorithms for Shortness of Breath (p26), and also Infections & Sepsis (both pertinent for Covid-19 infections) (pg40)

Commonly- asked questions

• How can I get protective and hygiene equipment?  As you will no doubt have gathered from the media; all items are in very short supply and in high demand. Governments and hospitals have complete priority of supply. Suppliers have hiked up prices considerably and so sourcing remains very challenging. 

• Vaccination? You will also have heard that several vaccines are being developed. These will become available towards the end of the year, so some time away yet. Again, they are not 100% effective, but will be worthwhile to have once available.

• Feeling unwell? if you have a fever, persistent cough, short of breath and perhaps a loss of taste or smell, either contact your  telemedical support service, or a local hospital for further assessment. 

• Testing & Covid-19 testing kits? A rather complex subject, and no completely straightforward answer. But as a starting point, no test is completely 100% accurate.

In terms of C-19 testing, there are two main types:

• PCR – based on nasal and throat swabs. Accuracy 70-80% or so. Based on viral load, so comes positive reasonably quickly (say within ten days or so), but may be falsely negative if the test is done too early. Laboratory-based testing.

• Immunoglobulin (usually IgG) – a rapid test, with variable results. Becomes more reliable after a couple of weeks or more after the onset of symptoms. So a bit delayed. Some labs are claiming great accuracy, which may be the case, but that is some weeks after the onset of symptoms.

PCR Testing can be arranged – Swabs would need to be sent to the yacht, you would need to take the samples and then send back to a laboratory, where they would be tested. Before an individual is tested, they would have to be in isolation for at least a week beforehand.  And as I mentioned above, still not 100% accurate.

Most labs will only test people who are symptomatic, rather than just screening, and obviously tests remain in short supply.  As you will have read in the media, the UK Government has yet to use a point-of-care test (an IgG based test) due to doubts about efficacy, with good reason. IgM tests are reported to be quite unreliable.

• Antibody testing – This is a blood test and not intended to identify an infection but only confirms that you have had the coronavirus even if you have never felt sick and usually only 3 weeks later.  So an antibody test will determine if you have been infected but not if you have developed immunity and for how long after an infection.  These are questions that experts are still seeking answers for and until then we won’t really know the true value of having antibodies.

Managing crew and eventually owner/guests movements

This presents significant logistical problems for yachts with crew rotation programs and crew and or guests returning to the yacht. In time, there will be a point-of-care test, but any such test will not be 100% accurate, and will always be subject to the exact point in the disease process when the test is performed.

In terms of a quarantine period of 14 days, this is more or less the accepted period internationally, but there is certainly evidence that a small number of people may become symptomatic after this period. So continual surveillance is always going to be a mainstay of good care on board.

A certain way of reducing risk is to reduce crew turnover, and limit contact on/off the vessel. Easy to say but difficult to put in to action.

www.msos.org.uk