IMPACT OF COVID-19 AND OTHER VIRAL OUTBREAKS ON BOARD SHIPS

Introduction

On 12 March 2020, the World Health Organization (WHO) declared that the ongoing COVID-19 outbreak was a pandemic[1]. Two significant concerns were — and remain — first, the speed and scale of transmission, and second, the evidence-based belief that some countries were not handling the threat with the desired level of political commitment.^[2]

With reports having emerged of a few members of the crew of more than one US warship being infected with COVID-19, the question of the degree to which warships and merchantmen are vulnerable to this viral disease has become a pressing one.  This article addresses this question.

COVID-19 cases on board Warships

Conventional wisdom appears to be that warships are especially vulnerable to the spread of viral infection, due to the density of manpower on board, and, the constricted workspaces that are characteristic of such ships.  On 13 March 2020, a sailor on board the US Navy’s Amphibious Assault Ship, the USS Boxer(LHD 4), was declared ’Presumptive Positive‘ for COVID-19, making this the first case of a sailor on a warship being infected by Severe Acute Respiratory Syndrome Coronavirus-2 (SARS-CoV-2), as the virus is formally known[3]. The Boxer, a WaspClass warship of the US Navy, which was, at the time, berthed at the Naval Base in San Diego, California, has an estimated complement in excess of 1,200 personnel.^[4] As per more recent updates, on 24 March 2020, eight sailors aboard the aircraft carrier USS Theodore Roosevelt, too, have tested positive for COVID-19, making this the first COVID-19 case aboard a warship on active deployment.  Those infected are being airlifted, while those suspected, have been quarantined.[5]  The Theodore Rooseveltis the centerpiece of one of the US Navy’s Carrier Strike Groups (CSG).  This particular CSG comprises the aircraft carrier itself, along with the USS Bunker Hill(a Ticonderoga Class guided-missile cruiser with a crew strength of 330 (30 officers and 300 sailors), and three Arleigh Burke Class guided-missile destroyers: the USSRussell, the USS Kiddand the USS Rafael Peralta, each of which have a crew-complement of about 325 (25 officers and 300 sailors).  Thus, the number of naval personnel in the CSG as a whole would be in the region of 2,500 individuals.  During its ongoing deployment, the CSG made a port-call at Da Nang, Vietnam.  It is not yet confirmed whether or not the infected members of the crew came in contact with other crew members of the CSG while in port.  That answer, important as it is, is perhaps less relevant than the answer to the question of how warships — including those of the Indian Navy — deal with viral infections such as this one.  It is also important to compare this infection rate of the CSG with the cruise-ship Diamond Princess, which was quarantined in Yokohama after an outbreak of COVID-19 amongst its 3,711 passengers and crew.  More about this later in this article.  At this juncture, it would suffice to remember that unlikemerchant ships (including cruise-liners), which perform a single port-to-port logistic function, warships are required to discharge multiple roles that include, inter alia, warfighting, constabulary functions, disaster response, diplomacy, search-and-rescue, to name just a few.  A warship is required to respond to multiple challenges and threats in a single mission or sortie, often simultaneously.  It is packed with many different types of equipment, including, in many cases, fixed-wing and rotary-wing aircraft, each manned by a number of experts.  Hence, warships have severe space constraints, making it difficult for people onboard to maintain the requisite social distance.

Moreover, warships, unlike their merchant marine counterparts, are designed to operate in environments contaminated by nuclear and/or biological and/or chemical agents.  In the instant case, of course, focus needs to be retained on ‘biological’ safeguards.  In general, the several vertical segments (decks) and horizontal segments (‘compartments’ or ‘spaces’) of a warship are capable of being sequentially isolated from one another through a system of watertight and/or gastight ‘walls’ (bulkheads and the ship’s side), doors and hatches.  A group of such watertight ‘compartments’ and/or ‘decks’ that can be completely isolated from the external environment is known as a ‘citadel’ and warships, depending upon their size and complexity, may have one or more ‘citadels’. Entrance-into and exit-from the citadel is controlled by specifically designed ‘airlocks’.  Thus, an individual seeking ingress into a given citadel, who may have been contaminated by the contaminants prevalent in the environment that is external to the citadel, will first enter an airlock, undergo a repetitive cycle of ‘monitoring’ and ‘cleansing’ until he or she is declared free of contamination and only then will ingress into the citadel be permitted. This is done by adopting Standard Operating Procedures (SOPs) for a ‘lockdown’, which, in naval terminology, is known as imposing/adopting a ‘Gastight Condition’. There are grades of severity of such a ‘lockdown’ and these translate to different gastight conditions.  In the Indian Navy, these are usually two — Condition ALPHA and Condition BRAVO, the former promulgating a more severe ‘lockdown’ than the latter.  Two questions now arise.  First, what if the contaminant has already entered the citadel before the lockdown could be imposed/adopted?  Second, does the warship have the necessary monitoring and cleansing capacity and capability for the biological agent in question?

The relevance of the first question stems from the fact that an infection from the SARS-CoV-2 may not manifest itself in any discernible symptoms for quite a few days and, hence, the carrier of COVID-19 and potential victims who may contract the disease from the former might both already be within the citadel. The second question could well related to the first, since if the citadel has already been breached, the monitoring and cleansing cycles are rendered ineffective. It would, however, be premature and imprudent to dismiss the importance of the questions, because it is certainly not necessary that the transmitter of the disease is already inside the citadel, and, if he/she is not, then the monitor-cleanse-monitor procedures within the airlocks become very important.

Will the outbreak of the COVID-19 disease within an Indian warship that is at sea and on a mission-based deployment render the warship incapable of discharging its primary mission?  The answer is probably a ‘No’, because although it is very difficult to quarantine more than a very small number of afflicted individuals on board a ship by socially distancing them, all major Indian Naval warships (certainly frigate-sized and larger ones) carry highly-trained medical personnel on board and are equipped with medical facilities of varying complexity.  Large ships such as aircraft carriers and fleet-replenishment ships have fairly extensive facilities available in dedicated onboard hospitals, while smaller warships will certainly have a ‘sickbay’ capable of handling battle-casualties.  Moreover, all Indian warships have elaborately-detailed SOPs for rapid and significant expansion of their medical facilities by ‘requisitioning’ pre-designated mess-decks (living spaces).

In the above context, it is pertinent to recall a 2017 case of an outbreak of H1N1 aboard an Indian Naval warship.  Over a three-week period in June of 2017, 21 patients sought treatment at sickbay of a single warship of the Indian Navy.  Of these 21, swab-tests of 14 turned out to be positive for Influenza A (H1N1).  Effective Standard Operating Procedures relating to preventive and containment measures were instituted on a war footing and the outbreak was controlled within 14 days. The majority of the cases responded well to treatment and attained disease-free status without developing any complications.[6]  The subsequent report unsurprisingly highlighted the fact that controlling the spread of the H1N1 influenza outbreak in the confined environment of a warship was a challenging, but it also reinforced the fact that the Indian Navy was well equipped and adequately well-trained to be able to rapidly implement effective preventive measures.

Merchant Shipping

Taking cognizance of the threat posed by the pandemic to the shipping industry, the International Maritime Organization (IMO), which is a specialised agency of the United Nations that is responsible for shipping, is making concerted efforts to ensure uninterrupted shipping operations.  The IMO Sectary-General, Mr Kitack Lim, has stated that, “In these difficult times, the ability for shipping services and seafarers to deliver vital goods, including medical supplies and foodstuffs, will be central to responding-to and eventually overcoming this pandemic.”[7] In compliance with WHO recommendations, the IMO has promulgated guidelines on the precautions to be taken to minimise the risk to seafarers, passengers, and others aboard ships, from COVID-19.  For example, IMO Circular Letter Number 4204/Add 3 dated 02 March 2020 on, “Operational Considerations for Managing COVID-19 Cases/Outbreaks on board Ships”, provides guidelines to all authorities involved in the public-health response to COVID-19, and these are being implemented on board merchant ships.

A case in point is the COVID-19 outbreak that occurred on the Cruise Ship Diamond Princess. The was quarantined in Yokohama, on 05 February 2020, for nearly a month, with about 3,700 passengers and crew on board.  As per updates, around 700 people have been infected, with the death toll reaching eight.[8] At least 25 other cruise liners have confirmed COVID-19 cases — including 78 cases on the Grand Princess, which was quarantined off the coast of California.[9] After the consequent issue of travel advisories and warnings against cruise-ship travel, many cruise-ship companies have suspended operations.  Paradoxically, however, these vessels, especially the Diamond Princesshave provided healthcare researchers and professionals with a rare opportunity to understand features of the new coronavirus that are hard to investigate in the wider population, where only some people — typically those with severe symptoms — are tested and monitored.[10]  “Japanese officials performed more than 3,000 tests on the Diamond Princess, starting with older passengers and those with symptoms. Some passengers were tested more than once, offering insight into the virus’s spread over time. Testing almost all of the passengers and crew helped researchers to understand a key blind spot in many infectious-disease outbreaks — how many people are actually infected, including those who have mild symptoms or none at all. These cases often go undetected in the general population.  A major finding of experts who have analysed theDiamond Princessdata, concerns the effectiveness of the stringent quarantine measures that were introduced, in reducing the virus’s spread.  On 05 February 2020, the day the quarantine was introduced, one person could go on to infect more than 7 others, largely because people were living in close quarters and touching surfaces contaminated with the virus.  However, once the crew and passengers had been quarantined in their rooms, the average number of others to whom one infected person passed the virus dropped below one, thereby providing robust evidence that ‘quarantine’ is, indeed, effective.[11]

Other than cruise-liners, merchant ships generally have very small numbers of onboard staff (crew).  The large size of merchant ships per semeans that there is far more space available per human being on board, than there is aboard a warship. At first glance, therefore, merchant ships might be expected to be better placed to handle an onboard outbreak of COVID 19.  On the other hand, the crew of a merchantman (other than a cruise-liner) will seldom, if ever, include a fully-trained and experienced medical officer along with the requisite support-staff.  The ship’s Chief Officer is expected to handle medical emergencies on board, but has only a very basic level of medical competence and experience.

Involvement of the Indian Armed Forces in Evacuation and setting up Quarantine Facilities as an Internal-Security Response

With the global number of COVID-19 cases approaching 650,000, most countries have scaled up their efforts and even pressed their armed/defence forces into action.  For their part, the Indian Defence Forces have been proactive in rendering assistance to the National and State authorities in the fight against COVID-19.  For instance, the Indian Air Force has evacuated Indians and foreign citizens from countries such as China and Iran.  One batch of these evacuees was quarantined in naval facilities at Mumbai, while a second batch (including 234 Indians was brought to Jaisalmer and quarantined at the Indian Army Wellness Centre.^[12]  Likewise, army field-hospitals are being constructed using equipment used in combat zones.  The Vice Chief of the Naval Staff recently provided an excellent overview of the commendable performance of the Indian Navy in combating the COVID-19 disease. Speaking in a television interview[13]on the NewsX TV News Channel, the Vice Chief mentioned that amongst other steps, the Indian Navy had set-up quarantine facilities and isolation wards, for use by uniformed personnel and their families as well as by civilians in its hospital-establishments in all three naval commands — not just in the cities where the command-headquarters are located, but in outlying units, too.  The countrywide shortfall of surgical-masks is being ameliorated by mass-production of high-quality masks by the several tailoring units under the Naval Wives Welfare Units, and a naval aircraft was used just a couple of days ago to rush 60,000 face-masks from Delhi to Goa for use by civilian healthcare workers.[14]  Likewise, naval aircraft are being used to airlift doctors to Pune, to receive training at Pune’s virology centre.  India’s ability to respond to the global pandemic hinges on the efficiency and wellbeing of its armed forces.

Naval Preparedness for Biological Warfare

There has been some speculation on social media that the SARS-CoV-2 virus is a manmade product of biological research, even if it was not intended to be an actual weapon for biological-warfare.[15]  This, however, has been debunked by more reliable research-findings such as those of the Scripps Research Institute.[16]  This notwithstanding, the fact that the virus has struck naval personnel aboard warships that are on active deployment serves to re-focus attention on the defensive measures that warships can and do adopt against biological-warfare threats. Although the exact contours of the Indian Navy’s capabilities in this regard are largely classified, substantial ‘general’ information is, indeed, available in the public domain.  For instance, the report of the committee formed in 2004 by the ‘Naval Studies Board’ of the USA’s ‘National Research Council’, which was mandated by the US Chief of Naval Operations (CNO) to examine the defensive capabilities of naval forces against chemical and biological warfare threats offers invaluable research-insights.[17]

As far back as 2001, it was already widely acknowledged that biological weapons are potentially comparable to nuclear weapons in the scale of damage they might do.[18]  And yet, there appears to be some reluctance in acknowledging that defensive measures in warships against biological agents is not a contemporary priority, but one that can be tackled in slow time.  This reluctance might possibly have to do with the fact that India is a ratifying party to the ‘Biological and Toxin Weapons Convention’ (BTWC), which came into force on 26 March 1975, and that as many as  183 States — including China and Pakistan — have ratified or acceded to the treaty.[19]  The COVID-19 incidents aboard US Navy warships could, therefore, be considered to be a timely and useful wake-up call.  This notwithstanding, a number of countries do have ostensibly ‘defensive’ research as ongoing activity.  Moreover, the relative ease of acquiring a biological weapons capability as opposed to a nuclear-weapons one — even by malevolent non-State actors — is something that cannot be forgotten.

Although the claim that the SARS-CoV-2 virus may be a biological weapon is entirely unsubstantiated, the almost total unpreparedness of India’s mercantile marine to withstand any form of Chemical, Biological, Radiological and Nuclear (CBRN) attack — including by malevolent non-State actors is something that needs to be addressed at a policy level.  On the one hand, Indian defence laboratories of the Defence Research and Development Organisation (DRDO), such as the Defence Research and Development Establishment (DRDE) and the Defence Bio-Engineering and Electro Medical Laboratory (DEBEL), working in tandem with a few Indian private-sector industries such as Larsen & Toubro, have developed equipment for the detection of microorganisms and hazardous chemicals, also for protection and decontamination against these hazards.[20] Much of this equipment is capable of being installed aboard warships as well as merchantmen.  It is pertinent to mention that the Indian Navy, inaugurated a Nuclear, Biological and Chemical Training Facility (NBCTF), named Abhedya, which is a Sanskrit word meaning ‘Impenetrable’, at its premier engineering-training establishment, INS Shivaji, in Lonavala, in March of 2019.[21] Given that there are several privately-owned training centres of the merchant marine in the immediate proximity of INS Shivaji(e.g., the Tolani Maritime Institute, the Samundra Institute of Maritime Studies, etc.) and some more in the neighbouring city of Pune, perhaps the Navy could contribute towards enhancing the preparedness of at least some segments of India’s mercantile marine.  For its part, the mercantile marine needs to get over its present Ostrich syndrome and be more proactive about its own preparedness.

Recommendations for Indian Naval Authorities and Organisations under the Ministry of Shipping

• Given the possibility of the number of COVID-19 cases detected on board ships increasing, it is imperative that all stakeholders involved in shipping operations implement — in letter and spirit — the guidelines being periodically issued by the IMO, WHO and International Maritime Health Associations.

• Formulate (where necessary) and revisit (where extant) SOPs for the management of viral outbreaks. These SOPs must be comprehensive, and, inter alia, include aspects such as the earmarking of isolation wards, cabins, etc., the clinical management of affected and suspected cases, including their food, laundry, medical needs, utensils, waste-management, cleaning, disinfection, etc.

• Undertake/revitalise the training of onboard crew for the setting-up of isolation wards, handling of patients, paramedical duties, etc. Authorise and earmark additional crew for maintaining health, hygiene, sanitation and disease-control measures.

• Recheck the inventory and holdings of onboard Personal Protective Equipment, medical equipment, testing kits, etc.

• Implement pre-boarding screening and briefings to all passengers and crew and formulate comprehensive questionnaires (incorporating travel-history, health-history, of the individual, as also his/her relatives, etc.).

• Make shore-based and onboard arrangements to ensure that if one or more passenger or crew of a ship should present symptoms suspected to be those of COVID-19, even after a certificate of ‘free pratique’ has been received[22], the port health authorities are notified and provided with all essential information for contact-tracing.

• Formulate/revisit and implement SOPs for the disembarkation and transfer of suspected cases to an onshore health facility at the earliest for further assessment and laboratory testing. (The SOPs must emphasise the need for proactive actions by both, the onboard staff and the health authorities ashore, and the need to minimise the exposure of other persons and environmental contamination.

• Work assiduously toward enhancing the availability of testing kits.

• Formulate/revisit SOPs for basic training and knowledge on swab collection, and, the expeditious despatch of environmental samples (such as surface swabs from cabins where suspected/presumed/positive COVID-19 cases have occurred, frequently touched surfaces in public areas, food-preparation areas [including pantries], and air from relevant cabins) to a laboratory for testing.can be helpful in this regard.

• Insofar as enhancing naval preparedness in particular (and the preparedness of shipping in general) for biological attack is concerned, the Navy’s senior leadership must:

• Recognise that threats posed by chemical and biological weapons are similar but not identical.

• Commit to strengthening and integrating chemical and biological defence at levels (not seagoing ones alone).

• Invest in training at all levels, not merely at basic ones. 

• Commission operational net-assessment studies and the formulation of a layered defence that exploits the synergies among individual components and levels of the Navy.

• Formally task naval-intelligence echelons to obtain, upgrade and regularly update intelligence on the capacities and capabilities for biological warfare amongst adversarial State and non-State entities.

• Provide requisite manpower and associated resources to enable a successful tasking of the Directorate of Strategy, Concepts and Transformation, in conjunction with the National Maritime Foundation, for the collection, compilation, collation, and retrieval (information-management) of publicly available literature on the defensive-preparedness of other navies against biological warfare threats.

• Wargame a number of scenarios that would enable a truthful evaluation of the current levels of defensive-preparedness of the Indian Navy against biological threats, deeply and intensively involving not just operational staff but also the Director General Medical Services (Navy) and his/her subordinate medical echelons at Command-, Fleet-, Dockyard-, hospital-, and, ship-levels.

• Proliferate available theoretical knowledge and practical onboard experience to the merchant marine, through a top-down approach, involving the Ministry of Defence and the Ministry of Shipping, as also a simultaneous approach pursued at the functional-level by proactively engaging naval and merchant marine training colleges/ institutions.

Conclusion

Seagoing ships need to be prepared for a viral outbreak such as COVID-19.  Adequate knowledge, training, equipment and comprehensive SOPs are the keys to combating COVID-19.  It must be recognised that a deployed warship may not be able to disembark infected and/or suspected cases.  At the same time, the naval and national leadership must be cognisant of the challenges a warship would encounter in enforcing a quarantine on board.  It must also be recognised that the preventive and curative measures, procedures and practices adopted against the COVID-19 will almost certainly stand the navy and the nation in good stead in the years ahead and efforts in these areas must, therefore, maximised.  Best practices must be shared in terms of both, disseminating one’s own experiences and imbibing those of others.  The availability of medical advice/support through tele/video conferencing/ satellite communication must be maximised, along with a significant intensification of ship-wide paramedical training to all onboard crew members on aspects such as the setting-up and maintenance of an isolation ward, CBRN measures, swab-testing, etc..  Finally, the Navy’s senior leadership must proactively drive the navy’s initiatives and seek the guidance of the IMO and the WHO wherever practicable.

*****************

About the Authors

*Vice Admiral Pradeep Chauhan, AVSM & Bar, VSM, IN (Retd) is the Director-General of the National Maritime Foundation.

**Commander Saurav Mohanty is a Research Fellow at the National Maritime Foundation. The contents of the article are the personnel views of the author and do not represent the official policy of the Indian Navy or the Government of India

Endnotes

[1] “The amount of a particular disease that is usually present in a community is referred to as the baseline or ‘endemic’level of the disease. This level is not necessarily the desired level, which may in fact be zero, but rather is the observed level. An ‘Epidemic’refers to an increase, often sudden, in the number of cases of a disease above what is normally expected in that population in that area.  ‘Pandemic’refers to an epidemic that has spread over several countries or continents, usually affecting a large number of people”. Principles of Epidemiology in Public Health Practice, Third Edition, Updated November 2011; Lesson One, Section One.    https://www.cdc.gov/csels/dsepd/ss1978/lesson1/section11.html

[2]WHO Director-General’s opening remarks at the Mission Briefing on COVID 19. 12 March 2020.https://www.who.int/dg/speeches/detail/who-director-general-s-opening-remarks-at-the-mission-briefing-on-covid-19—12-march-2020

[3]World Health Organization (WHO).  “Naming the Coronavirus Disease (COVID-19) and the Virus that causes it”. https://www.who.int/emergencies/diseases/novel-coronavirus-2019/technical-guidance/naming-the-coronavirus-disease-(covid-2019)-and-the-virus-that-causes-it

[4]  Military.com.2020. “ Navy has 1^stCoronavirus case on a ship days after family event onboard”. 15 March 2020. https://www.military.com/daily-news/2020/03/15/navy-has-1st-coronavirus-case-ship-days-after-family-event-onboard.html

[5]News.usni.org. 2020. “8 Sailors on USS Theodore Roosevelt have COVID-19; Port Calls cancelled as Navy investigates outbreak”, 24 March 2020. https://news.usni.org/2020/03/24/3-sailors-on-uss-theodore-roosevelt-have-covid-19-port-calls-canceled-as-navy-investigates-outbreak

[6]Arun Gupta, Sougat Ray, Rahul Tyagi & Avishek Kumar. “Control of H1N1 Influenza Outbreak: A Study Conducted in a Naval Warship”. Journal of Marine Medical Society, 2017. 19. 142. 10.4103/jmms.jmms_70_17.

https://www.researchgate.net/publication/323123413_Control_of_H1N1_influenza_outbreak_A_study_conducted_in_a_naval_warship

[7]Iims.org.uk. 2020. “IMO Secretary-General asks for pragmatic approach in response to COVD-19”. 23 March 2020. https://www.iims.org.uk/imo-secretary-general-asks-for-pragmatic-approach-in-response-to-covid-19/.

[8]Ship-technology.com.2020. “COVID-19 : Diamond Princess Cruise Ship reports eighth death”. 23 March 2020. https://www.ship-technology.com/news/covid-19-diamond-princess-cruise-ship-eighth-death/.

[9]Smriti Mallapaty. “What the cruise-ship outbreaks reveal about COVID-19”, “Nature” Journal, 26 March 2020 https://www.nature.com/articles/d41586-020-00885-w

[10]Ibid.

[11]Ibid.

[12]  Business-standard.com.2020. “234 Indians evacuated from Iran, quarantined at Army Camp in Jaisalmer. 15 March 2020.https://www.business-standard.com/article/pti-stories/over-230-indians-evacuated-from-iran-quarantined-at-army-wellness-centre-in-jaisalmer-120031500142_1.html

[13]YouTube (NEWSX Channel), 27 March 2020. https://www.youtube.com/watch?v=S9cHtdwfBuA

[14]The Economic Times, 27 March 2020. “COVID-19: Indian Navy mobilises IL38 aircraft to transport 60,000 face masks from Delhi to Goa”.

https://economictimes.indiatimes.com/news/defence/covid-19-indian-navy-mobilises-il38-aircraft-to-transport-60000-face-masks-from-delhi-to-goa/articleshow/74850995.cms

[15]Dr Rashid Buttar.  “The Virus Is Not a Naturally-Occurring Phenomenon”  https://www.youtube.com/watch?v=-T9vlpC0bRo

[16]  Scripps Research Institute, 17 March 2020. “The COVID-19 Coronavirus Epidemic has a Natural Origin, Scientists Say”.  https://www.scripps.edu/news-and-events/press-room/2020/20200317-andersen-covid-19-coronavirus.html

[17]  “Naval Forces’ Defense Capabilities Against Chemical and Biological Warfare Threats (2004)”, The National Academies Press; 500 Fifth Street, N.W. Washington, DC 20001. https://www.nap.edu/download/11034

[18] Ibid, p. 18

[19]Wikipedia.  “List of parties to the Biological Weapons Convention” https://en.wikipedia.org/wiki/List_of_parties_to_the_Biological_Weapons_Convention

[20]Defence Research Development Establishment (DRDE) – Achievements, 27 March 2019. https://www.drdo.gov.in/defence-research-development-establishment-drde-achievements

[21]Economictimes.indiatimes.com. 2019. “Indian Navy nuclear, biological, chemical training facility launched “. 26 March 2019.

[22]A ‘Certificate of Free Pratique’ is a certificate from the port-health-authorities that the ship is without infectious disease or plague on board and is therefore permitted to enter port and to allow people to board and disembark.