EU HEALTHY GATEWAYS JOINT ACTION PREPAREDNESS AND ACTION AT POINTS OF ENTRY (PORTS, AIRPORTS, GROUND CROSSINGS)

COVID-19

Preparedness and response for Points of Entry and transport operators. Published guidance and reports for COVID-19.

 

 

 


 

Interim advice for preparedness and response to cases of COVID-19 at points of entry in the European Union (EU)/EEA Member States (MS)

The interim advice documents listed below were prepared after a request from the European Commission's Directorate-General for Health and Food Safety (DG SANTE). An ad-hoc working group was established with members from the EU HEALTHY GATEWAYS joint action consortium.

The scope of the advice provided in the documents listed below is to assist public health authorities in developing their short-term and long-term national and local preparedness plans. It further contains useful advice for the air, maritime and ground transport sectors.

POINTS OF ENTRY

 

AVIATION

   and general advice at points of entry for public health measures and screening: 

 

MARITIME

and general advice at points of entry for public health measures and screening: 

 

GROUND CROSSINGS

- Buses and bus stations

and general advice at points of entry for public health measures and screening: 

 

- Trains and rail stations

and general advice at points of entry for public health measures and screening: 

 

Communications from the Commission about COVID-19 and transport

 

Training resources for COVID-19


Online training resources for COVID-19
 

- EU HEALTHY GATEWAYS JOINT ACTION

  • Training courses
  • Training of the trainers’ course “Preparedness and response to public health events at airports” (EU HEALTHY GATEWAYS 2019);
  • Training of the trainers’ course “Preparedness and response to public health events at ports” (EU HEALTHY GATEWAYS 2019);
  • Evidence-based best practices on entry/exit screening for infectious diseases in humans (DG SANTE 2019).

The training materials of the training course are available to the EU MS and access can be given by the EU HEALTHY GATEWAYS joint action (contact email: info@healthygateways.eu).

  • Pre-recorded webinars:

All past webinars are listed here https://www.healthygateways.eu/Core-work-packages/Training

To access the available for play-back viewing webinars please apply on the link below by completing the webinar(s) you are interested in: https://www.healthygateways.eu/Contact-Us 

- WHO

- ECDC

 

 

 

Q & A

 

Τhe following questions were made by participants during the webinars conducted by the EU HEALTHY GATEWAYS joint action in response to the COVID-19 outbreak. Answers are based on guidelines from ECDC and WHO considering the current knowledge about SARS-CoV-2 as of 5 March 2020. Answers were updated to include latest available guidance from ECDC and WHO as of 01 April 2020. For any further information or comment please contact info@healthygateways.eu


Environmental persistence of SARS-CoV-2

The survival time of SARS-CoV-2 in the environment has been evaluated in recent publications reporting experimental studies that estimated the environmental stability of SARS-CoV-2 as up to three hours in the air post-aerosolisation, up to four hours on copper, up to 24 hours on cardboard and up to two to three days on plastic and stainless steel, albeit with significantly decreased titres [1]. SARS-CoV-2 RNA was identified on a variety of surfaces in cabins of both symptomatic and asymptomatic COVID-19 infected passengers, up to 17 days after cabins were vacated on the Diamond Princess, but prior to conducting disinfection procedures [2]. SARS-CoV-2 has been isolated from respiratory specimens, stool, urine and gastrointestinal mucosa [3-5]. SARS-CoV-2 has also been detected by PCR in rooms where COVID-19 patients were hospitalised, specifically from surfaces of the toilet bowl and sink, and the air exhaust outlets [6]. Furthermore, SARS-CoV-2 was also detected on different objects such as self-service printers used by patients to print the results of their own exams, desktop keyboards, doorknobs and on gloves [7]. In an analysis of 75,465 COVID-19 cases in China, airborne transmission was not reported [6]. There have been no reports of faecal−oral transmission of the COVID-19 virus to date [8].

Interim guidance for environmental cleaning in non-healthcare facilities exposed to SARS-CoV-2 can be found at: https://www.ecdc.europa.eu/en/publications-data/interim-guidance-environmental-cleaning-non-healthcare-facilities-exposed-2019  [9].

Guidance on disinfection of environments in healthcare and non-healthcare settings potentially contaminated with SARS-CoV-2 can be found at:

https://www.ecdc.europa.eu/en/publications-data/disinfection-environments-covid-19 [7].

Technical recommendations for cleaning and disinfection on ships

The EU HEALTHY GATEWAYS has developed suggested procedures for cleaning and disinfection of ships during the pandemic or when a case of COVID-19 has been identified on board and are available here: https://www.healthygateways.eu/LinkClick.aspx?fileticket=_qOvPmjVu_E%3d&tabid=97&portalid=0

 

Technical recommendations for cleaning and disinfection on aircrafts

Following an event of an Acute Respiratory Illness (ARI) case on board, the airline should ensure that cleaning and disinfection procedures are followed consistently and correctly using the licenced products suitable for the aircraft at the highest acceptable concentrations [22, 23]. Special attention should be given to the zone of risk in the cabin area (e.g. seats, headrests, table-tops, handsets, and other materials coming in contact with the suspect case) where the case was seated, as well as all shared facilities and high-touched surfaces[11, 23, 24]. According to EASA guidance, after disembarkation of passenger and crew, the cabin doors should be closed and the air conditioning adjusted to the maximum volume to ensure all air exchange is completed[23]. The service staff who will clean and disinfect the aircraft should be specially trained and apply the standard procedures for cleaning and disinfecting contaminated surfaces with infectious agents using the appropriate PPE.

WHO advises the following procedures for cleaning and disinfection in case a public health event has occurred on board [25]:

  • Ensure any disinfection is conducted using products licensed for use in the country occupied. The disinfectants must be tested by a certified laboratory according to the specifications of the aircraft manufacturers for material compatibility tests.
  • Any contaminated items must be handled appropriately to mitigate the risk of transmission:
    • Disposable items (hand towels, gloves, tissues) should be double bagged and sent to incineration or similar final disposal, according to the States Parties guidelines for infectious waste management.
    • Reusable items that can be washed and treated/disinfected (gowns or linens) must be tagged and sent to a facility for washing and treatment, as recommended according to infection control procedures, depending on the type of contamination/infectious agent, if known.

Based on recommended disinfectants for aircrafts during the previous 2003 SARS outbreak and for MERS CoV, the recommended disinfectants are products containing ethanol in concentration of 70% or 0.1% sodium hypochlorite, provided that these products have been tested by a certified laboratory according to the specifications of the aircraft manufacturers for material compatibility tests. For other products, the label of the manufacturer should mention that the disinfectant is effective against emerging viruses or against coronaviruses or that have sporicidal effect.  

Detailed guidance for Aircraft preventive disinfection and for aircraft disinfection after an event can be found at the EASA Interim guidance on Aircraft Cleaning and Disinfection in relation to the SARS-CoV-2 pandemics at:

https://www.easa.europa.eu/sites/default/files/dfu/Interim-guidance-on-Aircraft-Cleaning-and-Disinfection.pdf

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1. To make the chlorine solution with a concentration of 1000ppm, 4 teaspoons or 20 ml of household bleach (5%) should be diluted in 1 liter of water.

14. Centers for Disease Control and Prevention. Cleaning and Disinfection for Households - Interim Recommendations for U.S. Households with Suspected or Confirmed Coronavirus Disease 2019 (COVID-19). Available from: https://www.cdc.gov/coronavirus/2019-ncov/prevent-getting-sick/cleaning-disinfection.html.

15.  European Centre for Disease Prevention and Control, ECDC TECHNICAL REPORT. Infection prevention and control in the household management of people with suspected or confirmed coronavirus disease(COVID-19). 2020, ECDC: Stockholm

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[1]

Affected areas are defined by WHO in the website https://www.who.int/

In the latest travel advice published by WHO on 29 February 2020, the following are defined as affected areas:

“Affected areas” are considered those countries, provinces, territories or cities experiencing ongoing transmission of COVID-19, in contrast to areas reporting only imported cases. As of 27 February 2020, although China, particularly the Province of Hubei, has experienced sustained local transmission and has reported by far the largest number of confirmed cases since the beginning of the outbreak, lately the situation in China showed a significant decrease in cases. At the same time, an increasing number of countries, other than China, have reported cases, including through local transmission of COVID-19. As the epidemic evolves, it will be expected that many areas may detect imported cases and local transmission of COVID-19. WHO is publishing daily situation reports on the evolution of the outbreak (available at: https://www.who.int/emergencies/diseases/novel-coronavirus-2019/situation-reports/). The outbreaks reported so far have occurred primarily within clusters of cases exposed through close-contacts, within families or special gathering events. COVID-19 is primarily transmitted through droplets from, and close contact with, infected individuals. Control measures that focus on prevention, particularly through regular hand washing and cough hygiene, and on active surveillance for the early detection and isolation of cases, the rapid identification and close monitoring of persons in contact with cases, and the rapid access to clinical care, particularly for severe cases, are effective to contain most outbreaks of COVID-19 [15].

Relevant guidance is provided in the advice documents published by EU Healthy Gateways Joint Action: ‘Interim advice for preparedness and response to cases of COVID-19 at points of entry in the European Union (EU)/EEA Member States’ [27]. Proper use and disposal of masks and proper hand hygiene need to be ensured by training users before distributing masks.

The type of PPE to be used by the staff at the PoE and on board conveyances can be found at: https://www.healthygateways.eu/Portals/0/plcdocs/EUHG_PPE_Overview_07_03_2020.pdf?ver=2020-03-10-161517-680

Advice from WHO in regard to PPE at PoE can be found at:

https://www.who.int/publications-detail/management-of-ill-travellers-at-points-of-entry-international-airports-seaports-and-ground-crossings-in-the-context-of-covid--19-outbreak

and

https://apps.who.int/iris/bitstream/handle/10665/331498/WHO-2019-nCoV-IPCPPE_use-2020.2-eng.pdf

and

https://www.who.int/publications-detail/advice-on-the-use-of-masks-in-the-community-during-home-care-and-in-healthcare-settings-in-the-context-of-the-novel-coronavirus-(2019-ncov)-outbreak

Specimen collection and laboratory testing will be conducted at the health care facility where the suspect case has been transferred.

Available training materials from EU HEALTHY GATEWAYS:

  • Training of the trainers’ course “Preparedness and response to public health events at airports” (EU HEALTHY GATEWAYS 2019);
  • Training of the trainers’ course “Preparedness and response to public health events at ports” (EU HEALTHY GATEWAYS 2019);
  • Evidence-based best practices on entry/exit screening for infectious diseases in humans (DG SANTE 2019).

EU Member States have access; further access can be given by the EU HEALTHY GATEWAYS joint action (contact email: info@healthygateways.eu).

 

Additional materials for COVID-19 are available in the WHO website and the ECDC website:

https://www.who.int/emergencies/diseases/novel-coronavirus-2019/training/online-training

https://extranet.who.int/hslp/training/course/view.php?id=325
 

and

https://eva.ecdc.europa.eu/mod/forum/discuss.php?d=1627

Ferry boats are advised to implement the guidance provided by EU HEALTHY GATEWAYS and WHO about ship operators and passenger ships. The guidance documents can be found at:

 

https://www.healthygateways.eu/Novel-coronavirus

and

https://www.who.int/publications-detail/operational-considerations-for-managing-covid-19-cases-outbreak-on-board-ships

 

Although currently there is no evidence of airborne transmission, a precautionary approach is recommended due to uncertainties surrounding the potential for aerosol-mediated transmission of the virus. Transmission through inhalation of aerosols during aerosol-generating procedures, may have occurred in some cases [17] [7].

Whenever possible, ships isolation rooms with mechanical ventilation should have negative pressure with minimum of 12 air changes per hour, while isolation rooms with natural ventilation, should provide a ventilation rate of at least 160 litres/second [18]. All air handling units on board the ship should be adjusted to supply 100% outside air and no air recirculation should take place.

This will depend on the policy of each country and authority. Exchange of questions, opinion, and experiences could be done between points of entry or through the central level. 

This will be judged by the physician and occupational health specialist for the specific persons and workplace. 

Scenario 1: A suspect case is detected on board while a ship is in port and as many travellers are on tours, others walking in the city and others are on board.

Answer:

Since according to the scenario the symptomatic person is currently on board, the procedures for managing the symptomatic suspect traveller will start immediately on board. The procedures for identifying the close contacts will start immediately with the persons who are currently on board. The procedures for identifying the close contacts who are currently ashore will start once they are back to the ship. If it is feasible, their return back could be arranged earlier than scheduled.  All other steps will be followed according to the EU HEALTHY GATEWAYS advice for ship operators: https://www.healthygateways.eu/Novel-coronavirus.

 

Scenario 2: A suspect case is detected in one of the buses that are transferring passengers to the organized tours (there could be other buses doing the same stops and visiting the same places at the same time of the bus where a suspect case was detected).

Answer:

The suspect case on board the bus should be transferred with an ambulance to the hospital immediately, if this is feasible. Further advice about management of a suspect case on the bus can be found in the EU HEALTHY GATEWAYS advice for bus operators: https://www.healthygateways.eu/Novel-coronavirus

The identification and management of close contacts on board the ship will take place according to the procedures described in the EU HEALTHY GATEWAYS advice for ship operators: https://www.healthygateways.eu/Novel-coronavirus.

 

Scenario 3: One of the drivers or guides becomes a suspect case and has performed tours for cruise lines in the past 14 days or is at that moment working with cruise line passengers.

Answer:

The advice for bus operators should be followed in regard to the suspect driver or guide while on the bus. All persons who had been in close contact with the suspect driver or guide the previous 14 days should be informed about their exposure. Close contacts who are still on board should be managed according to the EU HEALTHY GATEWAYS advice. All other persons who participated in previous cruises and have disembarked should be managed according to the ECDC advice for management of close contacts: https://www.ecdc.europa.eu/en/publications-data/public-health-management-persons-including-health-care-workers-having-had-contact

The items 3.4.6 to 3.4.9 of European Manual for Hygiene Standards and Communicable Disease Surveillance on Passenger Ships are relevant to receiving food provisions on board cruise ships. In addition, items 3.4.10 through 3.4.21 relate to storage of food.  The European Manual for Hygiene Standards and Communicable Disease Surveillance on Passenger Ships is available here: http://www.shipsan.eu/Home/EuropeanManual.aspx 

There is no special requirement for receiving food due to potential contamination with COVID-19. WHO advises that “It is highly unlikely that people can contract COVID-19 from food or food packaging”. When receiving food, the ship should follow the standard hygiene practises as defined on the HACCP Plan of the ship, as well as follow some general infection control practices. These include reporting of symptoms, frequent hand washing with warm water and soap (the use of gloves does not replace the need for frequent handwashing), physical distancing (by maintain more than 1 meter distance from other crew members, good respiratory hygiene (cover mouth and nose when coughing or sneezing; dispose of tissues and wash hands), frequent cleaning and disinfection of work surfaces and frequently touched surfaces such as door handles. Food workers should avoid touching their nose, mouth and eyes when wearing gloves and without washing their hands first. Moreover, while working with food, hands should be washed after touching nose, mouth and eyes.

Additional information regarding food safety and COVID-19 is available in the WHO Interim Guidance on COVID-19 and Food Safety: Guidance for Food Businesses: interim guidance available here:  https://www.who.int/publications-detail/covid-19-and-food-safety-guidance-for-food-businesses  

 

References

 

1.            van Doremalen, N., et al., Aerosol and Surface Stability of SARS-CoV-2 as Compared with SARS-CoV-1. N Engl J Med, 2020.

2.            Moriarty, L.F., et al., Public Health Responses to COVID-19 Outbreaks on Cruise Ships - Worldwide, February-March 2020. MMWR Morb Mortal Wkly Rep, 2020. 69(12): p. 347-352.

3.            Ling, Y., et al., Persistence and clearance of viral RNA in 2019 novel coronavirus disease rehabilitation patients. Chin Med J (Engl), 2020.

4.            Ren, L.L., et al., Identification of a novel coronavirus causing severe pneumonia in human: a descriptive study. Chin Med J (Engl), 2020.

5.            Holshue, M.L., et al., First Case of 2019 Novel Coronavirus in the United States. N Engl J Med, 2020. 382(10): p. 929-936.

6.            Ong, S.W.X., et al., Air, Surface Environmental, and Personal Protective Equipment Contamination by Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) From a Symptomatic Patient. JAMA, 2020.

7.            European Centre for Disease Prevention and Control, ECDC TECHNICAL REPORT. Disinfection of environments in healthcare and nonhealthcare settings potentially contaminated with SARS-CoV-2. 2020, ECDC: Stockholm

8.            World Health Organization. Scientific brief - Modes of transmission of virus causing COVID-19: implications for IPC precaution recommendations. 29 March 2020 [cited 30/03/20; Available from: https://www.who.int/news-room/commentaries/detail/modes-of-transmission-of-virus-causing-covid-19-implications-for-ipc-precaution-recommendations.

9.            European Centre for Disease Prevention and Control, ECDC TECHNICAL REPORT - Guidelines for the use of non-pharmaceutical measures to delay and mitigate the impact of 2019-nCoV February 2020 2020: Stockholm.

10.          Klaus, J., et al., Disinfection of aircraft : Appropriate disinfectants and standard operating procedures for highly infectious diseases. Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz, 2016. 59(12): p. 1544-1548.

11.          European Aviation Safety Agency. Interim guidance on Aircraft Cleaning and Disinfectionin relation to the SARS-CoV-2 pandemics. Issue: 01 –Date: 20/03/2020. 2020 20/03/2020 [cited 27/03/2020; Available from: https://www.easa.europa.eu/sites/default/files/dfu/Interim-guidance-on-Aircraft-Cleaning-and-Disinfection.pdf.

12.          World Health Organization, Interim Guidance - Laboratory testing for coronavirus disease (COVID-19) in suspected human cases. 2020.

13.          World Health Organization. Summary of SARS and air travel. 2003 23 May 2003 21/1/2020]; Available from: https://www.who.int/csr/sars/travel/airtravel/en/.

14.          World Health Organization, Handbook for the Management of Public Health Events in Air Transport. Updated with information on Ebola virus disease and Middle East respiratory syndrome coronavirus. 2015: World Health Organization.

15.          World Health Organization. International travel and health Updated WHO recommendations for international traffic in relation to COVID-19 outbreak 29 February 2020. 2020; Available from: https://www.who.int/ith/2019-nCoV_advice_for_international_traffic-rev/en/

16.          EU HEALTHY GATEWAYS JOINT ACTION PREPAREDNESS AND ACTION AT POINTS OF ENTRY (PORTS, A., GROUND CROSSINGS),. INTERIM ADVICE FOR PREPAREDNESS AND RES PONSE TO CASES OF COVID-19 AT POINTS OF ENTRY IN THE EUROPEAN UNION(EU)/EUROPEAN ECONOMIC AREA MEMBER STATES (MS) - Public health measures at points of entry. 2020 20/02/2020; 3rd:[Available from: https://www.healthygateways.eu/Novel-coronavirus.

17.          Rothe, C., et al., Transmission of 2019-nCoV Infection from an Asymptomatic Contact in Germany. The New England journal of medicine, 2020: p. 10.1056/NEJMc2001468.

18.          World Health Organization. Interim guidance - Clinical management of severe acute respiratory infection (SARI) when COVID-19 is suspected. 2020 13 March 2020; Available from: https://www.who.int/publications-detail/clinical-management-of-severe-acute-respiratory-infection-when-novel-coronavirus-(ncov)-infection-is-suspected.

 

 

Disclaimer: This document arises from the EU HEALTHY GATEWAYS Joint Action that was funded by the European Union’s Health Programme (2014-2020).The content of this document represents the views of the authors only and is their sole responsibility; it cannot be considered to reflect the views of the European Commission and/or the Consumers, Health, Agriculture and Food Executive Agency (CHAFEA) or any other body of the European Union. The European Commission and the Agency do not accept any responsibility for use that may be made of the information it contains.

 


Guidance for COVID-19 from WHO, ECDC, US CDC, EASA, ICAO, IATA, ACI, IFALPA, IFATCA, UIC, IMO, ICS, IOM

 

World Health Organization

 

European Centre for Disease Prevention and Control

 

US Centers for Disease Control and Prevention

 

EASA

 

ICAO

IATA

 

ACI

 

IFALPA

 

 

IFATCA

 

UIC

 

IMO

 

ICS

 

IOM

 

Other

 

 

Peer-reviewed scientific articles on COVID-19 and transportation

  1. Nikolaou, P. and L. Dimitriou, Identification of critical airports for controlling global infectious disease outbreaks: Stress-tests focusing in Europe. J Air Transp Manag, 2020. 85: p. 101819.
  2. Daon, Y., R.N. Thompson, and U. Obolski, Estimating COVID-19 outbreak risk through air travel. J Travel Med, 2020.
  3. Cadnum, J.L., et al., Evaluation of Ultraviolet-C Light for Rapid Decontamination of Airport Security Bins in the Era of SARS-CoV-2. Pathog Immun, 2020. 5(1): p. 133-142.
  4. Sriwijitalai, W. and V. Wiwanitkit, COVID-19 Outbreak in International Airport - Where the Incidence Case Occurs? Int J Prev Med, 2020. 11: p. 51.
  5. Zhang, Y., A. Zhang, and J. Wang, Exploring the roles of high-speed train, air and coach services in the spread of COVID-19 in China. Transp Policy (Oxf), 2020. 94: p. 34-42.
  6. Christidis, P. and A. Christodoulou, The Predictive Capacity of Air Travel Patterns during the Global Spread of the COVID-19 Pandemic: Risk, Uncertainty and Randomness. International Journal of Environmental Research and Public Health, 2020. 17(10): p. 3356.
  7. Clifford, S., et al., Effectiveness of interventions targeting air travellers for delaying local outbreaks of SARS-CoV-2. J Travel Med, 2020.
  8. Lau, H., et al., The association between international and domestic air traffic and the coronavirus (COVID-19) outbreak. J Microbiol Immunol Infect, 2020.
  9. Linka, K., et al., Outbreak dynamics of COVID-19 in Europe and the effect of travel restrictions. Comput Methods Biomech Biomed Engin, 2020: p. 1-8.
  10. Iacus, S.M., et al., Estimating and Projecting Air Passenger Traffic during the COVID-19 Coronavirus Outbreak and its Socio-Economic Impact. Saf Sci, 2020: p. 104791.
  11. Xu, J.W., et al., Deep thought of COVID-19 based on Diamond Princess's quarantine and home quarantine. Eur Rev Med Pharmacol Sci, 2020. 24(7): p. 4027-4029.
  12. Chen, C.M., et al., Containing COVID-19 among 627,386 Persons Contacting with Diamond Princess Cruise Ship Passengers Disembarked in Taiwan: Big Data Analytics. J Med Internet Res, 2020.
  13. Yamahata, Y. and A. Shibata, Preparation for the Quarantine of The Diamond Princess Cruise Ship for COVID-19 in Japan: Study Design. JMIR Public Health Surveill, 2020.
  14. Wong, J., et al., High proportion of asymptomatic and presymptomatic COVID-19 infections in travelers and returning residents to Brunei. J Travel Med, 2020.
  15. Bruinen de Bruin, Y., et al., Initial impacts of global risk mitigation measures taken during the combatting of the COVID-19 pandemic. Saf Sci, 2020: p. 104773.
  16. Devi, S., Travel restrictions hampering COVID-19 response. Lancet, 2020. 395(10233): p. 1331-1332.
  17. Hirotsu, Y., et al., Environmental cleaning is effective for the eradication of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in contaminated hospital rooms: A patient from the Diamond Princess cruise ship. Infect Control Hosp Epidemiol, 2020: p. 1-8.
  18. Lytras, T., et al., High prevalence of SARS-CoV-2 infection in repatriation flights to Greece from three European countries. J Travel Med, 2020.
  19. Arashiro, T., et al., SARS-CoV-2 and Legionella Co-infection in a Person Returning from a Nile Cruise. J Travel Med, 2020.
  20. Vaidya, R., et al., Travel restrictions and infectious disease outbreaks. J Travel Med, 2020.
  21. Petersen, E., et al., COVID-19 travel restrictions and the International Health Regulations - call for an open debate on easing of travel restrictions. Int J Infect Dis, 2020.
  22. Kraemer, M.U.G., et al., The effect of human mobility and control measures on the COVID-19 epidemic in China. Science, 2020.
  23. [Health protection guideline of passenger transport stations and transportation facilities during COVID-19 outbreak]. Zhonghua Yu Fang Yi Xue Za Zhi, 2020. 54(4): p. 359-361.
  24. Al Nsour, M., et al., The Role of the Global Health Development/Eastern Mediterranean Public Health Network and the Eastern Mediterranean Field Epidemiology Training Programs in Preparedness for COVID-19. JMIR Public Health Surveill, 2020. 6(1): p. e18503.
  25. Anzai, A., et al., Assessing the Impact of Reduced Travel on Exportation Dynamics of Novel Coronavirus Infection (COVID-19). J Clin Med, 2020. 9(2).
  26. Arab-Mazar, Z., et al., Mapping the incidence of the COVID-19 hotspot in Iran - Implications for Travellers. Travel Med Infect Dis, 2020: p. 101630.
  27. Arashiro, T., K. Furukawa, and A. Nakamura, COVID-19 in 2 Persons with Mild Upper Respiratory Symptoms on a Cruise Ship, Japan. Emerg Infect Dis, 2020. 26(6).
  28. Bogoch, II, et al., Potential for global spread of a novel coronavirus from China. J Travel Med, 2020. 27(2).
  29. Bwire, G.M. and L.S. Paulo, Coronavirus disease-2019: is fever an adequate screening for the returning travelers? Trop Med Health, 2020. 48: p. 14.
  30. Candido, D.D.S., et al., Routes for COVID-19 importation in Brazil. J Travel Med, 2020.
  31. Chinazzi, M., et al., The effect of travel restrictions on the spread of the 2019 novel coronavirus (COVID-19) outbreak. Science, 2020.
  32. Craig, A.T., A.E. Heywood, and J. Hall, Risk of COVID-19 importation to the Pacific islands through global air travel. Epidemiol Infect, 2020. 148: p. e71.
  33. Dahl, E., Coronavirus (Covid-19) outbreak on the cruise ship Diamond Princess. Int Marit Health, 2020. 71(1): p. 5-8.
  34. Elachola, H., S.H. Ebrahim, and E. Gozzer, COVID-19: Facemask use prevalence in international airports in Asia, Europe and the Americas, March 2020. Travel Med Infect Dis, 2020: p. 101637.
  35. Eldin, C., et al., Probable aircraft transmission of Covid-19 in-flight from the Central African Republic to France. Travel Med Infect Dis, 2020: p. 101643.
  36. Fernandes, E.G., J.D.S. Santos, and H.K. Sato, Outbreak investigation in cargo ship in times of COVID-19 crisis, Port of Santos, Brazil. Rev Saude Publica, 2020. 54: p. 34.
  37. Gherghel, I. and M. Bulai, Is Romania ready to face the novel coronavirus (COVID-19) outbreak? The role of incoming travelers and that of Romanian diaspora. Travel Med Infect Dis, 2020: p. 101628.
  38. Gostin, L.O. and L.F. Wiley, Governmental Public Health Powers During the COVID-19 Pandemic: Stay-at-home Orders, Business Closures, and Travel Restrictions. JAMA, 2020.
  39. Haider, N., et al., Passengers' destinations from China: low risk of Novel Coronavirus (2019-nCoV) transmission into Africa and South America. Epidemiol Infect, 2020. 148: p. e41.
  40. Kakimoto, K., et al., Initial Investigation of Transmission of COVID-19 Among Crew Members During Quarantine of a Cruise Ship - Yokohama, Japan, February 2020. MMWR Morb Mortal Wkly Rep, 2020. 69(11): p. 312-313.
  41. Mallapaty, S., What the cruise-ship outbreaks reveal about COVID-19. Nature, 2020. 580(7801): p. 18.
  42. Meier, B.M., R. Habibi, and Y.T. Yang, Travel restrictions violate international law. Science, 2020. 367(6485): p. 1436.
  43. Mizumoto, K. and G. Chowell, Transmission potential of the novel coronavirus (COVID-19) onboard the diamond Princess Cruises Ship, 2020. Infect Dis Model, 2020. 5: p. 264-270.
  44. Mizumoto, K., et al., Estimating the asymptomatic proportion of coronavirus disease 2019 (COVID-19) cases on board the Diamond Princess cruise ship, Yokohama, Japan, 2020. Euro Surveill, 2020. 25(10).
  45. Moriarty, L.F., et al., Public Health Responses to COVID-19 Outbreaks on Cruise Ships - Worldwide, February-March 2020. MMWR Morb Mortal Wkly Rep, 2020. 69(12): p. 347-352.
  46. Mouchtouri, V.A., M. Dirksen-Fischer, and C. Hadjichristodoulou, Health measures to travelers and cruise ships in response to COVID-19. J Travel Med, 2020.
  47. Nakazawa, E., H. Ino, and A. Akabayashi, Chronology of COVID-19 cases on the Diamond Princess cruise ship and ethical considerations: a report from Japan. Disaster Med Public Health Prep, 2020: p. 1-27.
  48. Nishiura, H., Backcalculating the Incidence of Infection with COVID-19 on the Diamond Princess. J Clin Med, 2020. 9(3).
  49. Olsen, S.J., et al., Early Introduction of Severe Acute Respiratory Syndrome Coronavirus 2 into Europe. Emerg Infect Dis, 2020. 26(7).
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Last update: 05/08/2020