Although two months of this year have passed, however the challenges remained the same: fight against COVID-19 pandemic at the same time trying to learn to live in the different world with the new rules. The particular concern which all countries are facing are new COVID-19 strains, virus mutations and vaccination challenges.
All stakeholders faced with different practices and situations regarding the management of COVID-19 at the point of entries. Together with my colleagues we wanted to share with you an example of certainly not an everyday situation and activation of contingency plan of Vilnius airport (Lithuania),
I believe that all partners from consortium will agree that the amendment of the Grant agreement and extension of the Joint Action is a great possibility to complete all intended and new tasks. As one of the Joint Action sustainability example are EU digital passenger locator forms created and installed for the all modes of transport. I want to welcome the fact that up to the end of January, 2021, there were about 700 submitted passenger locator forms and almost 1000 of registered passengers. More about this likely successful pilot testing you can read in the article below.
We must not forget that there are a lot of other communicable diseases and we must be prepared to manage and control them. A very good example of the relevance of the situation is given by colleagues from Hamburg
For those who work at maritime sector, please look at the tool for public health emergency contingency plan development and assessment for ports and view the webinar - Public health emergency contingency plan at ports - EU HEALTHY GATEWAYS advice.
And the last, all the best from Vilnius.
Prof. Christos Hadjichristodoulou
EU HEALTHY GATEWAYS Joint Action Coordinator, Professor of Hygiene and Epidemiology, Department of Hygiene and Epidemiology, Medical Faculty, University of Thessaly, Greece
Τhe EU HEALTHY GATEWAYS joint action has submitted to CHAFEA a request for an amendment and an 8-month extension with no additional budget. This was necessary so as to include the activities the joint action delivered over the last year operating under the emergency mode due to the COVID-19 crisis. Moreover, an 8 month extension without additional budget was requested so as to allow enough time to complete all initial but also new tasks included in the joint action work plan (e.g. the European Passenger Locator form).
One of the specific objectives of the joint action is to provide capacity building including training on tested best practices, guidelines and validated action plans, at European, country and local level considering the local and national context and ensuring replicability, transferability and sustainability. The joint action has already conducted two face to face European level training courses: one focused preparedness and response at Airports and one in preparedness and response at Ports. To support the conduct of training courses the joint action has provided to all partners the relevant training materials and Standard Operating Procedures for conducting national training courses. In addition to this and in response to the pandemic four e-learning courses on preparedness and response in the context of COVID-19 are under development. To support the implementation of local level exercises the joint action will develop instructions for developing exercises for testing the local public health emergency contingency plan (ports, airports and ground-crossings). Moreover, materials will be developed for countries to implement multi sectorial table top exercise at national level for all points of entries. Finally in March 2021 a small scale multi sectorial table top exercise will be organised at EU level for ports.
Other activities and recent developments of the joint action include the EU HEALTHY GATEWAYS Tool for public health emergency contingency plan development and assessment for ports and the European passenger locator form platform that are presented in detail under the thematic sections.
Mrs Valerie Susan Clay
Consultant, World Health Organization
We regret to inform the HEALTHY GATEWAYS consortium of the recent death of Mrs Susan Clay. Susan passed away on Friday, January 8, 2021.
Susan was an exceptional professional and a warm person with a long and successful career in public health. Her interactions were always with grace, dignity and respect for others.
Her educational background included environmental health and epidemiology, the latter as part of the Canadian Field Epidemiology Program. She worked with all levels of government in Canada throughout her >30 year career in public health including drafting new legislation for national Travelling Public Program. She participated in the first IHR e-learning program with WHO and supported the implementation of the IHR in Canada. Since moving to Portugal in 2013, she had consulted with WHO Health Emergencies Office in Lyon. She was the technical writer for the Handbook for Public Health Events Management in Air Transport and had facilitated training at Points of Entry with EMRO and AFRO. Susan was also the subject matter focal point for development of the online course Public Health Event Management in Aviation (PHEMAT training) in 2019 and she had also a contract with WHO for preparation of simulation exercises, templates for Points of Entry (PoE) emergency plan, scenarios and evaluation of the reports and findings from the IHR monitoring framework.
The EU HEALTHY GATEWAYS consortium had the opportunity to collaborate with Susan in September 2019 for the face-to-face training course on Preparedness and response to public health events at airports that was held in Belgrade, Serbia. Susan represented WHO Lyon on the pre-course planning day and throughout the training. The purpose of the training of the trainer’s programme was to increase competence and capacity for managing public health events in air transport including risk assessment, decision-making and crisis communication.
Susan Clay will be greatly missed by all that knew her and had the opportunity to collaborate with her.
Lithuania’s best practice of activation of contingency plan after a person with positive COVID-19 test got into the territory of Vilnius airport
Robertas Petraitis, Brigita Kairiene, Rimantas Zajarskas, Diana Bruneviciene
National Public Health Centre under the Ministry of Health, Lithuania
The COVID-19 epidemiological situation in the world shows the importance of prompt response to emergency situations and appropriate communication between different stakeholders.
The contingency plan (Plan) of Vilnius airport for the identification and management of communicable diseases on the aircraft or in the airport territory was activated in the end of December, 2020. It is notable, that according to the international agreement with Belorussia, all passengers during the process of registration had to provide a negative laboratory test for COVID-19 diseases (coronavirus infection) performed not earlier than 48 hours before the flight together with other documents of the flight.
There were in total 84 passengers who were registered to the flight to Minsk. One citizen from the country from the Middle Asia region, who had contact with others as a driver in Lithuania, was registered at registration deck and provided documents of the flight together with the certificate from the laboratory. This test showed a positive SARS-CoV-2 test result.
The registration officer immediately stopped the registration. The information about the situation was immediately forwarded to the leader on duty who informed about the situation the Leader of management of emergency situations in the airport. Also this information was forwarded to the organizer of National Public Health Centre under the MoH actions in the airport.
All travellers were directed to another registration deck. During the initial collection of the information it was clarified that COVID-19 positive travellers didn’t have a contact with other travellers for more than 15 minutes and all were wearing masks.
Police officers together with airport security staff leaded the COVID-19 positive traveller to special prepared isolation premises where he stayed till ambulance came. The airport departure terminal, (luggage and cargo transportation) were disinfected.
The staff of the Vilnius airport was asked to evaluate the level of their risk. All of the staff informed that they wore appropriate PPE, kept distance 1,5 meters and the contact with COVID-19 positive traveller was shorter than 15 minutes.
No information about persons being infected during the time of the incident was received.
This event shows the necessity of an intersectoral approach to deal with emergencies like COVID-19.
Tool for public health emergency contingency plan development and assessment for ports
According to the EU HEALTHY GATEAYS Grant Agreement, a tool for contingency plan development and assessment will be developed based on best practice identification results and considering existing guidance from the World Health Organization (WHO). The Joint Action has been operating in an emergency mode since January 2020 in order to support response of EU Member States (MS) to the COVID-19 pandemic, and in this framework, specific guidelines were prepared for adapting the generic plan to a COVID-19-specific port emergency contingency plan.
The purpose of this technical tool is to suggest concrete steps for developing or assessing current port-specific public health emergency contingency plans and protocols, not to replace them. The tool focuses on assisting local stakeholders at the port and country level where the IHR 2005 and/or Decision No1082/2013/EU on serious cross-border threats to health is implemented in practice.
This tool is consisted of:
- a template of a generic public health emergency contingency plan for all types of public health threats including infectious diseases, vectors, chemical and radiological threats as per International Health Regulations (IHR 2005) Annex 1B, which must be in place at all times at designated ports.
- Practical guidelines specifically for restarting cruise ship operations after lifting restrictive measures enforced in response to the COVID-19 pandemic, in the format of a process map.
- A template for adapting the generic public health emergency contingency plan specifically for preparedness and response to COVID-19 cases on cruise ships at a port (designated or not).
Please find here the link to access the tool (including the main body of the tool and the four annexes) from the EU HEALTHY GATEWAYS website:
Preliminary results from pilot testing the EU digital passenger locator form platform
Objective of the EU dPLF platform
In response to COVID-19, HEALTHY GATEWAYS has developed in coordination with the European Commission Directorate General for Health and Food Safety (DG SANTE), Directorate General for Mobility Transport (DG MOVE), and the support of European Maritime Safety Agency, European Centre for Disease Prevention and Control, European Aviation Safety Agency, European Railways Agency and International Air Transport Association, an EU application for common digitalised Passenger Location Forms for all transport sectors (aircrafts, cruise ships/ferries and ground transport). Developing digitalized Passenger Location Forms for all three transport sectors would allow for more efficient and rapid data collection, making contact tracing more effective. It would also make it easier on passengers and conveyance crew/medical staff involved in collection of contact details during cross-border checks.
So far pilot testing has been completed for the air sector with Slovenia (National Institute of Public Health, Ljubljana Airport) (one flight), with Italy (Directorate General of Prevention, Ministry of Health, Fiumicino Airport) (two flights) and recently with France (Health Ministry - Ministére des Solidarités et de la Santé) (one flight). A pilot test has also been completed with Spain (Directorate General for Public Health of the Ministry of Health, port of Barcelona) involving a ferry travelling between Italy and Spain.
Translation of the EU dPLF platform and the website are ongoing. The EU dPLF pilot platform (https://pilot.euplf.eu/) provides a multilingual mechanism allowing for online translation of all platform content, including the public section and the internal form (labels and variables) into national languages. Once a translation is published, it is automatically activated and added to the language selector menu. Data submitted in the dPLFs will always be in English language except some specific fields (e.g. Address, City). A public, multilingual website is also under development, which includes useful and relevant information for passengers related to the usage of the EU dPLF (the website can be found at the temporary url: https://euplf.med.uth.gr/). This website will be the first point of information for users before they proceed to the EU dPLF app.
EU HG in collaboration with the subcontractors for software development are working on finalising the development of the EU dPLF and making all the necessary adjustments so as to make the platform as user friendly as possible.
Moreover, the working group with the subcontractors are working on issues related to General Data Protection Regulation and legal issues.
Moreover, a technical working group has been established between EU HG, EASA, DG SANTE and DG MOVE focusing on the technical requirements and procedures for connecting the EU dPLF and the EASA exchange platform.
Preliminary evaluation results
To date (20/01/2021) there are 684 Passenger Locator Forms submitted and 978 passengers registered. Also 20 inspectors and 6 National analysts accounts were created.
A total of 97 passenger evaluation questionnaires have been completed and submitted. Initial feedback from passengers is good with >56% declaring that the process of completing the PLF was easy (Yes=56,70% and Partial=20,62%), >62% that the information about passenger’s personal details to be completed was clear enough (Yes=62,89% and Partial=15,46%) and >63% that the instructions provided for completing the PLF were clear (Yes=63,92% and Partial=18,56%). Also 26,80% of the passengers declared that they needed less than 5 minutes to complete the PLF, 41,24% needed between 5 to 10 minutes to complete it and only 8,25% had difficulty completing any specific question in the PLF. Finally, 60,82% of the passengers declared that they received an e-mail confirmation quickly after submitting the completed PLF.
A very detailed evaluation feedback has been received by France and the overall results were positive. Some adjustments were identified that would improve user experience and ensure passengers adhere to the mechanism. It was noted that the data filled was comprehensive and of good quality. It was also suggested encompassing passenger data collection into the check-in process (online on the Internet, on the smartphone app, interactive terminals at the airport or at check-in desks).
Pilot testing is a continuous process that will continue with the EUMS that want to test the platform.
Priority has been given in finalising the EU dPLF platform and in the interconnection with the EASA platform for the exchange of PLF data between Member States. Further pilot testing with other countries and transport sectors is to follow.
2021 Ebola virus disease – Guinea and Democratic Republic of Congo: considerations for the risk of introduction in Hamburg port and airport and other points of entry in the EU
Authors: Dr.med. Christina Stabenow*, Dr.med. Birgit Grassl*, Nadine Appel*.
*Hamburg Port Health Center, Germany
The document is also available for download here: https://www.healthygateways.eu/Portals/0/plcdocs/Ebola_2021_Example_Hamburg.pdf?ver=2021-02-22-161126-710
- Monitoring the Ebola outbreak in West Africa
As of Feb. 18, 2021, seven confirmed cases have been reported in Guinea, including 6 deaths and 216 contacts. In the Democratic Republic of Congo, more than four cases have been reported, including 2 deaths and 400 contacts to date.
The border region of Nzérékoré in the southeast of Guinea and the town of Butembo in the province of North Kivu in Congo are affected.
The first currently traceable case in Guinea concerns the funeral of a nurse in Gouéké (01.02.2021), at which 6 people were infected with high probability. The funeral took place, as is often the case, without any special safety precautions. At traditional funerals, it happens that people involved wash and touch the corpses, which can promote the spread of the virus.
According to the WHO, the species is Zaire Ebola virus (ZEBOV), against which a vaccination exists and is stored in Switzerland and the USA.
In addition to the knowledge gained from the last epidemic about hygiene measures and the procurement and use of protective clothing, the particular importance of vaccinating the population has become apparent here. In total about 350,000 people in Guinea and the Democratic Republic of the Congo have been vaccinated against Ebola since the last outbreak; currently, 340 people in the Dem. Rep. Congo have been vaccinated.
Due to the close location of Nzérékoré to the border to Liberia, where the virus spread strongly during the last Ebola epidemic, the Liberian government is alarmed. Here, too, the population is to be vaccinated. In order for a large part of the population of the three countries mentioned above to be vaccinated, thus achieving sufficient herd immunity, 22 million vaccine doses are required. Currently, 6890 vaccine doses are available worldwide, which must be stored at minus 60°C.
The countries currently affected can build on their experience of recent epidemics to establish rapid outbreak control. In addition to attempting to stockpile vaccines, including for bolting vaccination, this involves, among other things, containment measures with identification of sources of infection and contact tracing.
- Shipping connections from Guinea and Democratic Republic of Congo
There are regular, partly weekly, ship connections between Hamburg and Conakry and Pointe Noire (Republic of the Congo). The Democratic Republic of Congo, which is currently affected by the outbreak, has its only port in Matadi, which can only be reached by small ships due to draught obstructions, so cargo is transhipped at Pointe Noire.
Numerous connections between West African countries (neighbouring countries as Liberia and Ivory Coast) come along, as well as direct connections between Conakry and Pointe Noire.
A detailed backtracking of ships entering Hamburg from West Africa is not quite easy due to numerous and changeable stopovers. As an example, there is a weekly connection from Pointe Noire to Antwerp for a duration of 49 days, calling at 8 ports along the way. A second example: There is a connection from Pointe Noire via Antwerp (previously Monrovia and Abidjan) to Hamburg with a duration of about four weeks.
In addition, there are possible crew changes, which are not listed in advance.
From the point of view of infectious medicine, the risk of Ebola being introduced into Germany via the sea route appears to be low, but cannot be ruled out due to the difficult traceability described above and a long incubation period of up to 21 days. Another dynamic is the spread via neighbouring West African countries such as Liberia or Ivory Coast, where shipping connections to Europe and Hamburg also exist.
- Consideration on the air travel volume from the outbreak areas using Hamburg as an example.
To estimate the volume of travel from the affected areas, we analysed the possible flight movements from Conakry, Guinea to Hamburg. Using the flight data which are shown on flightradar24.de it was first possible to show the connections to the nearest international airports. Connecting flights from there were considered with a limitation to a maximum of three changes on the onward journey to Hamburg (see figure 1).
Here it was shown that, based on the weekly flights in an exemplary week, the airports Paris Charles de Gaulle (CDG) and Istanbul (IST) in particular enable a high level of forwarding to Hamburg. CDG is served both directly from Conakry and in transit from various other airports. IST is reached via Bamako Senou (BKO, Mali), Nonakchott Oumtounsy (NKC, Mauritania) and Dakar (DSS, Senegal) airports. From there, however, the route continues to Hamburg with relatively high frequency (currently 7 times a week), resulting in a possible relevant inbound traffic here.
Journey times naturally vary depending on the route chosen from e.g. CKY to CDG to HAM with 6h 40min, CKY to BKO to IST to HAM10h 18min or CKY to DXB to HAM 14h 33min. Variable transfer times must be added. Nevertheless, it can be assumed that Hamburg can usually be reached from Conakry within 24 hours.
Furthermore, it seems worth noting that the other international airports in Germany can also be reached from Conakry within the framework of these connections. From there, the onward journey can conceivably continue by other means of transport, such as the German federal Railways or intercity buses.
For the flight connections between the Democratic Republic of Congo and Hamburg, an analogous analysis shows that the main travel routes here are via Addis Ababa and Nairobi, and in transit via European airports, primarily via Paris and Istanbul, but also Amsterdam, Vienna and Liegen (Belgium).
Figure 1: Analysis of possible flight connections from Conakry, Guinea to Hamburg using the flight data on flightradar24.de for an exemplary weeks in February 2021.
List of references:
RKI - Ebolafieber
Ebola-Ausbruch in Guinea: Schon drei Menschen gestorben (msn.com)
Ebola-Impfungen nach neuem Ausbruch im Kongo (msn.com)
Hafen Hamburg | Linerservices Datenbank | Alle Direktverbindungen via Hafen Hamburg (hafen-hamburg.de)
Grimaldi Germany (grimaldi-germany.de)
Terrestrial & Satellite AIS Tracking Service in Echtzeit - vesseltracker.com
Webinar - Public health emergency contingency plan at ports - EU HEALTHY GATEWAYS advice
EU HEALTHY GATEWAYS joint action organised with the support of EU SHIPSAN ASSOCIATION and the MedCruise a webinar titled “Public Health Emergency Contingency Plan at ports – EU HEALTHY GATEWAYS advise”. The live webinar was broadcasted on Wednesday 10th February 2021 and aimed to present to the stakeholders the tool for public health emergency contingency plan development and assessment at ports developed by EU HEALTHE GATEWAYS.
A total of 490 participants registered to view the live or recorded webinar from 27 European and 24 non-EU countries.
The webinar is available for playback viewing. To access the play-back viewing webinar please apply on the link below by completing the webinar title you are interested in:
https://www.healthygateways.eu/Contact-Us or send an email to firstname.lastname@example.org
Effect of internationally imported cases on internal spread of COVID-19: a mathematical modelling study
Countries have restricted international arrivals to delay the spread of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). These measures carry a high economic and social cost, and might have little effect on COVID-19 epidemics if there are many more cases resulting from local transmission compared with imported cases. Our study aims to investigate the extent to which imported cases contribute to local transmission under different epidemic conditions.
To inform decisions about international travel restrictions, we calculated the ratio of expected COVID-19 cases from international travel (assuming no travel restrictions) to expected cases arising from internal spread, expressed as a proportion, on an average day in May and September, 2020, in each country. COVID-19 prevalence and incidence were estimated using a modelling framework that adjusts reported cases for under-ascertainment and asymptomatic infections. We considered different travel scenarios for May and September, 2020: an upper bound with estimated travel volumes at the same levels as May and September, 2019, and a lower bound with estimated travel volumes adjusted downwards according to expected reductions in May and September, 2020. Results were interpreted in the context of local epidemic growth rates.
In May, 2020, imported cases are likely to have accounted for a high proportion of total incidence in many countries, contributing more than 10% of total incidence in 102 (95% credible interval 63–129) of 136 countries when assuming no reduction in travel volumes (ie, with 2019 travel volumes) and in 74 countries (33–114) when assuming estimated 2020 travel volumes. Imported cases in September, 2020, would have accounted for no more than 10% of total incidence in 106 (50–140) of 162 countries and less than 1% in 21 countries (4–71) when assuming no reductions in travel volumes. With estimated 2020 travel volumes, imported cases in September, 2020, accounted for no more than 10% of total incidence in 125 countries (65–162) and less than 1% in 44 countries (8–97). Of these 44 countries, 22 (2–61) had epidemic growth rates far from the tipping point of exponential growth, making them the least likely to benefit from travel restrictions.
Countries can expect travellers infected with SARS-CoV-2 to arrive in the absence of travel restrictions. Although such restrictions probably contribute to epidemic control in many countries, in others, imported cases are likely to contribute little to local COVID-19 epidemics. Stringent travel restrictions might have little impact on epidemic dynamics except in countries with low COVID-19 incidence and large numbers of arrivals from other countries, or where epidemics are close to tipping points for exponential growth. Countries should consider local COVID-19 incidence, local epidemic growth, and travel volumes before implementing such restrictions.
Effects of COVID-19 on maritime industry: a review
Devran Yazir, Bekir Şahin, Tsz Leung Yip, Po-Hsing Tseng
International Maritime Health 2020;71(4):253-264.
COVID-19 is a global disease that has quickly shaken the world economy since the beginning of 2020 and consequently has significantly affected the shipping industries development (including shipping operators, port operators, government authorities, shippers, seafarers, passengers, supply chain operators, etc.). Currently, the clinical management of COVID-19 remains unclear. In order to understand the newest challenges and figure out potential solutions for the maritime industries post COVID-19, this paper selected four shipping industries (including dry bulk, tanker, container, and cruiser sector) and reviewed these industries’ newest development. The research findings can strengthen the awareness of COVID-19 and reduce operational risk and further improve business performance for the maritime related industries and authorities.
A rapid review of the effectiveness of screening practices at airports, land borders and ports to reduce the transmission of respiratory infectious diseases such as COVID-19
T Chetty, B B Daniels, N K Ngandu, A Goga
South African Medical Journal 2020;110(11):1105-1109.
Background. Travel screening for infectious diseases is often implemented to delay or prevent the entry of infected persons to a country/area.
Objectives. To evaluate the effectiveness of different point-of-entry screening strategies in achieving a reduction in imported COVID-19 transmission.
Methods. A rapid evidence review was conducted, systematically searching PubMed and Google Scholar and grey literature on 27 March 2020.
Results. We screened 1 194 records. Nine potential full-text articles were assessed for eligibility and included. Three articles investigated the effectiveness of entry-based thermal and body temperature scanning. Entry-based infrared thermal or body temperature scanning for COVID-19 was unlikely to be effective. Two systematic reviews found no additional benefit of travel restrictions/screening. In a COVID-19 modelling study, airport screening was not effective, with exit and entry thermal scanning identifying half and missing almost half of infected travellers. Two other modelling studies found that entry-based travel screening would achieve only modest delays in community transmission, while international travel quarantine could reduce case importations by 80%.
Conclusions. There is insufficient evidence to support entry and exit screening at points of entry, as these strategies detect just over half of the infected cases, missing almost half at entry points. The benefits of airport screening therefore need to be context specific and weighed against the resources and cost of implementation, the contribution of imported cases to total cases, and the benefits of identifying 50% of cases in the South African context with the country’s high HIV and tuberculosis prevalence and limited resources to deal with a pandemic of this nature.