As summer approaches and cruise travel restarts EU HEALTHY GATEWAYS has published revised advice to support competent authorities at ports and passenger ships. Read more about it on the news from the consortium along other important documents and dissemination activities.
In this issue we present all latest developments of the work packages for air, maritime and ground-crossings. All partners and leaders of work packages have been working hard to prepare training courses, advice documents, table-top-exercises and support the competent authorities to continue responding to COVID-19 while summer is approaching and operations are restarting. Read more under the thematic sections about all latest achievements and what to expect in the upcoming months from the joint action. Last but not least do not omit to read about the European Union digital Passenger Locator Form System that has been developed by EU HEALTHY GATEWAYS and provides a single entry point and database for the collection of passenger locator forms.
Finally we announce two important events that will be organised in May:the 3rd EU HEALTHY GATEWAYS Sustainability Working Group and Advisory Board meetings and the web-based training of the trainers’ course - Preparedness and response to public health events at ground crossings and workshop on the management of public health event due to chemical agent at ground-crossings.
Advisor of Quality Management and Communication Department
National Public Health Centre under The Ministry of Health
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
This is the final year of operation for the EU HEALTHY GATEWAYS joint action that in line with the latest amendment will conclude on December 2021 and the EU HEALTHY GATEWAYS consortium are working on activities and deliverables according to the annual work plan as described in the Grant Agreement (training events, table top exercises, guidance documents). Additionally, under the emergency mode operation, partners are working in preparing new interim advise documents or updating previous ones so as to further support the competent authorities in EUMS during restart of operations as this summer period is about to start.
I would like to take this opportunity to bring to your attention the latest documents delivered by the consortium of the EU HEALTHY GATEWAYS:
- Model MoU for airport local competent authorities’ agreement of cooperation for responding to public health events (joint action milestone 6.8)
This model MoU includes rules of cooperation among the different competent authorities at airports at local level, that need to be involved in the response to a public health event (including appropriate human and animal health, law enforcement and defense personnel), as described in the WHO tool for Joint External Evaluation.
- Model MoU for port local competent authorities’ agreement of cooperation for responding to public health events (joint action milestone 7.6)
This model MoU includes rules of cooperation among the different competent authorities at ports at local level, that need to be involved in the response to a public health event (including appropriate human and animal health, law enforcement and defense personnel), as described in the WHO tool for Joint External Evaluation.
Even under this new state of play where physical meetings are no longer possible the consortium has managed to participate in many key web-based dissemination events. The EU Healthy Gateways Joint Action Tool for Public Health Emergency Contingency Plan Development and Assessment for Ports was presented on 10th March 2021 to a webinar organised by the Cruise Line International Association (CLIA). On 15th of April the Coordinator together with our partners from Italy and Lithuania participated in a Health Security Committee meeting presenting the EUdPLF system and the experience of the two countries from pilot testing and implementing the EUdPLF system. EU HEALTHY GATEWAYS presented in the working group meeting of the social partners in the field of Maritime transport (European Transport Workers' Federation (ETF) and European Community Shipowners' Associations (ECSA)) that was held on 16th April 2021. Many coordination meetings are scheduled with DG SANTE, DG MOVE, EASA and EUMS for EU dPLF system implementation and sustainability. Finally it was a pleasure to give an interview to Peter Greenberg, a travel journalist in the USA for a series of episodes called “Cruise Views” filmed for the CLIA Global communication channel presenting all the work completed by the consortium to support the ports and maritime transport sector during this pandemic. You can view it here.
EU HEALTHY GATEWAYS ON SERIES OF EPISODES CALLED “CRUISE VIEWS” BY CLIA GLOBAL
Prof. Hadjichristodoulou representing EU HEALTHY GATEWAYS gave an interview to Peter Greenberg, a travel journalist in the USA for a series of episodes called “Cruise Views” filmed for the CLIA Global communication channel.
View it here.
Authors: Kristina Militzer*, Jan Heidrich*, Thomas von Münster*, Martin Dirksen-Fischer*
* Hamburg Port Health Center, Germany
The following is a summary of the most recent and upcoming tasks within work package 4 (Integration in National Policies and Sustainability) and work package 6 (Air transportation).
Work package 4
In the last weeks, the focus of WP 4 was on the preparation, conduction and post processing of Milestone M.4.4. (Multi-sectorial table top exercise at European level for ports). The SHIPSAN Association was subcontracted in order to achieve this deliverable. An important objective of the exercise was to test the link between risk assessment on public health events related to ships and communication at local, national and EU level. Further, the exercise aimed to support the development of the inter-country communication guidelines developed by Healthy Gateways. The small scale, discussion based table-top exercise was conducted on 24 March 2021. Players from local and national levels of five European Members States (Greece, Spain, Italy, the Netherlands and Germany), two shipping companies (MSC and TUI) and the ECDC were actively involved during the exercise. Additionally, observers from several European Members States, WHO, DG Sante, DG Move, EMSA and others took part and commented on the content and progress of the exercise. Two scenarios were discussed: Scenario A) outbreak of gastrointestinal illnesses (Salmonella and Norovirus) on a cruise ship with 3000 passengers and 1000 crew members in the North Sea; Scenario B) outbreak of respiratory diseases (Influenza and COVID-19) on a cruise ship with 1200 passengers and 450 crew members in the Mediterranean Sea. The final report will be completed and shared among all participants within the next weeks.
The next milestone of WP 4 will be the organisation of the third Sustainability working group meeting. During the web-based meeting, work package leaders will elaborate with DG Sante, DG Move, CHAFEA, ECDC and EASA on different sustainability issues of the EU HEALTHY GATEWAYS Joint Action, including options to identify long-term/permanent solutions for continuous operation and maintenance of joint action outputs.
Work package 6
Numerous tasks have been addressed within Work Package 6 over the past weeks and months by and in cooperation with different consortium members. The “Tool for contingency plan development and assessment for airports Version 1” (M 6.5.) is in its final steps, the same applies to the “Report of the legal framework of the countries in regards to the contact tracing in the air sector in response to public health events” (M.6.3). Members of WP 6 provided expertise for the e-learning course on “Preparedness and response at airports in the European Union (EU)/EEA Member States (MS) in the context of COVID-19” which will be launched soon. Input for the design and development of the EU dPLF application was provided on a regular basis.
In the next weeks, there will be a focus on the finalisation of “Table top /simulation exercise at airports version 1” (M.6.1). At a later stage, the update of the AIRSAN bibliography on guidance documents on the control of public health threats and air transport is foreseen.
Authors: Assoc. Prof. Barbara Mouhtouri, University of Thessaly, Greece
The focus of the maritime transport work package the last few months was the completion of the tool for public health emergency contingency plan development and assessment for ports and the support of the organisation and delivery of the Multi-sectorial table top exercise at European level for ports as described in the article “Summary of events of work package 4 (Integration in National Policies and Sustainability) and work package 6 (Air transportation”. In addition to the above input to the working group for the development of the EUdPLF system has been provided especially for the maritime sector component.
The Joint Action under the emergency mode operation since January 2020 has developed 15 interim advice documents out in order to support response of EU Member States (MS) to the COVID-19 pandemic out of which 10 are applicable to ports and the shipping industry.
The following interim advice documents have been updated and new versions of the documents are available:
- Advice for restarting cruise ship operations after lifting restrictive measures in response to the COVID-19 pandemic
- Advice for ship operators for preparedness and response to the outbreak of COVID-19
In addition to the above, two more advice documents are under preparation:
- EU HEALTHY GATEWAYS in collaboration with the European Commission’s Directorate General for Mobility and Transport (DG MOVE) are jointly developing interim advice for facilitating safe crew changes and supporting seafarer wellbeing during the COVID-19 pandemic.
- An interim advice document is prepared by EU HEALTHY GATEWAYS on restarting river-ship operations after lifting restrictive measures in response to the COVID-19 pandemic
Finally the upcoming months the following will be delivered:
- Guidelines for inter-country communication & information flow in outbreak investigations & public health event management (Deliverable 9.4)
- Instructions for developing exercises for testing the local public health emergency contingency plan for ports (Milestone 7.5)
- Multisectorial table-top exercise for all points of entry at national level (Milestone 9.6)
Authors: Brigita Kairiene1, Janusz Janiec2, Giedre Aleksiene1, Diana Bruneviciene1
1 National Public Health Centre under the Ministry of Health, Lithuania
2 National Institute of Public Health – National Institute of Hygiene, Poland
In the context of Points of Entry, ground crossings are different from ports and airports. Taking into account that ground crossings topic in EU has not been broadly analysed so far, within Joint Action the report on “Cross Border Health Threats: State of the Art Report for Ground Crossings” was prepared.
The importance of communication and cooperation of different stakeholders at national, but especially at local level that was why two templates of “Model Memorandums of Understanding” were developed:
A. For personal data exchange for the purpose of contact tracing in the field of public health
B. For coordination of response to public health events of mutual interest (ground crossings
COVID-19 pandemic made some changes to the planned tasks and activities were focused on its management:
- Preliminary advice for preparedness and response to cases of COVID-19 at ground crossings (buses and bus stations) in the European Union (EU)/ European Economic Area (EEA) Member States (MS)
- Webinar “Events related to COVID-19 at ground crossings”
Activities planned in the near future:
- Web-based training of the trainers’ 1-day course titled “Preparedness and response to public health events at ground-crossings”
- International simulation exercise related to management of public health threats at ground crossings (planned on the Lithuania – Poland border)
- Bibliography and catalogue of best practices on core capacities implementation at ground crossings
Passenger Locator Forms (PLFs) are used by public health authorities to facilitate contact tracing in case travellers are exposed to an infectious disease during their travel by plane, ship (cruise/ferry), rail, bus or automobile. In response to COVID-19, EU HEALTHY GATEWAYS developed a common European Union digital Passenger Locator Form System (EUdPLF) for all transport sectors (aircrafts, cruise ships/ferries and ground transport) providing a single entry point and database for the collection of PLFs. The development of digital PLFs allows for easier, more rapid data collection and exchange between all stakeholders, making contact tracing more effective and efficient.
- EU dPLF app (private access - login) https://app.euplf.eu - This is the web app for completion of EUdPLF for all transportation modes. The app is fully functional and stored on the Amazon AWS cloud service covering all security requirements. The app provides a very flexible multilingual mechanism allowing for online translation of all content. Each Member State (MS) will have access only to their national data (data owner). Data will always be in English except some specific fields (e.g. Address, City). One dPLF is completed per family/group, a QR code is generated and the dPLF is sent to the passenger’s email. Passengers can then view, access, edit or update all submitted PLF(s). The dPLF includes mandatory minimum set of PLF data.
The EUdPLF system was pilot tested (December 2020-February 2021) with Slovenia, Italy and France for the air sector and with Spain and Italy for the ferry sector. Ground crossing pilot testing was postponed due to non-operation of international trains. During pilot testing 1013 PLFs were submitted and 1450 passengers registered. Feedback received by passengers via evaluation questionnaires was positive and were used to make adjustments and improve user experience. In addition, the interconnection test of EUdPLF with the EASA exchange platform allowing the exchange of data between MS with their own national digital PLF systems on the one hand and MS using the EUdPLF on the other hand has been completed successfully.
Italy is officially using the EUdPLF system for “COVID-tested flights” arriving from the USA. Lithuania with an existing nationally developed dPLF is currently transferring to the EUdPLF system for all sectors. Discussions are ongoing related to technical specifications with France and Slovenia. Germany completed the translation process but final decision is pending. Spain will consider using it for the maritime sector.
Who can use the EUdPLF system
uPCOMING EVENTS OF THE JOINT ACTION
- 3rd EU HEALTHY GATEWAYS Sustainability Working Group and Advisory Board meetings
The 3rd EU HEALTHY GATEWAYS Sustainability Working Group meeting and Advisory Board meeting, will be conducted back-to-back (total duration: 4 hours) on Thursday May 20, 2021 from 13:00-17:00 CEST (Central European Summer Time), in a web-based format using the platform MS Teams.
The meetings are organized jointly by the University of Thessaly (EU HEALTHY GATEWAYS Coordination) and the University Medical Center Hamburg-Eppendorf (Leaders of Work Package 4: Integration in National Policies and Sustainability).
The objectives of the Sustainability Working Group meeting will be to discuss internal sustainability issues of EU HEALTHY GATEWAYS, including options to identify long-term/permanent solutions for the continuous operation and maintenance of joint action outputs.
The objectives of the Advisory Board meeting are to:
- Provide an update on joint action activities in the context of COVID-19 and joint action operation in emergency mode
- Discuss and advise on technical/policy matters related to the joint action
- Discuss evaluation results of joint action activities to date
- Discuss sustainability issues and ways that joint action activities can be implemented on a sustainable basis
- Explore linkages with existing networks and structures in the EU and internationally
- Web-based training of the trainers’ course - Preparedness and response to public health events at ground crossings and workshop on the management of public health event due to chemical agent at ground-crossings
The web-based training of the trainers’ course will be held on 26 May 2021.
The purpose of the training of the trainers’ programme is to increase competence and capacity for managing public health events in ground transport including risk assessment, decision-making and crisis communication. The training course will address issues of decision making for implementing evidence based health measures proportionate to the health risks. After completing this course, the nominated participants could act as trainers to the training course at national level to be organised within the framework of the EU HEALTHY GATEWAYS joint action at their country.
Moreover, a half-day web-based workshop on management of public health events due to chemical agents at ground-crossings will be held back-to-back with the web-based training of the trainers’ course. The workshop is organised by the Public Health England (PHE), UK and the National Institute of Public Health (NIJZ), Slovenia. The purpose of the workshop is to identify gaps, opportunities and raise awareness of best practice for chemicals and improve understanding of existing arrangements in Member States. It will address, at a national level, the plans for preparedness and action for dealing with a chemical incident.
This course it targeted to persons working at a competent authority at a country central level (Ministry of Health, National Public Health Institute or other) AND/OR technical/scientific experts representing ground transport health authorities working at a competent authority at a local level responsible for responding to public health events and implementing health measures at ground crossings.
The course is organised by co-leaders of Work Package 5-Ground Crossings: National Institute of Public Health - National Institute of Hygiene (NIPH-NIH), Poland and National Public Health Centre under the Ministry of Health, Lithuania with the support of the Coordinators: University of Thessaly, Laboratory of Hygiene and Epidemiology, Greece and leaders Work Package 9 for capacity building and training: National Institute of Public Health and the Environment, Netherlands
The chemical workshop is organised by co-leaders of Work Package 8-Chemical treats at PoE - National Institute of Public Health (NIJZ), Slovenia and Department of Health - Public Health England (DH-PHE), United Kingdom on the management of public health event due to chemical agent at ground-crossings.
Advice for restarting cruise ship operations after lifting restrictive measures in response to the COVID-19 pandemic (Version 2 - 30 April 2021)
A revised advice for restarting cruise ship operations after lifting restrictive measures in response to COVID-19 has been published.
The revised version incorporates the following changes:
- Definitions of contacts and cases
- Diagnostic testing policy for crew and passengers
- Use of face masks
- Considerations for vaccinations
The revised document is available here: https://www.healthygateways.eu/Portals/0/plcdocs/EU_HEALTHY_GATEWAYS_COVID-19_RESTARTING_CRUISES_2021_30_4_2021.pdf?ver=2021-04-30-102640-827
Advice for cruise ship operators for preparedness and response to an outbreak of COVID-19
The revised version incorporates the following changes:
- Definitions of contacts and cases
- Diagnostic testing policy of crew and passengers
- Criteria for stopping a cruise due to a COVID-19 event
- Use of face masks
The revised document is available here: https://www.healthygateways.eu/Portals/0/plcdocs/EU_HEALTHY_GATEWAYS_COVID-19_MARITIME_CRUISE_30_4_2021.pdf?ver=2021-04-30-092015-073
COVID-19: cross-border contact tracing in Germany, February to April 2020
Introduction: The Robert Koch Institute (RKI) managed the exchange of cross-border contact tracing data between public health authorities (PHA) in Germany and abroad during the early COVID-19 pandemic.
Aim: We describe the extent of cross-border contact tracing and its challenges.
Methods: We analysed cross-border COVID-19 contact tracing events from 3 February to 5 April 2020 using information exchanged through the European Early Warning Response System and communication with International Health Regulation national focal points. We described events by PHA, number of contacts and exposure context.
Results: The RKI processed 467 events, initiating contact to PHA 1,099 times (median = 1; interquartile range (IQR): 1–2) and sharing data on 5,099 contact persons. Of 327 (70%) events with known exposure context, the most commonly reported exposures were aircraft (n = 64; 20%), cruise ships (n = 24; 7%) and non-transport contexts (n = 210; 64%). Cruise ship and aircraft exposures generated more contacts with authorities (median = 10; IQR: 2–16, median = 4; IQR: 2–11) and more contact persons (median = 60; IQR: 9–269, median = 2; IQR: 1–3) than non-transport exposures (median = 1; IQR: 1–6 and median = 1; IQR: 1–2). The median time spent on contact tracing was highest for cruise ships: 5 days (IQR: 3–9).
Conclusion: In the COVID-19 pandemic, cross-border contact tracing is considered a critical component of the outbreak response. While only a minority of international contact tracing activities were related to exposure events in transport, they contributed substantially to the workload. The numerous communications highlight the need for fast and efficient global outbreak communication channels between PHA.
Air and maritime transport during the COVID-19 pandemic in Germany: challenges for the public health service
COVID-19 has been challenging our society since January 2020. Due to global travel, the new coronavirus has rapidly spread world-wide. This article aims to provide an overview of the challenges in implementing measures in the air and maritime transport sector from the perspective of the German Public Health Service (Öffentlicher Gesundheitsdienst,ÖGD). Significant events and measures for air and maritime transport between January and August 2020 were selected. Lessons learned are discussed. During the COVID-19 pandemic, the ÖGD ha sbeen operating in a field of tension between the dynamics of scientific knowledge, political decision-making, social acceptance and consent. There are specific challenges at points of entry such as airports and seaports. These include staff shortages and the need to implement measures with a high organisational effort at very short notice such as health authority passenger checks carried out on aircraft, the establishment of test centres at points of entry and control of compliance with quarantine measures. Aggravating the situation, passenger lists, which are necessary for effective contact tracing, are often not available or incomplete. There is also a lack of digital tools for contact tracing but also, for example, the exchange of personal data within the ÖGD. Further difficulties in outbreak management arise from the cramped conditions on board ships and from the potential psychological stress on crewmembers and passengers, which have not yet been sufficiently considered. In view of all these challenges, it is paramount to strengthen the German Public Health Service in general and at points of entry and to intensify the exchange between the national, federal state and local levels.
Symptoms and Characteristics Which Require Attention During COVID-19 Screening at a Port of Entry
Background: The quarantine process at a country's port of entry has an important role in preventing an influx of coronavirus disease 2019 (COVID-19) cases from abroad and further minimizing the national healthcare burden of COVID-19. However, there has been little published on the process of COVID-19 screening among travelers entering into a country. Identifying the characteristics of COVID-19 infected travelers could help attenuate the further spread of the disease.
Methods: The authors analyzed epidemiological investigation forms and real-time polymerase chain reaction (PCR) results for severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) of entrants to Incheon International Airport between March 11 to April 30, 2020. We performed univariate and multivariate logistic regression analysis to determine the odds of positive SARS-CoV-2 result.
Results: A total of 11,074 entrants underwent reverse-transcription PCR for SARS-CoV-2, resulting 388 confirmed cases of COVID-19 infection. COVID-19 had a strong association with the reported loss of smell or taste and association with self-reported fever, chill, cough, and vomiting. If a traveler reported contact with an individual with either respiratory symptoms or confirmed COVID-19 in the last two weeks directly prior to landing, the probability of a positive result was increased.
Conclusion: If overseas travelers experience loss of smell or taste in the two weeks prior to arrival, they may require an immediate examination to rule out COVID-19 at a port of entry. As to measure body temperature upon arrival at a port of entry, it is important to screen for any occurrence of fever within the two weeks prior to travel. Also, information with epidemiological relevance, such as recent contact with an individual suffering from any respiratory symptoms or with confirmed COVID-19, should be included in COVID-19 screening questionnaires for international travelers.