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
Tool for contingency plan development and assessment for ports
Advice for restarting cruise ship operations after lifting restrictive measures in response to the COVID-19 pandemic (Version 3 - September 2021)
Advice for preparedness and response to cases of COVID-19 on board ferries after lifting restrictive measures in response to the COVID-19 pandemic.
Interim advice for restarting river cruise ship operations after lifting restrictive measures in response to the COVID-19 pandemic
WHO, WHERE, HOW: Overview of personal protective equipment (PPE) recommended for personnel, crew and passengers at points of entry and on board conveyances in the context of the COVID-19 pandemic (VERSION 4 – 20/05/2020)
and general advice at points of entry for public health measures and screening:
General guidance for restarting transportation activities to serve tourism after lifting restrictive measures in response to the COVID-19 pandemic (Version 1 - 15/05/2020)
Suggested procedures for cleaning and disinfection of ships during the COVID-19 pandemic (Version 2 – 20/04/2020)
Advice for health authorities and ship operators who have decided to suspend sailings and for the long-term docking of ships at the ports of EU/EEA MS during COVID-19 pandemic
It is recommended that the EU HEALTHY GATEWAYS document “Advice for health authorities and ship operators who have decided to suspend sailings and for the long-term docking of ships at the ports of EU/EEA MS during COVID-19 pandemic” should be read and used also considering the following Commission Guidelines on protection of health, repatriation and travel arrangements for seafarers, passengers and other persons on board ships:
- Commission Guidelines on protection of health, repatriation and travel arrangements for seafarers, passengers and other persons on board ships. (08 April 2020). Available here
Advice for cruise ship operators for preparedness and response to the outbreak of COVID-19
It is recommended that the EU HEALTHY GATEWAYS document “Advice for ship operators for preparedness and response to the outbreak of COVID-19” should be read and used also considering the following Commission Guidelines on protection of health, repatriation and travel arrangements for seafarers, passengers and other persons on board ships:
- Commission Guidelines on protection of health, repatriation and travel arrangements for seafarers, passengers and other persons on board ships. (08 April 2020). Available here
Public health measures at points of entry (VERSION 3 - 20/02/2020)
Exit and entry screening at points of entry (VERSION 1 - 06/02/2020)
- 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
Digital Green Certificate https://ec.europa.eu/health/ehealth/covid-19_en
Communication: A common path to safe and sustained re-opening https://ec.europa.eu/info/sites/info/files/communication-safe-sustained-reopening_en.pdf
Proposal for a Regulation on interoperable certificates on vaccination, testing and recovery (Digital Green Certificate) https://ec.europa.eu/commission/presscorner/detail/en/ip_21_1181
EU health preparedness: A common list of COVID-19 rapid antigen tests, including those of which their test results are mutually recognised, and a common standardised set of data to be included in COVID-19 test result certificates https://ec.europa.eu/health/sites/health/files/preparedness_response/docs/covid-19_rat_common-list_en.pdf
Coronavirus: Commission proposes additional safeguards on travel from outside the EU and updated criteria for applying travel restrictions https://ec.europa.eu/commission/presscorner/detail/en/ip_21_194
EC Proposal for a COUNCIL RECOMMENDATION on the temporary restriction on non-essential travel into the EU and the possible lifting of such restriction, amending Council Recommendation 2020/912 https://ec.europa.eu/home-affairs/sites/homeaffairs/files/pdf/25012021_proposal_council_recommendation_temporary_restriction_non_essential_travel_into_eu_com-2021-39_en.pdf
EC Coronavirus: Commission proposes update to coordinated approach on free movement restrictions https://ec.europa.eu/commission/presscorner/detail/en/ip_21_195
Communication: "A united front to beat COVID-19" https://ec.europa.eu/info/sites/info/files/communication-united-front-beat-covid-19_en.pdf
Commission Recommendation on a coordinated approach to travel and transport in response to the SARS-COV-2 variant observed in the United Kingdom https://ec.europa.eu/info/sites/info/files/commission-recommendation-coordinated-approach-travel-transport_en.pdf
Travel restrictions: Council reviews the list of third countries for which restrictions on non-essential travel should be lifted 17/12/2020 https://www.consilium.europa.eu/en/press/press-releases/2020/12/17/travel-restrictions-council-reviews-the-list-of-third-countries-for-which-restrictions-on-non-essential-travel-should-be-lifted/?utm_source=dsms-auto&utm_medium=email&utm_campaign=Travel+restrictions%3a+Council+reviews+the+list+of+third+countries+for+which+restrictions+on+non-essential+travel+should+be+lifted#
COMMUNICATION FROM THE COMMISSION TO THE EUROPEAN PARLIAMENT AND THE COUNCIL. Staying safe from COVID-19 during winter https://ec.europa.eu/health/sites/health/files/preparedness_response/docs/covid-19_stayingsafe_communication_en.pdf
COMMISSION RECOMMENDATION of 28.10.2020 on COVID-19 testing strategies, including the use of rapid antigen tests https://ec.europa.eu/health/sites/health/files/preparedness_response/docs/covid19_testingstrategies_recommendation_en.pdf
European Commission Communication on additional COVID-19 response measures https://ec.europa.eu/info/sites/info/files/communication-additional-covid-19-response-measures.pdf
Policy considerations for a pandemic and other major crisis contingency plan for the European freight transport sector - Approval of Council Conclusions https://www.consilium.europa.eu/register/en/content/out?typ=SET&i=ADV&RESULTSET=1&DOC_TITLE=&CONTENTS=&DOC_ID=12060%2F20&DOS_INTERINST=&DOC_SUBJECT=&DOC_SUBTYPE=&DOC_DATE=&document_date_from_date=&document_date_from_date_submit=&document_date_to_date=&document_date_to_date_submit=&MEET_DATE=&meeting_date_from_date=&meeting_date_from_date_submit=&meeting_date_to_date=&meeting_date_to_date_submit=&DOC_LANCD=EN&ROWSPP=25&NRROWS=500&ORDERBY=DOC_DATE+DESC
A coordinated approach to measures restricting free movement in the EU 13 october 2020 https://ec.europa.eu/info/sites/info/files/factsheet_-_coronavirus_-_a_coordinated_approach_to_measures_restricting_free_movement_in_the_eu.pdf
EC - 15 June 2020 - ‘Re-open EU’ – a new web platform launched to safely resume free movement and tourism in the EU https://reopen.europa.eu/en
EC FAQ Passenger Rights and Package Travel - 27 May 2020 https://ec.europa.eu/info/sites/info/files/faqs-travel-transportation.pdf
Press release. 13/05/2020 . Tourism and transport: Commission's guidance on how to safely resume travel and reboot Europe's tourism in 2020 and beyond https://ec.europa.eu/commission/presscorner/detail/en/ip_20_854
COVID-19: Guidelines on the progressive restoration of transport services and connectivity https://ec.europa.eu/info/files/covid-19-guidelines-progressive-restoration-transport-services-and-connectivity_en
Communication from the Commission: Tourism and transport in 2020 and beyond https://ec.europa.eu/info/files/tourism-and-transport-2020-and-beyond_en
COVID-19: Towards a phased and coordinated approach for the lifting of internal border controls and restoring freedom of movement https://ec.europa.eu/info/files/covid-19-towards-phased-and-coordinated-approach-lifting-internal-border-controls-and-restoring-freedom-movement_en
COVID-19: Recommendation on vouchers offered to passengers and travellers as an alternative to reimbursement for cancelled package travel and transport services https://ec.europa.eu/info/files/covid-19-recommendation-vouchers-offered-passengers-and-travellers-alternative-reimbursement-cancelled-package-travel-and-transport-services_en
COVID-19: EU Guidance for the progressive resuming of tourism services and for health protocols in hospitality establishments https://ec.europa.eu/info/files/covid-19-eu-guidance-progressive-resuming-tourism-services-and-health-protocols-hospitality-establishments_en
European Commission - Questions and answers: Coronavirus: a common approach for safe and efficient mobile tracing apps across the EU. https://ec.europa.eu/commission/presscorner/detail/en/qanda_20_869
European Commission - Questions and answers: TOURISM AND TRANSPORT PACKAGE. https://ec.europa.eu/commission/presscorner/detail/en/qanda_20_870
Factsheet: The EU helps reboot Europe's tourism. https://ec.europa.eu/commission/presscorner/detail/en/FS_20_851
Factsheet: Travel and tourism in Europe: practical guidance for travelers and companies. https://ec.europa.eu/commission/presscorner/detail/en/FS_20_850
COMMUNICATION FROM THE COMMISSION Guidance on free movement of health professionals and minimum harmonisation of training in relation to COVID-19 emergency measures –recommendations regarding Directive 2005/36/EC https://ec.europa.eu/info/sites/info/files/guidance-movement-health-professionals-harmonisation-training-covid19_en.pdf
Coronavirus: European roadmap shows path towards common lifting of containment measures https://ec.europa.eu/commission/presscorner/detail/en/ip_20_652
- Commission Guidelines on protection of health, repatriation and travel arrangements for seafarers, passengers and other persons on board ships. 08 April 2020 https://ec.europa.eu/transport/sites/transport/files/legislation/c20203100.pdf
- Questions & Answers for people travelling to and from the EU during the pandemic https://ec.europa.eu/info/sites/info/files/faqs-communication-travel-restrictions-08042020_en.pdf
Communication on assessment of state of play of the Communication on non-essential travel https://ec.europa.eu/info/sites/info/files/communication_on_assessment_of_state_of_play_of_the_communication_on_non-essential_travel.pdf
- Note of the Director-General: Exceptional measures in transport to deal with COVID-19; Inability to comply with certain provisions of EU legislation https://ec.europa.eu/transport/news/2020-03-27-exceptional-measures-inability-comply-legislation_en
- Union law requirements that addressees may be unable to comply with due to measures taken in the context of the COVID 19 crisis (Non-exhaustive list, to be updated if necessary) https://ec.europa.eu/transport/sites/transport/files/2020-04-06-issue_of_expiry_of_licences_and_certificates.pdf
- Communication from the Commission COVID-19 - Guidance on the implementation of the temporary restriction on non-essential travel to the EU, on the facilitation of transit arrangements for the repatriation of EU citizens, and on the effects on visa policy 2020/C 102 I/02 https://eur-lex.europa.eu/legal-content/EN/TXT/?qid=1585642173770&uri=CELEX:52020XC0330(02)
- Communication from the Commission Guidelines concerning the exercise of the free movement of workers during COVID-19 outbreak 2020/C 102 I/03 https://eur-lex.europa.eu/legal-content/EN/TXT/?qid=1585642173770&uri=CELEX:52020XC0330(03)
- Communication from the Commission European Commission Guidelines: Facilitating Air Cargo Operations during COVID-19 outbreak 2020/C 100 I/01 https://eur-lex.europa.eu/legal-content/EN/TXT/?qid=1585642173770&uri=CELEX:52020XC0327(03)
- COMMUNICATION FROM THE COMMISSION TO THE EUROPEAN PARLIAMENT, THE EUROPEAN COUNCIL AND THE COUNCIL COVID-19: Temporary Restriction on Non-Essential Travel to the EU https://eur-lex.europa.eu/legal-content/EN/TXT/?qid=1585642173770&uri=CELEX:52020DC0115
- Covid-19 Guidelines for border management measures to protect health and ensure the availability of goods and essential services 2020/C 86 I/01 https://eur-lex.europa.eu/legal-content/EN/TXT/?qid=1585642710515&uri=CELEX:52020XC0316(03)
- Communication from the Commission on the implementation of the Green Lanes under the Guidelines for border management measures to protect health and ensure the availability of goods and essential services 2020/C 96 I/01 https://eur-lex.europa.eu/legal-content/EN/TXT/?qid=1585642173770&uri=CELEX:52020XC0324(01)
- Commission Notice Interpretative Guidelines on EU passenger rights regulations in the context of the developing situation with Covid-19 2020/C 89 I/01 https://eur-lex.europa.eu/legal-content/EN/TXT/?qid=1585643022886&uri=OJ:JOC_2020_089_I_0001
- Commission Implementing Regulation (EU) 2020/466 of 30 March 2020 on temporary measures to contain risks to human, animal and plant health and animal welfare during certain serious disruptions of Member States’ control systems due to coronavirus disease (COVID-19) (Text with EEA relevance) https://eur-lex.europa.eu/legal-content/EN/TXT/?qid=1585642710515&uri=CELEX:32020R0466
Training resources for COVID-19
Online training resources for COVID-19
- EU HEALTHY GATEWAYS JOINT ACTION
- 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: email@example.com).
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
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 firstname.lastname@example.org
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 . 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 . 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 . 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 . In an analysis of 75,465 COVID-19 cases in China, airborne transmission was not reported . There have been no reports of faecal−oral transmission of the COVID-19 virus to date .
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 .
Guidance on disinfection of environments in healthcare and non-healthcare settings potentially contaminated with SARS-CoV-2 can be found at:
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. 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 :
- 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:
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
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 .
Specimen collection and laboratory testing will be conducted at the health care facility where the suspect case has been transferred.
Please see answer to question 1 above.
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  .
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 . 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.
This could be applied as a precautionary measure.
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.
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).
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.
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
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 other sources
Points of Entry
European Centre for Disease Prevention and Control
World Health Organisation
Transport and travellers
European Centre for Disease Prevention and Control
US travel association
US department of state
World Health Organisation
European Maritime Safety Agency
Joint Statement on prioritization of COVID-19 vaccination for seafarers and aircrew https://wwwcdn.imo.org/localresources/en/MediaCentre/Documents/Circular%20Letter%20No.4204-Add.38%20-%20Coronavirus%20(Covid-19)%20-%20Joint%20Statement%20Calling%20On%20All%20GovernmentsTo%20Prioritize%20Covid-19...%20(Secretariat).pdf
Circular Letter No.4204/Add.37 (22 December 2020) - Coronavirus (COVID 19) – Third video meeting for Port State Control (PSC) regimes on harmonized actions at the time of pandemic of Covid-19 https://wwwcdn.imo.org/localresources/en/MediaCentre/HotTopics/Documents/COVID%20CL%204204%20adds/Circular%20Letter%20No.4204-Add.37%20-%20Coronavirus%20(Covid%2019)%20-%20Third%20Video%20Meeting%20For%20Port%20State%20Control(Psc)%20Regimes.pdf
Circular Letter No.4204/Add.36/Rev.1 (23 December 2020) - Coronavirus (COVID 19) – ʺNo crew changeʺ clauses in charter parties https://wwwcdn.imo.org/localresources/en/MediaCentre/HotTopics/Documents/COVID%20CL%204204%20adds/CL.4204-Add.36%20no%20crew%20change%20clause.pdf
Circular Letter No.4204/Add.35/Rev.1 (23 December 2020) - Coronavirus (COVID-19) – Designation of seafarers as key workers https://wwwcdn.imo.org/localresources/en/MediaCentre/HotTopics/Documents/COVID%20CL%204204%20adds/Circular%20Letter%20No.4204-Add.35%20-%20Coronavirus%20(Covid-19)%20-%20Designation%20Of%20Seafarers%20As%20Key%20Workers.pdf
Circular Letter No.4204/Add.33 (5 November 2020) - Coronavirus (COVID-19) – Joint Statement IMO-UNWTO to support the safe resumption of cruise ship operations following the COVID-19 pandemic https://wwwcdn.imo.org/localresources/en/MediaCentre/HotTopics/Documents/COVID%20CL%204204%20adds/Circular%20Letter%20No.4204-Add.33%20-%20Coronavirus%20(Covid-19)%20-%20Joint%20Statement%20Imo-Unwto%20To%20Support%20TheSafe%20Resumption%20Of%20Cruise.pdf
IMO Circular Letter No.4204/Add.14/Rev.1 – 5 October 202 Coronavirus (COVID-19) –Recommended Framework of Protocols for ensuring safe ship crew changes and travel during the Coronavirus (COVID-19) pandemic
- Coronavirus (COVID-19) –Joint Statement IMO-UNWTO to support the safe resumption of cruise ship operations following the COVID-19 pandemic
- IMO Circular Letter No.4204/Add.30 (11 September 2020) - Coronavirus (COVID-19) – Joint Statement calling on all Governments to immediately recognize seafarers as key workers, and to take swift and effective action to eliminate obstacles to crew changes, so as to address the humanitarian crisis faced by the shipping sector, ensure maritime safety and facilitate economic recovery from the COVID-19 pandemic http://www.imo.org/en/MediaCentre/HotTopics/Documents/COVID%20CL%204204%20adds/Circular%20Letter%20No.4204Add.30%20Joint%20Statement%20Seafarers.pdf
- IMO Circular Letter No.4204/Add.28 (26 August 2020) - Coronavirus (COVID 19) – WHO guidance to promote public health measures on cargo ships and fishing vessels http://www.imo.org/en/MediaCentre/HotTopics/Documents/Circular%20Letter%20No.4204-Add.28.pdf
- IMO Circular Letter No.4204/Add.24 (13 July 2020) - Coronavirus (COVID-19) – Outcome of the International Maritime Virtual Summit on Crew Changes organized by the United Kingdom http://www.imo.org/en/MediaCentre/HotTopics/Pages/Coronavirus.aspx
- Circular Letter No.4204/Add.20 (5 June 2020) - Coronavirus (COVID-19) – Accelerating digitalization of maritime trade and logistics – A call to action http://www.imo.org/en/MediaCentre/HotTopics/Documents/COVID%20CL%204204%20adds/Circular%20Letter%20No.4204-Add.20%20-%20Coronavirus%20(Covid-19)%20-%20Accelerating%20Digitalization%20Of%20Maritime%20Trade.pdf
- IMO Circular Letter No.4204/Add.18 (26 May 2020) - Joint Statement IMO-ICAO-ILO on designation of seafarers, marine personnel, fishing vessel personnel, offshore energy sector personnel, aviation personnel, air cargo supply chain personnel and service provider personnel at airports and ports as key workers, and on facilitation of crew changes in ports and airports in the context of the COVID-19 pandemic http://www.imo.org/en/MediaCentre/HotTopics/Documents/COVID%20CL%204204%20adds/Circular%20Letter%20No.4204-Add.18%20-%20Joint%20Statement%20Imo-Icao-Ilo%20On%20Designation%20Of%20Seafarers.pdf
- IMO Circular Letter No.4204/Add.17 (21 May 2020) - Coronavirus (COVID 19) – Preparing for post COVID-19 operations: considerations and practicalities for port community systems, single window and other electronic exchange platforms http://www.imo.org/en/MediaCentre/HotTopics/Documents/COVID%20CL%204204%20adds/Circular%20Letter%20No.4204-Add.17%20-%20Coronavirus%20(Covid%2019)%20-%20Preparing%20For%20Post%20Covid-19%20OperationsConsiderations.pdf
- Circular Letter No.4204/Add.15 (6 May 2020) - Coronavirus (COVID 19) - Personal protective equipment http://www.imo.org/en/MediaCentre/HotTopics/Documents/COVID%20CL%204204%20adds/Circular%20Letter%20No.4204-Add.15%20-%20Coronavirus%20(Covid%2019)%20-%20Personal%20Protective%20Equipment.pdf
- Circular Letter No.4204/Add.6 (27 March 2020) Coronavirus (COVID-19) – Preliminary list of recommendations for Governments and relevant national authorities on the facilitation of maritime trade during the COVID-19 pandemic http://www.imo.org/en/MediaCentre/HotTopics/Documents/Circular%20Letter%20No.4204Add.6%20%20Coronavirus%20Covid-19%20Preliminary%20List%20Of%20Recommendations.pdf
- Circular Letter No.4204/Add.5 (17 March 2020) Coronavirus (COVID-19) – Guidance relating to the certification of seafarers http://www.imo.org/en/MediaCentre/HotTopics/Documents/CL.4204-Add.5.pdf
- Circular Letter No.4204/Add.4 (5 March 2020) contains ICS Coronavirus (COVID-19) Guidance for ship operators for the protection of the health of seafarers http://www.imo.org/en/MediaCentre/HotTopics/Documents/Circular%20Letter%20No.4204-Add.4.pdf
- Circular Letter No.4204/Add.3 (2 March 2020) - Operational considerations for managing COVID-19 cases/outbreak on board ships.http://www.imo.org/en/MediaCentre/HotTopics/Documents/Circular%20Letter%20No.4204-Add.2%20-%20Joint%20Statement%20Imo-Who%20On%20The%20Response%20To%20The%20Covid-19%20Outbreak%20(Secretariat).pdf
- Circular Letter No.4204/Add.2 (21 February 2020) contains the Joint Statement IMO-WHO on the Response to the COVID-19 Outbreak and encourages Member States and international organizations to disseminate it as widely as possible. http://www.imo.org/en/MediaCentre/HotTopics/Documents/Joint%20Statement_COVID-19.pdf
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Coronavirus ‘SARS-CoV-2’ Infections – Operational Recommendations. https://ad.easa.europa.eu/ad/2020-02R3
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- ECDC Mobile applications in support of contact tracing for COVID-19 - A guidance for EU EEA Member States
- ECDC Contact tracing for COVID-19: current evidence, options for scale-up and an assessment of resources needed
- ECDC TECHNICAL REPORT - Contact tracing: Public health management of persons, including healthcare workers, having had contact with COVID-19 cases in the European Union
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Latest on COVID-19
Epidemiology and clinical characteristics
Modes of transmission
Peer-reviewed scientific articles on COVID-19 and transportation [1-429]
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4. Dube, K., G. Nhamo, and D. Chikodzi, COVID-19 pandemic and prospects for recovery of the global aviation industry. Journal of Air Transport Management, 2021. 92.
5. Grout, A. and P.A. Leggat, Cabin crew health and fitness-to-fly: Opportunities for re-evaluation amid COVID-19. Travel Med Infect Dis, 2021. 40: p. 101973-101973.
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7. Silich, B.A., A Model for Inhalation of Infectious Aerosol Contaminants in an Aircraft Passenger Cabin. International Journal of Aviation, Aeronautics and Aerospace, 2021. 8(1): p. 6-6.
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9. Kleine-Kampmann, S., et al., [Air and maritime transport during the COVID-19 pandemic in Germany: challenges for the public health service]. Bundesgesundheitsblatt gesundheitsforschung gesundheitsschutz, 2021.
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12. Malagón-Rojas, J.N., M. Mercado, and C.P. Gómez-Rendón, SARs-CoV-2 and work-related transmission: Results of a prospective cohort of airport workers, 2020. Revista Brasileira de Medicina do Trabalho, 2021. 18(4): p. 371-380.
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18. Levin, M.W., M. Shang, and R. Stern, Effects of short-term travel on COVID-19 spread: A novel SEIR model and case study in Minnesota. PLoS One, 2021. 16(1): p. e0245919-e0245919.
19. Kasper, M.R. and J.R. Geibe, An Outbreak of Covid-19 on an Aircraft Carrier. Reply. N Engl J Med, 2021. 384(10): p. 976-977.
20. Song, S.W., et al., Symptoms and Characteristics Which Require Attention During COVID-19 Screening at a Port of Entry. J Korean Med Sci, 2021. 36(2): p. e14-e14.
21. Choi, J.H., Changes in airport operating procedures and implications for airport strategies post-COVID-19. Journal of Air Transport Management, 2021: p. 102065-102065.
22. Sean, M.K., et al., Aerosol tracer testing in the cabin of wide-bodied Boeing 767 and 777 aircraft to simulate exposure potential of infectious particulate such as SARS-CoV-2. 2021.
23. Spoelder, E.J., et al., Helicopter transport of critical care COVID-19 patients in the Netherlands: protection against COVID-19 exposure-a challenge to critical care retrieval personnel in a novel operation. Scand J Trauma Resusc Emerg Med, 2021. 29(1): p. 41-41.
24. Swadi, T., et al., Genomic Evidence of In-Flight Transmission of SARS-CoV-2 Despite Predeparture Testing. Emerg Infect Dis, 2021. 27(3): p. 687-693.
25. Talaat, K., et al., Simulation of aerosol transmission on a Boeing 737 airplane with intervention measures for COVID-19 mitigation. Physics of Fluids, 2021. 33(3).
26. Vivek, G., et al., COVID-19 International Border Surveillance Cohort Study at Toronto’s Pearson Airport. 2021.
27. Wang, Z., et al., Inflight Transmission of COVID-19 Based on Experimental Aerosol Dispersion Data. J. travel med, 2021.
28. Wilder-Smith, A., COVID-19 in comparison with other emerging viral diseases: risk of geographic spread via travel. Tropical Diseases Travel Medicine & Vaccines, 2021. 7(1): p. 3-3.
29. Zhang, T., et al., Public health information on COVID-19 for international travellers: lessons learned from a mixed-method evaluation. Public Health, 2021. 193: p. 116-123.
30. Hadei, M., et al., Presence of SARS-CoV-2 in the air of public places and transportation. 2021.
31. Strods, C., A. Berka, and S. Linney, Effective Global Mobility and International Recruitment During A Pandemic. Lecture Notes in Educational Technology, 2021: p. 53-67.
32. Schultz, M.S.M., Analytical approach to solve the problem of aircraft passenger boarding during the coronavirus pandemic. Transportation Research Part C: Emerging Technologies, 2021: p. 102931-102931.
33. Norizuki, M.H.M.M.A.M.A.M.K.K.M.S.W.A.H.U.T., Effective screening strategies for detection of asymptomatic COVID-19 travelers at airport quarantine stations: Exploratory findings in Japan. Global Health & Medicine, 2021.
34. Lee, H., et al., Risk assessment of importation and local transmissions of COVID-19 in South Korea. 2021.
35. Horstman, R. and H. Rahai, A Risk Assessment of an Airborne Disease inside the Cabin of a Passenger Airplane. SAE Techni. Paper., 2021.
36. Cave, K.M., et al., Aircrew Performance and Safety While Using Protective Masks in Response to Coronavirus Disease. Aerosp Med Hum Perform, 2021. 92(4): p. 274-280.
37. Liptakova, D., J. Kolesar, and M. Keselova, Challenges to the global aerospace industry due to the pandemic epidemy of COVID-19. NTinAD - New Trends in Aviation Development - Int. Scientific Conf., Proc., 2020: p. 155-158.
38. Jenna, K.P., et al., Probability and Estimated Risk of SARS-CoV-2 Transmission in the Air Travel System: A Systemic Review and Meta-Analysis. 2021.
39. Horinka, I.J. and I.L. Kontrikova, Covid-19 Pandemic Impact on the Aviation Future. NTinAD - New Trends in Aviation Development - Int. Scientific Conf., Proc., 2020: p. 99-104.
40. Freire de Souza, C.D.M.M.F.G.d.S.J.A.B.R.N.B.E.F.d.C.R., Airports, highways and COVID-19: An analysis of spatial dynamics in Brazil. Journal of Transport & Health, 2021. 21: p. 101067-101067.
41. Bernathova, S., et al., Impact of global pandemic COVID-19 on Air Transport in Slovakia in the Period from March to June 2020. NTinAD - New Trends in Aviation Development - Int. Scientific Conf., Proc., 2020: p. 24-27.
42. Memish, Z.A., et al., COVID-19 air travel restrictions and vaccine passports: An ongoing debate. Travel Med Infect Dis, 2021: p. 102049-102049.
43. Salehian, A. and M.H. Sheikholeslami, The Impact of the Aviation Industry on International Security Threats, Case Study of Health Threats (2002–2020). Journal of Applied Security Research, 2021.
44. Zhou, S., et al., Global health governance for travel health: lessons learned from the coronavirus disease 2019 (COVID-19) outbreaks in large cruise ships. Glob Health J, 2020. 4(4): p. 133-138.
45. Zhang, S., et al., Estimation of the reproductive number of novel coronavirus (COVID-19) and the probable outbreak size on the Diamond Princess cruise ship: A data-driven analysis. Int J Infect Dis, 2020. 93: p. 201-204.
46. Yoshimura, Y., et al., Clinical characteristics of the coronavirus disease 2019 (COVID-19) outbreak on a cruise ship. J Infect Chemother, 2020. 26(11): p. 1177-1180.
47. Yazir, D., et al., Effects of COVID-19 on maritime industry: a review. Int Marit Health, 2020. 71(4): p. 253-264.
48. Yasri, S. and V. Wiwanitkit, COVID-19, guests and crews of cruise: observation on Thai citizens. Int Marit Health, 2020. 71(1): p. 9.
49. Yang, W., et al., [Retrospective analysis of the on-site treatment of the coronavirus disease 2019 epidemic on the Costa Crociere cruise]. Zhonghua Wei Zhong Bing Ji Jiu Yi Xue, 2020. 32(6): p. 750-753.
50. Yamamoto, K., et al., Underperformance of Reverse-Transcriptase Polymerase Chain Reaction in Japan and Potential Implications From Diamond Princess Cruise Ship and Other Countries During the Ongoing COVID-19 Pandemic. Int J Health Policy Manag, 2020.
51. 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.
52. Yamagishi, T., et al., Environmental Sampling for Severe Acute Respiratory Syndrome Coronavirus 2 During a COVID-19 Outbreak on the Diamond Princess Cruise Ship. J Infect Dis, 2020. 222(7): p. 1098-1102.
53. Yamagishi, T., et al., Descriptive study of COVID-19 outbreak among passengers and crew on Diamond Princess cruise ship, Yokohama Port, Japan, 20 January to 9 February 2020. Euro Surveill, 2020. 25(23).
54. Yamagishi, T. and Y. Doi, Insights on COVID-19 epidemiology from a historic cruise ship quarantine. Clin. infect. dis, 2020.
55. Xu, L., et al., Lessons and suggestions to travelers and cruise ships in the fight against COVID-19. QJM, 2020.
56. 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.
57. Visser, J.T., Patterns of illness and injury on Antarctic research cruises, 2004-2019: a descriptive analysis. J Travel Med, 2020. 27(6).
58. Tsuboi, M., et al., Epidemiology and quarantine measures during COVID-19 outbreak on the cruise ship Diamond Princess docked at Yokohama, Japan in 2020: a descriptive analysis. Global Health & Medicine, 2020: p. 2020.01037-2020.01037.
59. Tokuda, Y., et al., COVID-19 outbreak on the Diamond Princess Cruise Ship in February 2020. J Gen Fam Med, 2020. 21(4): p. 95-97.
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63. Stannard, S., COVID-19 in the maritime setting: the challenges, regulations and the international response. Int Marit Health, 2020. 71(2): p. 85-90.
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65. Sossai, P., et al., Coronavirus variant COVID-19 pandemic: a report to seafarers. Int Marit Health, 2020. 71(3): p. 191-194.
66. Sloane, P.D., Cruise Ships, Nursing Homes, and Prisons as COVID-19 Epicenters: A "Wicked Problem" With Breakthrough Solutions? J Am Med Dir Assoc, 2020. 21(7): p. 958-961.
67. Slišković, A., Seafarers' well-being in the context of the COVID-19 pandemic: A qualitative study. Work, 2020. 67(4): p. 799-809.
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69. Sekizuka, T., et al., SARS-CoV-2 Genome Analysis of Japanese Travelers in Nile River Cruise. Front Microbiol, 2020. 11: p. 1316.
70. Sekizuka, T., et al., Haplotype networks of SARS-CoV-2 infections in the Diamond Princess cruise ship outbreak. Proc Natl Acad Sci U S A, 2020. 117(33): p. 20198-20201.
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76. Roques, L., et al., Using Early Data to Estimate the Actual Infection Fatality Ratio from COVID-19 in France. Biology (Basel), 2020. 9(5).
77. Rocklov, J., H. Sjodin, and A. Wilder-Smith, COVID-19 outbreak on the Diamond Princess cruise ship: estimating the epidemic potential and effectiveness of public health countermeasures. J Travel Med, 2020. 27(3).
78. Radic, A., et al., Fear and Trembling of Cruise Ship Employees: Psychological Effects of the COVID-19 Pandemic. Int. j. environ. res. public health (Online), 2020. 17(18).
79. Qin, J., et al., How many COVID-19 PCR positive individuals do we expect to see on the Diamond Princess cruise ship? medRxiv, 2020.
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Last update: 17/09/2021