COVID-19: guidance for staff in the transport sector – GOV.UK #AceHealthDesk reports

COVID-19: guidance for staff in the transport sector

1. Signs and symptoms of COVID-19

Based on current evidence, COVID-19 presents with flu-like symptoms including:

  • cough
  • difficulty breathing
  • a fever (feeling hot or feverish or as measured by a doctor or nurse)

The current evidence is that most cases appear to be mild. The majority of those that have died in the current outbreak appear to have had pre-existing health conditions or have had weakened immune systems.

2. Case definition

On 6 February the UK’s Chief Medical Officers agreed on a precautionary basis to expand the clinical case definition for COVID-19 to include:

  • China
  • Hong Kong
  • Japan
  • Macau
  • Malaysia
  • Republic of Korea
  • Singapore
  • Taiwan
  • Thailand

The UK’s Chief Medical Officers’ advice to passengers who have travelled or passed through (such as transit through an airport) any of these countries in the previous 14 days and who develop flu like symptoms (cough, fever, shortness of breath) should:

  • stay indoors and avoid contact with other people, as you would with the flu
  • call NHS 111 to inform them of recent travel to the country

The case definition was further revised on 25 February 2020 to advise those who have returned from these specific areas since 19 February, to call NHS 111 and stay indoors and avoid contact with other people, even if they do not have symptoms:

  • Iran
  • specific lockdown areas in northern Italy as designated by the Government of Italy
  • special care zones in South Korea as designated by the Government of the Republic of South Korea
  • Hubei province (returned in the past 14 days)

If people have returned from these areas since 19 February and develop symptoms, however mild, they should stay indoors at home and avoid contact with other people immediately and call NHS 111. They do not need to follow this advice if they have no symptoms:

  • northern Italy (anywhere north of Pisa, Florence and Rimini)
  • Vietnam
  • Cambodia
  • Laos
  • Myanmar

Please follow this advice even if symptoms are minor.

3. Transmission

Although evidence is still emerging, information to date indicates human-to-human transmission is occurring. Hence, precautions to prevent human-to-human transmission are appropriate for both suspected and confirmed cases (see infection prevention and control guidance). COVID-19 infections have been reported in healthcare workers in China.

3.1 How COVID-19 is caught and spread

Seasonal flu and coronavirus are both spread from person to person by close contact. Some examples of how it can be spread include:

  • large droplets from coughing and or sneezing by an infected person within a short distance (usually one metre or less) of someone
  • touching or shaking the hand of an infected person and then touching your mouth, eyes or nose without first washing your hands
  • touching surfaces or objects (such as door handles) that have become contaminated with the virus and then touching your mouth, eyes or nose without first washing your hands

It is advisable to check Foreign and Commonwealth Office (FCO) and local guidance and advice on avoiding infection during the current outbreak if travelling overseas.

Latest advice from the UK Government is available.

In practice, it can be difficult to ascertain with any degree of reliability if someone who is asymptomatic has been exposed if they do not report this directly.

4. General precautions

4.1 Possible risk to staff

Staff and crew in contact with international passengers (or the general public) are not considered to be at a heightened risk of contracting coronavirus as a result of their work. This means that they are at no greater risk of contracting coronavirus than any other member of the public.

4.2 Taking necessary precautions

There is currently no vaccine for coronavirus but there are things you can do to help stop coronavirus spreading.

Public Health England (PHE) recommends that the following general cold and flu precautions are taken to help prevent people from catching and spreading COVID-19:

  • cover your mouth and nose with a tissue or your sleeve (not your hands) when you cough or sneeze
  • put used tissues in the bin straight away
  • wash your hands with soap and water often – use hand sanitiser gel if soap and water are not available
  • try to avoid close contact with people who are unwell
  • clean and disinfect frequently touched objects and surfaces
  • do not touch your eyes, nose or mouth if your hands are not clean

4.3 How long can the virus survive?

How long any respiratory virus survives will depend on a number of factors, for example:

  • what surface the virus is on
  • whether it is exposed to sunlight
  • differences in temperature and humidity
  • exposure to cleaning products

Under most circumstances, the amount of infectious virus on any contaminated surfaces is likely to have decreased significantly by 24 hours, and even more so by 48 hours.

Once the virus is transferred to hands, it survives for fewer than 5 minutes. Regular cleaning of frequently touched hard surfaces and hands will therefore help to reduce the risk of infection.

4.4 Facemasks

Staff are not recommended to wear respiratory masks. They do not provide protection from respiratory viruses. Respiratory masks are only recommended to be worn by symptomatic passengers to reduce the risk of transmitting the infection to other people.

PHE recommends that the best way to reduce any risk of infection is good hygiene and avoiding direct or close contact (closer than 2 metres) with any potentially infected person. Any member of staff who deals with members of the public from behind a screen will be protected from airborne particles.

4.5 Hand hygiene standards to follow

If staff are concerned that they may be exposed to risk, they should wash their hands regularly. Washing with water and soap is preferable to wipes and gels as it removes any potential infection directly. Wipes and gels are good alternatives if that’s all you have available. See hand washing guidance.

4.6 Handling baggage, post or freight

Staff should continue to follow existing risk assessments and safe systems of work. There is no perceived increase in risk for handling baggage, post or freight from specified countries.

4.7 If a passenger becomes unwell at a transport hub

Where possible staff should ask if they have recently returned from one (or passed through) any of the areas listed in the COVID-19 case definition in the last 14 days. If they have then, where possible, staff should remove themselves to be at least 2 metres distance from the passenger and call for medical assistance, informing the medical staff that they have been to a specified country in the last 14 days.

If they have not been to a specified area in the last 14 days, then normal practice should continue.

4.8 Cleaning standards

Coronavirus symptoms are similar to a flu-like illness and include cough, fever, or shortness of breath. Once symptomatic, all surfaces that the passenger has come into contact with must be cleaned including:

  • all surfaces and objects which are visibly contaminated with body fluids
  • all potentially contaminated high-contact areas such as toilets, door handles, telephones
  • clothing and linen used by the passenger should be set aside pending assessment of the passenger by a healthcare professional

Public areas where a symptomatic passenger has passed through and spent minimal time in (such as corridors) but which are not visibly contaminated with body fluids do not need to be specially cleaned and disinfected.

Further advice on environmental cleaning standards for potential COVID-19 contamination is available.

4.9 What staff should do if they think they have been exposed to COVID-19

If you think you have been exposed or if you develop symptoms consistent with coronavirus, in England call the NHS 111 helpline or the equivalent in Scotland, Northern Ireland and Wales.

If overseas, follow your transport company’s arrangements for seeking medical advice.

5. Arrivals into the UK

5.1 Maritime

Maritime Declarations of Health are already required for all ships arriving from a foreign port. If the maritime declaration of health reports any instances of illness, the usual procedures for infectious diseases will be followed.

In addition, for vessels that arrive with potential cases, PHE’s local Health Protection Team (HPT) will deliver enhanced port health monitoring commensurate with that in place at airports for the passengers and crew on board.

Enhanced monitoring arrangements involve assessing recent travel history; who they have been in contact with and where they are going next, as well as a possible medical assessment. Medical assessments will be carried out by trained medical staff and not by Border Force or other staff.

Passengers and crew will also be given advice on what to do should they develop symptoms later, again consistent with enhanced monitoring arrangements at airports.

5.2 Aviation

Direct flights to the UK from specified areas are required to provide health announcements to passengers relating to the current COVID-19 outbreak. Flights are also required to provide a general declaration 60 minutes before landing on any passenger health issues or suspected cases.

5.3 International rail

Eurostar runs trains between the UK and France, the Netherlands and Belgium so has no direct links with specified areas. Visitors may fly into Europe from specified areas but then travel around by other modes of transport including Eurostar, however there is no assessment of Eurostar passengers’ recent travel history. Currently Eurostar has no enhanced port health monitoring in place, although this will be kept under review.

Performing body or bag searches

PHE recommend that passengers be asked if they have travelled to (or passed through) any of the specified areas in the last 14 days. If they have and feel unwell, then the passenger should be immediately assessed by Port Health staff prior to the search.

For all well passengers, PHE recommend that staff use an alcohol-based hand sanitiser that contains at least 60% alcohol after each search.

5.4 If a passenger becomes symptomatic on-board a vessel, train or aircraft

Cooperate with the emergency medical service or public health officials at the relevant port or airport, as far as possible.

Keep your transport company operations centre informed of any requests by the public health officials such as requests for passenger information (except where provided by the passengers themselves) and crew details.

If the emergency medical services or public health officials are concerned that the ill person may have COVID-19, they are likely to request specific information to assist with the clinical and public health risk assessment, such as:

  • what are the main symptoms of the individual?
  • do they have a fever?
  • were they unwell during the journey and if so:
    • what symptoms did they have?
    • were there any episodes of contamination with bodily fluids (including vomit, diarrhoea and blood) of the crew or passengers during the journey or during disembarkation?
    • are there any co-passengers? Clarify with them, about both the individual and themselves
    • how long the individual has been unwell?
    • what have the symptoms been?
    • have they had a temperature?
    • where exactly have they come from?
    • have the co-passengers experienced any symptoms, and if so, clarify using the information above

Contacts of confirmed COVID-19 case

Any contacts of a confirmed case need to self-isolate. In practice, for passengers who have travelled via airplane, this will include all passengers within 2 seats of a confirmed case. Contacts of a possible case do not need to change their daily activities.

6. Further guidance

Additional guidance has been published in relation to the current COVID-19 outbreak aimed at healthcare workers.

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