This article looks at some of the issues which arise from efforts to control the spread of Ebola (Viral Haemorrhagic Fever), including the announcement by the Australian government on 28 October 2014 that it was suspending entry visas for people from countries affected by Ebola, including Liberia, Sierra Leone and Guinea.
This is a serious epidemic. According to the US Centre for Disease Control and Prevention, as of 24 October 2014 there were over 10,100 cases and almost 5,000 deaths. Owners and operators of cruise ships need to have their own procedures in the event of a suspected infected passenger on board.
The recent case of Mr Thomas Duncan (the only fatality in the US from the disease to date) demonstrates the risks if proper measures are not taken. According to press reports, Mr Duncan died at a hospital in Texas and two nurses at the hospital contracted Ebola from him. Those nurses are being treated for the disease, but one was allowed to fly to Ohio to make arrangements for her wedding. As a result, over 100 further people are being monitored for signs of Ebola, and the chief executive of the airline on which the nurse flew has himself taken a flight, sitting in the seat she used, to reassure the public that the airline is safe.
The case then directly affected the cruise industry, as it emerged that a lab technician who had carried a box containing Mr Duncan’s blood samples was on board a cruise ship from Galveston to the Caribbean. The lab technician quarantined herself in her cabin and informed the captain, but the ship was apparently refused entry to ports in Belize and Mexico. Fortunately, blood tests on the lab technician showed that she had not contracted Ebola, but the case shows how important it is that owners and operators have a clear emergency response procedure in place, so that they are prepared in advance for the risk of a suspected infected passenger on board.
The symptoms of Ebola include fever, weakness, muscle pain, headache and sore throat, followed by vomiting, diarrhoea, rash and in some cases bleeding, with infected persons being infectious once they begin to show symptoms. The disease is communicated via direct contact with blood, secretions, organs or other body fluids of infected persons or animals.
Practical measures which can be taken include updating the pre-boarding questionnaire (to find out about possible exposure to Ebola) and careful monitoring of passengers before boarding, so that access to the ship can be refused to anyone who may be infected. Likewise, passengers and crew on board should be monitored and prominent notices should be displayed so that people are aware of the symptoms and can monitor themselves.
According to World Health Organisation guidelines, if an infected person is on board, the following precautions should be applied:
- They should be placed in an isolation room or a closed cabin.
- Anyone who will come into contact with them should be made aware of the risks and mechanisms of transmission, and a log should be kept of those people.
- Anyone who comes into contact with the infected person should wear personal protective equipment (PPE) - and have had training on effecting donning and doffing of PPE - and perform hand hygiene.
- Waste should be handled as clinical infectious waste.
The infected person should leave the vessel at the next port of call, disembarking in such a way as to avoid contact with healthy people on board.
The Master should of course be informed and, while there is currently no travel ban, the vessel should contact the local coastguard. In some areas, for example in the UK, ships are already being monitored so that vessels which have called at countries where the Ebola virus is present are identified in advance.
Different ports and countries are likely to take different action. For example, according to press reports, the Maltese authorities denied entry to a ship in September 2014 because a Filipino crew member had symptoms similar to Ebola, and Maltese health officials considered that the country did not have adequate facilities to treat Ebola patients.
The French government has published recommendations for ships, including passenger ships, which include general recommendations as well as specific recommendations for when there is a suspected case on board.
Operators should also carry out effective due diligence before embarking, in order to assess the risks of Ebola at ports where the vessel is due to call. If these checks are not carried out and a cruise becomes adversely affected by an Ebola infected passenger or other Ebola incident such that a significant proportion of the services contracted for is not provided, passengers on that cruise might bring a claim under the UK Package Travel, Package Holidays and Package Tours Regulations 1992 (the Regulations) or equivalent. In order to benefit from the defence under the Regulations, the operator will need to be able to demonstrate that it took all reasonable steps and exercised all due diligence to avoid any such disruption.
This is a developing situation, and we will publish further updates in due course.