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SEVERE
ACUTE RESPIRATORY SYNDROME (SARS)
PREVENTIVE MEASURES AND ACTIONS
ALCOAST 159/03
P 042351Z APR 03
ALCOAST 159/03
COMDTNOTE 16700
SUBJ: SEVERE ACUTE RESPIRATORY SYNDROME (SARS) PREVENTIVE MEASURES AND ACTIONS
1. THE WORLD HEALTH ORGANIZATION (WHO) AND CENTERS FOR DISEASE CONTROL AND PREVENTION (CDC) HAVE ISSUED ALERTS ABOUT SARS, A SERIOUS RESPIRATORY ILLNESS. THE ILLNESS USUALLY BEGINS WITH A FEVER (MEASURED TEMPERATURE GREATER THAN 100.50F (38.00C). THE FEVER IS SOMETIMES ASSOCIATED WITH CHILLS OR OTHER SYMPTOMS, INCLUDING HEADACHE, GENERAL FEELING OF DISCOMFORT, AND BODY ACHES. SOME PEOPLE ALSO EXPERIENCE MILD RESPIRATORY SYMPTOMS AT THE OUTSET. AFTER 2 TO 7 DAYS, SARS PATIENTS MAY DEVELOP A DRY, NONPRODUCTIVE COUGH. THE ILLNESS APPEARS TO BE TRANSMITTED BY DIRECT CONTACT WITH RESPIRATORY SECRETIONS AND BODY FLUIDS, OR BY LIVING WITH OR CARING FOR, SARS INFECTED PERSONS. IT HAS MOSTLY BEEN LIMITED TO HEALTH CARE WORKERS AND DIRECT CONTACTS OF CASES.
2. AREAS WITH DOCUMENTED SARS ARE CURRENTLY THE FOLLOWING: HONG KONG, MAINLAND CHINA, HANOI VIETNAM, SINGAPORE, AND TORONTO CANADA. THESE ARE AREAS WHERE COMMUNITY TRANSMISSION HAS OCCURRED. THIS LIST DOES NOT INCLUDE AREAS WHERE TRANSMISSION HAS BEEN LIMITED TO HEALTH CARE WORKERS OR FAMILY MEMBERS ONLY.
3. RESPIRATORY ILLNESSES ARE PROBLEMATIC WHERE LARGE NUMBERS OF TROOPS LIVE IN CLOSE PROXIMITY TO ONE ANOTHER, SUCH AS DURING BASIC TRAINING, ABOARD SHIPS, AND ON DEPLOYMENTS.
4. TO MINIMIZE THE THREAT OF THIS DISEASE TO COAST GUARD PERSONNEL IN DOMESTIC OPERATIONS AND TO PREVENT THE SPREAD WITHIN THE U.S., THE FOLLOWING MEASURES WILL BE IMPLEMENTED:
A. ALL PERSONNEL IN DIRECT CONTACT WITH PERSONS SUSPECTED OF HAVING SARS WILL OBSERVE STRICT INFECTION CONTROL MEASURES.
1) FREQUENT HAND WASHING IS CRITICAL AND PROBABLY THE BEST PREVENTIVE MEASURE AVAILABLE. HAND HYGIENE CONSISTS OF WASHING WITH SOAP AND WATER FOR TWO TO THREE MINUTES. AT A MINIMUM, PERSONNEL SHOULD WASH HANDS AFTER BEING IN CONTACT WITH SUSPECT CASES, AFTER REMOVING DISPOSABLE GLOVES, AND BEFORE ACTIVITIES THAT BRING THE HANDS IN PROXIMITY TO THE FACE, SUCH AS EATING, SMOKING, APPLYING COSMETICS, OR HANDLING CONTACT LENSES. ALCOHOL BASED WATERLESS HAND CLEANERS ARE ACCEPTABLE IF HANDS ARE NOT VISIBLY SOILED OR IF SOAP AND WATER ARE UNAVAILABLE. DISPOSABLE GLOVES SHOULD BE USED WHENEVER DEALING WITH PERSONS SUSPECTED OF HAVING SARS. GLOVES WILL BE DISCARDED AND HANDS WASHED IMMEDIATELY AFTER SUCH CONTACT. WHEN CONTACTING SUSPECT CASES, LEATHER OR OTHER GLOVES, INCLUDING FLIGHT GLOVES, SHOULD NOT BE USED, SINCE THEY ARE NOT DISPOSABLE OR WASHABLE.
2) RESPIRATORY SECRETIONS ARE THE SUSPECTED MODE OF TRANSMISSION OF SARS. RESPIRATORY DROPLETS MAY BE SUSPENDED IN AN AREA OF SEVERAL FEET AROUND A PERSON WHO IS COUGHING. PROTECTION INVOLVES THE USE OF THE FIT-TESTED N-95 RESPIRATOR. IF N-95 RESPIRATORS ARE NOT AVAILABLE, SURGICAL MASKS MAY BE USED AND THEN DISPOSED OF IMMEDIATELY. EYE PROTECTION (FACE SHIELDS OR GOGGLES) IS ALSO CRUCIAL TO INFECTION CONTROL. IF POSSIBLE, EYE PROTECTION (FACE SHIELDS OR GOGGLES) AND PROTECTIVE DISPOSABLE GOWNS SHOULD BE WORN. CLOTHING SHOULD BE LAUNDERED AS SOON AS POSSIBLE AFTER CONTACT WITH A PERSON SUSPECTED OF HAVING SARS.
3) CARDIOPULMONARY RESUSCITATION (CPR) SHOULD ONLY BE PERFORMED USING A RESUSCITATION BAG-VALVE MASK EQUIPPED WITH HEPA FILTRATION OF EXPIRED AIR.
4) THE SUSPECT CASE WILL WEAR A PAPER SURGICAL MASK, IF TOLERATED, TO REDUCE DROPLET PRODUCTION.
5) QUESTIONS REGARDING THE USE OF MEDICAL EQUIPMENT SHOULD BE DIRECTED TO THE APPROPRIATE AREA MLC(K).
B. ADDITIONAL INTERIM GUIDANCE FOR AEROMEDICAL EVACUATIONS MAY BE FOUND AT: HTTP://WWW.CDC.GOV/NCIDOD/SARS/AIRTRANSPORT-SARS PATIENTS.HTM
5. OPERATIONAL MEASURES ROLE OF THE CDC:
A. CDC AUTHORITY: IN 42 CFR PART 71.21 THE CDC HAS AUTHORITY AND REQUIRES THAT THE MASTER OF A VESSEL REPORT TO THE NEAREST QUARANTINE STATION, ANY DEATH OR ILLNESS ONBOARD A VESSEL WHEN IT OCCURS WITHIN EITHER 15 DAYS OF ARRIVAL OR DEPARTURE FROM A U. S. PORT.
B. IN ADDITION TO THE REQUIRED REPORTING, THE CDC HAS THE AUTHORITY TO DETAIN ANY VESSEL, WITH INDIVIDUALS ONBOARD WHO ARE SUSPECTED TO HAVE A COMMUNICABLE DISEASE, AT A QUARANTINE ANCHORAGE OR OTHER APPROPRIATE LOCATION. THE PURPOSE OF THE DETAINMENT IS TO ALLOW FOR CDC TO SEND A RESPONSE TEAM TO INVESTIGATE AND CONTAIN THE POTENTIAL SPREAD OF A DISEASE. SHOULD THE NEED ARISE FOR THE CDC TO DIRECT/CONTROL AN INDIVIDUAL SUSPECTED OF HAVING SARS, THEY WILL COORDINATE WITH STATE AGENCIES THAT HAVE AUTHORITY OVER THE MATTER TO ENSURE THE ISOLATION/QUARANTINE OF CONTAGIOUS INDIVIDUALS.
C. CG ACTIONS: THE COAST GUARD HAS A DUTY TO SUPPORT AND ASSIST THE CDC IN CARRYING OUT THESE REGULATIONS PURSUANT TO 42 U.S.C. 268(B). PURSUANT TO THESE AUTHORITIES, VESSEL ARRIVAL INFORMATION SHOULD BE SCRUTINIZED FOR INFORMATION REGARDING A VESSELS PREVIOUS PORTS OF CALL. VESSELS THAT HAVE VISITED PORTS OF CALL IN ANY OF THE LOCATION NOTED ABOVE (PARA. 2) SHOULD BE CONSIDERED AS POTENTIAL CARRIERS OF SARS. BOARDING PERSONNEL, UPON INITIAL ARRIVAL ON BOARD ANY VESSEL SCHEDULED FOR EXAMINATION, REGARDLESS OF A VESSELS PREVIOUS PORTS OF CALL, SHALL IMMEDIATELY ASK THE FOLLOWING QUESTIONS OF THE VESSEL MASTER. THIS PROCEDURE SHALL CONTINUE UNTIL FURTHER NOTIFIED:
1) DOES ANY PERSON ON BOARD HAVE A RESPIRATORY ILLNESS OF UNKNOWN ORIGIN WITH ONSET SINCE FEBRUARY 1, 2003 AND CONSISTING OF FEVER MEASURED TO BE OVER 100.5 DEGREES AND ONE OR MORE OF THE FOLLOWING: COUGH, SHORTNESS OF BREATH, DIFFICULTY BREATHING?
2) HAS THE ILL PERSON(S) HAD CLOSE CONTACT WITHIN 10 DAYS OF ONSET OF RESPIRATORY ILLNESS SYMPTOMS WITH A PERSON UNDER INVESTIGATION OR SUSUPECTED OF HAVING SARS?
3) HAS THE ILL PERSON(S) TRAVELED WITHIN 10 DAYS OF ONSET OF RESPIRATORY ILLNESS SYMPTOMS TO HONG KONG, MAINLAND CHINA, HANOI VIETNAM OR TORONTO CANADA? IF THE MASTER ANSWERS YES TO QUESTION 1 AND YES TO EITHER QUESTION 2 OR 3, THE BOARDING SHALL ENSURE THAT THIS INFORMATION IS IMMEDIATELY DELIVERED TO THE NEAREST CDC QUARANTINE STATION. QUARANTINE INFORMATION AND QUARANTINE STATIONS MAY BE FOUND AT HTTP://WWW.CDC.GOV/NCIDOD/SARS/QUARANTINE.HTM
D. UPON NOTIFICATION, THE CDC WILL COORDINATE FURTHER ACTIONS TO MANAGE THE CASE. THIS WILL INCLUDE ON SITE INVESTIGATION OF THE CASE BY EITHER CDC PERSONNEL OR LOCAL PUBLIC HEALTH OFFICIALS. IF THE CASE IS DETERMINED TO BE AN ACTUAL SARS CASE, THE CDC WILL DETERMINE THE BEST ACTIONS TO BE TAKEN, WHICH MAY INCLUDE REMOVAL OF THE CASE FROM THE VESSEL OR POSSIBLE QUARANTINE ON BOARD THE VESSEL. SURVEILLANCE OF OTHER VESSEL PERSONNEL, PASSENGERS AND CREW, WILL CONTINUE AS APPROPRIATE AND COORDINATED BY CDC.
E. COTPS SHOULD BECOME FAMILIAR WITH THE INFORMATION AVAILABLE ON THE CDC WEBSITE AND CONTACT THE NEAREST CDC QUARANTINE STATION IN ORDER TO DEVELOP CONTINGENCY PLANS TO MANAGE RESPONSE PROCESSES SHOULD A SARS CASE BE REPORTED IN PORT. IN MOST AREAS, CDC QUARANTINE PERSONNEL ARE LOCATED AT MAJOR AIRPORTS. CDC PERSONNEL ARE READY AND ANTICIPATING PHONE CONTACT FROM COTP PERSONNEL. IN ADDITION, TO IMPROVE AWARENESS OF REPORTING REQUIREMENTS TO THE CDC, COTPS SHOULD USE E-MAIL, INFO BULLETINS, COMMITTEE MEETINGS, ETC. TO WIDELY DISSEMINATE THIS INFORMATION TO VESSEL OWNERS, OPERATORS AND AGENTS WITHIN THEIR PORTS.
6. MEDICAL OFFICERS WILL CAREFULLY MONITOR THE HEALTH OF BOARDING PARTY MEMBERS WHO HAVE CONTACTED SUSPECTED SARS PATIENTS MONITORED CAREFULLY FOR 10 DAYS FOLLOWING THE CONTACT.
7. THIS PUBLIC HEALTH SITUATION IS RAPIDLY EVOLVING. THE LATEST RECOMMENDATIONS AND CASE DEFINITION ARE FOUND AT HTTP://WWW.CDC.GOV/NCIDOD/SARS/INDEX.HTM
8. THE HQ POCS FOR THIS MESSAGE ARE CDR SHARON LUDWIG (G-WKH) AT 202-267-1725 AND LT LINDSAY DEW (G-MOC) AT 202-267-0476.
9. INTERNET RELEASE AUTHORIZED
10. MINIMIZE CONSIDERED
11. RELEASED BY: RADM PAUL J. PLUTA, ASST COMDT FOR MARINE SAFETY, SECURITY AND ENVIRONMENTAL PROTECTION
BT
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