Being a ship's doctor in the age of Corona

This story was first published in "Paraplyen" the magazine for Hordaland and Sogn og Fjordane Legeforening, no. 1 2022.

When Statsraad Lehmkuhl left Arendal in August 2021, it set out on a journey lasting until April 2023. The goal of the OneOcean Expedition is to create attention and share knowledge about the crucial role of the ocean in a climate perspective, and as a food source and habitat for a large and diverse number of species.

Along the way, scientists from several institutions doing research in climate, environmental issues, meteorology and biology participate. On board there are also students, and enthusiasts of all ages eager to participate as fellow sailors on the over one hundred year old school ship.

My employer, Helse Bergen, is responsible for the ship's doctors. Consultants who want to participate, use the paid weeks set aside for personal and professional development for this. The Norwegian Center for Maritime and Diving Medicine at the Department of Occupational and Environmental Medicine, is responsible for the appointment and training of the ship's doctors.

The voyage started in Arendal. The ship sailed to La Coruña in Spain, then to Lisbon and via Cádiz to Las Palmas in Gran Canaria. The next leg was across the Atlantic Ocean to the Caribbean island Curacao. Then onwards to Jamaica, Cuba and the Bahamas, before docking in Miami December 7 last year.

So far, with alternating crews, fellow sailors and visitors, there were no Covid-19 infections on board. The strategy was to test all fellow sailors on arrival, after three days at sea, and also do occasional systematic temperature monitoring.

We adhered to the guidelines of the authorities in the next port. Vaccines were a requirement, and since Curacao, everyone who was to take part in the voyage needed to have two doses of vaccine. This strategy proved successful and infections were kept off the ship for the first months.

The last week before my departure, the news of a new extra contagious coronavirus variant broke; Omicron, detected in South Africa. Shortly afterwards, entry rules to the United States were tightened. To gain access you had to be fully vaccinated, as well as having a negative PCR test taken within 24 hours prior to the start of your journey.

I walked up the gangway of Statsraad Lehmkuhl in Miami December 7 2021, being the 6th ship doctor in a row during the circumnavigation.
For a guy living in Bergen, Norway, Statsraad Lehmkuhl is an old acquaintance. She has her homeport here, moored at Bradbenken in the center of the city. To get the chance to be on board as ship doctor on the leg from Miami to New York was an assignment I looked forward to with reverence.

It is not easy to deal with outbreaks on ships, as we have seen several examples of in the last two years. Even less on a sailing ship over 100 years old, where you live really close together. The fellow sailors sleep in shifts in two large rooms (orlops) with only half a meter of space between the hammocks. Everyone shares shower and toilet facilities. Excellent conditions for virus transmissions in other words.

How to handle infections on board had been discussed between us, the Statsraad Lehmkuhl Foundation and the ship officers. We worked out plans based on the number of infected at any given time, but an outbreak would still be difficult to stop with the ship's limited space for insulation.

The days in Miami were busy. We received new supplies of medicines and medical equipment, and registered everything in the ship's logistics system. In addition, all newly arrived fellow sailors and crew were tested before they were allowed up the gangway and into the ship.

On this leg the ship was manned by scientists, 67 all together. All of them took part in running the ship, doing 2 x 4 hours of various tasks such as helmsman watch, lookout, buoy guard, fire guard, cleaning, and all the work related to sailing the ship. Everything planned and overseen by the permanent crew of 27. The ship can take 130 fellow sailors, so it was not as crowded as it could have been.

We departed Miami December 10, and during the evening the mainsail and staysails were set, and the engine was turned off. We were sailing. The silence under the starry sky was amazing.

I had a few daily consultations in the days that followed, only minor injuries. A few learned the hard way that they were novices in pulling ropes and climbing the rig, so sore hands, tendons and muscles were not uncommon. I put my scalpel in a mature abscess on one occasion, and had to look at a possible head injury one dark night. The fellow sailors took good care of themselves, so off-duty I too got to climb the rig and learn some seamanship. I began to settle down as the ship's doctor.

We had no indications of corona infections. Both on departure and on day three all
fellow sailors and the entire crew were tested using rapid tests. Everyone was negative. At this time we were pretty sure that the ship was corona-free, so we skipped using masks and distance-rules, but still upheld good hand hygiene.

The whole ship was regarded as one cohort. We were literally a "bubble floating in the ocean" without physical contact with the outside world.

In the early afternoon of December 17, we anchored up a few hundred meters from The Statue of Liberty and historic Ellis Island, where hundreds of thousands of immigrants entered USA, most arriving on tall ships. In the background were Manhattan with its landscape of skyscrapers, reminding us that we were, after all, a small ship from a small country. We were happy to come to New York on our beautiful ship, and the mood was high on board.

We got cell phone coverage again, and could share selfies with the Statue of Liberty or the Manhattan skyline in the background.

According to the plan, Saturday December 18, would be a busy day.

First UN ambassadors from the countries that Statsraad Lehmkuhl will visit during the voyage, and other important guests, would be given a tour on board. Later the ship would be moved to Brooklyn using tugboats, and dock there. In the evening a reception for invited guests was planned. The fact that Norway now has a seat in the UN Security Council would also be honoured.

I realised that I would have a lot to do, so my day at the doctor's office started early. Preparing the ship hospital for the handover to the Naval Academy's doctor soon to take over was on my plan, among other things.

Then he stood there, the young crew boy. A fever set in during the night, and his nose was a little bit stuffy too, but otherwise he was in quite good shape. He asked for Paracetamol.

"Sure, but first we have to take a new covid test," I said, putting on gloves, a face mask and goggles. Everyone on board had tested negative at least three times along the way, so my surprise was real when the double lines appeared on the test kit.

Thoughts were spinning through my mind as I walked to the captain's office. I wondered how this information was going to change the plans for the day, and in the worst case for the weeks ahead.

The patient was not allowed to leave the doctor's office and the next step was to do a PCR test, which confirmed the infection. He was isolated, and during the morning we tested the entire crew. First the ones he had been in close contact with. We were really anxious waiting for the results. Fortunately, everyone was negative. Then we tested the rest of the permanent crew.

Before lunch we gathered all fellow sailors on the main deck and the captain informed us all about the situation. Wearing face masks became temporarily mandatory.

Then we tested all the fellow sailors, watch team by watch team, and as if by a miracle, all of them were also negative. The sense of relief was palpable. But much was still unresolved, and a number of practical questions arose:
When can the ship dock? Are we all to be defined as close contacts? Where to set up a quarantine area? Will I reach my plane? Am I coming home for Christmas?

The afternoon and evening was hectic, with a lot of communication going on with insurance companies, the US Coast Guard and the New York health authorities. The role of the ship's doctor had changed fast. My medical journals, views and judgments were suddenly important.

Back in Bergen, the Statsraad Lehmkuhl Foundation was also involved in the ongoing contact with the coast guard and health authorities. We were still at anchor, and did not know when we could dock. The fact that all on board was tested using rapid-tests was a key factor. In the evening we were given permission to dock the next morning, and that all with negative tests could leave the ship. This did wonders for the mood on board.

The patient was still in pretty good condition. Since he was otherwise healthy and fully vaccinated, his prognosis was good. He was isolated in the sick bay, which at Statsraad Lehmkuhl is a 12 square meter room with four bunks, and a separate bathroom. We store much of our medical equipment in the same room. Not ideal, but pretty good for a vessel built in 1914.

The doctor's office is well equipped and has a medical monitor similar to the monitors in intensive care units. A monitor like this was not strictly needed in this case, but the function that measures oxygen saturation in the nail bed (pulse oximeter) is a very useful monitoring function in handling covid-cases. I could do daily checks, and ensure that the O2 saturation did not decrease.

I tested all close contacts with PCR tests the day after the infection was detected, all were negative. The one infected was left in the hands of the crew. They were people he knew, and since we had our infirmary with its own bathroom and toilet, I recommended that the patient complete his isolation on board, and not alone in a hotel room ashore. He spent at least ten days in isolation, in accordance with the US guidelines at this time.

Within a week, a number of new crew members tested positive, one after the other. So, the remaining crew had to celebrate Christmas and New Year in isolation on board, before the new crew arrived and they finally were allowed to leave the ship.

As of today, Statsraad Lehmkuhl is on its way again, with cadets and officers from
the Royal Norwegian Naval Academy on board. Having cadets on board is an annual tradition, but this time a part of the One Ocean Expedition. The ship is sailing south towards Rio de Janeiro, where it is scheduled to arrive February 23, 2022.

The need for Covid-19 testing and planning may diminish during the voyage, and hopefully the pandemic is history when Statsraad Lehmkuhl arrives in Bergen again in April 2023.

Facts: Quarantine and infection control were well known for all seafarers of the sailing ship era. The word "quarantine" originates from the 40 (quarant in Italian) days ships had to wait outside Venice when they arrived from the Far East, before being allowed to unload goods and the crew being allowed ashore. Hopefully without bringing any infections to Europe.

About the author: Roald Flesland Havre is a Senior consultant at the Medical Clinic, HUS, Helse-Bergen, Section for Digestive Diseases. He is also Adjunct Professor at Clinical Institute 1, at the University of Bergen, Norway. His first time as a ship's doctor was on board Statsraad Lehmkuhl on the OneOcean Expedition from Miami to New York, in December 2021.

Translated into English by Ronald Toppe