COVID-19 isolation and containment strategies for ships: Lessons from the USS Theodore Roosevelt outbreak

  1. Madison Stoddard
  2. Kaitlyn Johnson
  3. Doug White
  4. Ryan Nolan
  5. Natasha Hochberg
  6. Arijit Chakravarty

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Abstract

The control of shipborne disease outbreaks represents a vexing but entirely predictable challenge at the start of any pandemic. Passenger ships, with large numbers of people confined in close quarters, can serve as incubators of disease, seeding the pandemic across the globe as infected passengers return home. Short-term steps taken by local authorities can exacerbate this problem, creating humanitarian crises and worsening the scale of the outbreak. In this work, we have undertaken a model-based examination of the USS Theodore Roosevelt outbreak to understand the dynamics of COVID-19 spread aboard the aircraft carrier. We have used a series of counterfactual “what-if” analyses to better understand the options available to public health authorities in such situations. The models suggest that rapid mass evacuation and widespread surveillance testing can be effective in these settings. Our results lead to a set of generalizable recommendations for disease control that are broadly applicable to the current COVID-19 crisis as well as to future pandemics.

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    SciScore for 10.1101/2020.11.05.20226712: (What is this?)

    Please note, not all rigor criteria are appropriate for all manuscripts.

    Table 1: Rigor

    Institutional Review Board Statementnot detected.
    Randomizationnot detected.
    Blindingnot detected.
    Power Analysisnot detected.
    Sex as a biological variablenot detected.

    Table 2: Resources

    No key resources detected.

    Results from OddPub: We did not detect open data. We also did not detect open code. Researchers are encouraged to share open data when possible (see Nature blog).

    Results from LimitationRecognizer: We detected the following sentences addressing limitations in the study:
    However, a recent outbreak at the Rose Garden of the White House demonstrated the limitations of antigen tests (Facher, 2020), for which the CDC itself regards negative results as “presumptive” (CDC, 2020). Previous studies on the Roosevelt demonstrated the limitations of social distancing in an onboard setting (Payne, 2020), and our prior work has demonstrated the limited utility of symptom-based testing for the containment of SARS-CoV-2 outbreaks (Johnson et al., 2020). As an alternative, we suggest requiring negative PCR tests for all passengers after a 14-day quarantine, as the CDC requires for crewmembers (HHS, 2020). Arguably, if testing on the Roosevelt had been operating at full capacity, isolating the infected sailors by airlifting them to land using the organically embedded air wing of the Roosevelt (two C-2 Greyhounds and six MH-64 Sea King helicopters) could have had a significant impact on the growth and spread of the outbreak (“USS Theodore Roosevelt (CVN-71),” 2020). Although testing was slow to ramp up in the specific case of the Roosevelt, mass testing and targeted removal can be decisive in enabling continued safe operations. The relationship between testing frequency and strategy effectiveness is steep: low levels of testing are ineffectual, while high levels of testing can be highly effective. For a ship with similar disease spread dynamics as the Roosevelt, a crew of any size can be maintained aboard while containing disease if testing is sufficient. Thus...

    Results from TrialIdentifier: No clinical trial numbers were referenced.

    Results from Barzooka: We did not find any issues relating to the usage of bar graphs.

    Results from JetFighter: Please consider improving the rainbow (“jet”) colormap(s) used on page 9. At least one figure is not accessible to readers with colorblindness and/or is not true to the data, i.e. not perceptually uniform.

    Results from rtransparent:
    • Thank you for including a conflict of interest statement. Authors are encouraged to include this statement when submitting to a journal.
    • Thank you for including a funding statement. Authors are encouraged to include this statement when submitting to a journal.
    • No protocol registration statement was detected.

    About SciScore

    SciScore is an automated tool that is designed to assist expert reviewers by finding and presenting formulaic information scattered throughout a paper in a standard, easy to digest format. SciScore checks for the presence and correctness of RRIDs (research resource identifiers), and for rigor criteria such as sex and investigator blinding. For details on the theoretical underpinning of rigor criteria and the tools shown here, including references cited, please follow this link.

  2. Version published to 10.1101/2020.11.05.20226712 on medRxiv