Our thanks to Dr. Mac Ernest for this additional article on traveling the Waterway during the pandemic. See COVID-19 Practices Related to Boating for his earlier article.

Travelling the ICW and COVID  by Dr. Mac Ernest

Cruising the ICW is a privilege and a pleasure for those of us fortunate enough to have spent time travelling the East Coast by water, creating wonderful memories along the way. As boaters, we appreciate the scenery, the wildlife, and the folks that we encounter along the way. We also recognize the inherent risks of boating whether they be inclement weather, waterway hazards, or boating mishaps. While underway, we constantly scan our vessel gauges for impending problems and the waters for dangerous situations and are always thinking about “Plan B” in case something goes awry.

We are practicing Risk Mitigation as we cruise the ICW and as we navigate the COVID-19 pandemic.

I chose to view our current pandemic situation with COVID-19 as a series of personal risk mitigation issues that I consider, make choices about, and act on every day. As I make those choices—do I cruise this season, do I eat out, do I invite friends to the boat– I realize that the choices I make impact not only MY risk of contracting COVID-19 but also the risk to my family, friends, and people with whom I interact. I understand that my responsibility during this pandemic does not end at the tip of my nose and try to act accordingly. Making these choices involves a basic understanding of the coronavirus (and viruses in general) and how infections result. With this basic understanding, I can then make my choices within my comfort level of risk of developing COVID-19 since everything I do will impact that risk.

A basic understanding of the novel coronavirus can help us make safe and acceptable choices.

A virus cannot move on its own and can only reproduce when it is inside a particular type of cell in our body (or another susceptible host such as a bat). Even if a virus contacts our skin, it will not cause infection because our intact skin is an effective barrier against the virus which does not have the ability to penetrate our skin to begin reproducing. How then does it get into our body to cause infection?

The coronavirus enters our body by way of the mucous membranes of our eyes, nose, and mouth.

-After entering our body by way of our eyes, nose, or mouth, the virus attaches and invades tissues with specific attachment points called receptors. It then begins to divide, reproduce, and invade other parts of the body.

-A favorite receptor for the novel coronavirus is called ACE2 which is found extensively in the lung, heart, and blood vessels (among other tissues). These tissues are particularly suspectible to coronavirus invasion, and are the source of much of the serious disease caused by it including pneumonia, inflammation of the heart muscle, and blood clots and strokes.

-Smoking increases the number of ACE2 receptors in the body which may be one reason why smokers have a higher risk of infection and complications with COVID-19.

How to we protect ourselves from a virus?

If we can protect those entry points (eyes, nose, and mouth), we can minimize our risk of developing a COVID-19 infection. We protect ourselves by avoiding the virus when possible, and limiting the amount of virus to which we are exposed when avoidance is not possible. Here is where risk mitigation needs to be considered because everything we do will either increase or decrease to some degree our risk of developing COVID.

1. Avoiding the virus would occur only if we remained in a virus-free environment with virus-free individuals. Travelling on OUR boat with OUR immediate family is one way to avoid the virus, but as soon as we leave our boat, bring things onto our boat, or invite others (even other family members who do not live with us) onto our boat, we begin to increase the chance of virus exposure. We can reduce exposure risk by avoiding large gatherings (the more people, the more chance one or more will be infected and emitting the virus), avoiding small confined areas such as small stores or cafes (the smaller the space, the less diluted the air we will breathe and the greater the chance of breathing someone’s exhaled coronavirus). The converse is also true. Being outside in the sunshine (viruses are destroyed by UV light) with a breeze dilutes virus in the environment, making the chance of inhaling virus particles less likely.
2. We can limit the amount of virus to which we are exposed by washing our hands thoroughly and frequently. Appropriate and aggressive hand washing (at least 20 seconds with liquid soap and water at any temperature) followed by completely drying them will not only physically remove virus particles from our skin, but the soap can also disrupt the surface of the virus, rendering it harmless. Reducing the number of virus particles on our hands means fewer get to our face (and the entry points of our eyes, nose, and mouth) as we unconsciously touch or scratch our face or as we eat. When should we wash? Any time we’ve touched a surface that others frequently use, such as a fuel pump, shore power pedestal, shared marina bath facilities, shopping cart, checkout counter or card reader, we are likely getting exposed to viruses, and handwashing will minimize their transfer to our mucous membranes. Of course, handwashing before eating is a given since our hands are headed for our mouth! Liquid soap is better than foam soap, and even plain water is better than not washing at all.
3. Since we are constantly being exposed to the coronavirus in the environment, we need to filter what goes out and what come into our eyes, nose and mouth. Masks or proper facial coverings on others and on our face act as that critical filter. We all know people who “sputter” when they talk and have all been the recipient of another person’s spit as they speak excitedly, loudly, and usually “too close for comfort” to our face. If they are infected, the respiratory droplets that these folks which can contain coronavirus can be effectively reduced or prevented by their wearing a mask and remaining at a distance from us (the “six foot rule” of social distancing comes from the ability of these droplets to travel six feet or more). While we cannot always control those around us, we can reduce our risk by maintaining at least six feet of physical distance from others, particularly those who choose to not wear a mask. When we also wear a mask, we not only return the favor to other mask-wearers, but we have an additional filter from some of the droplets that may escape their mask, again protecting our entry points from the coronavirus.

So, we follow all the appropriate guidelines, maintain the 3 W’s (washing our hands, wearing a mask, and waiting to maintain 6 feet of social distance) and work hard to protect the entry points of coronavirus into our body. What next? Cruising during a pandemic gets back to RISK MITIGATION, and how much risk we are willing to accept.

Here are some things to consider as you plan your ICW trip to reduce your risk of virus exposure.

1. Should you be cruising at all this year? Your age, your health, and your current medications all play a role in how vulnerable you will be if exposed to coronavirus. Talk with your health care provider about your situation if you are over 65, have a heart or lung condition or diabetes, or have immunosuppression from any cause. Not only do you need to decide if you are comfortable with the risk of travel, but you also need to decide how and where you will get medical assistance if you are out of town on your boat and become ill. Take a copy of your medical history, plenty of your prescription medications, and your pharmacy number in case you need a prescription transferred.
2. If you are not already underway, consider self-imposed quarantine at home for 14 days before departing. By doing so, you will have a lower chance of harboring the virus in your body as you begin your cruise.
3. How can you reduce exposure to the virus as you travel?
   1. Choose your ports wisely by researching where “hotspots” are occurring and avoiding them when possible. Johns Hopkins University has a website (https://coronavirus.jhu.edu/us-map) that allows you to check cases by locale which may be useful.
   2. Check for local or statewide rules regulating COVID testing and quarantines for areas through which you will be passing or where you plan to go ashore. If required, be sure you have a copy of your negative COVID-19 test results to document your status.
   3. Once in port, search out merchants who follow safe guidelines. In North Carolina, the website www.countonmenc.org has a list of merchants who do so. In other locales, it may be as simple as looking at customers who enter and exit a business and determining whether they and the merchants are wearing masks and are socially distancing when in the business. When you have a choice, shop where safe guidelines are being followed and utilize curb side pickup when available.
   4. Order groceries and supplies on-line when possible. In Oriental NC, for example, the local grocery and other local merchants will deliver to your boat at the local marinas.
   5. After putting up supplies and groceries, wash your hands. When bringing supplies or groceries back to your boat, assume that they are contaminated with virus and avoid placing them on surfaces where you will later prepare or consume food. If you must do so, wipe down the surface with appropriate disinfectant before preparing or consuming food.
   6. Carry enough stores on board so that if you become ill and have to quarantine for 14 days, you can be self-sufficient.
   7. Keep your hands virus-free after washing and while eating by not using your phone during meals. Remember your phone is probably one of the most contaminated surfaces you will touch during the day so reduce your risk by putting it away during meals. Wash your hands, prepare your food, set the table, and wash again before moving hands toward your face as you eat to minimize any virus you may have picked up during meal preparation.
   8. While docking, tying up, and signing into the marina, wear your mask to protect yourself and the dockhands.
   9. After docking and checking in, remember to wash your hands before returning to your boat. The intact skin on your hands is protecting you as you hand or receive lines, or sign into the marina, and washing your hands after those activities reduces the amount of virus that you may bring back onto your boat.
   10. When eating out, remember that your greatest risk of exposure is when dining inside. Even when waitstaff wear masks, diners will not and air flow and air volume issues inside a restaurant may allow virus particles that others have exhaled to remain in the air for extended periods of time. This increases your chance of inhaling the virus and becoming exposed. Your lowest risk of exposure is carry-out. You may find a happy medium of risk mitigation by eating outside at a safe distance from other diners.
   11. Only allow immediate family members (those that normally live with you) to stay overnight on your boat. This is a difficult one, because one of the pleasures of boating is having family and friends visit and stay with us. To reduce risk of virus exposure, we must treat everyone not living in our home or on our boat as potentially being infected. Asymptomatic people can and do transmit the virus, and children and grandchildren who come to visit are common sources of infection. Inviting friends or family to stay in a local motel near our marina will lower the risk of our exposure. Inviting them to stay on our boat with tight living quarters and small enclosed spaces will GREATLY increase our risk of exposure with no effective way to mitigate that risk.
   12. Share meals or docktails in the cockpit or on the flybridge remaining at least 6 feet apart. Brief tours of the boat should involve all wearing a mask, and visitors should be asked to wash their hands before entering your boat to minimize virus that they might transmit as they touch surfaces. Meals or drinks outside the boat while socially distancing, especially with a gentle breeze blowing, reduces risk of exposure although masks after eating will lower the risk even more.
   13. Vacate the boat when your mechanic comes to do work. Many marine mechanics would prefer that you do this regardless of a pandemic but these days, he will likely not want to wear a mask while working, and leaving the work area reduces his and your risk. Once he is finished, opening windows for fresh air in the work area will reduce lingering virus particles in the air. Wiping off frequently touched surfaces with an appropriate disinfectant will also reduce virus exposure.

Travelling on the ICW is a pleasure and a challenge.

This season, we have the added challenge of COVID. Assessing the risk of our boating activities has never been more difficult, but constant risk assessment for all of our activities on the water with risk mitigation when possible is key to a successful and healthy cruising season.

Remember to:

1. Follow the 3 W’s—wash frequently and aggressively, wear a mask regularly, and wait to distance 6 or more feet from others
2. Protect the entry points of your eyes, nose, and mouth from coronavirus
3. Mitigate risk of exposure to the virus whenever possible

References:

https://www.webmd.com/lung/news/20200306/power-of-hand-washing-to-prevent-coronavirus