Enhanced Data Collection During COVID-19 Pandemic

OMB Approved

Control No. 0920-0134

Exp. 03/31/2022

Enhanced Data Collection During COVID-19 Pandemic

**Please submit to [email protected] every Monday by 0900 EDT**

Directions: Enter new cases diagnosed from Monday 0000 EDT to Sunday 2359 EDT for each category as defined below.

Ship:
Date Submitted (mm/dd/yy):
Total # of crew members onboard:
Closest seaport at time of submission (City and Country):
Case Counts and Diagnostic Testing: Please ensure these counts are independent of each other (i.e., crew member is not listed as an ILI† and a pneumonia case)	Enter Numbers Below (Unless Otherwise Specified)
What is your ARI* case count for the specified time period?
What is your ILI† case count for the specified time period?
What is your pneumonia case count for the specified time period?
How many persons were tested for influenza via rapid diagnostic test?
Of the persons tested for influenza via rapid diagnostic test, how many tested positive?
How many persons were tested for coronavirus via rapid serology test?
Of the persons tested for coronavirus via rapid serology test, how many tested positive?
What brand of test was used?
How many persons were tested for COVID-19 via PCR test?
Of the persons tested for COVID-19 via PCR test, how many tested positive?
What brand of test was used?
How many persons needed hospitalization?
Of those hospitalized, how many required mechanical ventilation?
Of those hospitalized, how many were medically evacuated from the ship?
Please explain the reason for medevac(s).
Isolation Practices: Were persons with ARI, ILI or pneumonia isolated for COVID-19 per CDC guidelines? (see footnote for isolation discontinuation)

* Acute Respiratory Illness (ARI) is defined as the presence of cough, sore throat, or rhinorrhea in the absence of fever.

† Influenza-like Illness (ILI) is defined as fever (100.4 °F [38 °C]) plus either cough or sore throat in the absence of another diagnosis.

Persons with ILI, ARI or pneumonia symptoms should be isolated using the same guidelines as a confirmed COVID-19 case. Isolation may be discontinued for symptomatic crew with suspected or confirmed COVID-19 under conditions outlined at. www.cdc.gov/coronavirus/2019-ncov/hcp/disposition-in-home-patients.html

Public reporting burden of this collection of information is estimated to average 10 minutes per response, including the time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information.  An agency may not conduct or sponsor, and a person is not required to respond to a collection of information unless it displays a currently valid OMB Control Number.  Send comments regarding this burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden to CDC/ATSDR Reports Clearance Officer, 1600 Clifton Road NE, MS D-74, Atlanta, Georgia 30333; ATTN: PRA 0920-0134.