Depression, suicide and COVID19

Suicide reports  due to depression   are  sad manifestations  of the  negative mental health effects  of the coronavirus disease 2019 (COVID-19) outbreak.

Pandemic anxiety   can be overwhelming  which if not handled properly   may  become   emotional, physical and economic catastrophes.

On May 10, a 39-year-old Ukrainian crew member  on the Regal Princess ship died after jumping overboard while the ship was anchored off Rotterdam, Netherlands.

This was followed by news of a crew member who jumped off Royal Caribbean’s Jewel of the Seas ship while it was near Greece late last month. His body was never found.

Although the suicide incidents can be considered as isolated cases, it can not be denied that emotional and financial stressors are well-recognised risk factors for suicide.

For many seafarers,  the primary source of their depression is initially connected with repatriation issues, as they wait for news about the schedule of  their journey  home and see their families again.

Airline and port restrictions have made  the repatriation process  difficult .

In some instances, travelling  is almost impossible because most international air traffic is grounded.

Similarly, many cruise lines suspended their operations to mitigate the spread of the pandemic.

Fear of the unknown and uncertainty of their  future is compounded  by  the repeated COVID-19 outbreaks on ships,  the anxiety  of contracting the virus and   the company’s inability to provide  them  adequate protection and reliable information.  

They also had to deal with  financial issues, like the  alteration or non-payment   of their  contractual monetary benefits, especially those  with expired employment contracts who  have been forced into continued labor aboard ships. 

 Actual repatriation to the Philippines did not stop the emotional stress to some of the OFWs, as the  return to  respective homes are still in limbo.

Repatriated OFWs have to wait for the results of their COVID-19 tests before they can return home.

 Cruise ships are presently  at the Manila Bay anchorage area  with  thousands of Filipino seafarers waiting for  the clearance.  Some are billeted in quarantine facilities.

Some of the stranded OFWs complained about their continued stay at the facilities that already  exceeded  the recommended 14-day quarantine.

The Department of Health attributed the delay in the release  of the tests results   to encoding issues and slow pace of testing.

Sadly, one  OFW from Kuwait   committed suicide inside a temporary quarantine facility in Pasay City. 

The COVID19 pandemic validates the   2019  “Seafarer Mental Health Study”  conducted by  Yale University funded by the ITF Seafarers’ Trust that  has  identified worrisome levels of depression, anxiety and suicidal thoughts among seafarers.  

It revealed a link between depression, anxiety and suicidal thoughts and a greater likelihood of injury and illness on board.

Factors cited included lack of adequate training, an uncaring work environment, low job satisfaction, and existing medical conditions.

Stress causes  the  immune systems to weaken , inducing  one to be more susceptible to illness, both mental and physical .

The study noted that seafarers with depression reported less control over their work, less ability to set their own work pace or influence decisions.

Depression is a mental state associated with loss of interest, feelings of helplessness or worthlessness and heightened levels of anxiety.

 If left untreated, depression can lead to considerable impairments in an individual’s ability to take care of his or her everyday responsibilities.

In extreme cases, depression can lead to suicidal tendencies and actual suicide.

Under the POEA contract,  the employer is liable to pay the heirs of the deceased seafarer for death benefits once it is established that he died during the effectivity of his employment contract. 

However, the employer may be exempt from liability if it can successfully prove that the seaman’s death was caused by an injury directly attributable to his deliberate, criminal  or willful act.

If the cause of death is closely related to depression due to COVID19, its compensability will be a debatable issue. 

In Leonis Navigation vs. Obrero (G.R. No. 192754, September 07, 2016), the Court ruled that work-related stress may precipitate the disorder noting that the seafarer’s prolonged stint at sea eventually taxed his coping abilities which rendered him incapable of handling the stress.

Nevertheless, the heirs must be paid either US$10,000 (natural death) or US$15,000 (accidental death) under the Compulsory Insurance Coverage of  Republic Act 10022 or the amended Migrant Workers Act (Amwa) whether or not there is a suicide issue as cause of death.

Atty. Dennis R. Gorecho heads the seafarers’ division of the Sapalo Velez Bundang Bulilan law offices. For comments, email info@sapalovelez.com, or call 09175025808 or 09088665786).

History of Pandemics due to ship voyages

  

Many Filipinos   knew by heart the  Korean phrases like "annyeonghaseyo" (hello) or "kamsahamnida" (thank you)  due to  their    fascination  with Koreanovelas, especially now that they had to stay home due to   the COVID 19  community quarantine.

“Kingdom” is one interesting Netflix series  that  revolved around the story of crown Prince Lee Chang as he struggle to save his people from the spread of a  plague and the royal dynasty from being overthrown.

“Kingdom” takes place in the late 15th or early 16th century — in the Joseon dynasty period — after the Japanese invasion. It is based on the historical plague that swept through Korea during the Joseon dynasty, killing thousands in days.

The infection spreads at an alarming rate transforming the locals into  yowling monsters that crave human flesh and blood.

In one scene,  the  higher officials decided to burn the infected  peasant’s bodies but bury those from higher social class. As the havoc continued, the noblemen attempted to return home   via the only ship in dock. Unfortunately, said voyage brought the infection closer to the seat of  power causing more outbreak.

The gates of the fortress were also closed as a form of quarantine against the infected. 

The word “quarantine” is  derived  from the Italian quarantena, or 40 days.  

It was first used in the 14th century for ships suspected of carrying a contagious disease that were held in isolation offshore for 40 days  before passengers and crew were allowed to disembark.

History has seen the desolating  role  of ships as the transporters of innumerable pandemics when   viruses  travel with  international trade across geographies.   

These are characterized by the  devastating effects throughout history  not only in terms of the great mortalities of humans  and animals  but also the ensuing   social, economic and cultural aftermaths.  

The  pandemics of plague  of the 6th, 14th and 20th centuries  were  spread along  the international trade routes  as   rice and wheat grain, clothing, and trade merchandise  were infested by infected fleas. The primary hosts of the fleas were the black urban rat and the brown sewer rat.

In October 1347, twelve  ships from the Black Sea docked at the Italian port of Messina, which  were called “death ships” as most sailors aboard were dead or almost dead.  The plague became known as the “Black Death” as it moved from the ports to land and to other ports in Europe.

Cholera pandemics throughout the 19th century  that originated from India were  also attributed to  British army and naval ships  traveling from India  to the Persian Gulf. The disease eventually made its way to European territory by 1821.

A large factor in the worldwide occurrence of the  1918-1919 Spanish influenza was increased travel. It was originally carried by soldiers on overcrowded troop ships during the first world war. The rate of transmission on these ships was rapid, and soldiers died in large numbers. The  global death toll was estimated to have been anywhere from 17 million to 50 million.

Fast forward.

The current COVID19 pandemic  has again brought to international attention the cruise ships  industry, though cruise ships have a long history of infectious disease outbreaks.

Ships have been notably vulnerable to  the spread of  due to the fact that there are hundreds or thousands of passengers in a relatively confined environment for days or weeks.

Cruise ships are particularly susceptible  as they are intended  to engage the passengers in public  activities like  dining, swimming and dancing together in enclosed spaces over a sustained period of time.

There were  even reports that virus particles spreads  from room to room through the ship’s ventilation, which relies on re-circulated air.

Many companies initially  negotiated for their passengers to disembark,  talking  with countries and local governments circumspect  of sick travellers.

Sadly, most  crew members remained on board vessels floating off-coast as the pandemic  disrupted voyages  around the world .

Reports of infected seafarers and fatalities raised fears among seafarers  that some  companies  failed to protect its workers  , including their right to healthy and safe environment  as well as repatriation under international law like the Maritime Labour Convention of 2006.  

International Labour Organization (ILO)  Director-General Guy Ryder has earlier asked governments “to ensure that, in these challenging times, seafarers are adequately protected from the COVID-19 pandemic, have access to medical care, and can travel to and from their ships, as necessary, in order to continue to play their crucial role”.

The International Transport Workers' Federation (ITF) ITF said that it  will not let up the pressure until every seafarer is home safely and those seafarers that have patiently waited at home to relieve their colleagues are on board.

"Anjeon yuji" as they say "Stay safe"  in Korean.

Atty. Dennis R. Gorecho heads the seafarers’ division of the Sapalo Velez Bundang Bulilan law offices. For comments, send email  at info@sapalovelez.com, or call 09175025808 or 09088665786)

The story of a seafarer COVID19 survivor

Anxiety due to lack of proper information on the coronavirus disease 2019 (COVID19)  might be fatal for someone infected with the pandemic virus.

“I am a Covid-19 survivor and may God protect us all”.  

This was the pronouncement made by Filipino seafarer  Lourence Tan de Leon who was among the 149 recorded COVID19 cases of infected crew on board the cruise Costa Atlantica.

Costa Atlantica is one of the over 40 cruise ships that  had confirmed positive COVID19 cases.  

Costa Atlantica  was docked  in Nagasaki from February  20, 2020  where it was under repair.  A positive case was  first reported aboard  on April 20, 2020.  They have all been quarantined since then.

Costa Atlantica had 623 crew members of 36 different nationalities and no passengers at the time the first positive case was first reported. It has  a capacity for 2,114 passengers.

“During the first 3 days that I've been isolated, no words from the doctor or any medical person whom at least tried explaining to me what to do. The silence at my cabin made me feel that I am alone. When I watched any film it made me cry for no reason at all. Those were the days I felt frustrated and I don't even know how to tell this to my family,” De Leon said.

He noted that it is true that the virus can kill any weak person and will release symptoms in one’s body. The worse is once your lungs are infected, one  has to be intubated which is really not comfortable and easy.

Fortunately, his condition  is considered as a  mild case only.

“Mild symptoms”  have been compared to the flu or a cold ― fever, fatigue, dry cough, aches, chills, sore throat, runny nose and diarrhea.

De Leon  realized  that in cases   Covid19 per se  will not kill a person , it might still be fatal because of   the anxiety due to lack of proper knowledge  of the virus compounded by over-exaggerated reports.

He started to read every information from the internet  that could help, including videos from Dr. Willie Ong.   He added that  the most powerful medicine is prayer.

The ship left Nagasaki port on May 31, 2020  with the latest affected  cases count at 149.

De leon arrived in the Philippines last June 5 and is now under the mandatory 14 day quarantine.

Heightened risk and rapid spread of the disease is inevitable with the nature of cruise  ship, particularly due to its  crowded semi-enclosed areas.

With one Filipino out of every four or five seafarers on board a ship (whether cargo or cruise ), the largest population of crew members comes from the Philippines. There are over 375,000 deployed Filipino seafarers that contribute an estimated  $6.14 Billion as remittances in 2018.

In an online signature campaign at Change.Org. led by the Migrante International,  they are calling for the full protection of the rights and welfare of all stranded and repatriated Filipino seafarers during the COVID19 pandemic.

One of their demands is that timely psycho-social counselling and intervention should be given to stressed and distressed seafarers onboard and upon arrival due to any trauma and anxiety caused by the lockdown and the pandemic.

Pandemic anxiety can be overwhelming which if not handled properly may become emotional, physical and economic catastrophes.

Fear of the unknown and uncertainty of their future is compounded by  the repeated COVID-19 outbreaks on ships, the anxiety of contracting the virus and the company’s inability to provide  them  adequate protection and reliable information.

They also had to deal with financial issues, like the alteration or non-payment of their contractual monetary benefits, especially those with expired employment contracts who have been forced into continued labor aboard ships.

The group  urged the Immediate and prompt payment by the manning agencies and shipowners of the earned wages, hazard pay, unpaid allotments, termination pay, leave pay and medical benefits of seafarers.

The group likewise called for the immediate release of the promised one-time US$200 or P10,000 cash assistance from the DOLE-AKAP program to all seafarers who are in need. The release should be fast, and without any red tape and unrealistic requirements that cannot be produced due to the lockdown.

Frustrations grew as seafarers tried exasperatedly to avail themselves of the cash assistance  due to the stringent requirements imposed  which, many of them found redundant, tedious and impractical.

They added that there should be effective government intervention and information campaign to prevent all acts of discrimination against OFWs, both landbased and seabased.

Fear and anxiety about the disease can lead to social stigma toward these seafarers. Some of the manifestations of stigma are social avoidance or rejection, physical violence and denials of health care, housing or employment. 

Atty. Dennis R. Gorecho heads the seafarers’ division of the Sapalo Velez Bundang Bulilan law offices. For comments, send email  at info@sapalovelez.com, or call 09175025808 or 09088665786)