16/03/2020 : UPDATED MEDICAL INFORMATION AND AMENDED RECOMMENDATIONS REGARDING THE NOVEL 2019-nCoV CORONAVIRUS EPIDEMIC STARTED IN WUHAN, CHINA
Europ Assistance is issuing the following medical advice
In order to support readers of this notice, we have highlighted (in bold) the changes from the last edition March 13th 2020.
TODAY'S UPDATED MEDICAL INFORMATION AND ACTION RECOMMENDATIONS REGARDING THE COVID-19 PANDEMIC
MARCH 16th 2020, 16H30 Paris time – Dr M. Kalina, EA Group Medical Director, F. Tits, RN, EA Group Sr Project Manager and J. Heywood, EA Group communication and CSR,
The purpose of this bulletin is to provide all the entities of Europ Assistance (EA), GEB and GGH, to the Generali Group Management, and all their clients, with a current summary and analysis of information available both in general media and especially from Chinese and international scientific sources regarding the coronavirus outbreak in and disseminated from Wuhan to other Chinese cities, and then to many countries around the world, and to make specific recommendations for each of the client groups, national travelers, expatriates in the targeted areas, and international travelers, both corporate and leisure, as well as to EA’s own staff.
This outbreak started officially December 31st 2019 in a live animal and fish market in Wuhan and is thought to originate from the Chinese horseshoe bat. It initially caused relatively few cases, was managed with energetic local isolation measures, and showed no evidence of human to human contagion. Recommendations were therefore limited to avoiding contacts with animals and patients, and no travel restrictions were advised by either Chinese or international authorities. A significant deterioration of the situation in China was reported by the media over the January 18th weekend and increasing ever since. It was confirmed the following week by the Chinese authorities, including the transmission, probably through droplets, between human beings. The disease is highly contagious but appears less severe than SARS or MERS at this stage. The proportion of severe cases has stabilized around 15% of the total number of cases. Deaths occur mostly in older people’ above 70 years of age, most with underlying diseases such as diabetes, chronic pulmonary diseases and cardiovascular diseases. The signs and symptoms to watch for are first of all contact with a proven or potential case or environment, then respiratory symptoms like cough and dyspnea/shortness of breath, and feeling sick. Fever is often but not always present. The incubation is usually 3 to 7 days, rare cases are transmitted from symptom free patients, and the maximum is currently thought to be 14 days although there may be cases exceeding this length.
The World Health Organization (WHO) has congratulated the Chinese authorities for their efforts in the fight against this outbreak and their contribution to research. It declared a Public Health Emergency of International Concern on January 30th 2020 in view of the growth in the numbers and the restrictions applied by China and many countries. It supported the Chinese initiatives but strongly argued against the global spread of any measure to restrict travel as economically unsound. The WHO cooperates with IATA to standardize precautions onboard airlines. On February 11th 2020 to be coherent with international virus and disease naming rules the International Committee on the Taxonomy of Viruses renamed the virus SARS-CoV-2 and the WHO named the disease COVID-19. The March 3rd edition is important because it reminds all of the definition of cases. A suspect case either has a combination of fever and one respiratory symptom and a history of travel to or contact with a source of COVID or a patient with severe respiratory illness and no other etiology. The case becomes confirmed with a positive test irrespective of symptomatology. On March 5th the WHO’s director general made a strong appeal to all countries to take the situation seriously and to put in place measures to reduce the transmission of the disease. He warned against misinformation related to media spreading too many uncontrolled news and insisted on the importance of balance and coherent communications. The February 29th travel recommendations have remained unchanged but the March 10th situation report clearly and rightly warns against any limitations in international travel not objectively founded on the reduction of infection transmission. On March 11th the WHO’s Director General declared that this outbreak now qualified as a PANDEMIC. The next day he declared that this pandemic must be considered CONTROLLABLE. ICAO and the WHO have issued a joint statement to support guidelines to mitigate risks in the travel industry, but there is no statement regarding the maintenance or not of air travel capabilities. The focus of the recommendations remains on decreasing contacts likely to increase contamination and early access to formal isolation and proper treatment for positive cases.
Most governments are now advising that anyone showing symptoms related to COVID-19 is asked to remain isolated and to contact the emergency services (112 or the equivalent) . The key preventive measures are targeted towards avoidance of contact with potential sources of contamination, hygiene and strictly restricting diagnosis and treatment to facilities designated by the authorities.
Travelers and expatriates have to realize that several countries have seriously reduced access to activities in their countries. When possible accelerated return to the home countries is an appropriate strategy especially if the situation at home is less challenging than at the client’s current location. First and foremost are the cancellation of any crowd event, including sport competitions and the closing of schools, but several countries have gone beyond this and reduced access to shops, to elective health care, to restaurants and early return home may have to be considered if flights are still available, sometimes through modified itineraries.
At this stage the latest modified data available, as of 14H00 March 16th China time, the total volume of confirmed cases in China was 81078, of which 67869 had recovered, and 3218 deaths had occurred. A total of 88647 cases, only 9918_of whom had recovered (later peak) and 3298 deaths have been identified outside of China, a continued marked increase that shows that the problem is not related to China but global. The general situation of the epidemic is improving in China and the confirmed case volume is continuing to decrease as more and more healed cases, over 75% of the total cases, emerge. New cases, fewer of them, continue to occur mainly but now almost not in Wuhan but mostly at entry points like international airport. However the last weekend saw a marked increase outside of China, mainly in Europe.
Initially many countries implemented rules against travel to and from China, but as the number of affected countries has increased significantly, and that many measures have been taken by many countries to reduce or forbid access to their territory to anyone directly or indirectly coming from a high contamination risk country it has become imperative for people to enquire about any limitations with the EA entity they are contracted with. The EA entity will contact the one in the country concerned or the agent to ensure that accurate and up to date information is provided in addition to adapted assistance services, always aligned to government advice.
Italy (now the second hardest hit country with 24938 cases and 1809 deaths) and also France (5423 and 127), Spain (7753 and 268), Germany (5917 and 13) and the USA (3774 cases and 69 ), bringing the overall situation to the level of a pandemic, although in all countries specific areas only are the main target so far.
The week of 16 March has seen the situation dramatically evolve in Europe as cases escalate. Italy first took the measure to lockdown the Lombardy Region and a number of provinces, it then took further steps to lock down the entire country. Currently in Italy all travel into our out of is banned unless there is urgent reasons to do so and most governments have recommended a halt to all travel to Italy, with subsequent mass cancelation of flights. Italian citizens are being urged to remain at home unless they have an urgent health or work reason or purchase food and household cleaning products or medicine. Shops and restaurants, schools and universities are closed.
Subsequently, action has followed across the rest of Europe with the UK the main notable exception at this stage. The measures taken vary country per country however most countries have adopted the closure of schools and universities, sporting events and mass gatherings while others have gone further to issue travel restrictions and in the case of several countries strong measures on border control to limit entry to nationals and sometimes control health status in addition.
There are now more 520 cases recorded in Africa, according to the latest figures from the World Health Organization. Egypt remains the nation with most reported cases, of whom were passengers and crew members aboard a Nile cruise ship coming from southern city of Aswan to Luxor.Starting from Saturday 0H00, the United States imposed restrictions to travel to a large number of European countries, focused on the Schengen travel area. The US government has also imposed restrictions on travel to China, Korea and Iran.
On March 16, the European Commission has proposed a 30 day travel ban for all non-essential travel for non-EU nationals. This is expected to be implemented shortly, pending approval from the member states.
Europ Assistance Recommendations
In these circumstances Europ Assistance recommended, to first and foremost avoid any contact with patients with COVID-19, and more generally with patients with cough and fever. This is also recommended to national clients. Of course the usual hygiene precautions should remain a priority considering that regular handwashing, disinfection and adequate use of mask wearing, especially in public transports and crowded places, are part of these essential hygienic attitudes. In addition for expatriate patients planning to remain in these countries one would suggest to avoid exposure to mass transport, visits to hospitals and clinics, as well as to markets with live fish and animals. In addition a worldwide push to reduce social interaction between people to reduce contamination is supported by EA.
For those seeking to enter or exit countries or regions with government imposed restrictions will face severe travel distribution. For expatriates wishing to travel back and for travelers the individual decision should take into account the measures and travel restrictions issued by several governments, and the fact that many airlines have temporarily suspended flights. Clearly any travel undertaken have formal restrictions were announced could be challenged cover wise. For non-essential travel to China the sensible individual decision may be to delay travel for several days until the information regarding this epidemic is more reliable. These considerations concern China, Korea, Iran and Italy as there are no medical reasons to restrict travel anywhere in Asia or the world because of the COVID-19 epidemic. There is an increasing risk that countries, Thailand, Israel, Czech Republic, Denmark or Morocco being examples, put restrictions in place for travelling visitors from affected countries thus reducing access to care even to people with no COVID-19 issue.
Our internal procedures are until further advise to ensure negative test for COVID-19 has been carried out for any EA patient with respiratory disease, who travels by air (air ambulance or commercial carrier) from any affected country to any other country. Patients no matter where they are must monitor signs of infection, fever and respiratory symptoms and follow local rules after calling their EA platform before seeking care. In general if positive they will be asked to remain in isolation for 14 days if not very sick, or to be cared for locally.
Europ Assistance has provided detailed information with simple prevention measures for employees, partners and corporate clients. These will be centered on minimizing contacts by increasing work at home, reducing physical meetings, and even reducing usual means of showing friendship such as handshakes and kisses. It emphasizes the need for frequent handwashing with soap and water, plus, wherever appropriate alcoholic disinfectant. These should be provided at offices. Masks should be used by anyone dealing with potential patients, people living in the same room as suspect cases, and of course people with symptoms. They are marginally useful otherwise to protect healthy people from getting the virus.
We encourage our readers to nevertheless consider the situation as one that will be overcome, and to remember that most people affected will not be seriously ill. The key is adherence to public health advice and optimism. Europ Assistance cares for its clients and it’s staff and will do everything to help.