January 30th 2020, 11H30 M Paris time - Dr M. Kalina, EA Group Medical Director

The purpose of this bulletin is to provide all the entities of Europ Assistance, GEB and GGH, 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, as well as to foreign countries, and to make specific recommendations for each of the client groups, national travelers, expatriates in the targeted areas, and corporate travelers and tourists. 

This bulletin is critically important as the Chinese authorities have gradually enforced strict measures to reduce contact between people, among others by restricting transport and extending holidays, first in Wuhan and Hubei province, then nationwide. Travel to and from China is more and more restricted, as for instance airlines like British Airways and Lufthansa stopped flights to and from China yesterday, 29th January. In addition several countries including the USA, Korea, Japan and France have provided evacuation flights from Wuhan to their citizens.

This outbreak started officially on 31st December 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 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 was reported by the media over the weekend of 18th January and confirmed early last week by the Chinese authorities, including the transmission, probably through droplets, between human beings. The disease is highly contagious but less severe than SARS. Deaths occur mostly in people with underlying diseases. The WHO issued a statement in the late afternoon.

Thursday, 23th January after two days of meetings recognizing the severity of the outbreak but not declaring yet a public health emergency of international concern. Their Emergency Committee welcomed the efforts made by China and an official visit to China was made by the WHO director. The Committee will meet again this afternoon to review its recommendation in view of the growth in the numbers and the restrictions applied by China and many countries. It among others focused on the detection of cases at airports in both China and other countries. The CDC also published a document on 23rd January. They consider the public health threat serious but state it is too early to predict the evolution. They strongly recommend to avoid travelling to China unless one has a critical reason to go. Most foreign cases did originate from Wuhan initially but transmission of the virus outside of China has started occurring. The CDC stated that given the release of the full genome of the “2019-nCoV” they have the tools required for case detection. They have begun entry screening of passengers coming from China to the main airports of entry in the US. This type of screening was extended to other arrival points and also undertaken under a variety of formulas by many countries. Europ Assistance did through its local medical and operational team at Europ Assistance China become aware of the current situation as reported by the Chinese authorities. It has monitored the situation from the onset and is regularly getting accurate information this way. Reports from several national public health authorities are also monitored.

At this stage the latest data available, as of 13H00 January 30th China time, the total volume of confirmed cases with pneumonia is 7742, and 170 deaths have occured (162 of them still in Hubei province). There are 12167 suspicious cases, and 77 cases have been identified abroad (Thailand, US, Singapore, Japan, Korea, Australia, Malaysia, France, Vietnam, Cambodia, UAE, Germany, Nepal, Finland and Canada). The decision to isolate Wuhan and several other cities in the region and to enforce increased surveillance and prevention measures including a delay of return to work till at least February 9th in the whole of China may have an impact on reducing contagion. The reduction measures may be negatively impacted by among others the serious lack of supplies even country-wide of notably soap and masks, including protective devices for hospital use. 

For expatriates in Wuhan, in Hubei and now in the rest of China there is no special regulation scheduled for foreign patients who need to be medically assessed for respiratory symptoms with fever. If they have symptoms, they have to follow the public system at this stage. Some international / VIP clinics in China might refuse to accept consultation with suspicious cases and their resources are limited under the current threatening environment. There are 9 designated hospitals in Wuhan for fever patient consultations, but the government plans to open more hospitals and beds for patient accommodation. They are actually building a brand new prefabricated hospital of a 1000 beds for early February to meet the demand. So far there is a significant shortage of ward beds for admission of patients. Our recommendation is that our platforms involve our Chinese colleagues if a client needs medical attention in any region. If people wish to travel out of the country they ought not to show any symptoms and should not have been in direct contact with Novel Coronavirus patients.

Europ Assistance Recommendations

In these circumstances Europ Assistance recommended - taking into account the unavoidable increase of in-country travel during the Chinese New Year festivities - to first and foremost avoid any contact with patients with Wuhan flu, 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 the country one would suggest to avoid exposure to mass transport, visits to hospitals and clinics, as well as to markets with live fish and animals.

Clients in the isolated zone of Wuhan cannot travel unless they are involved in government authorized evacuations, outside of the scope of Europ Assistance. There is no necessity to leave the country as long as prevention measures are adhered to but it may make the concerned individuals feel more at ease. There are medical evacuation schemes in place, but these are voluntary and organized by national authorities not private concerns. Any decision to travel out of the country, in anticipation of potentially broadened isolations or hard to apply safety measures remains a personal choice. Should people arrive from China to their country of destination they should declare any symptoms of fever or cough having appeared during the flight to the airline and airport staff. They should remain isolated for the 14 days after arrival and report symptoms to the designated institution by phone and follow instructions and not go to health care providers or emergency rooms. For those outside the China planning travel back and for non-essential travel to China the recommendation is to delay travel for several days until the information regarding this epidemic is more reliable.

Our internal procedures are until further advise to ensure negative test for "2019-nCoV" has been carried out for any EA patient with respiratory disease, who travels by air (air ambulance or commercial carrier) from China to any other country. Patients isolated in the Wuhan area are asked to call Europ Assistance and the Chinese platform will direct them to the appropriate consultation facility. Should a patient be diagnosed with the new virus he or she will have to be treated in China as evacuation is very unlikely to be authorized by the country of destination or even feasible by air ambulance.

The current bulletin will be updated regularly until the situation stabilizes.