TODAY’S UPDATED MEDICAL INFORMATION AND ACTION RECOMMENDATIONS REGARDING THE COVID-19 PANDEMIC

Generali Global Assistance/Europ Assistance is issuing the following medical advice

APRIL 14th 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 a crisp, quick information update with an analysis focused on recommendations regarding COVID-19. 

Where is information sourced from:  the most reputable international sources (WHO, Chinese CDC, CDC, international media, medical journals etc.) and government websites.

Who is this bulletin prepared for: Generali Global Assistance/Europ Assistance and Generali employees, managers clients, insurers, travelers, expatriates, partners and… anyone interested! 

Overview / Historic reminder 

In December 2019 the infection was first recognized in a Wuhan market, initially transmitted from animals (initially probably a bat) to men but man to man transmission quickly developed with a rapid deterioration into a local epidemic in Hubei province. The unfortunate coincidence with the Chinese New Year and a large number of Chinese people travelling both in country and abroad contributed to the rapid spread of this novel virus. The outbreak deteriorated in China in mid-January and forced the Chinese authorities to take stringent measures to confine the people and reduce transport, first in Wuhan and Hubei province and then in the whole country. Exported cases started to be reported at the end of the month in countries such as South Korea and Japan, and individual cases, initially of Chinese origin or having travelled to China, were notified in several countries. The situation evolved rapidly, and restrictions in air travel began to be imposed. On January 30th the WHO declared a Public Health Emergency of International concern. 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. In late February and early March new major outbreaks occurred in Iran and Italy, seeing a huge growth in the epidemic, which was now affecting over one hundred countries and territories. The WHO declared a PANDEMIC on March 11^th. At that time, and as the situation in China was starting to improve, many countries introduced lockdown measures starting by Italy, extending rapidly in Western Europe and on most continents including countries like India or more recently in the USA. Clearly this major health crisis has created a very significant ongoing economic crisis worldwide.

Clinical picture 

The disease is highly contagious although it appears less severe than other coronavirus diseases as SARS or MERS at this stage. The proportion of severe cases has stabilized at around 15% of the total number of cases. Deaths, at around 4% to 5 % overall but with wide variation between high (Iran, Italy) and low (Germany, Austria, South Korea), 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 shortness of breath, and feeling sick, with often head and muscle aches. Fever is often but not always present. The WHO is stating that cases are the most infectious in the first three days of the symptoms. A significant incidence of anosmia (loss of smelling sensation) is now also reported. 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.

Key protection measures

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.  The key measures are to decrease contacts therefore travel has decreased over 90% and countries have introduced lockdowns that should last at least two months in most cases. In addition, hand washing, disinfection and wearing masks for care and service providers, as well as for the public when in contact with others, are the key.

Treatment

Access to regular treatment of usual diseases is limited and a lot of elective interventions have been cancelled. If someone feels symptoms possibly related to COVID-19 they should to use the local public designated numbers. They can also access help lines like the ones provided by Generali Global Assistance/Europ Assistance for their employees. Some will need to be examined and tested. Examination by family doctors and house call doctors are always preferable to attempting to visit crowded clinics, hospitals or emergency rooms. Testing is currently varying across countries restricting the possibility of detecting the presence of viruses. New tests enabling the detection of antibodies will soon be added and will help to determine immunity status and, indirectly, ability to return to work. Similarly, several scientific studies are underway to investigate the objective value of several treatment modalities such as antiviral drugs, or chloroquine. Obviously due to the huge decrease of flight availability not only tourists and expatriates have trouble returning home, but also providing a challenging environment for assistance companies such as Generali Global Assistance/Europ Assistance, specializing in repatriations. Exceptional evacuation of even COVID cases from isolated places or overwhelmed regions have happened. Of course, sadly, the repatriation of mortal remains has also been a complicated task. The cases admitted to hospital can normally be offered especially oxygen supplementation and tight surveillance, but many have to be admitted to intensive care. The duration of stay is up to two weeks with heavy physical and psychological repatriation needs.

Current global situation

At this stage the latest modified data available, as of 17H00 April 14th China time, the total volume of confirmed cases in China was 83700, 78310 persons were healed, and 3551 deaths had occurred. A total of 1857598 cases and 117972 deaths have been identified worldwide, a continued marked increase that shows that the problem is still truly a pandemic and currently most acute in the United States. 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 90% of the total cases, emerge.  China is mainly concerned about imported cases at this stage and has stopped allowing foreigners to enter the country. The beginning of a post crisis situation is also noticed in Korea and some European countries, notably Austria.

Europe

Italy, with 159516 cases and 20465 deaths, Spain (172541 and 18056), Germany (131074 and 3778), France (137877 and 14986), and the UK (89571 and 11347) have high rising numbers which challenge the capability of the overwhelmed health care delivery systems in many areas. Unfortunately, many senior homes have become clusters for death cases in many countries.

Asia (without China)

Although it was hit early, right after China, Asia has resisted quite well with the exception of Iran, which accounts for 74877 cases and 4683 deaths and a bit of a worrying growth in Turkey (61049 cases and 1296 deaths). South Korea has a large number of cases (10564, very few of them recent) but relatively few deaths (222). This is probably due to the strong health infrastructure response and access to easy screening as in Japan and SE Asia. India remains a question mark. There is a rise in cases in India, which just introduced a three weeks lockdown. 

The Americas

The USA are now the country with the most cases, 527039, as well as 23765 deaths, and the government has acknowledged the extent of the challenge and began to restrict travel into the country, with week March 16 seeing the introduction of a travel ban to a number of European countries. California was the first state to introduce a lockdown, followed by others including New York, now the hardest hit state in the country. The number in South America is spread out but Brazil or Peru start having large numbers (2265 new cases in one day yesterday). 

Africa

Africa has a low but growing number of cases but is doing its best together with international organizations to prepare as the impact could be severe given the relatively weak public health infrastructures.

Generali Global Assistance/Europ Assistance Recommendations 

In these circumstances Generali Global Assistance/Europ Assistance recommends to:

1. First and foremost, realize that this pandemic is a worldwide phenomenon and the more all of us take it seriously the lesser the health, sociological and economic impacts.
2. Avoid any contact with patients with COVID-19, travelers to regions with a high incidence of COVID 19, and more generally with patients with cough and fever. When contact is required for help, protection by distance and if available masks and gloves is important.
3. Follow the usual hygiene precautions as a priority considering that regular handwashing, disinfection and adequate use of mask wearing, especially in public transport and crowded places, are part of these essential hygienic attitudes.
4. Accept the need for a worldwide push to reduce social interaction between people including long distance transportation to reduce contamination. From the corporate and company standpoint maximization of work at home is the key action when feasible.
5. Accept the drastic reduction in access to travel means when not required for functions such as international health programs.
6. Plan to maintain the current restrictions at least partially over time and take home the lessons learned regarding contagious disease prevention for the future
7. Support your local health care system and facilities helping fragile people such as the old people homes.
8. Maintain communications with colleagues, friends and families to reduce the risk of depressive reactions to the situation.
9. Carefully design deconfinement plans that should be gradual and supported by much increased preventive measures and carefully monitored.

Generali Global Assistance/Europ Assistance has provided detailed information with simple prevention measures for employees, partners and corporate clients. These are centered on minimizing contacts by increasing work at home, reducing physical contact, 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, but nevertheless are seen as a strong signal to enhance the efficacy of other measures. Frequent team e-contacts allow the maintenance of professional activities, team spirit and morale. Establishing access to psychological support is a useful component of a COVID centered service package.

We encourage our readers to nevertheless consider the situation as one that will be overcome, especially if personal hygiene and governmental restrictions are adhered to, and to remember that most people affected will not be seriously ill. The key is adherence to public health advice. Generali Global Assistance/Europ Assistance cares for its clients and its employees and will do everything to help. We want to thank all of you who are providing care and assistance to the most fragile people in our communities.

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

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