Dr M. Kalina, EA Group Medical Director

The purpose of this bulletin is to provide 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 travelers , both corporate and tourists. This bulletin is critically important as the Chinese authorities took the decision just before the New Year holiday to stop all public transport between Wuhan and other cities in Hubei province mostly in China and abroad , and the restrictions related to outbreak control measures are significant.

This outbreak started officially December 31st in a live animal and fish market in Wuhan and is thought to originate from the Chinese horseshoe bat, 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 January 18th weekend 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 January 23rd 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 will meet again this week. It among others focused on the detection of cases at airports in both China and other countries. The CDC also published a document on the 23rd of January. They consider the public health threat serious but state it is too early to predict the evolution. They recommend to avoid travel to Wuhan and to take precautions if travelling to China. The first US case and most foreign cases did originate from Wuhan. They state that given the release of the full genome of the “2019-nCoV” they have begun entry screening of passengers coming from Wuhan to the three main airports of entry in the US. This type of screening was extended to other arrival point and also undertaken under a variety of formulas by many countries. Generali Global Assistance/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 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 11H00 January 27th  China time, the total volume of confirmed cases with pneumonia is 2762, and 80 deaths (276 of them still in Hubei province). There are 5794 suspicious cases, and 38 cases have occurred abroad (Thailand, US, Singapore, Japan, Korea, Australia, Malaysia, France, Vietnam Nepal and Canada). The decision to isolate Wuhan and several other cities in the region and to enforce increased surveillance and prevention measures may have an impact, but the latter will be reduced by among others the serious lack of supplies even country-wide of notably soap and masks, including protective devices for hospital use.

For expats in Wuhan, there is no special regulation scheduled for foreign patients. If they have symptoms, they have to follow the public system at this stage, some international VIP clinic in Wuhan 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. 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 of the isolated regions.

Travel Recommendations

In these circumstances Generali Global Assistance/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 and to use masks in mass transport. This is also recommended to national clients. Of course the usual handwashing recommendations remain essential. 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 Generali Global Assistance/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 is no medical evacuation in place and 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 to the designated institution by phone and follow instructions and not go to health care providers or emergency rooms. For those outside the country and for non-essential travel the recommendation is to delay travel for a 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 Generali Global Assistance/Europ Assistance and our Customer Service Team 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 feasible by air ambulance.

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