What are coronaviruses?
Coronaviruses are a large family of viruses, some of which can infect people. Some cause mostly mild illness, such as the strains responsible for some common colds. Others can potentially also lead to severe, or even fatal, disease - such as Middle
East Respiratory Syndrome Coronavirus (MERS-CoV), which continues to circulate in some parts of the world. The Severe Acute Respiratory Syndrome (SARS) outbreak was caused by a coronavirus. It caused severe and fatal disease, however, is no longer
in circulation. The natural reservoir for coronaviruses is thought to be animal hosts. New strains emerge from this reservoir, infect an 'intermediate' host, and from there infect people. The viruses may then be capable of being transmitted from
one person to another. Some are efficient at human-to-human transmission, while others are not.
What does "novel" mean?
Novel means new. In this case, the 2019-novel coronavirus was given a new name SARS-CoV-2 as of 12 February, reflecting that the new virus is related to the SARS coronavirus seen in 2002. The virus is a previously-unidentified strain of coronavirus.
It is responsible for the outbreak of pneumonia which began in Wuhan, China in December 2019. The disease caused by the virus has been called COVID-19, or Coronavirus Disease-2019.
Who is at risk for infection?
The disease can move from person to person, but it is not yet known how easily or sustainably it spreads. Scientists are studying the data as it becomes available. The initial cases reported having visited a seafood/animal market, which may have been
a source of exposure. However now the main way the disease is spreading is from person to person.Some people have had a mild illness and recovered. Others have had more severe infections. Critical and fatal cases have occurred. Preliminary
evidence indicates that people with underlying medical conditions, elderly people and those with compromised immune systems may be at higher risk for severe illness.
Are pregnant women at higher risk for severe disease?
A review of 28 pregnant women in China who were infected with COVID-19 found that they did not have a more severe illness than non-pregnant women, and none of their babies were infected. The Royal College of Obstetricians & Gynaecologists states "Generally, pregnant women do not appear to be more likely to be seriously unwell than other healthy adults if they develop coronavirus. It is expected the large majority of pregnant women will experience only mild or
moderate cold/flu like symptoms." The European Centre for Disease Prevention and Control states "No current evidence suggests that infection
with COVID-19 during pregnancy has a negative effect on the foetus. At present, there is no evidence of transmission of COVID-19 from mother to baby during pregnancy." See the United States Centers for Disease Prevention and Control Frequently Asked Questions and Answers: Coronavirus Disease 2019 (COVID-19) and Pregnancy
What are the symptoms of COVID-19?
The illness is still being studied. So far, we know that common symptoms include fever, headache, chills (including "rigors" - chills with shaking), fatigue, cough, sore throat, muscle aches, shortness of breath and difficulty breathing. These symptoms
are not limited to COVID-19. Respiratory illnesses and pneumonia caused by other organisms (including bacteria) and other viruses (such as influenza) can also cause these symptoms. Other less common symptoms of COVID-19 include nausea and diarrhoea.
Loss of the sense of smell and taste has also been described. Conjunctivitis (pink eyes due to inflammation
of the lining of the eyeball) and rashes have also been reported in some cases.It is capable of causing severe illness, with kidney problems, neurological and cardiovascular complications, and multi-organ failure, which can be fatal.
It is possible that people with underlying health conditions are at higher risk for severe disease.
Do people with COVID-19 lose their sense of smell or taste?
Several groups of doctors, particularly those who work in the ears/nose/throat field, have reported that some people who lost their sense of smell or taste and tested positive for the disease even without other symptoms. Though a
reduced ability to taste to smell can be common in people with a 'stuffy nose' (nasal congestion) attributed with seasonal allergies and other medical conditions, these COVID-19 patients often reported the change in senses without any stuffy nose.
The medical groups reporting this information suggested that it might be useful for people who lose their sense of taste or smell to self-isolate for at least 7 days to prevent spreading the virus — which they can do even if they have no
other symptoms. They also suggested these symptoms might be added to COVID-19 screening tools used by clinicians to determine who should be tested and advised to self-isolate. The World Health Organization is investigating the situation and has
not yet made a formal declaration on any changes to protocol based on these symptoms.
What does cough etiquette mean?
Cough etiquette, or respiratory hygiene, is a measure taken to reduce person-to-person transmission of infected droplets. Individuals should distance themselves, cover their mouth and nose with a tissue when coughing and sneezing. It is important
that tissues are disposed of correctly (in nearest waste bin) after use and that hands are washed immediately with soap and water or alcohol based hand sanitizer (containing 60-85% alcohol).
Is there a vaccine?
Over 200 vaccines against COVID-19 are being developed. Following the announcement that the Pfizer/BioNTech vaccine prevents at least 90% of COVID, we expect efficacy announcements from Moderna and AstraZeneca/Oxford vaccines before the end of 2020. Announcements from other manufacturers will follow.Pfizer/BioNTech are expected to apply for “Emergency Use Authorization” in the US towards the end of November 2020. Other vaccine manufacturers will also apply once efficacy data is released. Note that vaccines must be authorized by local authorities prior to use.
Given these uncertainties, we don’t yet know exactly when a safe and effective COVID-19 vaccine will be ready for distribution, but we estimate that it could be in early to mid-2021.
In addition, production limitations and the pre-purchase of large quantities of vaccine by higher-income countries will initially lead to an inequitable distribution of COVID-19 vaccine.
Where does MedAire get its information?
The information provided to clients by International SOS and MedAire through our membership and other services comes from many sources. Read More.
What COVID-19 testing options are currently available?
Can MedAire supply test kits?
There are very limited options of available test kits for sale for the private sector. Our subject matter experts are available to consult with clients on specific questions related to potential crew, passenger, guest testing and screening protocols
and/or testing solutions for their operations based on each specific situation and availability.
What Is The Process For Evacuation & Repatriation?
The consideration of international evacuation of patients with active COVID-19 virus infection is complex.
How does COVID-19 spread?
While the first cases in Wuhan may have 'jumped' from an animal or environmental source to people, the spread now is from a sick person to others who are in close contact. In general, coronaviruses spread through infected respiratory droplets, just
like other respiratory infections, including colds and influenza. A sick person expels these droplets when they cough, sneeze, or talk. Others can get the disease via contact (direct or indirect) with these contaminated droplets.
The World Health Organization states as at 21 February 2020, "The spread of COVID-19 between humans is being driven
by droplet transmission The virus is transmitted from a sick person to a healthy person through respiratory droplets when the sick person coughs or talks close to another person. Current diagnostic tests have yielded positive results from a variety
of specimens including throat swabs from asymptomatic people and feces. These positive results are not a conclusive indication that people are contagious. People may have been exposed and infected but are NOT necessarily transmitting the disease.
More investigations into potential other routes of transmission are ongoing. What has been reported so far it that the main driver of transmission is droplet transmission from people with symptoms."Per the World Health Organization, "People can catch COVID-19 from others who have the virus. The disease can spread from person to person through small droplets from the nose or mouth which are spread when a person with COVID-19 coughs
or exhales. These droplets land on objects and surfaces around the person. Other people then catch COVID-19 by touching these objects or surfaces, then touching their eyes, nose or mouth. People can also catch COVID-19 if they breathe in droplets
from a person with COVID-19 who coughs out or exhales droplets. This is why it is important to stay more than 1 meter (3 feet) away from a person who is sick. WHO is assessing ongoing research on the ways COVID-19 is spread and will continue to
share updated findings."
Does COVID-19 spread through the air or air-conditioning?
So far there is no evidence that this virus is spread through the air or through air-conditioning systems. The patterns of spread are consistent with transmission through droplets from an infected person to someone who is in close unprotected contact.
Nevertheless, in the hospital setting, patients are currently managed in special 'negative pressure' rooms if available, and healthcare workers will take 'airborne precautions' when performing certain procedures.The World Health Organization
stated in their 26 March Situation Report "The virus can spread directly from person to person when a COVID-19
case coughs or exhales producing droplets that reach the nose, mouth or eyes of another person. Alternatively, as the droplets are too heavy to be airborne, they land on objects and surfaces surrounding the person. Other people become infected
with COVID-19 by touching these contaminated objects or surfaces, then touching their eyes, nose or mouth. According to the currently available evidence, transmission through smaller droplet nuclei (airborne transmission) that propagate through
air at distances longer than 1 meter is limited to aerosol generating procedures during clinical care of COVID-19 patients.""Aerosol generating procedures" are procedures and treatments that can generate very small droplets - such
as ventilation, suctioning of airways, nebulising medication, and "induced" sputum.
What should I be doing to reduce the spread of COVID-19?
Can the virus be transmitted through packages shipped from an area with COVID-19?
This coronavirus is primarily spreading to people who are in close unprotected direct contact with an infected person. The United States CDC advises "Currently there is no evidence to support transmission of COVID-19 associated with imported goods."
The World Health Organization states "The likelihood of an infected person contaminating commercial goods is low and the risk of catching the virus that causes COVID-19 from a package that has been moved, travelled, and exposed to different conditions
and temperature is also low. "
Is protective equipment needed to handle a package shipped from an area with COVID-19?
The World Health Organization in its 27 February 2020 interim guidance on Rational use of personal protective equipment for coronavirus disease 2019 (COVID-19) does not recommend any type of mask is used, and gloves are only needed if they are ordinarily required to protect against mechanical hazards. "To date, there is no epidemiological information to suggest that contact with goods or products shipped
from countries affected by the COVID-19 outbreak have been the source of COVID-19 disease in humans. "
Can COVID-19 spread through bank notes and coins?
Theoretically, cash, like any other frequently handled object, could become contaminated with the virus that causes COVID-19. People could potentially transfer the virus to their eyes / nose / mouth via their hands after handling cash. However the
main way the disease is spreading is through direct contact with infected people. In 2006, the European Center for Disease Prevention and Control issued a report that in part looked at the risk of bank notes as a potential vehicle for influenza transmission. It concluded that for the general public "handling banknotes and coins is not practically avoidable and will confer
no discernible increased risk compared with handling almost any other communal object used in daily life; and compared with exposure to respiratory droplets (coughs and sneezes) and communal hard surfaces and fittings (hand rails, escalator hand
belts, door handles, etc.) the ability of money to transmit influenza will pretty much pale into insignificance compared with what else is going on in society at the time. The overwhelmingly important issue will be compliance with frequent handwashing
and 'no-touch-face' advice." Individuals who frequently handle money might have an increased risk and are advised to avoid licking their fingers while counting, and not to touch their face during and after handling money."Again these risks would
be significantly reduced across a wide range of occupations by compliance with hand hygiene regimens and 'no-touch-face' advice."
What about pets and other animals?
cats are the most commonly infected domestic animals. They can develop symptoms, and in a lab setting infected cats were able to spread the disease on to other cats. Pet cats have been found infected in Belgium, Hong Kong, China and and the United
Tigers and lions at a zoo in New York were infected by a human caregiver. Several dogs have also tested positive. The United States Center for Disease Control and Prevention (CDC) issued guidelines for pet
owners, including limiting a pet's exposure to people outside its household and reducing their contact with humans who have COVID-19. The World Organisation for Animal Heath's FAQ on pets and other animals is available here. They state, "Currently, there is no evidence to suggest that animals infected by humans are playing a role in the spread of COVID-19. Human outbreaks are driven by person to person contact." Note that tests used on animals
are different than those used to detect human infections. There is no evidence that poultry. pigs or other livestock animals can be easily infected.
Can a person have no symptoms but spread the infection?
There have been instances of people with minimal or no symptoms of COVID-19 infecting others. Evidence suggests that the asymptomatic (no symptoms) patients can carry virus loads similar to those of infected people with symptoms. This indicates that
asymptomatic people can potentially infect others. Virus particles were detected in the upper respiratory tract of asymptomatic confirmed cases for at least 5 days. These cases constitute a minuscule proportion of the total number of cases. A
study from China comprising of 72,314 cases indicates about 1% of the people were asymptomatic.
Another study reports that people who showed minimal or no symptoms belonged to the younger age group, did not have severe illness, and none died.
Can I get re-infected with COVID-19?
The data around re-infected cases is emerging and still limited. The immune response to COVID-19 is not yet fully understood. Virus particles can persist in body fluids for long periods and may lead to a positive test although the person might not
be infectious. False positive tests can also occur. Alternatively, it is also possible that the virus particles may reactivate under certain conditions.
How can I identify if someone has a contagious disease?
As recommended by the World Health Organization (WHO) and Centers for Disease Control (CDC): A contagious disease is suspected when a traveller (guest or a crewmember) has a fever (temperature of 38°C/100°F or greater) associated with one
or more of the following signs or symptoms:
NOTE: COVID-19 can also present with fever OR sore throat alone.
I think I may have been exposed. How do I know if I am sick?
Crew and travellers should self-monitor their health for 14 days:
Can COVID-19 be treated?
There are currently no medications that are proven to be consistently effective in the prevention or treatment of COVID-19. Patients receive supportive care, aimed at relieving their symptoms and preventing complications while they recover.This can include the use of mechanical ventilation if required. Studies are underway to see if new or existing medications may be effective. These medications are generally available only on prescriptions, have significant side effects
and potentially can cause serious adverse events. They should not be used except under the guidelines of local authorities or within hospital settings. The drugs being trialled include:
Solidarity is the World Health Organization's (WHO) multi-country clinical study for potential treatments for COVID-19, established to hasten the search for effective treatments. At least 45 countries are participating. The trial tests four different
drugs or combinations – chloroquine; remdesivir; a combination of the two drugs lopinavir and ritonavir; and those two drugs plus interferon beta. The trial started on 27 March 2020 and the first patient was enrolled in Oslo University Hospital,
Norway. More information on the medications being tested is available here.United States Centers for Disease Control and Prevention Information for Clinicians on Therapeutic Options for COVID-19 Patients
Note that French Ministry of Health on 14 March advised against the use "non-steroidal anti-inflammatory drugs (NSAIDS)" (such as ibuprofen) as they may make the disease worse. Several other authorities have stated there isn't sufficient evidence for this position. See the European Medicines Agency statement 18 March, the United States Food and Drug Administration statement 19 March,
and World Health Organization Tweet 19 March. On 19 April, WHO stated the outcome of their review of available literature indicates "there is no evidence of severe adverse events, acute health care utilization, long-term survival, or quality of life in patients with COVID-19, as a result of the use of NSAIDs."Nevertheless all agree that paracetamol / acetaminophen can be used if required to relieve fever, mild pain and headache.
Is Tamiflu useful?
The antiviral medication Tamiflu (oseltamivir) is not effective against COVID-19. Tamiflu is used to treat influenza.
What about alternative treatments?
Some authorities have recommended alternative treatments for COVID-19. However, there is no evidence to confirm or disprove the effectiveness and safety of alternative treatments.
What should I do if I develop symptoms?
What should I do if a Crewmember shows signs of respiratory illness?
What signs require immediate medical support?
If any of the following occur with the ill passenger, immediately contact MedAire's MedLink service:
What can I do to protect myself?
Avoid potential exposure. Practice good hygiene measures and safe food practices.
How should the crewmember assigned to care for unwell passengers or guests care for themselves?
Should Aviation Crew Wear Personal Protective Equipment (PPE) & Face Masks?
The CDC, as well and many other international health agencies, recommends wearing cloth face coverings in public settings, where other social distancing measures are difficult to maintain, especially in areas of significant .Therefore
many aviation authorities are recommending, some even requiring, that face masks should be worn by crew members having direct contact with passengers, at all times and replaced regularly (at intervals not exceeding 4 hours). Correct disposal of
the PPE and of other items that may be contaminated should be ensured. Provide detailed instructions and dedicated disposal bags as to where such items should be placed.Once on the ground, the contents should be appropriately disposed
following the guidelines for the disposal of biohazardous materials.As it is possible for pre-symptomatic transmission of the virus, and as the flight deck is a confined space (distancing is less than the recommended 6 feet); a pilot
may want to wear a mask. However, IFALPA, among others, argue that the need for quick donning oxygen masks in the situation of cabin decompression speaks against the use of face coverings continuously along the flight, adding a critical delay
on the time of useful consciousness.
What Masks Should We Have On Board?
A facemask should be used by all passengers on board the aircraft, to minimize the chances of pre-symptomatic transmission and/or environmental contamination.
What is the difference between quarantine and isolation?
Quarantine is the separation and monitoring of people who have been exposed to an infected person (or have been to an outbreak area) to see if they become ill. This separation helps reduce the risk that the quarantined person will
spread the disease. Quarantine generally requires a person to remain in a nominated place or at home for a certain period of time after exposure to a disease. The duration of quarantine will vary depending on the estimated incubation period. For
COVID-19, early estimates indicate a quarantine duration of 14 days.Isolation is the separation of people who are ill with a potentially contagious disease from those who are healthy.
What Should We Do If We Suspect Someone Is Infected With COVID-19?
If there are symptoms of fever, loss of smell or taste, sore throat, cough or shortness of breath; have the person take the following steps:
Discontinuation of isolation in hotel or at home will depend on current, local health authority guidelines.If they are notified that someone they have been in contact with — within the prior 14 days — has been diagnosed with
COVID-19, the risk assessment must be done to determine if close contact criteria was met. Self-isolate at home or in a hotel and monitor for symptoms until 14 days post contact. If at home, contact your physician for risk assessment.
Contact MedAire if away from home for risk assessment and to see if safe to passenger home with mask and seat spacing.
What Environmental Measures Can Be Taken?
Environmental measures aim at reducing transmission of infection and include the routine cleaning of frequently used surfaces and objects; minimising shared objects; and good ventilation. Frequently touched surfaces and objects should be washed with
water and detergent, followed by a dilute household bleach solution. These objects /surfaces may include desks, phones, keyboards, doorknobs and toilets. Laundry should be washed according to detergent manufacturer’s instructions at the
warmest specified temperature. Shared objects should be kept to a minimum including such things as drinking glasses, eating utensils, towels and linen. Good air ventilation is important in rooms where people gather regularly.
European Centre for Disease Prevention and Control
How Should Crew, Passengers And Guests Be Screened For Covid-19?
Thermal screening prior to travel should be conducted (if possible), in addition to symptom and contact questioning.If there is a fever - or a YES response to any of the below questions — then the person should be assessed by a medical
professional for further risk stratification. If the person is at their home location, they should contact their local medical resource. If they are travelling, they should contact MedAire for assistance.
If there is no fever and the answer to ALL questions is negative then the risk of currently developing or transmitting COVID-19, recognising the incidence of asymptomatic infection, is not negligible but less should you continue best practices recommended
by health authorities including social distancing, hand hygiene and consideration of wearing face mask if essential travel is required.Ultimately, proof of immunity (via testing) will need to be incorporated in a fit to travel determination.
Should We Transport A Person Infected With COVID-19?
Air transportation of actively ill persons who meet case definition for COVID-19 is not recommended unless conducted via air ambulance or similarly outfitted aircraft with proper medical equipment, personnel and isolation measures. Transportation
of persons who meet close contact criteria with someone with COVID-19 within past 14 days or have recovered from COVID-19 should be approached cautiously and in accordance with health authority guidelines. If clearance is given, incorporate
the standard precautions, PPE and seat spacing guidelines.
What Are The Best Practices For Aircraft Disinfection?
How is TeleConsultation different to what I have today when I call MedAire and speak to a doctor or nurse?
When you call MedAire during your ground-based travels (not in-flight or at while at-sea) you can speak to our medical team of doctors and nurses for medical advice. Since our medical team is not licensed to prescribe medications remotely, if further
assistance or medication is needed MedAire will refer you to the most appropriate medical facility based on your location. This could be a doctor’s office, urgent care, clinic, or a hospital emergency department. TeleConsultions are another
way we can offer you an appointment.
What is "delegated authority" and why have I been asked to approve it to use the TeleConsultation service?
"Delegated Authority" is a term used to provide MedAire with the ability to cover medical expenses on your behalf. Our TeleConsultation providers require that MedAire cover the payment of appointments. We do this standard for many clients, it is what
we refer to as "Guarantee of Payment" or GOP. In order to provide this GOP we need your approval up to a certain dollar amount.
Who is eligible for this service?
Teleconsultation is available to anyone covered by your MedAire Membership that has qualifying medical symptoms/issues.
What are the qualifying medical categories?
The types of illnesses that qualify for TeleConsultation fall in line with our top five most common medical case categories. Those categories are Ear, Nose and Throat; Gastrointestinal, Respiratory, Musculoskeletal, and Urological / Renal.
How do we initiate a video TeleConsultation appointment?
There is no change to how you would contact MedAire today. If the case qualifies for a TeleConsultation it will be offered by our medical team.
How is the TeleConsultation performed?
TeleConsultation can be done via the MedAire TeleConsultation App available for iPhone, iPad and Android devices, as well online when using a computer with a web camera. You can download the app from Apple’s app store or the Google Play Store
in advance if you like, but you will be sent a link to download and it install it at the time of your appointment.
How long does it take to be seen by a TeleConsultation provider?
Our teleconsultation providers commit to schedule appointments within 2 hours of the request.
Is prescription delivery included in this benefit?
We try very hard to have prescriptions delivery in each of the locations that we have teleconsultation available. Unfortunately, we cannot offer it in every location.
Will I need to pay for the prescription out of pocket upon delivery?
No, the prescription and delivery fee is covered by MedAire’s Guarantee of Payment (GOP).
If prescription delivery is not available will the teleconsultation doctor call in a prescription?
Yes, if needed the teleconsultation physician will call in a prescription to the nearest pharmacy for pick up.
How do we select our service providers?
The providers are selected by MedAire’s Global Assistance Network (GAN) team following the same vetting process we use for our house call doctors and medical facilities. In fact, many of our house call doctors are now also offering teleconsultation.
How do we decide on the locations we are offering TeleConsultation?
We are continually working on adding locations to our list. There are many things to take into consideration when doing this including locations our client base frequently travels to and local laws permitting teleconsultation services. We are
adding providers in the locations where these services are legal, available, affordable, and have enough volume to support the provider contract.
EXPERT CARE, EVERYWHERE.
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