Global Travel Update in Response to COVID-19

From: Dr. Cai Glushak, International Medical Director
Entity: AXA Partners US


Current Situation

The COVID-19 pandemic continues to evolve across the globe, but is in different phases of development in different regions. The course of the outbreak is still largely unpredictable. While some nations and regions have achieved considerable success in controlling spread, numbers are still rising at a worrisome rate in other regions. It is critical to remember that the virus is still intrinsically highly contagious and that ongoing control at this point depends on maintenance of heightened hygiene measures and avoidance of inbound contamination from carriers from areas where the virus has high prevalence.

Public health experts are watching the pandemic closely for evidence of resurgence resulting from relaxation of confinement measures, opening of international borders and a return to air travel.

While we expect a gradual increase in leisure travel as restrictions ease, there is obvious urgency on commercial enterprises to resume business and hence address essential travel and expatriation.  While presumably necessary, these activities should be planned with heightened caution and ongoing awareness of risks.

Effectively, most of the risks previously communicated related to business travel and long-term stay, especially in regions of developing health systems and economies, are still fully present. Specifically, although disease presence and restrictions have lessened in Europe and parts of Asia:
 

1. The outbreak is considered uncontrolled and rising in the Americas, Africa and parts of south Asia (specifically areas of India, Indonesia and Pakistan).
2. In the unfortunate case of a death abroad, return of remains is generally delayed. The deceased may be subject to local regulations governing preservation and shipping of remains (some countries do not allow cremation or embalming).  Shipping of remains meantime may be delayed due to unavailability of commercial carriers.
3. Many developing countries where health infrastructures are fragile are having difficulty coping with the burden of COVID – their ability to handle baseline non-COVID patients as well as serious COVID cases is severely stretched and may not be able to support the needs of seriously ill foreigners.
4. In Africa, access to South Africa as the usual target for superior medical care is severely restricted or absent. The continent is undergoing a severe rise in cases and South Africa is among the most affected countries. Additionally, border restrictions and supply chain disruptions have limited South Africa’s ability to support neighboring countries who depend on it for essential medical supplies (including cancer therapies). South Africa has severely restricted acceptance of non-COVID and COVID evacuations from neighboring countries.
5. Restrictions of inbound travel from and between countries of Africa are still in place, including into Europe and South Africa. This includes for critical patients who need access to a higher level of care.
6. Where evacuation can be arranged, the time required for immigration and aviation permissions is prolonged compared to normal, even in critical situations. Many countries restrict refueling stops for aircraft with a COVID patient making certain routes unavailable.
7. Though AXA Partners has arranged for exceptions, most countries will not accept a COVID evacuation for any patient unless they are a citizen or national of that country. Hence, if an expatriate worker is not a national or resident of a nearby country that has the needed level of medical care, they may not have the same access that would be available before the pandemic. it should be assumed that access to superior care in centers of excellence like Singapore, Australia, the US and Europe may not be accessible for non-native COVID or non-COVID patients.
8. Only specific air ambulances are equipped to safely handle COVID patients. While the pool of such providers is expanding, there are fewer air ambulances available to transport confirmed or possible COVID patients and these providers are in high demand.
9. In general, it will be necessary to have the result of a COVID test before a patient will be accepted for international evacuation.  Handling of the patient will depend on the result.   A negative test does not guarantee the patient is COVID-free; the clinical scenario will determine whether COVID must still be considered, as there is a significant rate of false negative tests.
10. Expect permissions and approvals for aviation to take longer than normal and to manage the patient in place until flight plans are approved.
11. While AXA Partners has had considerable success evacuating and repatriating COVID and non-COVID patients in need of a higher level of care, the situation is highly fluid and each request will depend on local circumstances, national policies and available transport providers.

 
Preparatory Measures
 

1. Travelers should continue all the enhanced hygiene practices that have been advocated since the beginning of the outbreak including frequent handwashing; wearing masks outside of the home; maintaining social distance, etc.
2. Check the destination ahead of traveling for:
        a. Severity of outbreak at the destination
        b. Any entry restrictions and quarantine requirements on arrival or during stay
        c. Any entry restriction or quarantine requirements upon return
        d. Level of health care capacity at the destination
3. Understand possible evacuation options or limitations from the intended destination.
4. Consider personal risk to self and family related to vulnerable conditions:
        a. Hypertension
        b. Diabetes
        c. Obesity
        d. Advanced age
        e. Immuno-suppressed condition – including medications
        f. Other medical conditions that would require evacuation if they became worse
5. Check the intended airline’s policies and procedures for COVID safety including seating arrangements, mask requirement and distancing measures.  Some airlines are not filling middle seats. Consider upgrading the class of service to ensure greater distancing.
6. Register with the local embassy to be notified of rescue flights and for support in case of need for evacuation.
7. If anticipating need for evacuation, request a COVID test (even for a non-COVID emergency) and have official documents with results available to accelerate planning.

AXA Partners Measures
 

1. AXA Partners is continuously monitoring the progress of the outbreak by country and region.
2. AXA Partners is monitoring country policies, including entry/exit and quarantine requirements.
3. AXA Partners closely monitors airline policies and availability.
4. AXA Partners has identified all providers specially equipped and willing to transport a COVID patient.
5. Working with its providers, AXA Partners has adapted procedures to streamline special processes for obtaining flight authorization and readmission for destination hospitals.
6. AXA Partners is prepared to assist clients with travel preparation and advice relevant to the COVID situation (please contact your account manager to learn about available supports).