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).

• Centers for Disease Control and Prevention
• European Centre for Disease Prevention and Control

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?

• Laboratory testing for the respiratory coronavirus disease 2019 & SARS-CoV-2 virus includes methods that detect the presence of virus and those that detect antibodies produced in response to infection.
• Testing for the live virus requires trained medical professionals in PPE.
• Testing for detection of antibodies is best used for evidence of immunity, contact tracing and population surveillance. (Click link for more information.
• Current testing efforts are being led through government and health care agencies around the world. Supply is being prioritized for public health measures and access to testing is limited at this time, with the exception of a handful of countries
• New test options are being developed and produced for quick market introduction, making quality control a challenge. Our product and medical experts are closely monitoring the situation and will evaluate appropriate testing options for our clients as they become 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.

• Availability of aircraft operators that they are willing to consider the transport of patients.
• Acceptance of patient by hospital\provider, Health Authorities and other Governmental bodies in the designated receiving country and authorisation of Health Authorities in the originating country for discharge of the patient.
• Granting of over flight and landing permission by countries that the aircraft carrying the patient needs to overfly or land in to refuel en route to the destination. Strict public health regulations may be enforced, and countries retain the right of refusal for such medical transport flights.
• Timeframes for visa approvals for aeromedical and flight crew.
• Patient considered medically transportable
• Generally, the more serious the condition of the patient, the more likely restrictions would apply due to limitations in undertaking medical interventions and maintaining adequate infection control when utilizing a portable isolation

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?

• Practice respiratory, cough, and hand hygiene.
• Advise guests and crew of the importance of covering coughs and sneezes with a tissue.
• Dispose used tissues immediately in a disposable container (e.g., plastic bag) or a washable trash can.
• Remind passengers and crewmembers to wash their hands often with soap and water, especially after coughing or sneezing.
• If soap and water are not available, they can use a hand sanitizer containing 60%-95% alcohol).
• Crew should carry a small bottle of hand sanitizer on their person, and use frequently.
• Avoid touching your mouth, eyes and nose unless hands have been cleaned.

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 States.  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:

• Appearing obviously unwell
• Persistent coughing
• Impaired breathing
• Persistent diarrhoea
• Persistent vomiting
• Skin rash
• Bruising or bleeding without previous injury
• Confusion of recent onset

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:

• Take temperature twice daily for fever 38°C (100.4°F) or higher, and watch for cough or difficulty breathing.
• Report any of the above signs or symptoms to your employer.
• Call doctor or local health department for advice.
• Notify local health department and authorities if above signs or symptoms occur and there was travel to an area with widespread community transmission or potential exposure to a person suspected of being infected with Covid-19.

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:

• Remdesivir: an experimental antiviral medication which has been used to treat Ebola virus.
• Chloroquine: oral prescription medication used for malaria prevention or treatment in areas where malaria remains sensitive.
• Hydroxychloroquine: oral prescription medication used for treatment of rheumatoid arthritis.
• Lopinavir-Ritonavir: antiviral medication used against HIV

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?

• Self-isolate and inform onboard medical personnel immediately if you develop a fever / begin to feel feverish, or develop other signs or symptoms of sickness.
• The unwell crewmember should immediately put on a face mask. Any crewmember with a general cold should also wear a basic surgical mask.
• All suspected cases should be reported to MedAire for further advice and care plan.

What should I do if a Crewmember shows signs of respiratory illness?  

• Follow basic isolation procedures until the crewmember can be tested. The crewmember is to be isolated to a designated cabin and head.
• Ensure the cabin is well-ventilated and, if possible, with a porthole.
• Ensure the crewmember gets several hours of sun and fresh air per day.
• Any time the ill crewmember receives a visitor, the ill crewmember should don a fresh surgical mask.
• One crewmember should be assigned to monitor and tend to the sick crewmember to minimise exposure to the disease.
• All food and drinks for the ill crewmember should be delivered to their cabin. Disposable plates and cups should be used.  
• Observe the ill crewmember every four hours, more often if they become sicker.
• Ask specifically about any shortness of breath.
• If there is a finger pulse oximeter onboard, have the crewmember take their own pulse and oxygen saturation. If there is more than one ill patient with respiratory symptoms, clean and sanitise all medical equipment used between patients.

What signs require immediate medical support?

If any of the following occur with the ill passenger, immediately contact MedAire's MedLink service:

• The ill crewmember develops shortness of breath,
• The oxygen saturation drops below 95%,
• The temperature is 38.5°C or above (101.3°F)
• In all cases of suspected COVID-19 infection, contact MedAire immediately for advice.

What can I do to protect myself?

Avoid potential exposure. Practice good hygiene measures and safe food practices.

• Avoid direct contact with animals (live or dead) and their environment. Do not touch surfaces that may be contaminated with droppings.
• Keep some distance from people who are obviously sick.
• Maintain good personal hygiene. Wash your hands frequently with soap and water. Carry hand sanitiser for use when soap and water are not readily available. Some authorities are advising hand sanitisers containing 60-85% alcohol. Avoid touching your face.
• Ensure food, including eggs, is thoroughly cooked.
• Do not travel if you are sick. Note that some locations have implemented screening, and travellers may face quarantine and testing.

How should the crewmember assigned to care for unwell passengers or guests care for themselves?

• The medic should to wear a mask (N95), eye protection, gown and gloves when entering and leaving the room. The gown can be reused but must always be hung up inside out as this reduces the fomite contamination risk
• Immediately dispose of the gloves and mask.
• Hands should also be washed with soap and water or hand sanitizer after exit.

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.

• Surgical masks or other means of face coverings are apparently good enough to fulfill the requirement above
• N95 Masks are meant for the trained medical professional. They must be fitted properly for maximum protection.
• For crew and guests on board, surgical masks should suffice, if needed.
• Surgical masks should also be worn, in addition to eye protection, gloves and gown or apron, by anyone attending a anyone suspected of COVID-19 during a flight.

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?

Aviation

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:

• Self-isolate in hotel,
• Call their doctor or medical support services or the local COVID-19 hotline
• Obtain testing (if available)

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.

Yachting

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:

• Self-isolate off ship if possible or single cabin (with own lav, if possible)
• Contact the local COVID-19 Hotline for hospital/ emergency department and/ or local COVID-19 testing capability
• Thoroughly clean the ship. Focus on areas that are frequently touched by hands (rails, door knobs; pantry), common areas, lavatory, crew room
• Isolate close contacts and have remaining crew self-monitor for 14-days
• Consider enhanced hygiene/ social distancing measures on ship
• We recommend not heading out to sea until 14 days of no one ill onboard (or pre-isolated for 14 days shore side prior to boarding).
• If health authority involved, they have final clearance say

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.

1. Have you been diagnosed with — or are you suspected to have — COVID-19 infection?
2. Have you had fever, sore throat, loss of smell or taste, cough or shortness of breath in the last 14 days?
3. Have you been in contact or shared a household with someone diagnosed with or who has had COVID-19 like symptoms in the last 14 days?
4. Have you been on a cruise ship, in a hostel, a correctional facility or any other group residential facility in the last 14 days?

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?

• CDC provides guidelines for Cleaning of Aircraft after Flight.
• NBAA members and professional aircraft detailers have provided theirrecommendations.
• Additional disinfectants for use against COVID-19 can be found on the EPA's website, however, these products require testing on interior surfaces prior to full use.

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.