FAI Client Update #6: Novel Coronavirus COVID-19 / SARS-CoV-2
Dear clients and partners,
the global COVID-19 Pandemic continues to dominate our daily lives and that of every business sector across the globe. FAI continues to adapt and respond to the ever-evolving crisis to support our clients.
Here is our sixth COVID-19 Client Update.
Since our last update, the global focus has moved through several phases in the evolution of the pandemic, the landscape is shifting rapidly.
As shown dramatically by the epidemic curve graphic produced daily by the WHO, the epicentre has now moved unequivocally to the USA, with the huge outbreak in New York state and New York City dominant in the news cycle. The UK also continues to see significant increase in its case numbers, and in both countries, health experts are debating how soon the peak will be reached. In Europe, Spain and Italy both predict that their countries are now past the peak, as both new case numbers and death rates start to decline. In Germany, case volumes remain high, deaths remain very low.
Russia is now seeing its numbers rising. Singapore, Japan and China are already seeing “second wave” spikes in new case numbers, these are being closely analyzed.
Cities and communities in virtually all countries remain in lockdown, subject to wide variations which are in a state of constant flux as governments tackle the delicate balance between containment of the outbreak vs severe economic hardship. France has just extended its lockdown till May 11th, UK is likely to similarly extend. Spain has started to relax its measures to allow limited return to work, Denmark and Austria are to follow suit. There remains deep international anxiety about triggering a “second wave” through premature relaxation of restrictions.
Latest FAI Operations Position Statement
At FAI, we remain vigilant, flexible and responsive to these developments.
Our aggregate COVID-19 case experience over the last 2 months, tackling multiple variables and case complexities, has validated our position on a strong and consistent policy for management of our aeromedical patient transport cases. Our first priority as always, is to protect our own crews, both flight crews and medical teams. We’re very glad that to date, we have been able to protect both our flight crews and medical crews with a 100% record against COVID-19 secondary infection.
We thank our clients for their positive response to our recent appeal for closer collaboration, and we again repeat that call in this Update.
We are working more deeply on our documentation and information circulars and will shortly distribute a complete Client Briefing Pack with specific templates we have drafted to assist clients to position cases with FAI, together via a team approach.
Latest Developments as at 14 April 2020
- Aviation Operations update
- PMIU update
- Update on Red Zone countries
- FAI position on COVID-19 PCR testing
- FAI position on Companions on air ambulance flights
- FAI position on transportation of recovered COVID patients
1. FAI Aviation Operations Update
Unprecedented restrictions continue on air traffic between countries across the globe.
FAI aviation operations continue to most destinations globally, and we continue our twice-daily Risk Assessments in this regard.
We have experienced sporadic delays in overflight clearances and landing permits, but with our strong network of operating partner relationships we have overcome all obstacles. We will continue to work to keep clients closely updated of all changes in our mission briefings, as they occur.
We have needed to involve diplomatic channels in several African countries to obtain urgent landing clearances – we anticipate that this situation will continue for the foreseeable future, and we thank our clients for your close support to achieve these objectives case by case.
As we announced previously, and as clients have seen, we have had to amend our logistical planning to include more tarmac transfers at most destinations to overcome local entry restrictions. We continue to work closely with clients on a case by case basis to ensure patient safety and optimal patient care at all times, to the highest standards.
Client collaboration in flight preparation and planning has become a key factor in the smooth execution of COVID-19 aeromedical transport cases. Client input is essential in securing a number of case-critical elements in all missions. We have summarised these requirements into a client checklist which will be sent out in the Client Briefing Pack to be distributed shortly.
We thank clients for your ongoing commitment to supporting the success of these critical missions.
2. PMIU Update
Due to unprecedented demand, FAI is expanding our options in mobilising Portable Medical Isolation Units for COVID-19 air ambulance transportation. We are launching a second EpiGuard EpiShuttle unit as announced previously, and in addition we have deployed our existing Iso Ark N36-2 PMIU as a transport option for specific patients.
All transportation requests are closely reviewed by risk assessment on a case by case basis.
- Complex patients requiring ventilation and full critical care modalities will be transported by EpiShuttle PMIU. The EpiShuttle offers greater access for invasive interventions and superior patient positioning options.
- Stable patients requiring minimal intervention will be considered for Iso Ark PMIU transportation, which offers additional flexibility in several areas.
- Unstable patients or rescue missions pose a significant challenge, as active reanimation with CPR is severely limited in any PMIU setting.
Close discussion with clients is essential in considering these categories, on a case by case basis.
Aircraft types and configurations can be adapted accordingly and will be discussed in detail with the client. (All other Conditions and Limitations relating to PMIU cases remain in place as per previous editions of our Updates.)
3. FAI Position on Red Zone/Blacklisted countries
We have reviewed our approach to Red Zone / Blacklisted countries which previously included the following:
- South Korea
- Regional outbreaks in Austria, Germany, France and USA on case by case basis
We have now adapted our position on transport cases from such countries to fall in line with latest international expert opinion on the nature of the Global Pandemic. Accordingly we will no longer use such country categories as a reference point, and will apply the same principles to all countries across the globe.
ALL requests for aeromedical transportation will be subject to a universal COVID-19 Risk Assessment on a case by case basis irrespective of country of origin or destination.
4. FAI Policy on COVID-19 PCR Testing
COVID-19 PCR test result continues to be mandatory to accept any person onto an FAI air ambulance flight.
We reiterate our call for strong support from our clients to make extra efforts to push for these tests despite limitations in local public health screening policy.
By exception on a case by case basis, where all measures have been actively applied at local level, and no COVID-19 PCR test result can be obtained, we may conditionally accept a Hospital Certificate stating that “the patient does not have COVID-19 Infection”.
To simplify this process, FAI has drafted a template which can be used by clients in obtaining the necessary documentation. This will be included in the Client Briefing Pack to be sent out shortly.
5. FAI Companion Policy
In our previous Client Update, FAI introduced limitations for companions on our air ambulance flights.
We listed the serious difficulties in obtaining COVID-19 PCR test results for companions, the issues to facilitate companions under the strict immigration exit / entry and health screening restrictions in place at most destinations, and the limitations imposed through tarmac transfers. Nevertheless, FAI has been able to find ways to overcome many of these issues.
We’re pleased to inform clients that we are able to relax some of these restrictions depending on the circumstances of each case.
We will implement the following requirements case by case:
- COVID-19 PCR test results for companions remains the gold standard
- COVID-19 Hospital Certificates for companions will be considered case by case
- Face masks may be implemented for companions for the duration of the flight
- General health screening for companions at the tarmac prior to boarding
- Temperature screening of companions at the tarmac prior to boarding
Please note the final acceptance of all companions onto our aircraft rests with the FAI Medical Crew on the spot. Close collaboration with clients will be maintained in all such cases.
6. FAI Position on recovered COVID-19 patients
We have received numerous requests for repatriation transportation of patients who have recovered from COVID-19, who have been discharged from hospital and remain in isolation either in private residences or in hotels. This includes patients with mild cases who did not require hospital admission in the first place, or patients who were suspect cases or contact cases, who did not undergo testing for various reasons.
This cohort of patients remains a grey area where there is not yet a clear international consensus.
The epidemiology of the COVID-19 recovery phase is not yet fully understood. The conventional definition of a recovered case remains:
- Clinically recovered from COVID-19 illness
- 2 negative COVID-19 PCR test results over a period exceeding 24 hours
FAI is concerned about 3 key factors:
- False negative test results due to technical issues during sampling
- False negative test results due to reported quality control issues with specific batches of test kits
- An alarming cluster of case reported in the last week, of patients with previously negative test results who subsequently tested positive
Accordingly, FAI is not yet able to make a specific ruling on acceptance of previously COVID-19 positive patients who now test negative, for transportation without special precautions.
All such cases will be handled subject to our Universal COVID-19 Risk Assessment process.
We are closely watching international expert opinion in this critical area and will update our position once the evidence is clear.