Corona Virus (EN)

 

Current Developments

    Complications of SARS-CoV-2 infection in children (12.05.2020)

    Antibody tests (05.05.2020)

    First relaxation measures in Germany (16.04.2020)

    Extended measures in Germany (30.03.2020)

    Border closures in Germany and Europe (17.03.2020)

    Measures in Germany (17.03.2020)

    Tightened entry regulations (13.03.2020)

    Declaration of the WHO (22.04.2020)

    Current guidelines (11.03.2020)

    Current information bulletins (16.03.2020)

    Current case numbers (12.05.2020)

    Updated risk assessment (05.03.2020)

        Course and lethality

        Risk of infection and protective measures

    Current Travel Alerts and General Notes

        Worldwide (17.03.2020)

        Egypt (24.03.2020)

        USA (24.03.20)

        Italy (24.03.2020)

        China (16.03.2020)

        South Korea (05.03.2020)

        Iran (05.03.2020)

        Information for returnees from risk areas and contact persons of infected persons (26.03.2020)

        International Exhibitions, Trade Fairs and Major Events (24.02.2020)

General Information

    Risk of Infection

    Selfcare Measures - What to Do to Prevent Infection?

    Test and reporting system

    Dashboard of Current Illnesses

    What to Do If You Are Suspected of Being Infected

    Evacuation / Repatriation of Patients from China (general - independent of Corona)

    Evacuation / Repatriation of Patients from China with Confirmed Corona Infection or Reasonable Suspicion of Infection

    Risk Assessment

    Contact us:

Timeline

    Quarantine measures for travel to China become stricter (19.02.2020)

    Travel restrictions after stays in China (18.02.2020)

    Number of cases in Italy has risen sharply (14.02.2020)

    Case numbers in South Korea have risen sharply (13.02.2020)

    Case numbers in China have risen sharply (13.02.2020)

    Major events can be cancelled worldwide (13.02.2020)

    New name for the virus and the disease caused (12.02.2020)

    Note on the quick test and reporting system (11.02.2020)

    Increased entry controls (11.02.2020)

    Therapy and vaccine development (06.02.2020)

Current Developments

Complications of SARS-CoV-2 infection in children (12.05.2020)

In connection with COVID-19, at least 100 cases of multisystemic inflammation in children were registered in Europe and the USA within about two weeks. Individual deaths have also been reported. In specialist circles, this clinical picture is now known as "Pediatric Multisystem Inflammatory Syndrome". It is presumably an overreaction of the immune system to the corona virus.

Fever, abdominal symptoms and skin rash are the main symptoms. Sometimes - comparable to the Kawasaki Syndrome - an inflammation of the coronary vessels occurs. Doctors are advised to pay particular attention to the symptoms of this syndrome in children, so that the syndrome requiring treatment is not overlooked. Signs of such a multisystem inflammation can appear days to weeks after acute SARS-CoV-2 infection, often at a time when no more viruses are detectable in the nasopharynx. Since COVID-19 is often asymptomatic in children anyway, there is a risk that corresponding subsequently occurring inflammatory symptoms will not be associated with COVID-19 and a "Pediatric Multisystem Inflammatory Syndrome". Treatment options include the administration of human immunoglobulin, anti-inflammatory measures such as aspirin and antibiotics to protect against secondary bacterial infections. (ProMED 09.05.2020)

Antibody tests (05.05.2020)

The U.S. Food and Drug Administration (FDA) has approved an antibody test from Roche "for use in emergency situations", which appears to have a low error rate. False-positive results are expected in only about 0.19 percent of cases, while the rate of false-negative results is practically 0 (zero) percent. According to the manufacturer, the test will also be available in Germany from mid-May 2020. However, this is not a "quick test" that can be used at home or in a doctor's practice, but requires Roche's cobas e series immunological analysers, which are however broadly available throughout Germany. (Outbreak News Today 04.05.20, Roche 04.05.20)

First relaxation measures in Germany (16.04.2020)

On 15 April, the federal and state governments agreed on a gradual relaxation of the measures for containing the coronavirus pandemic. The decision includes the following points:

  • Distance regulations and contact restrictions will remain in place until 3 May. A distance of at least 1.5 metres to other persons must still be maintained. Staying in public is only permitted in the circle of relatives or with another person not living in the own household.
  • School operations are to be gradually resumed from 4 May onwards.
  • The ban on assembly in places of worship remains in force.
  • Major events will remain prohibited until 31 August.
  • Shops up to 800 m² in size, as well as car dealerships, bicycle dealers and building houses may reopen from 20 April if the hygiene regulations are observed.
  • Hairdressing salons may resume operations from 4 May, subject to hygiene regulations.

Extended measures in Germany (23.03.2020)

On 22 March, the Federal Government and the States decided to extend the guidelines for restricting social contacts. The new measures have been in force since 23 March. They include the following points:

  • I. Citizens are urged to reduce contacts with other people outside the members of their own household to an absolutely necessary minimum.
  • II. In public, wherever possible, a minimum distance of at least 1.5 m must be kept from persons other than those mentioned under I.
  • III. The stay in public space is only permitted alone, with another person not living in the household or in the circle of members of one's own household.
  • IV. The way to work, emergency care, shopping, visits to the doctor, participation in meetings, necessary appointments and examinations, help for other or individual sports and exercise in the fresh air as well as other necessary activities remain possible.
  • V. Groups of people celebrating in public places, in apartments and private facilities are considered unacceptable in view of the seriousness of the situation. Violations of the contact restrictions shall be monitored by the authorities and the police and sanctions are imposed in the event of infringements.
  • VI. Gastronomic establishments will be closed. This does not include the delivery and pick-up of take-away food for consumption at home.
  • VII. Personal hygiene service providers such as hairdressers, beauty salons, massage parlours, tattoo studios and similar establishments will be closed because physical proximity is essential in this area. Medically necessary treatments remain possible.
  • VIII. In all establishments and especially those open to the public, hygiene regulations shall be observed and effective protective measures implemented for employees and visitors.

In the individual federal states, numerous measures beyond this (such as the closure of educational and cultural facilities and of shops that do not provide basic services) apply. According to current information, the measures will remain in force at least until 20 April. Further regulations based on regional peculiarities or epidemiological situations in the federal states or districts remain possible.

Border closures in Germany and Europe (17.03.2020)

On 16 March, the Federal Ministry of the Interior (BMI) has ordered temporary border controls. These will take place at the internal borders with Austria, Switzerland, France, Luxembourg and Denmark. German citizens, persons with residence status and first residence in Germany may still enter Germany. The cross-border movement of goods and commuters will remain guaranteed. In addition to Germany and many other countries, the European Union will also close all its external borders from 17 March. Travel between EU states and other countries will be suspended for 30 days. There will be exceptions for citizens with a permanent residence permit for the EU. There will also be exceptions for relatives of EU citizens, diplomats, doctors, nurses, scientists and experts as well as for people transporting important goods and commuters working in the EU.

Measures in Germany (17.03.2020)

In order to reduce the spread of the novel coronavirus, the following infection control measures have been adopted in Germany:

  • Closure of day-care centres, schools and universities
  • Prohibition on the operation of restaurants, with the exception of restaurants where sufficient distance between seats is guaranteed
  • Ban on major events
  • Prohibition or restriction of visits to hospitals, dialysis facilities, day clinics, old people's and nursing homes and inpatient facilities for people with disabilities
  • Prohibition to operate the following facilities: Cultural facilities of any kind, in particular museums, theatres, playhouses, open-air theatres; educational facilities of any kind, in particular academies and further education facilities; adult education centres, cinemas, swimming pools and indoor swimming pools, thermal baths, saunas, fitness studios and other indoor sports facilities, adult education centres and youth centres, public libraries, entertainment facilities and prostitution facilities.

Tightened entry regulations (13.03.2020)

More and more countries around the world are tightening their entry regulations or imposing complete entry stops. This mostly affects travellers who have previously stayed in a country with a high number of SARS-CoV2 cases. Some countries also quarantine travellers, sometimes regardless of their previous stay or clinical status.

You can find out whether and to what extent you are affected by contacting the Foreign Office of your country of origin or the embassies and immigration authorities of your destination country. You can also obtain information from the travel agency or airline that is operating the flight.

Declaration of the WHO (22.04.2020)

On 11 March 2020, for the first time the WHO classified the multinational COVID 19 outbreak as a pandemic. You can find the current Situation Report by the WHO here.

Current guidelines (11.03.2020)

The RKI has updated, specified and structured its guidelines and recommendations for doctors and health authorities on the tracking and treatment of contact persons. According to these, isolation or quarantine in one's own home could be ordered or recommended more frequently.

Current information bulletins (16.03.2020)

Please note the information in the COVID-19 leaflet and on the pages of the World Health Organization WHO and the European Centre for Disease Prevention and Control. There are maps for both the development of case numbers worldwide and for Germany.

Due to the currently very dynamic international epidemic situation, we recommend before travelling to enquire in advance at your Foreign Office, your country’s embassy in the destination country or the embassy of the destination country.

Current case numbers (12.05.2020)

Worldwide, 4,256,729 infections with 287,355 deaths were registered. Currently 2,439,768 people are infected, 98% of patients show mild signs of disease, while 2% are in a serious or critical state of health (May 12, 07:14 GMT, source: worldometers.info). The following 212 countries/ regions registered infections with the novel coronavirus (number of cases/deaths):

USA (1,385,834/81,795), Spain (268,143/26,744), United Kingdom (223,060/32,065), Russia (221,344/2,009), Italy (219,814/30,739), France (177. 423/26,643), Germany (172,576/7,661), Brazil (169,594/11,653), Turkey (139,771/3,841), Iran (109,286/6,685), China (82,919/4,633), India (70. 827/2,294), Canada (69,981/4,993), Peru (68,822/1,961), Belgium (53,449/8,707), Netherlands (42,788/5,456), Saudi Arabia (41,014/255), Mexico (36. 327/3,573), Pakistan (32,081/706), Switzerland (30,344/1,845), Chile (30,063/323), Ecuador (29,509/2,145), Portugal (27,679/1,144), Sweden (26,670/3,256) ... OTHERS. (May 12, 07:14 GMT, source: worldometers.info)

Further new infections are detected in Germany, with cases occurring in:

Bavaria (44,593/2,182), North Rhine-Westphalia (35,333/1,456), Baden-Württemberg (33,359/1,568), Lower Saxony (10,895/507), Hesse (9,031/415), Rhineland-Palatinate (6,355/206), Berlin (6,274/165), Hamburg (4. 960/216), Saxony (4,947/190), Brandenburg (3,111/136), Schleswig-Holstein (2,956/125), Saarland (2,665/144), Thuringia (2,594/118), Saxony-Anhalt (1,648/50), Bremen (1,058/35), Mecklenburg-Western Pomerania (729/20). Total: 170,508/7,533. Difference to previous day: + 933 cases. (Source: Robert Koch Institute, as of 12.05.2020, 00:00 hrs)

Current risk assessment (05.03.2020)

Course and lethality

Current data suggest that about 83% of symptomatic infections are mild, while in about 17% the disease has a severe to critical course. The fatality rate appears to be between 2 and 3.4%, but due to numerous inconspicuous undocumented infections it is more likely to be in the range of 0.3 to 0.7%.

The elderly and people with pre-existing conditions, especially those of the respiratory and immune systems, are particularly at risk for severe courses of the disease. The risk of dying from the infection increases significantly from the age of 50. People over 80 are most at risk, with a mortality rate of 14.8%. Gender also seems to play a role: While the fatality rate for men is 2.8%, it is only 1.7% for women.

In infants and children, the disease generally appears to be milder. Transmission from infected pregnant women to the unborn child seems possible, but has hardly been investigated so far, so an assessment is not yet possible.

Risk of infection and protective measures

The novel coronavirus is significantly less contagious than the measles virus, but seems to be as easily transmissible as influenza viruses. It is assumed that SARS-CoV-2 is even more contagious than the 2002/2003 SARS pathogen.

According to current estimates by researchers from the Universities of Greifswald and Bochum, coronaviruses can survive for up to nine days on surfaces at room temperature. However, the pathogens react sensitively to numerous disinfectants. Ethanol (62-71 Vol%), hydrogen peroxide (0.5%) and sodium hypochlorite are particularly suitable for surface disinfection. Thus a sufficient effect can be achieved with an exposure time of only one minute. (Journal of Hospital Infection 2020)

Most important is personal hygiene, especially regular and proper hand washing. It is also recommended to avoid contact with persons suffering from respiratory diseases. Volatile contacts are considered to bear little risk; in general, "face-to-face contacts" of at least 15 minutes are required for direct infection.

Current Travel Alerts and General Notes

Worldwide (17.03.2020)

On 17.03. the Federal Foreign Office issued a worldwide travel warning. This is a warning against unnecessary, touristic trips abroad. It is to be expected that drastic restrictions in air and travel traffic, worldwide entry restrictions, quarantine measures and the restriction of public life in many countries will continue to intensify.

Egypt (24.03.2020)

On 21.03.2020 the Robert Koch Institute declared the whole of Egypt a risk area.

In the wake of the spread of the respiratory disease COVID-19, Egypt has announced to close all airports in the country from 19 March 2020. Empty planes for picking up passengers are still allowed to land until the end of the month.

The number of infected persons in the country is increasing, including German nationals. There have already been fatalities. Staying in larger groups, especially in confined spaces, for example on cruise ships, means an increased risk of infection.

The Egyptian authorities have stepped up health checks with temperature measurements as well as quarantine measures, including compulsory ones. Forced quarantine is also carried out in Egyptian state facilities, which are significantly below German standards.

  • At present, it is not recommended to travel to Egypt if not necessary.
  • Check your travel plans and if in the country, contact your tour operator or airline. Also check alternative ways of leaving the country via third countries.
  • Avoid centres of tourism, especially Nile cruises and seaside resorts such as Hurghada, as there is a considerable risk of infection.
  • Expect compulsory quarantine measures if symptoms of the disease appear or if you are in the vicinity of a sick person.
  • Please note our continuously updated information on COVID-19 / Coronavirus.

USA (24.03.20)

From Saturday, 14 March 2020, people who have stayed in the Schengen area in the last 14 days before the trip may no longer enter the USA for an initial period of 30 days. So this mainly affects the EU and Great Britain, but not the Balkan states, Romania, Bulgaria and others. Certain groups of people are excluded from the regulation, first and foremost US citizens and their immediate family members, as well as people who are permanently resident in the USA. In addition, there are already restrictions on travel to the USA from China, Hong Kong, Macau and Iran.

In the states of California, Washington and New York, the US health authorities estimate that there is a persistent virus transmission within the population, which is why the Robert Koch Institute has classified these as risk areas. It is therefore not advisable to travel to the states of California, Washington and New York.

China (16.03.20)

The German Federal Foreign Office advises:

At present, all travellers to China must expect to be obliged to undergo a 14-day quarantine after entry or after an intra-Chinese journey due to the spread of the coronavirus. This will take place at home or in a hotel, and by special arrangement also in a quarantine centre. Decisions on these measures are taken by different authorities at different levels and may also vary within a city. Before entering the country, you should therefore contact your property management or your hotel as well as other contact persons such as your employer or university to find out the regulations that apply to you there. During the quarantine period you will not be able to leave China.

When Entering China from risk areas you will be obliged to observe a 14-day quarantine period. These include Iran, Italy, Japan and South Korea. Travellers from Germany, France, Spain, the USA and possibly other countries are also often subjected to a 14-day quarantine, especially when entering Shanghai. For Beijing, a 14-day quarantine obligation will apply from 16 March 2020, in principle in a central facility for travellers from all countries, including Germany.

On arrival of international flights, intensive health checks are carried out on board and after leaving the aircraft. This results in considerable waiting times. Depending on the results of the health checks, various quarantine measures can be ordered. In the event of a suspected case of coronavirus on the entry flight, you must expect to be placed in a quarantine centre for 14 days immediately after entry or afterwards.

At Shanghai airport, after a quarantine measure has been ordered, a private transfer from the airport is only possible after prior registration. Otherwise, transport to the individual districts will be provided by shuttle buses provided by the city of Shanghai. This also applies in the case of planned onward travel to another province.

As a general rule, the situation remains dynamic and the specifications of the local authorities can change without notice. International embassies and Consulates General have no influence on the quarantine measures decided upon in accordance with national infection control regulations.

The Chinese authorities have imposed travel restrictions on Wuhan and other cities in Hubei province since 23 January 2020. It is still not possible to travel there by train, plane, bus, ferry or car. Other provinces in China have also imposed restrictions on travel and freedom of movement to varying degrees. Fever controls are possible on entry and exit as well as on overland travel within the country; quarantine measures are to be expected if symptoms occur.

Neighbouring countries, including Russia, have temporarily closed border crossings, and many airlines have temporarily restricted or suspended air travel.

Due to the enormous strain on the health system, there may be restrictions on general medical care.

Stays in China have an impact on entry possibilities to numerous other countries.

  • Travel to Hubei province is warned against.
  • For the time being, unnecessary travel to the rest of the People's Republic of China, with the exception of the Hong Kong and Macao Special Administrative Regions, is discouraged.
  • If you are staying in China, please consider leaving the country temporarily or prematurely due to increasing restrictions.
  • Register in your country’s crisis prevention list, if available
  • Please note the information in official COVID-19 leaflets (e.g. here and here).
  • Keep in close contact with your tour operator or airline regarding possible changes in the flight schedule.
  • Follow the instructions of the local security forces.
  • Before traveling, be vaccinated against influenza with the current northern hemisphere vaccine. An influenza vaccination can help to avoid unnecessary suspicious cases.
  • If you intend to travel to other countries following a stay in China, please observe the current entry regulations of the respective destination countries.

South Korea (05.03.2020)

On 23 February 2020 the highest alert level was declared for the novel coronavirus SARS-CoV2. Authorities were ordered to take measures to contain the spread of the virus. These include possible travel restrictions, school closures and the prohibition of public events. Particularly affected are Daegu and Cheongdo in the eastern province of Gyeongsangbuk-do (North Gyeongsang), which has been declared a special zone, allowing for special behavioural measures such as a ban on gatherings.

  • Travel to Gyeongsangbuk-do Province and Daegu City is currently not recommended.
  • Please note the information in official COVID-19 leaflets (e.g. here and here).
  • Due to the dynamics of the spread of the coronavirus in South Korea, follow news and agency reports closely.
  • If necessary, enquire at your local South Korean mission before you start your journey.
  • Always follow the instructions of local authorities.

Italy (24.03.2020)

Notes from the Federal Foreign Office:
“Due to the current wave of disease with COVID-19, an emergency ordinance is in force. Italian airports are closed for direct flights to and from China until further notice. At airports and ports, but also in overland traffic in regions with detected cases of infection, health checks are carried out with temperature measurements. Airports, ports and railway stations are still in operation, but train connections to Austria have been suspended; transit through Austria by car and bus is currently only possible without a stopover. Due to lower demand, many flights are currently being cancelled. Border closures are not intended.

Since 19 March and until 3 April 2020, a decree has come into force which suspends the operation of Italian passenger/cruise ships and prohibits foreign-flagged passenger/cruise ships from docking in Italian ports. Italian ships must disembark their passengers in port. Non-Italian passengers not resident in Italy are then transported to the respective foreign destinations at the expense of the ship operator.

From now until initially 25 March 2020, persons arriving in Italy from abroad are subject to a duty to notify the authorities and a 14-day self-isolation obligation.

If COVid-19 symptoms occur, these must also be reported. Exceptions to the self-isolation can be made for professional reasons for a period of 72 hours, possibly extendable by a further 48 hours. A corresponding certificate must be presented. Exceptions also apply to employees of companies based in Italy. You can find more information on the website of the Italian Ministry of Health.

Throughout Italy, unnecessary movements are to be avoided; restrictions on freedom of movement and controls are to be expected nationwide. Schools, kindergartens and universities throughout Italy will initially remain closed until 3 April 2020. Congresses and meetings are suspended, as are cultural and social events in public or private places. Sporting events are suspended and many bars and restaurants are closed. Grocery stores, supermarkets, pharmacies, banks, post offices and government offices are open; public transport will be maintained.

The Decree of 9 March 2020 with restrictions on freedom of movement for the whole of the Lombardy Region and the provinces of Modena, Parma, Piacenza, Reggio Emilia and Rimini in Emilia-Romagna, Pesaro and Urbino in Marche, Padua, Treviso and Venice in Veneto and Asti, Alessandria, Novara, Verbano-Cusio-Ossola and Vercelli in Piedmont has been extended to the whole of Italy with effect from 10 March 2020, initially until 3 April 2020. Exceptions to the restriction on freedom of movement are made for verifiable work-related journeys, in the case of health reasons or in other emergency situations. It is still possible to return to a place of residence, both within and outside of Italy, and to leave Germany for this purpose. Checks and enquiries by security and law enforcement officers must be expected. A self-declaration of the necessity of the journey must be filled out for each journey and carried along.

  • All unnecessary travel to Italy is currently advised against.
  • If you are staying in Italy, please limit your travel to what is necessary at present and carry a self-declaration of necessity with you.
  • If you have planned a trip, please check with your tour operator or airline to see if it can still be carried out.
  • Follow the prevention recommendations in COVID-19.
  • If necessary, check with the Italian embassy or consulate responsible for your destination before you start your trip and with the Ministero della Salute, which has set up a hotline under 1500 that can be dialled within Italy. The Lombardy region offers this (local only): 800 894545.
  • Always follow the advice of local authorities.
  • Follow the information on the sites of the World Health Organization WHO and the European Centre for Disease Control.

Iran (05.03.2020)

In Iran, numerous cases of the Chinese respiratory disease COVID-19 have been detected. The provinces of Teheran and Ghom, which have been classified as risk areas by the Robert Koch Institute, are particularly affected. Other provinces are also recording rising case numbers. Health information in English is available on the hotline +98 992 158 2247.

On entry, checks are carried out to ensure that all passengers entering the country are medically examined. Checks are also carried out in country on entry and exit to Ghom Province and quarantine measures are ordered if infection is suspected.

On departure, temperature measurements are taken; a form must be filled out to confirm that the symptoms are not present, and there are delays at the airport.

According to information from the Iranian Foreign Ministry, foreigners who were not able to leave the country on time due to the corona outbreak can currently leave the country even if their visa has expired. A separate exit visa is not required.

  • Travel to Iran is currently not recommended.
  • Consider leaving the country prematurely or temporarily, even if there are currently waiting times for available seats due to very limited flight connections.
  • Check changes in the flight schedule with your airline.
  • Be at the airport about five hours before departure for departures.
  • Be especially careful when staying in Iran at the moment.
  • Observe the situation carefully and, if necessary, contact the relevant Iranian diplomatic mission before departure for the current entry regulations.
  • Before leaving Iran, check with the relevant authorities in your destination country to see if it is possible to enter the country from Iran.
  • Please note the information in official COVID-19 leaflets (e.g. here and here).

Information for returnees from risk areas and contact persons of infected persons (26.03.2020)

Within Germany, health authorities recommend the following procedure to persons who are concerned that they have been infected with the novel coronavirus or who are returning from regions where transmission has occurred:

Contact by telephone:

  • your family doctor
  • the responsible health office
  • the emergency medical service under 116 117
  • regional information hotlines, or
  • the nearest emergency room (ONLY in cases of serious illness),

to discuss the way forward for clarification.

See also on this:

International Exhibitions, Trade Fairs and Major Events (24.02.2020)

More than 300 trade fairs have already been cancelled or postponed worldwide. A current overview can be found here.

Worldwide, the probability is increasing that major events such as festivals, sporting events and trade fairs will be cancelled or postponed indefinitely.

General Information

The coronavirus belongs to the order Nidovirales, whose representatives can cause very different diseases in various vertebrates such as mammals, birds and fish.

Coronaviruses are genetically highly variable and can also cause serious infections in humans through so-called species transfers. Examples include the SARS pandemic of 2002/2003 and the MERS epidemic of 2012.

The coronavirus epidemic which has been spreading from the Chinese city of Wuhan since the turn of the year 2019/2020 is attributed to the previously unknown coronavirus 2019-nCoV. In humans it may lead to mild respiratory tract infections up to severe acute respiratory syndromes.

Symptoms of a possible infection can be:

  • Cough
  • Fever
  • Chills
  • Headache
  • Aching limbs
  • Weakness / fatigue
  • Frequently accompanied by diarrhoea

The incubation period is, according to current knowledge, on average (median) 5-6 days (range: 1-14 days). However, a risk of infection from infected persons can already be assumed before the outbreak of the disease. According to current estimates, a considerable proportion (44%) of those affected become infected via infected persons who were still symptom-free at the time of infection. At least 2-3 days before the outbreak of the first symptoms, infected persons can already infect contact persons. This finding underlines the general importance of "social distancing". The spread of COVID-19 can best be contained by avoiding social contacts as far as possible, regardless of whether potential contact persons show symptoms of infection or are (supposedly) healthy.

Risk of Infection

A characteristic of coronaviruses, which - like the pathogens of SARS and MERS - belong to the genus of beta-caronaviruses, is their comparatively low infectivity. However, 2019-nCoV appears to be more infectious than other pathogens of this genus.

Infection can occur when droplets or saliva containing the pathogen come into direct contact (or indirectly via the hands) with the mucous membranes of the nose, throat, mouth or eyes. At the present time, transmission via the digestive tract cannot be ruled out. Infection in encounters with infected persons is most likely to occur in close and prolonged contact (15 minutes at a distance of less than 180 cm). Medical personnel, especially in intensive care units (artificial respiration of patients), are also subject to an increased risk of infection. Depending on the degree of exposure, face masks of the classes FFP1 to FFP3 can reduce the risk of infection during personal contact. In addition, if symptoms of infection occur, the wearing of even the simplest face masks by the infected person can significantly reduce the risk of infection for third parties.

In places where many people live together in a confined space, the human-to-human transmission route - as in the current outbreak - is becoming increasingly important and is quickly becoming the main mode of transmission. Ultimately, coronavirus outbreaks can usually be contained, at least regionally, by intensive control measures by the health authorities.

Selfcare Measures - What to Do to Prevent Infection?

In order to keep the risk of infection as low as possible, one should observe the following rules of conduct:

  • Avoid large crowds and markets
  • Avoid using public transportation
  • Wear a face mask of at least protection class FFP 2 outside your apartment / hotel
  • Pay close attention to your hand hygiene and use a suitable hand disinfectant regularly
  • Avoid contact with sick people and colleagues and especially with free-range animals
  • Expatriates living and working in the area should, if possible, work as much as possible from their home offices.

Due to the surge in demand, suitable face masks and disinfectants have become scarce in some places and in some regions are no longer available to normal consumers or only at horrific prices.

On request, MD Medicus Assistance Service GmbH supplies the employees of their client businesses with face masks, gloves and disinfectants from Germany. Should you require further information, please send an e-mail to assistance@md-medicus.net.

Test and reporting system

A PCR test for infection with the novel coronavirus is available. Once the sample has arrived at a suitable laboratory, it ideally takes less than two hours to obtain the result. However, not every patient with respiratory symptoms or radiological evidence of lower respiratory tract infection will be tested; in general, certain additional criteria must be met, in particular:

  • association with an accumulation of pneumonia in a nursing home or hospital (if there is clinical or radiological evidence of viral pneumonia)
  • contact with demonstrably ill patients, regardless of the severity of the symptoms, up to a maximum of 14 days before the start of the illness, or
  • the doctor consulted considers the performance of the test to be medically necessary and orders it.

Note from the BZgA: Should a test be ordered in the case of a respiratory disease, even if it is only mild symptoms (coughing, sneezing, sore throat etc.)?

Yes, if:

  • you have been in contact with a sick person in the last two weeks, for whom a COVID-19 diagnosis was made in the laboratory,
  • you were in an area where many COVID-19 diseases have already occurred,
  • there is a previous illness or the respiratory disease is getting worse (shortness of breath, high fever, etc.),
  • if you come into contact with people at work or in voluntary work who are at high risk of serious illness (e.g. in hospital or in care for the elderly).

Even before the test result is available, one should isolate oneself, i.e. stay at home, avoid all close contact under 2 meters, maintain good hand hygiene and wear a mouth and nose protection when in contact with others (if available). (BZgA, 25.03.)

On February 1, 2020, the German Federal Ministry of Health issued an emergency ordinance on the obligation to report the new coronavirus. According to this regulation, doctors must report all suspected cases of illness and death in connection with the virus to the local health authority. Suspected cases must be clarified. An agreement between the KBV and the GKV-Spitzenverband on laboratory diagnostic clarification has also been in force since 1 February 2020.

According to this agreement, the statutory health insurance companies will cover the costs of testing for the novel coronavirus in justified cases of suspicion.

Note: In China, there have been increasing reports of rapid coronavirus tests (nCoV-PCR tests) which do not detect the pathogen in symptomatically infected persons or only after a time delay. Random samples presumably showed false negative results in 50-70% of the infected persons examined. The testing of throat swabs is particularly susceptible to false negative results. (ProMED 09.02.) According to current information, this problem did not occur in the tests used in Germany.

See also RKI: COVID-19: Suspicion Clarification and Measures - Guidance for Physicians (5.3.2020)

Dashboard of Current Illnesses

 

 

What to Do If You Are Suspected of Being Infected

The Chinese authorities have implemented a strictly followed schedule for all suspected corona cases. Patients with the above symptoms must present themselves in a fever clinic that is designated for the respective location.

The fever clinics are responsible for the correct recording of all suspected cases, carry out all necessary examinations and ultimately decide whether a corona infection is confirmed or not.

The private, internationally oriented hospitals in China, which are preferred by tourists and expatriates, are usually not part of this emergency plan and are currently not allowed to treat patients with fever!

 

Here is a list of the fever clinics:

 

Fieberkliniken in Wuhan

Fieberkliniken in Shanghai (Main)

Fieberkliniken in Beijing (Main)

Fieberkliniken in Suzhou

Fieberkliniken in Guang Dong

Fieberkliniken in HangZhou

 

The incubation period, i.e. the time between exposure to the virus and the possible onset of the disease, is between one and 12 days for corona. Patients who are already back home but who have been in Asia within the last two weeks should seek medical treatment immediately if the above symptoms occur and should also draw attention to their previous stay in Asia!

Evacuation / Repatriation of Patients from China (general - independent of Corona)

Flights, including ambulance flights to the quarantined areas such as the city of Wuhan or even into the entire Hubei region, are currently not officially possible and, if at all, in individual cases only feasible with a special permit that has to be to be applied for. For this reason, short-term evacuation flights from these regions are currently not feasible.

 

All non-quarantined regions can be flown to by the ambulance planes organized and provided by MD Medicus without any problems, as long as the patient to be transported does not suffer from unclear fever or even a confirmed coronavirus infection.

Evacuation / Repatriation of Patients from China with Confirmed Corona Infection or Reasonable Suspicion of Infection

In the event of undiagnosed fever or even of confirmed coronavirus infection, evacuation or repatriation is only possible under certain conditions, after consultation with the responsible epidemic control authorities in the recipient country and, in particular, only with aircraft specially equipped for transporting highly infectious patients.

 

MD Medicus Assistance Service GmbH is in a position to arrange everything for a speedy evacuation of patients with suspected or confirmed coronavirus infection around the clock. The special aircraft required for this purpose have been part of MD Medicus' worldwide network for years.

Risk Assessment

The Federal Foreign Office has issued a partial travel warning for China and especially for the Hubei region. According to the MD Medicus travel medicine experts, travel to the Hubei region including business trips should be completely avoided for the time being.

You should also consider to refrain from postponable trips / business trips to the rest of China. Tour operators and airlines already offer free cancellations of already booked China trips.  

 

As it must be assumed that the current evacuation radius will be extended by the Chinese authorities at short notice in case of continuously increasing case numbers, sufficient distance to the current evacuation zone should be maintained on all unpostponable trips to China. This also serves to avoid being detained overnight and not being allowed to leave the country until further notice.

 

MD Medicus issues travel medicine alerts to companies with business travellers and/or expatriates. If you are interested, we will be happy to make you an offer!

Contact us:

For corporate clients/insurers who have subscribed to our newsletter and have a customer number, our medical travel and tropical medicine experts are available at any time to answer individual questions. The travel medicine centre at the Bernhard-Nocht-Institute for Tropical Medicine, which is supervised by MD Medicus, is available around the clock.

Timeline

Quarantine measures for travel to China become stricter (19.02.2020)

China is currently regularly tightening quarantine regulations, including a 14-day quarantine period for Beijing. Travelers arriving in Beijing from Germany on an international flight and who have not been in China for the past 14 days are not subject to the 14-day quarantine and can stay in Beijing without any physical restrictions. If the entry into Beijing is from another area of China, the 14-day quarantine period must be observed. This can be done at home or in a hotel.

Travel restrictions after stays in China (18.02.2020)

Irrespective of the exact place of stay in China, many countries have massively tightened their entry regulations for arrivals from China or even from its neighbouring countries. This can lead to long compulsory quarantine or a complete ban on entry. Please enquire in advance at your Foreign Office, your embassy in the destination country or the embassy of the destination country.

Number of cases in Italy has risen sharply (14.02.2020)

In Italy, more than 655 people have now become infected with the novel coronavirus. The number of deaths has risen to 17. Italy has thus become the largest source of infection in Europe. The northern Italian region of Lombardy is particularly affected, but cases have also been reported in the regions of Veneto, Emilia Romagna, Piedmont, Friuli Venezia Giulia and the autonomous province of Trento.

Due to the sharp increase, the Italian government has adopted an emergency decree. Dozens of places have been quarantined and public life is largely at a standstill. Shops, businesses, educational institutions and museums will remain closed for the next few days, and some celebrations and sporting events have already been cancelled. Italian airports are closed to direct flights from China until further notice. At airports and ports, health checks with temperature measurements are carried out. An extension of the controls is possible at any time. Airports, ports and railway stations are currently still in regular operation.

Case numbers in South Korea have risen sharply (13.02.2020)

With an increase from 52 to 156 infected persons, South Korea is now the country outside China most affected by the epidemic. 41 of these new infections alone have been registered in the 2.5 million city of Daegu and its surroundings. The city also saw the first death from the lung disease (Covid 19) caused by the virus. Seoul has now declared the city a "special management zone".

Case numbers in China have risen sharply (13.02.2020)

From 12 to 13 February 2020, the number of infected people in China has risen massively by almost 15,000 to a total of around 50,000 in the Wuhan metropolitan region and around 60,000 overall in mainland China. On the one hand, this corresponds to the expected peak of the epidemic, and on the other hand, it is the result of a more precise diagnostic procedure by the Chinese authorities and doctors.

Major events can be cancelled worldwide (13.02.2020)

Since the beginning of the epidemic, all major events such as festivals, sporting events and trade fairs in China  have been cancelled or postponed indefinitely. Events may also be cancelled worldwide. For example, it was announced that the GSMA Mobile World Congress 2020 in Barcelona, the largest of its kind in the world, will be cancelled as a precautionary measure. It was to take place at the end of February.

New name for the virus and the disease caused (12.02.2020)

On February 11, 2020, the WHO announced that the official name for the pathogen previously named "2019-CoV" would in future be "SARS-CoV-2". The clinical picture triggered by the pathogen will in future be referred to as "COVID-19" (coronavirus disease 19).

Note on the quick test and reporting system (11.02.2020)

In China, there is a growing number reports about quick coronavirus tests (nCoV-PCR tests) which do not detect the pathogen in symptomatically infected persons, or only after a time delay. Random samples showed presumably false negative results in 50-70% of the infected persons examined. The testing of throat swabs is particularly susceptible to false negative results. (ProMED 09.02.20)

Increased entry controls (11.02.2020)

In general, increased entry controls to identify sick travellers, especially from China, and imported individual cases of illness, must currently be expected in all countries.

Therapy and vaccine development (06.02.2020)

An established treatment or vaccine is not yet available, but intensive work on a vaccine is underway. Mild disease progressions probably do not require targeted therapy, while severe disease progressions may require intensive medical treatment with the aim of keeping the patient's vital functions stable until his immune system has successfully contained the pathogen. Antiviral substances are used for severe clinical courses of the disease. In Thailand, initial successes have been achieved in healing trials with a combination of anti-HIV and anti-influenza agents. The active ingredients used were lopinavir, ritonavir and oseltamivir. However, the effectiveness of drugs can hardly be assessed in the context of healing trials, especially in the case of infections with a high spontaneous healing rate.

 

The next step on the way to an internationally recognized therapy is therefore the implementation of randomized, placebo-controlled studies. Active ingredients that appear to be particularly good candidates for controlled clinical trials due to their pronounced efficacy under laboratory conditions (in vitro activity) include the antiviral Remdesivir and Chloroquine, which is known primarily as a classic anti-malarial agent. However, the clinical effectiveness of these therapeutic approaches cannot yet be assessed at this stage.

 

Current statistics suggest a mortality rate of around two percent. However, the mortality rate in Wuhan is about twice as high as in the rest of China.

However, due to the expected number of undetected cases of mild undiscovered diseases, the actual mortality rate could also be significantly lower. The rate of patients with severe symptoms of infection could be around 25 percent of those infected.

 

 

 

 

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