1. Key facts
• There is an outbreak of a novel coronavirus (termed “2019-nCoV”) which originated in China.
• The origin of the current strain is thought to be from animals.
• The virus is contagious between people.
• Symptoms can include a cold or organ failure in some severe cases.
• Those with vulnerable immune systems are at higher risk.

2. Background
On 31 December 2019, the World Health Organization (WHO) China country office reported a cluster of pneumonia cases in Wuhan City, Hubei Province of China. Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has been confirmed as the causative virus of Coronavirus disease 2019 (COVID-19). As at 3 April 2020, there was over one million cases reported globally and 50 000 deaths.

3. Here in South Africa
The first case of Coronavirus in South Africa was confirmed on Thursday 5 March 2020. The patient had returned from a trip to Italy and, together with his doctor and the doctor’s family, were placed under quarantine upon diagnosis. There are now over 1 400 confirmed cases and five deaths.

4. Signs and symptoms
Symptoms of 2019-nCoV may appear in as few as two days or as long as 14 days after exposure. Symptoms may include:

• Fever
• Cough
• Shortness of breath
• Severe respiratory illness
• Multiple organ failure

People with underlying medical conditions may experience worse symptoms and even death.

5. Prevention
The NICD encourages the public to continue practising hand hygiene and cough etiquette, and adhering to the following:

• Wash your hands thoroughly for at least 20 seconds with soap and water especially after direct contact with ill people or their environment.
• Consider getting a hand sanitiser (minimum alcohol content 70%) for when you’re out and about, or have to use biometric access systems. If your hands are dirty or soiled, rather wash with soap and water.
• Don’t visit markets where live animals are sold.
• Avoid touching your face, eyes, nose and mouth.
• Avoid close contact with people who are sick, or suffering from acute respiratory infections.
• Stay at least two metres away from those coughing or sneezing.
• Stay home when you are sick.
• Cover your mouth with a paper tissue or handkerchief or the inside of your elbow when coughing or sneezing. Dispose of tissues immediately and wash hands.
• Clean and disinfect frequently touched objects and surfaces.
• If possible, postpone any unnecessary international or local travel.
• Avoid going to hospitals unnecessarily. Where possible, delay non-emergency/elective procedures.
• Travellers with symptoms of acute respiratory infection should practice cough etiquette (maintain distance, cover coughs and sneezes with disposable tissues or clothing and wash hands).
• Health practitioners should provide travellers with information to reduce the general risk of acute respiratory infections, via travel health clinics, travel agencies, conveyance operators and at points of entry. Travellers should self-report if they feel ill.

6. Clinical significance
How is this family of viruses transmitted?
• Respiratory droplets that are airborne
• Shared objects such as clothes, utensils and furniture that carry infection
• Faecal-oral contact

7. When should you call your GP?
Currently, the NICD lab is the only one testing for Coronavirus. If you, or a loved one, meet the following criteria, please call your GP (don’t visit their rooms in case you might risk infecting others):

Criteria for Person Under Investigation (PUI)
Persons with acute respiratory illness with sudden onset of at least one of the following: cough, sore throat, shortness of breath or fever [38°C (measured) or history of fever (subjective)] irrespective of admission status.

And
In the 14 days prior to onset of symptoms, met at least one of the following epidemiological criteria:
Were in close contact1 with a confirmed2 or probable3 case of SARS-CoV-2 infection;
Or
Had a history of travel to areas with presumed ongoing community transmission of SARS-CoV-2; i.e., Mainland China, South Korea, Singapore, Japan, Iran, Hong Kong, Italy, Vietnam and Taiwan
Or
Worked in, or attended a healthcare facility where patients with SARS-CoV-2 infections were being treated
Or
Admitted with severe pneumonia of unknown aetiology.

Footnotes:
1 Close contact: A person having had face-to-face contact or was in a closed environment with a COVID-19 case; this includes, amongst others, all persons living in the same household as a COVID-19 case and, people working closely in the same environment as a case. A healthcare worker or other person providing direct care for a COVID-19 case, while not wearing recommended personal protective equipment or PPE (e.g., gowns, gloves, NIOSH-certified disposable N95 respirator, eye protection). A contact in an aircraft sitting within two seats (in any direction) of the COVID-19 case, travel companions or persons providing care, and crew members serving in the section of the aircraft where the index case was seated.

2 Confirmed case: A person with laboratory confirmation of SARS-CoV-2 infection, irrespective of clinical signs and symptoms.

3 Probable case: A PUI for whom testing for SARS-CoV-2 is inconclusive (the result of the test reported by the laboratory) or for whom testing was positive on a pan-coronavirus assay.

8. What should I do if I suspect that I have contracted COVID-19?
Please remember that unless you’ve been travelling, or have had contact with people with known infection, your risk for contracting COVID-19 is almost negligible.

However, if you suspect that you might have contracted the virus and are showing signs of respiratory illness, please do the following:
• Call your doctor, who will assess you and see whether you qualify as a person under investigation. Please do not arrive at the hospital unannounced so that they can prepare to safely and efficiently receive you.
• Self-isolate at home, and avoid social contacts. If possible, stay in a specific room and away from other people in your home, and use a separate bathroom.
• Wear a mask if you have to be around other people in your home and wash your hands regularly. Remember however that only specific masks such as the N95 are approved to protect you from infecting others.
• If a family member cares for you, he/she should wear a face mask when they are in the room with you, and wash their hands thoroughly when they leave the room.
• Doctors have been informed and trained on how and from whom they should collect specimens. When you visit the doctor, clinic or hospital, you will be asked certain questions, examined and informed whether you should be tested. If so, they will collect a specimen for testing and send this to a laboratory.
• Various labs have been trained on testing for the virus and are working closely with NICD on the same.

Please note: Patient self-referrals will NOT be tested. You must go to your healthcare provider for assessment.

9. How will Fedhealth cover coronavirus tests and treatment?
All beneficiaries on all plans will be covered for the testing and the management of COVID-19 once a positive diagnosis is confirmed. If you or one of your dependants tests positive for COVID-19, the benefit cover applies according to the Scheme Rules:

What if the test outcome is positive?
In the case of a positive diagnosis, you, your representative or your healthcare provider must notify us of the diagnosis as soon as possible. Your healthcare provider will prescribe the necessary care, depending on the severity of your symptoms. Fedhealth will cover out-of-hospital and/or in-hospital treatment as PMB from Risk in line with formularies and other standard managed care protocols.

What if the test outcome is negative?
If the diagnosis is negative, the related tests will be covered from your day-to-day benefits. Any consultations with medical practitioners will be covered from the day-to-day benefits available on your option. There is no need to be tested more than once, but if you do this, it will also be covered in line with available day-to-day benefits.

To recap what Fedhealth covers and from which benefit:
• Only positive tests will be paid from Risk; if the test is negative, it will be paid from your day-to-day benefit.
• If you test positive and have a mild case that does not require hospitalisation, any treatment will be paid from your day-to-day benefits (similar to what happens in case of the flu).
• If you test positive and have a complicated case that requires hospitalisation, these expenses will be covered from your in-hospital benefit according to the benefits on your option.

Using CT scans to diagnose COVID-19
Fedhealth will NOT cover CT chest scans to diagnose COVID-19. However, CT chest scans will be covered for the management of COVID-19 positive members.

10. Postponing or cancelling elective surgery
Fedhealth urges that members reconsider undergoing any elective (non-emergency) surgery or procedures at this time, and delay it until the worst of the coronavirus is over.

Why are we asking this of our members?
• We don’t want to burden the healthcare system at this time, because we need as many hospital beds as possible to be available for patients requiring hospitalisation in the case of COVID-19;
• We’re all hearing about social distancing to slow down the spread of the virus. Avoiding hospitals is another way to protect yourself from possible exposure to the virus.

Mediclinic has temporarily terminated elective surgery
Following the announcement of the national lockdown, Mediclinic Southern Africa stopped all elective surgeries from midnight on 26 March 2020. This drastic measure is in line with the regulations and will also manage the risk to patients, staff and doctors as well as preserve limited stock of Personal Protective Equipment (PPE). Emergency, urgent and some semi-elective procedures will still be performed during this period. Members who have a procedure booked at a Mediclinic during the lockdown period should contact their doctor to discuss the postponement or cancellation of their surgery.

Netcare also announced that with effect from midnight 30/03/2020, all elective surgery has been postponed, provided that this will not result in the patient’s outcome or quality of life being significantly altered.

11. Fedhealth members on chronic medication
We strongly recommend that members on chronic medication consider having their medication delivered to their home or office. This is to avoid busy shopping centres and to support social distancing. Please contact your pharmacy directly to enquire about delivery options. Although pharmacies are open during lockdown, we strongly recommend that members ONLY go to the pharmacy for essential medication, observe social distancing, and go back home as soon as possible.

12. Preparing for the upcoming flu season in the time of COVID-19
Getting an annual flu vaccination is your best defence against the flu virus, and goes a long way towards reducing hospital admissions and even deaths.

Due to slight changes in the genetic material of the influenza viruses A and B, new virus strains emerge each year. So, last year’s flu shot won’t protect you against this year’s viruses. Fedhealth generally recommends that our members get vaccinated every year.

However, the flu vaccination may be limited this year. As such, we recommend that members who are at a higher risk of developing influenza and those who are above 65, try to make their vaccination a priority, whilst practicing the recommended precautions to avoid COVID-19 infection.

Tips for safely getting your flu vaccine during lockdown:
• Call in advance to see if your pharmacy has a supply of the vaccine available
• Schedule an appointment if the facility allows – this will reduce the time you have to spend in waiting areas and help with practicing social distancing

Although pharmacies are open during lockdown, you should ONLY go to the pharmacy if you absolutely need to and return home as quickly as possible after you’re done.

As a Fedhealth member, you and your dependants have a FREE flu vaccination benefit that’s paid from Risk, and not your Savings or MediVault and Wallet.

These flu vaccines* are covered by Fedhealth from your screening benefit (one per beneficiary per year):
· Influvac 0.5ml
· Vaxigrip Single Dose 0.5ml pre-filled
· Vaxigrip Single Dose 0.25ml pre-filled paediatric

* Important note: Vaxigrip Tetra (Nappi code: 3000826 VAXIGRIP TETRA SINGLE DOSE 0.5ML) is NOT covered by the screening benefit for the 2020 flu season. The Scheme covers other alternatives suitable against circulating strains of the virus in South Africa based on the most recent flu surveillance information provided by the WHO (World Health Organization). If you prefer this particular vaccine, it will be covered from your Savings/ MediVault and Wallet where applicable, or out of your own pocket (myFED members).

13. Telemedicine keeps you safe
Many GPs and specialists have made themselves available for telephonic consultations to assist patients without physically meeting them. These consultations can be claimed for from your benefits using the code 0130 - telephonic consultation (face-to-face contact needs to be avoided in order to use this code).

Fedhealth has implemented in-house telephone and virtual consultation codes for certain healthcare professionals including psychologists and psychiatrists who do not have such codes allocated in their respective national and private coding scheme. These codes are applicable where communication technology is used to provide services to patients during the COVID-19 nationwide public health emergency, using any non-face-to-face remote communication platforms that are available to connect with patients, inter alia telephonically, Skype, Facetime or any other form of virtual communication.

The diagnosis of the patient will determine whether the consultation claim pays as a PMB or from medical Savings or MediVault (flexiFED range of options).

14. What if I have been travelling to affected countries?
For members returning from affected countries, discuss with your doctor how you can self-quarantine (for example, working from home for 14 days after your return). If you develop symptoms of COVID-19, you need to get tested. If the test is negative, you should return to work after 72 hours.

15. Who should be especially careful to avoid infection?
Elderly members, as well as members with pre-existing conditions (for example cardiovascular disease, diabetes, chronic respiratory disease, hypertension, cancer, HIV and other immune-suppressive conditions), would be more at risk if they contract this virus. If you fall into one of these categories, please take extra care of your health.

16. Should I be wearing a mask?
If you’re healthy, you only need to wear a mask if you’re taking care of a person with suspected 2019-nCoV infection.

Medical masks
Medical masks of different size and shapes are available in the market. The most common ones are flat pleated masks of woven fabric which cover the nose and mouth and are affixed behind the head with straps/ elastic fasteners. There are also conical or duckbill shaped masks with valves (or without valves) that fit in the contour of face over the nose and mouth, but are costlier.

Use of masks by general public
• People without symptoms should not use masks, because it creates a false sense of security that can lead to neglecting other essential measures such as hand washing.
• There’s no scientific evidence proving the health benefits of wearing masks if you’re not sick. In fact, the incorrect use of masks, the continuous use of a disposable mask for longer than six hours, or the repeated use of the same mask, may actually increase risk of getting an infection.
• It’s an unnecessary cost.

Unless you’re a healthcare worker, only wear a medical mask when:
• You develop a cough or fever.
• Using medical masks when ill will prevent your infection from spreading to others. However, you also need to wash your hands frequently to avoid spreading infection to others.
• While visiting a healthcare facility.
• You are caring for an ill person.
• Close family contacts of suspected or confirmed cases undergoing home care.

Section 2

Other Fedhealth member services that are useful during lockdown

On midnight on Thursday 26 March 2020, South Africa was placed under a national lockdown. This was part of the measures put in place by government to curb the spread of coronavirus in the country and limit fatalities.

Fedhealth offers the following services to members that can prove to be especially valuable to members during this time:

1. Emotional Wellbeing Programme service expanded
To assist our members with COVID-19 related concerns and provide support for psychosocial
emergencies including trauma, the Emotional Wellbeing Programme has introduced a dedicated Crisis Support Desk. Contact them on 0860 111 646.

2. Using the Fedhealth Nurse Line
The lockdown is intended to make as many people stay at home as possible in order to curb the spread of COVID-19. That’s why the Fedhealth Nurse Line is especially valuable at this time, as it allows Fedhealth members to get medical advice from registered nurses without leaving the safety of their homes. Call 0860 333 432 to access this service, and press 3.

Speak to a personal health advisor/nurse:
• To help you assess day-to-day medical symptoms;
• For important health knowledge, e.g. to explain medical terms and give dietary advice;
• For a complete drug database – i.e. to understand everything about a specific medication including the side-effects and dietary requirements;
• For advice on poisoning and whether or not to send an ambulance if the patient is critical;
• Health counselling on diseases like HIV/AIDS, cancer, diabetes and asthma and support for caregivers, as well advice on dealing with addiction;
• To give you advice on stress management;
• To access the Teen Line – advice for teenagers on a wide range of topics, and support for children who are neglected and/or abused.

3. MediTaxi is still operational during the lockdown
MediTaxi is a medical taxi service available to qualifying members in Cape Town, Johannesburg, Pretoria and Durban. Fedhealth members who’ve had hospital authorisations can access the 24/7 MediTaxi benefit to take you to follow-up doctor’s appointments during the national lockdown, if you’ve undergone an authorised operation or medical treatment that prevents you from driving.

MediTaxi provides transport from the member’s home to the approved healthcare service provider such as physiotherapists, doctors, specialists or a radiology practice, and includes the return trip.

Booking the MediTaxi service
When members phone to book a trip, you need to provide your a) membership number, b) date of operation, and c) healthcare provider’s details.

To access the MediTaxi benefit
• Members need to save the number *130*3272*31# for Emergency Medical Service (EMS), Nurse Line and MediTaxi as a contact on their phones (under Europ Assistance or a name you’ll remember for emergencies).
• When you need to book MediTaxi, members need to choose this number and select the service (EMS, Nurse Line or MediTaxi). An SMS will be sent to the Europ Assistance Emergency Contact Centre who’ll phone you back within the agreed emergency timelines for each service: EMS – 120 seconds; Nurse Line – 2 hours; and MediTaxi – 2 hours before pick-up.

4. You can still benefit from Paed-IQ
Paed IQ is a 24/7 telephone advisory service available to all parents with children under the age of 14 years to support and advise on any healthcare related childcare issues. This service is also very useful during the lockdown period, since parents can contact Paed-IQ and avoid going out and risking exposing themselves and their children to an infected person in the doctor's waiting room, or the emergency rooms. Call 0860 444 128 to access this great service.

Section 3

Frequently asked questions

A. General Questions

1. Are medical aids/schemes part of essential services?
Yes, medical aids/schemes are part of the essential services and we are available to bring assistance to you during this time.

2. I am worried about potential shortages of medication, would my DSP be able to provide more of my medication?
There is no need to be stockpiling any medicines for now. We are engaging with drug manufacturers and distributors to ensure that every possible precaution is taken to prevent critically low stock levels, should it become a reality. Contingency plans are being made by government and business to ensure the risk to South African supply chains is kept minimal.

3. What is COVID-19?
Human coronaviruses are common throughout the world. The name ‘corona’ refers to a crown because these viruses have crown-like spikes on their surface when viewed under an electron microscope. There are many different coronaviruses identified in animals but only a small number of these can cause disease in humans. Some coronaviruses such as 229E, NL63, OC43 and HKU1 are common causes of illness, including respiratory illness, in humans throughout the world. Sometimes coronaviruses infecting animals can evolve to cause disease in humans and become a new (novel) coronavirus for humans. Examples of this are the Middle East Respiratory Syndrome Coronavirus (MERS-CoV), first reported from Saudi Arabia in 2012, and the Severe Acute Respiratory Syndrome Coronavirus (SARS-CoV), first recognised in China in 2002. On 7 January 2020, severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) was confirmed as the causative agent of coronavirus disease 2019 (COVID-19).

The majority of the case-patients initially identified were dealers and vendors at a seafood, poultry and live wildlife market (Huanan Seafood Wholesale Market) in Jianghan, District of Hubei Province. This suggests that the novel coronavirus has a possible zoonotic origin. The specific source of the virus is not yet known.

4. Can you explain COVID-19 in simple terms?
Coronavirus infection is caused by the latest strain (type) of coronavirus, called COVID-19. This causes respiratory illness (like flu) with symptoms such as a cough, fever, shortness of breath and in more severe cases, pneumonia.

5. How is the virus spread?
• When an infected person coughs, exhales or sneezes, they release droplets of fluid containing virus particles into the air. Other people can become infected by breathing in these droplets if they are standing within a few meters from the infected person. The larger droplets can also fall on nearby surfaces and objects.
• The virus can survive on hard surfaces (for example; plastic and stainless steel) for up to 72 hours.
• Other people can become infected when they touch contaminated surfaces, then touch their eyes, nose or mouth.

Note: People cannot be infected through the skin.

6. What are the signs and symptoms of COVID-19 infection in humans?
• Current symptoms reported for patients with COVID-19 have included mild to severe respiratory illness with cough, sore throat, shortness of breath or fever.
• The severity of illness can range from people who are infected without any illness (asymptomatic infection) to mild respiratory illness, to severe illness requiring admission to hospital or death.
• The majority of patients (approximately 80%) will have mild respiratory illness.
• Congestion of the nose of throat.
• Fatigue, often followed by muscle aches.
• Symptoms may appear 2-14 days after exposure or contact with an infected person, on average 5 days after exposure or contact with an infected person.

7. How is the COVID-19 infection treated?
Treatment is supportive (e.g. provide oxygen for patients with shortness of breath or treatment for fever). There is no specific antiviral treatment available. Antibiotics do not treat viral infections. However, antibiotics maybe required if bacterial secondary infection develops.

8. How can COVID-19 infection in humans be prevented?
Currently there is no vaccine for COVID-19. There are no specific measures currently recommended to prevent COVID-19, but the following can provide protection against infection with coronaviruses and many other viruses that are more common in South Africa:

• Wash your hands often with soap and water for at least 20 seconds. If soap and water are not available, use an alcohol-based hand sanitizer.
• Avoid touching your eyes, nose, and mouth with unwashed hands.
• Avoid close contact with people who are sick.
• Stay at home when you are sick and try and keep distance from others at home.
• Cover your cough or sneeze with a flexed elbow or tissue, then throw the tissue in the bin. Always wash hands afterwards.
• Clean and disinfect frequently touched objects and surfaces with water and bleach or alcohol-based sanitizer.
• Shared spaces should be well ventilated. If a fan is available, point it out of one window and keep another window open to facilitate increased air exchange in the room.
• Avoid contact with farm or wild animals (alive or dead), animal markets, and products that come from animals (such as uncooked meat).

9. A practical guide on when and how to use masks

When would I use a mask?
If you wear a mask, you must know how to use it and dispose of it properly.

Wear a mask only if:
• You are a healthy person but you are taking care of a person diagnosed with COVID-19 or with suspected COVID-19 infection.
• If you are coughing or sneezing.

Masks are effective only when used in combination with frequent hand cleaning with alcohol-based hand sanitizer or soap and water.

How do I put on a mask?
• Before putting on a mask, clean hands with alcohol-based hand sanitizer or soap and water.
• Cover your mouth and nose with the mask.
• Make sure there are no gaps between your face and the mask.

How must I use a mask?
• Avoid touching the mask while using it.
• If you do touch the mask, clean your hands with alcohol-based hand sanitizer or soap and water.
• Replace the mask with a new one as soon as it is damp.
• Do not reuse single-use masks.

How do I take off a mask?
• To remove the mask, remove it from behind (do not touch the front of a mask).
• Discard the mask immediately in a closed bin.
• Clean your hands with alcohol-based hand sanitizer or soap and water.

10. Who are vulnerable?
• The elderly: 60 years and above regardless of whether they have a premorbid condition
• Anyone with HIV with a CD4 count of less than 350
• Type-2 Diabetes which is uncontrolled
• Chronic kidney disease
• Cancer
• Patients on chemotherapy, long-term steroids and immunosuppressants
• Diabetes Mellitus
• Cardiovascular conditions such as Hypertension, and Congestive Cardiac Failure
• Autoimmune diseases such as Rheumatoid Arthritis, SLE and Sjorgen’s syndrome
• Respiratory conditions such as Asthma and Chronic Obstructive Pulmonary Disease
• Pregnant women

11. What effect does COVID-19 have on pregnant women?
Pregnant women do not appear to be more severely unwell if they develop COVID-19 than the general population. As this is a new virus, how it may affect you is not yet clear. It is expected that a large majority of pregnant women will experience only mild or moderate cold/flu like symptoms.

If you are pregnant you are more vulnerable to getting infections than a woman who is not pregnant. If you have an underlying condition, such as Asthma or Diabetes, you may be more unwell if you have COVID-19.

12. Will Fedhealth fund my test?
Fedhealth will fund all clinically appropriate care and related costs, including COVID-19 related testing, in line with the Council for Medical Schemes press release 3 of 2020. This means that the Scheme will cover the diagnosis, treatment and care costs of clinically appropriate care related to COVID-19 as a prescribed minimum benefit (PMB).

Non-PMBs will be funded subject to benefit limits and Scheme Rules.

Fedhealth will cover the diagnosis (screening test) as a PMB only where a positive diagnosis is confirmed and will not cover CT chest scans for diagnostic purposes.

Pathology:
If you meet criteria for testing and the COVID-19 test is positive, the pathology test will fund from Overall Annual Limit (Risk).
If the test is negative, Scheme Rules will apply. Fedhealth will fund the test out of available Savings or Wallet benefits.

No self-referrals will be funded – members must follow the process as set out by the NICD – that is, members must first consult with their doctor to determine eligibility.

Hospital:
Since COVID-19 is a PMB condition, you will not be liable for your hospitalisation costs if you are diagnosed.

Until the state of our health sector changes and hospitals become unavailable, you should still use the appropriate Fedhealth Network Hospitals to avoid any non network co-payments.

13. Where do I go to for my test?
If you are experiencing symptoms for having been exposed to someone who has tested positive for COVID-19, you must contact your doctor. Do not go to a hospital or emergency department.

Call your primary healthcare provider if you meet the case definitions for COVID-19 and suspect you may have COVID-19. Don’t go to the doctor rooms without warning in advance.

When making the call to your doctor, bring any relevant information to their attention including; your recent travel history, contact with persons who had recently travelled to countries with COVID-19 outbreaks, personal contact with a person with confirmed COVID-19, or symptoms associated with COVID-19 that you are experiencing.

The doctor may ask specific questions to assess you, advise whether you need to be tested for COVID-19, and give you a referral to a pathology laboratory for testing to be done.

If you have called your doctor and they want you to come to the consulting rooms, they will be able to take the necessary safety precautions to assist you promptly when you arrive whilst safeguarding themselves and others at the facility from possible infection.

Your doctor may examine you and take a swab from inside your nose and mouth, which will be sent to the laboratory for COVID-19 testing. You should receive the results within 48 to 72 hours, and you should self-quarantine at home until the results are known.

If you can’t get hold of your doctor: Members who are experiencing symptoms are advised to call the General Public COVID-19 Hotline: 0800 029 999.

If you are not very sick, it is best to call this number first rather than going to a health facility.

14. How will i be covered for COVID-19 whilst travelling internationally?
As part of your travel arrangements, you must ensure that you have taken travel insurance. The insurer will advise you how you will be covered when you are abroad.

15. Am I at higher risk if i have a chronic condition or am HIV positive?
If you are taking your medication, you are putting your immune system in the best position as possible to fight the COVID-19.

It is important to continue to take your medication and practice good lifestyle habits such as eating a healthy diet of fruits and vegetables and trying to stay as active as possible.

16. Are our hospitals and healthcare providers equipped to deal with positive cases?
There are designated hospitals in both the public and private sector with clearly defined protocols in the event of being faced with identified or potential cases.

All providers also know how to deal with the various scenarios.

B. What to do if I am exposed to someone with COVID-19

This advice is intended for people who are close contacts of a person with confirmed coronavirus disease (COVID-19), do not have any symptoms and have been asked to quarantine at home. This guidance does not apply to people who have been asked to quarantine in a designated facility.

1. What does close contact mean?
You have been in close contact with someone who has confirmed COVID-19 but you do not have any symptoms yourself. Close contact means that you had face-to-face contact within 1 metre or were in a closed space for more than 15 minutes with a person with COVID-19. This contact happened while the person with COVID-19 was still “infectious”, i.e. from 2 days before until 14 days after their symptoms began. For example, you may be someone who:

1. Lives in the same household as a person with COVID-19.
2. Works closely in the same environment as a person with COVID-19.
3. Sat in the same classroom as a person with COVID-19.
4. Attended the same gathering as a person with COVID-19.
5. Provided direct care for a person with COVID-19 in a healthcare setting without using the proper personal protective equipment.
6. Sat within two seats (1 metre) in any direction of a person with COVID-19 case in any kind of vehicle including buses, minibus taxis, etc.
7. Served as a crew member in the section of an aircraft where a person with COVID-19 was seated.

2. Who will be in touch with me from the government or National Institute for Communicable Diseases (NICD)?
The person with COVID-19, with whom you were in close contact, made a list of all the people he/ she had close contact with from 2 days before they became ill.

You may therefore be called, visited at home or advised by government officials, community health workers and/or the NICD.

The purpose of this contact is to assist you to self-quarantine at home for 14 days after your last contact and to monitor you for symptoms. The number of times you are contacted by government officials or the NICD is subject to change.

3. Will I be tested for COVID-19 as a close contact?
You will only have a laboratory test performed if you develop symptoms within 14 days of your last close contact with a person with COVID-19 who is considered infectious, i.e. able to transmit infection. A person with COVID-19 is considered infectious from 2 days before to 14 days after they became ill. Refer to guidance on what to do if I think I have COVID-19.

4. Will my own close contacts be tested?
No, your close contacts will only have laboratory testing if you are first confirmed to have COVID-19 and they develop symptoms. Refer to guidance on what to do if I think I have COVID-19.

5. Why have I been asked to quarantine at home?
You have been exposed to a person with COVID-19 while they were still able to transmit infection. It is therefore possible that you have been infected with the new coronavirus (SARS-CoV-2).

Staying at home in quarantine will help to control the possible spread of the virus to your friends, relatives and your wider community. In particular, staying at home will help prevent possible spread to the most vulnerable people in our communities, who are at risk for severe illness.

6. What does home quarantine mean for me?
• Stay at home. Do not go to work, school, or any public areas.
• If necessary, talk to your employer and let them know that you cannot come to work. Do not use any public transport (including buses, minibus taxis and taxi cabs).
• Do not travel.
• You should cancel all your routine medical and dental appointments.
• If possible, you should not even go out to buy food, medicines or other essentials.
• You should ask friends or relatives to help you to buy groceries and essentials.
• If you have access to the internet, you can order your shopping or medications online, but tell delivery drivers to leave any items for collection outside your house. Delivery drivers should not come into your house at all.
• You should not go outside to exercise, unless you can maintain a safe distance from others in an outdoor space.
• You should not have any visitors in your home during your quarantine period.
• Do keep in touch with your relatives, friends and colleagues over the phone, internet or by using social media.

7. What does home quarantine mean for other people who live in my household?
• If you live with other people, as far as possible, you should stay in a separate room and away from other people in your household.
• If a separate room is not possible, try to keep to one area of your home, at least 2 meters (3 steps) away from other people.
• Limit contact with any pets and animals.
• Wash your hands regularly using soap and water for at least 20 seconds or use alcohol-based hand sanitizer (containing at least 60% alcohol).
• If possible, use a separate bathroom. If you have to share a bathroom, clean the bathroom after every use.
• If you share a kitchen, avoid using the kitchen at the same time as other people.
• If possible, have your meals in your separate room/ area and use separate utensils.

8. What do Ido if i live with children?
If you live with children, you should keep following this advice to the best of your ability. However, we understand that this advice will be difficult to follow with younger children.

9. How long will I need to quarantine at home?
You can end your home quarantine 14 days after your last contact with a person with COVID-19. No laboratory tests will be done at any time during your home quarantine period, unless you develop symptoms.

10. Do other members of my household need to stay at home during my quarantine period?
If you live with other people, and you are able to stay physically apart from them, they can continue their usual activities outside the home. If you are unable to stay apart from members of your household, they should also quarantine for the same period.

11. What symptoms do I need to monitor for during my home quarantine?
If you develop a fever, cough, shortness of breath, sore throat, muscle aches or other flu-like symptoms from 2 to 14 days after your close contact with a person with COVID-19, you should immediately contact your healthcare provider.

12. How can I limit the spread of COVID-19 if I do become ill?
If you become ill, you should cover your mouth and nose if you sneeze or cough with disposable face tissue or into your elbow. Dispose of tissues then immediately wash your hands. Wash your hands regularly using soap and water for at least 20 seconds or use alcohol-based hand sanitizers (containing at least 60% alcohol).

C. What to do if I think I have COVID-19

This advice is intended for people who meet the current criteria for testing for coronavirus disease (COVID-19) and are not admitted to a healthcare facility.

1. What are the criteria for COVID-19 testing in people who are not admitted to hospital?
These criteria are regularly updated by the National Institute for Communicable Diseases (NICD). You will be tested only if you meet the PUI criteria, which includes having symptoms of a respiratory illness of recent or sudden onset.

Your Scheme might ask you the following questions:
a. Have you travelled recently? If not, your risk is reduced.
b. Have you come into contact with someone who has been confirmed or is being tested for COVID?
c. Do you have symptoms of cough, sore throat, shortness of breath or fever?

If symptoms develop, contact your doctor and they will be able to assist you with testing. If you have a fever, cough and difficulty breathing, seek medical care early.

2. If I want to be tested myself, can I do so?
NO, only your doctor can request this test because it has to be centrally coordinated according to the notifiable disease framework. If you meet the criteria to be considered as a person under investigation (PUI), you will be tested. A PUI is considered to be someone who has travelled internationally within the last 6 weeks and/or has been exposed to someone confirmed with the infection. This is to avoid testing for individuals who are ‘worried but well’.

3. Why should I not be tested for COVID-19 if I am concerned, but have no symptoms?
There are a number of reasons why we do not recommend testing of a person without symptoms, even if you are a close contact of a confirmed COVID-19 case, or have recently travelled to a country where COVID-19 is circulating in the community:

1. A negative test result in a person without symptoms does not mean that you do not have COVID-19. You could still be in the early stage of COVID-19 and develop symptoms later. Therefore, testing when you do not have symptoms could give a false-negative result.
2. Even if your laboratory test result was negative, you would still need to stay at home in quarantine for 14 days if you travelled to a region with high transmission or had close contact with a person with confirmed COVID-19. Refer to guidance on what to do if I am a close contact of a person with confirmed disease and am asked to home quarantine.
3. If you tested negative and mistakenly interpreted this to mean that you were not infected, you could go back to your usual activities and spread the virus while you still had an early infection.
4. There is a shortage of laboratory tests globally, and we need to reserve our valuable laboratory testing resources for those who are sick and for those groups of people where we can use these test results for public health good.

4. How do I get tested?
The exact testing process may be different in different provinces and between the public and private sectors. In general, you need to first contact your healthcare provider. This may be your doctor or your local clinic/ hospital. You should call ahead to your healthcare provider, if possible, and find out what the exact process is for you to be tested.

If you cannot get hold of your healthcare provider, you can try to call your nearest testing laboratory for information. If you have internet access, you can look for specific information on these testing laboratory websites. If you do not need emergency medical care, you should not visit a hospital emergency unit for testing.

Some hospitals or doctors may refer you to an off-site testing facility. The NHLS and some private laboratories offer testing at mobile facilities. You will need to pay for tests done at private laboratories.

5. What specimens will be collected from me and what do the test results mean?
The most commonly collected specimen is a swab collected through your nose. If you have a wet cough, you may be asked to produce a sputum specimen into a jar for testing. This specimen will be sent to a pathology laboratory.

The laboratory will test your specimen for genetic material from the new COVID-19. This virus has been named SARS-CoV-2. The test will be reported as either positive or negative. If your test is reported as positive, this means that genetic material from the coronavirus (SARS-CoV-2) was found in your specimen and you have confirmed COVID-19.

If your test is reported as negative, this may not necessarily exclude COVID-19 for a number of reasons. You should therefore complete your period of home quarantine as you have potentially been exposed to the infection, and you should only have a repeat test if this is advised by your healthcare provider.

6. How long will it take to get my laboratory result?
The turnaround time for testing specimens varies from laboratory to laboratory. In general, you should expect to receive your results within a few days.

7. Who will the test result be sent to?
Your test results will be sent to your healthcare provider. If you have agreed to be contacted with your test results, your test result may be sent directly to you.

8. What should I do while I wait for my test results?
While you wait for your results, you are advised to self-quarantine at home.

D. What to do if I test positive with COVID-19

This advice is intended for:
1. People with confirmed COVID-19, i.e. those with a positive laboratory test result – who have been asked to isolate at home.
2. Those living in households with someone who has confirmed COVID-19.

1. What does a positive laboratory test result mean?
Your healthcare provider took a specimen from you because you had symptoms and met the current criteria for testing. This specimen was sent to a laboratory. The laboratory tested your specimen for genetic material from the new COVID-19. This virus has been named SARS-CoV-2.

The test was reported as either positive or negative. If your test was reported to be positive, then genetic material from the coronavirus (SARS-CoV-2) was found in your specimen and you have confirmed COVID-19. This disease is now also called COVID-19.

2. What if the test outcome is positive?
In the case of a positive diagnosis, you, your representative or your healthcare provider must notify the Scheme of the diagnosis as soon as possible.

Your healthcare provider will prescribe the necessary care, depending on the severity of your symptoms, and as you are a member of a medical aid, you will be covered according to Scheme Rules if you should be hospitalised.

Your healthcare provider may suggest isolation, most probably at your home. However, the NICD and NDoH have also established hospitals in each province to assist patients and manage the quarantine process.

3. Who will be in touch with me from the government or the National Institute for Communicable Diseases (NICD)?
Your healthcare provider (your doctor or local clinic) is primarily responsible for your care. However, you may be called, visited at home or advised by government officials, community health workers or by the NICD.

Once you have confirmed COVID-19, the purpose of this contact is to assess if your home environment is suitable for isolation, to assist you and members of your household to adhere to the home isolation recommendations and to monitor your illness. If you are visited at home, officials will wear personal protective equipment such as masks, gloves and aprons to prevent themselves from becoming infected, maintain a distance of 2 meters and will not enter your home, unless necessary.

Visiting officials may provide a care pack to you (the contents of this pack will vary). The number of times you are contacted by government officials or the NICD is subject to change.

Your healthcare provider, government officials or NICD will also ask you to make a list of all the people you have had close contact with from 2 days before you became ill. These people will also be required to self-quarantine at home for 14 days and monitor themselves for symptoms.

4. If I have a positive laboratory test result, am I at risk for more severe illness?
The laboratory test will not be able to tell you if you are at risk for more severe illness because the result is only reported as positive or negative for the coronavirus (SARS-CoV-2). However, you would have been assessed by your healthcare provider in terms of your current COVID-19 illness and your other risk factors for more severe illness (i.e. older age, serious underlying medical conditions such as Diabetes Mellitus, heart disease, lung disease and immunosuppression, etc.).

If you were asked to isolate at home, your healthcare provider has assessed that you have a mild illness that can be managed at home, you have no/few risk factors for severe illness and your home environment is suitable for isolation.

However, some people with COVID-19 may worsen at home and need admission to hospital. It is very important that you carefully monitor your symptoms throughout your illness and look out for emergency warning signs.

5. How do I care for myself at home?
Most people who get sick with COVID-19 will have only a mild illness and should recover at home. You may continue to experience the typical symptoms which include a fever, cough and mild shortness of breath. Most people with mild illness will start feeling better within a week of first symptoms. Have your healthcare provider’s contact information on hand for emergencies – this could be your doctor or your nearest local clinic/ hospital.

Get rest at home and drink enough water/clear fluids during the day to make sure that your urine stays a pale clear colour. There are no specific antiviral treatments recommended for COVID-19. You can take over-the-counter medications if you have fever or pain. Use these according to the instructions on the packet or label and do not exceed the recommended dose. You should continue taking any other prescribed chronic medication.

Monitor your symptoms carefully. If your symptoms get worse, call your healthcare provider immediately. If you develop any emergency warning signs, get medical attention immediately. Emergency warning signs include: trouble breathing, chest pain or pressure in your chest that does not go away, coughing up blood, becoming confused, severe sleepiness, blue lips or face. If you have any warning signs, you or a member of your household should call your nearest hospital or emergency services immediately and notify them that you have confirmed COVID-19. Avoid taking public transport to the facility – either use private transport (preferably with windows rolled down) or call emergency services for an ambulance if required. You should wear a face mask if you travel to seek hospital care.

6. Will other members of my household be tested for coronavirus disease (COVID-19)?
Other members of your household (who are considered among your close contacts) will only have specimens collected for laboratory testing if they develop symptoms consistent with COVID-19. Refer to guidance on what to do if I am a close contact of a person with confirmed disease and am asked to home quarantine.

7. Why have I been asked to self-isolate at home?
Staying at home will help to control the spread of the new coronavirus (SARS-CoV-2) to your friends, relatives and your wider community. In particular, staying at home will help prevent spread to the most vulnerable people in our communities, who are at risk for severe illness.

8. How does COVID-19 spread?
COVID-19 is spread by droplets. When an infected person coughs, exhales or sneezes, they release droplets of fluid containing virus particles into the air. Other people can become infected by breathing in these droplets if they are standing within a few meters from the infected person.

The larger droplets can also fall on nearby surfaces and objects. The virus can survive on hard surfaces (plastic and stainless steel, for example) for up to 72 hours. Other people can become infected when they touch contaminated surfaces, then touch their eyes, nose or mouth. People cannot be infected through the skin.

If you understand how COVID-19 spreads, it will help you to understand how to prevent spreading the infection to others. Stay a few meters away from other people, and at frequent intervals wash your hands with soap and water for at least 20 seconds or sanitize your hands using an alcohol-based hand sanitizer, and cover your nose and mouth when you cough or sneeze.

9. Will other members of my household be tested for COVID-19?
Other members of your household (who are considered among your close contacts) will only have specimens collected for laboratory testing if they develop symptoms consistent with COVID-19. Refer to guidance on what to do if I am a close contact of a person with confirmed disease and am asked to home quarantine.

9. What does my home isolation mean for me?
• Stay at home. Do not go to work, school, or any public areas.
• If necessary, talk to your employer and let them know that you cannot come to work.
• Do not use any public transport (including buses, minibus taxis and taxi cabs).
• Do not travel.
• You should cancel all your routine medical and dental appointments.
• If possible, you should not even go out to buy food, medicines or other essentials.
• You should ask friends or relatives to help you to buy groceries and essentials.
• If you have access to the internet, you can order your shopping or medications online but tell delivery drivers to leave any items for collection outside your house. Delivery drivers should not come into your house at all.
• You should not go outside to exercise, unless you can maintain a safe distance from others in an oudoor space.
• You should not have any visitors in your home during your isolation period.
• Do keep in touch with your relatives, friends and colleagues over the phone, internet or by using social media.

10. What does my home isolation mean for other people who live in my household?

Separate space recommendations:
• If you live with other people, as far as possible, you should stay in a separate “sick room” and away from other people in your household.
• If a separate sick room is not possible, try to keep to one area of your home, at least 2 meters (3 steps) away from other people and wear a disposable face mask to prevent spread of the virus (through droplets produced by coughing and sneezing) to other people.
• Cloth masks should not be used.
• Limit contact with any pets and animals.
• Cover your mouth and nose when you sneeze or cough with a disposable face tissue.
• Dispose tissues into the waste bin in your sick room/area and then immediately wash your hands.
• Wash your hands regularly using soap and water for at least 20 seconds or use alcohol-based hand sanitizers (containing at least 60% alcohol).
• Clean your sick room/area every day, first using regular household soap and then after rinsing, using regular household disinfectant containing 0.5% sodium hypochlorite (make this using 1 part 5% bleach to 9 parts water).
• If you have a home carer, your carer should adhere to home-based infection control recommendations, including use of personal protective equipment.
• If someone else cleans your sick room/ area, they should use personal protective equipment including single-use or utility gloves and a plastic apron while cleaning.
• Do not share eating utensils, towels, and bedding with others in your household.

Bathroom:
• If possible, use a separate bathroom.
• Clean and disinfect bathrooms at least once a day, first using regular household soap and then after rinsing, using regular household disinfectant containing 0.5% sodium hypochlorite (bleach).
• If someone else cleans the bathroom that you have used, they should use personal protective equipment including single-use or utility gloves and a plastic apron while cleaning.
• Utility gloves should be cleaned with soap and water, then decontaminated with 0.5% sodium hypochlorite (bleach).
• Single-use gloves and plastic aprons should be discarded.
• If you have to share a bathroom, clean the bathroom after every use.

Laundry:
• Your laundry (clothes, bed linen, towels) should be placed in a laundry bag.
• Do not shake soiled laundry to avoid spreading the virus through the air.
• Machine-wash laundry at 60-90oC with regular detergent.
• If machine washing is not possible, wash laundry using regular laundry soap and hot water in a large container using a stick to stir.
• Hang washing outside to dry in the sunlight.

Shared spaces:
• Shared spaces should be well ventilated. If a fan is available, point it out of one window and keep another window open to facilitate increased air exchange in the room.
• If you share a kitchen, avoid using the kitchen at the same time as other people.
• If possible, have your meals in your separate room and use separate utensils.
• If you have a dishwasher, use this to clean and dry your cutlery and crockery.
• If you do not have a dishwasher, wash crockery and cutlery using your usual washing-up soap and warm water and dry thoroughly.
• Disposable face masks, single-use gloves, aprons, disposable face tissues and any other waste should be discarded in a waste bin with a lid in your separate “sick room”.
• The government officials who are in contact with you will advise you how to safely dispose of this waste.

11. What do I do if I live with children?
If you live with children, you should follow the advice shown here to the best of your ability. However, we understand that this advice will be difficult to follow with younger children.

12. How long will I need to isolate at home?
You can end your home isolation 14 days after your illness began. Your illness began on the day that you first developed symptoms, not on the day that a specimen was collected or on the day that the laboratory test was reported to be positive.

If you were tested with no symptoms (note – this is not currently recommended) and had a positive test result, you can end your home isolation 14 days after the positive specimen was collected. After a 14-day home isolation period, you are considered to no longer be infectious, i.e. you are very unlikely to transmit infection to others.

No follow-up laboratory tests will be done during or at the end of your home isolation period. Laboratory tests that only look for COVID-19 genetic material in specimens cannot tell us whether you can still transmit infection to others because a positive test may only pick up pieces of dead virus.

13. How long will other members of my household need to stay at home?
All members of your household are considered to be close contacts. They should self-isolate and record their symptoms for 14 days.

14. Where can I get more information on COVID-19?
Fedhealth continues to monitor the situation and members will be kept informed of any new developments through many channels (for example; scheme website, social media platforms, SMS and Customer Contact Centre).

The WHO, the NICD and Department of Health continue to provide valuable insight and updates regarding the virus and how it is spreading globally. Their dedicated websites are a great source of information.
https://www.nicd.ac.za/
https://sacoronavirus.co.za/
https://www.who.int/health-topics/coronavirus#tab=tab_1

Section 4
OPERATING HOURS AND SERVICE DURING LOCKDOWN

Operating hours of Fedhealth Customer Contact Centre and other services during the lockdown:

USEFUL RESOURCES
Covid-19 online resource and news portal: https://sacoronavirus.co.za/
The National Institute for Communicable Diseases (NICD): https://www.NICD.ac.za/
The World Health Organization: https://www.who.int/health-topics/coronavirus#tab=tab_1