Case Study: repatriating complex Covid-19 cases

Unfortunately, this is what happened to A. Five days after his first diagnosis, he was hospitalized, suffering from severely low oxygen saturation. He was treated with substantial oxygen supplements and medication, but his condition worsened. At the same time, his wife’s symptoms also worsened – however, she refused to be evacuated to a medical facility in order to remain by her son. Twenty-four hours later, A’s lung CT revealed severe inflammation, and his wife joined him in hospital, also suffering from respiratory distress. In order to maintain the son’s continued care, the insurance company arranged for a dedicated nurse to look after the boy in home quarantine. 

Remote control, as close as it gets

Meanwhile, the DavidShield - PassportCard group were working around the clock to service yet another call from an employer in Lagos, who reported that one of his employees had tested positive with Covid-19. The 69-year-old member, ‘B’, was classified as a high-risk patient, so concern was raised over the possibility of rapid deterioration of his condition. After an internal consultation between the group’s case manager and the patient’s local doctors in Lagos, B was quickly transferred to a more suitable hospital, only to suffer from further complications two days after. 

“At this point, we realized that we had two insured members in Lagos who were at immediate life risk,” said Ariel Kasanitz, Vice-President of Customer Service at DavidShield - PassportCard. “Days went by, their condition did not improve, and local health systems were on the verge of collapsing. It became clear to us that local providers would not be able to carry out proper treatment to our insured members, and so we were seeking out how to best fly them to a country that was experienced in treating severe cases of Covid-19. This task, to put it lightly, was hardly trivial – most patients’ conditions were critical, and the rest could not be left behind by themselves in Nigeria.”

Until that point, it was unheard of for a rescue flight to transfer four Covid-positive patients together in one plane, not to mention one in a critical condition. “After discussing with the medical professionals,” Kasanitz continued, “we concluded that although such a medical evacuation flight was unprecedented, it could still be done with the right plane and trained staff. We held emergency meetings into the night with our worldwide branches in Australia, Germany, Israel and Cyprus to determine which could undertake the operation in the shortest time and with the best possible results. We simultaneously liaised with the authorities in Nigeria, as well as neighboring countries to which we wanted to dispatch our members. As none of the neighboring countries agreed to take the patients, we submitted a special appeal to the Israeli authorities, who agreed to take them all in, and from that moment, our service division in Israel took ownership of the operation.”

But the challenges did not end there; DavidShield - PassportCard were required to locate a plane that could fly four patients together while abiding by strict Covid protocols. “We decided to contact Israel’s official airline, El Al,” Kasanitz says. “We asked to lease an empty Boeing 737, on which we could load four stretchers with designated isolation tents, as well as the full medical equipment necessary to handle any scenario. Fortunately, El Al agreed without hesitation.”

Diplomacy in a time of pandemic

The logistical difficulties were far from over. In fact, the solution led to two diplomatic challenges: due to the complexity of international relations between Nigeria and Israel, never had an Israeli plane landed in Lagos. In addition, an Israeli plane has never been approved to fly over Sudanese airspace. 

“It’s important to understand that when you plan a rescue operation, time is the most critical resource,” emphasized Kasanitz. “We had at least two patients in a serious condition, and another two who could deteriorate at any moment. We didn’t know how the Sudanese would respond to our request, whether they would even respond, and how long it would take to secure their approval.”

With patients’ lives at risk, DavidShield - PassportCard spared no efforts (including activation of international diplomatic connections), contacting the Israeli Foreign Ministry to provide assistance with the Sudanese authorities, explaining the gravity of the situation and ‘making sure that all official parties came onboard’. “Even though at certain points it seemed impossible, eventually the approval came in just before takeoff,” said Kasanitz. 

The diplomatic efforts did not end with Sudan. The insurer made a direct appeal to the Israeli Consul in Lagos to obtain landing permits for an Israeli airline landing in Nigeria for the first time. Then, the medical staff were required to board, and be approved for exiting and entering Israel while the country was in lockdown. Not only that, Nigerian airport authorities were asked to be equipped to perform maintenance on the 737, despite inadequate provision of these facilities. 

Fasten your stretchers

On 25 January, at 13:30 hours, the first ever El Al flight to Lagos departed from Tel Aviv, flying over Sudan and landing in Nigeria. Six hours later, the medical team realized the real and critical condition of the members. DavidShield - PassportCard ensured that ambulances would be awaiting in Israel fully equipped and, at 22:15 hours, the plane took off. For the first time since the coronavirus pandemic broke out, four Covid-positive patients were onboard, three in serious condition. 

On the ground, three fully staffed ambulances transported the patients to Covid departments at the receiving Israeli hospitals, after initial medical assessment and preliminary treatment. Another logistical issue the insurer had to overcome was to gain approval to move the 14-year-old boy, who was asymptomatic, to be hospitalized with his parents, so that he could be close to them while also being monitored. 

All’s well that ends well

In the end, A spent seven days in the coronavirus unit of the hospital with his wife and son at his side; his condition improved, and he was discharged with his son. Nine days later, his wife was also discharged. The fourth patient, the elderly employee, also recovered and was discharged after six days in the hospital. Today they are all in excellent health and are about to return to their home country.