Expat Focus International Healthcare Update October 2020

The pandemic continues to be the big story in expat healthcare, with reports in the press that the UK is back to where it was in the spring, and as Britain enters the new tiered lockdown system.

Do keep an eye on the UK government website if you’re travelling to and from Britain, and be aware that there are some regional variations between countries. At the time of writing, for instance, you may no longer need to self-isolate on your return from Crete, Mykonos and Lesvos, among other Greek islands. The requirement to self-isolate can depend on the date you travel. So, keep yourself informed and remain vigilant in relation to this fluid, changing situation. Some countries, such as Italy, came off the travel corridor list mid-month.

Basically, the government says that you do not have to self-isolate when you arrive in England if, during the last 14 days, you have only been somewhere on the travel corridor exempt list, or else in the UK. However, if you are entering from elsewhere, you must self-isolate for 14 days when you arrive in the UK. This applies to both residents and visitors. It is not clear yet whether countries internal to the UK, such as Wales, will viably be able to prevent people from travelling across their borders. You should be aware, if you are not a UK resident, that different restrictions are in place regionally. There are not only different rules between Northern Ireland, Wales and Scotland, but also within England itself. London remains febrile in relation to potential lockdowns.

China, where all this started, has also been revising its travel policies. The country has gradually been reopening. In late September, the Ministry of Foreign Affairs and the National Immigration Administration issued a statement to the effect that: foreign nationals who hold valid Chinese residence permits for work, personal matters, and reunion can enter China without applying for new visas. This was to be in place from September 28th. If your residence permit has expired (since the travel ban was imposed on March 28th), you can apply for the relevant visa by presenting your expired residence permit and any supporting documentation to the Chinese diplomatic mission, as long as the purpose of your visit remains unchanged.

The USA remains problematic in terms of pandemic travel arrangements. The UK government warns that travel to the USA is subject to entry restrictions. British nationals cannot enter the USA if they have been in the UK, Ireland, the Schengen zone, Iran, Brazil or China within the previous 14 days. The Foreign Office advises against all but emergency travel to the States at present. They also counsel caution in travelling to areas of political unrest and to regions where wildfires have been prevalent. This is particularly important if you have existing respiratory difficulties or underlying health conditions.

British expats resident in California have reported being unable to leave the house for days due to smoke pollution exacerbating conditions such as asthma, and many have had to invest in air quality meters. The wildfires have been lessening now that we are out of the summer months, but air quality remains a problem in some areas. This is also an issue that you might need to bear in mind if you are planning to travel to Australia.

In October, The Lancet published the latest Global Burden of Disease (GBD) study. This is a comprehensive worldwide observational epidemiological study, led by the Institute for Health Metrics and Evaluation (IHME) at the University of Washington, Seattle (USA). It examines trends from 1990 to the present day. The latest study includes data on mortality and morbidity in 204 countries and territories, 369 diseases and injuries, and 87 risk factors. It tracks progress within and between countries and thus is a tool to enable clinicians, researchers, and policy makers to promote accountability and improve lives worldwide. You can find the latest GDB data on The Lancet website.

According to the study, there is good news and bad news. The health of the world’s population continues to improve, with global life expectancy at birth rising from 67·2 years in 2000 to 73·5 years in 2019. Healthy life expectancy at birth in 21 countries has increased by more than 10 years between 1990 and 2019. However, the health of a population overall depends on a correlation between health and the socio-demographic index—a metric of a country’s overall development based on average income per capita, educational attainment, and total fertility rates. Universal health coverage continues to be a factor in the health of a nation. The study depicts COVID-19, obviously the most pressing health issue of 2020, as a syndemic of SARS coronavirus infection combined with “an epidemic of non-communicable diseases, both interacting on a social substrate of poverty and inequality.” Public healthcare must address more than just symptoms; diseases do not exist in a socio-economic vacuum.

Closer to home, Britons in the EU are concerned about the impact that Brexit will have on healthcare. Residents in the UK may have noticed that there has been supply-chain disruption of a number of medicines in the last couple of years, unrelated to either Covid or Brexit, but, some pharmacists claim, concerned with increasing restrictions on the use of some ingredients by the FDA in the US.

If you are in the UK and are worried about accessing your medication as a result of Brexit, you should talk to your doctor or pharmacy. Some measures are in place, such as new routes for shipping medicines into the UK and a six-week stockpile. At present, the plan is to continue to recognise EU regulatory processes, which should cut down on the enormous cost and bureaucracy that would result from putting new products through new regulations. Experts warn, however, that the double whammy of Covid and Brexit could cause serious funding shortfalls throughout the NHS, and this could have an impact on your prescriptions.