Covid-free for almost two years, some Pacific island nations are suddenly struggling with an explosion in cases as the virus, thought in most cases to be the more transmissible variant Omicron, breaches the defences they had so successfully put up since the beginning of the pandemic.
Kiribati, Samoa, Palau and Solomon Islands have all experienced outbreaks within the last three weeks. The countries have approached the arrival of the virus with different strategies, some imposing lockdowns while others rely on their high levels of vaccination for protection.
Given their remoteness and the fragility of health systems there are nevertheless concerns about how they will cope, with many locals fearful.
Kiribati: ‘taken by surprise’
Covid arrived in Kiribati two weeks ago, when two-thirds of the 54 passengers on a plane from Fiji, the first international flight to arrive in ten months, were diagnosed with the virus on arrival.
Since then the situation has spiralled. The island nation now has a total of 201 cases as of Friday, and the virus has spread from the capital, Tarawa, to Butaritari, an outer island located 186km to the north.
The government has imposed a full lockdown, extended on Thursday for another week, with people only allowed to leave their homes for essential services. The Butaritari cases arrived on a ship from Tarawa, but were not tested until they had already spent several days in the community.
South Tarawa businessman Kitina Etau, who comes from Butaritari, is worried about his 70-year-old father who remains on the island.
“I was taken by surprise that passengers were allowed to travel on the ship despite the lockdown measures enforced on Saturday,” Etau said.
With limited communication on the island, Etau is yet to hear from his father and is worried that though the infected passengers are now in quarantine he may have been in contact with them as his father had been expecting cargo on the ship.
As cases escalate, people fear the virus has spread across the islands faster than testing can keep up.
Dr. Tabutoa Eria, a doctor who works both on the frontlines and for the government, wrote on Facebook that medical teams would no longer be dispatched to conduct community testing, appearing to suggest that critical resources were running low.
“We are reserving our testing kits and other resources for patients who have underlying conditions because they will be hit hardest from the virus,” said Eria.
Palau: ‘left to fend for ourselves’
The first case of community transmission in Palau was reported on 10 January – by Thursday, just over two weeks later, the Ministry of Health had reported almost 800 cases in the country of just 18,000.
Despite the exponential increase and a plea from traditional chiefs last week, the government has ruled out a lockdown or a closure of the border, putting its faith in the country’s high vaccination rate of 96% of the eligible population (those aged five and over) and evidence that Omicron is less likely to lead to hospitalisation.
Instead it has closed schools and encouraged mask-wearing and social-distancing.
One woman, a mother of four, said that it felt like the government was doing less just as cases were starting to increase.
“Since the inevitable arrival of Covid to our tiny island nation, I feel we are left to fend for ourselves with little to no help from the government,” she said.
It is not clear how the virus entered the community. In a press release on 5 January, the Ministry of Health said only that three positive cases had been identified on 31 December and has not responded to requests for more information citing privacy reasons.
Senator Stevenson Kuartei, who is also a doctor, said the Covid surge was putting additional stress on Palau’s already “thin” health sector, especially as doctors and nurses were “removed” from duty due to Covid.
The Ministry of Health ministry is also running out of isolation spaces.
Health minister Gaafar Uherbelau said he expected a steep increase in cases in the coming weeks, “given how highly transmissible the Omicron variant is, which is what we suspect is in Palau now.”
“We are currently monitoring cases and should there be a surge with those needing to be admitted that would overwhelm the hospital capacity, then we’ll look to implement more community mitigation strategies,” he added.
Solomon Islands: From zero to 100 cases in 12 hours
The first case of community transmission in Solomon Islands was reported on 19 January; 12 hours later the country had recorded more than 100 cases and within two days 50 nurses at the National Referral hospital, the country’s largest, had tested positive.
“We now need to work together to ensure we get this under control,” prime minister Mannaseh Sogavare said in a nationwide address. The country is enduring its first lockdown, and reported its first two Covid deaths earlier this week as cases rocketed to almost 700.
But with only 59 beds in the national isolation centre in Honiara and the outbreak at its underfunded main hospital, there are fears about the health system’s ability to cope. Its vaccination rate is also low – in a population of about 700,000, just 264,085 vaccine doses had been administered as of 13 January.
“Our people are not ready to handle such a outbreak,” said taxi driver Walter Kito, who added that his business had also suffered and he had no money to support his family. “I appeal to those who have not vaccinated to please do so now.”
Samoa: a country in panic
In a country that lost more than 20% of its population in the 1918 influenza pandemic and more recently lost 83 babies and children in a measles epidemic three years ago, the arrival of Covid-19 has caused panic.
The numbers have grown steadily since 10 passengers tested positive after arriving in Samoa on a flight from Australia on 19 January. Another 12 passengers and five nurses who cared for them have since tested positive, bringing the total number of cases to 27 as of Thursday.
A lack of clear communication from the government on the cases sowed confusion that was compounded when it did not declare a level 3 alert, which is supposed to be triggered by 10 cases or more.
However, once cases reached 15 on Saturday, the prime minister, Fiame Naomi Mata’afa, declared a 48-hour lockdown which has since been extended. The lockdown includes complete border closures as well as the shutting down of inter-island travel, and internal transportation. In an unprecedented move, Samoa also mandated quarantine for 250 frontline workers who had dealt with the infected passengers and are now camped out in the national hospital at Motootua for 21 days.
“This decision is made for the country and their respective family’s interest,” said Leausa Take Naseri, the director general of health. He also called on quarantine hotel management and staff to self-isolate at their place of employment.
“We must contain any transmission of the virus inside quarantine for the country’s sake.”