Last Updated on 1 year by Publishing Team
Monday 04th July
Since the last update, we have recorded 181 new cases of which 73 new cases were recorded on 01/07/2022; 21 new cases were recorded on 02/07/2022; 44 new cases were recorded on 03/07/2022 and 43 new cases in the last 24 hours ending at 8 am this morning.
Of the 181 cases recorded, 116 cases were recorded in the Central Division; 43 cases were recorded in the Western Division; 19 cases were recorded in the Northern and 3 cases were recorded in the Eastern Division.
The national 7-day rolling average of cases as of 30th June is 31 daily cases.
The Central Division cases constitute 67% of the cumulative total cases nationally, with the Western division making up 28%, 3% in the Northern Division, and 2% in the Eastern Division.
The curve depicts daily COVID-19 deaths by division since May 2021. It indicates a surge from last December, with peaks in mid-January 2022 followed by a downward trend. The latest COVID death was reported on 28/06/22.
COVID Death Reports
We have no new COVID-19 death to report.
Analysis of Deaths in the Third Wave
Table 1: Death rates by Division
An analysis of the 165 deaths recorded in the third wave shows that, while the Western Division has the highest absolute number of deaths, the Northern Division has the highest rate of death when adjusted for population.
Table 2: Deaths by Age Group
For the 165 deaths in the third wave, the death rate adjusted per 100,000 population, has been highest in age groups 50 and onwards. There were 8 deaths below the age of 19 years, 7 out of the 8 children had significant pre-existing medical conditions, and one child had no known underlying medical condition.
Table 3: Deaths by Vaccination Status
Out of 165 COVID -19 deaths reported in the third wave, six (6) deaths were in the population not eligible for vaccination (under age 12). An analysis of the 159 deaths in the vaccine-eligible population reflected, that when adjusted per 100,000 population, for fully vaccinated (received 2 doses) and unvaccinated/not fully vaccinated (received 0 doses or only 1 dose) adults in Fiji, we have a death rate of 10.3 per 100,000 population for fully vaccinated adults and 313.5 per 100,000 population for unvaccinated adults. This means that unvaccinated adults in Fiji have been dying at a rate 30.4 times higher than fully vaccinated adults during the current COVID-19 wave. Individuals in the 12-17 age group who died were not vaccinated. There have been no COVID-19 deaths in individuals who received a booster (3rd dose) of the vaccine.
There have been a total of 866 deaths due to COVID-19 in Fiji. As of June 30th, 2022, the national 7 days rolling average for COVID-19 deaths per day is now 0.0, with a case fatality rate of 1.29%. Due to the time required by clinical teams to investigate, classify and report deaths, a 4-day interval is given to calculate the 7 days rolling average of deaths, based on the date of death, to help ensure the data collected is complete before the average is reported.
We have also recorded 943 COVID-19-positive patients who died from other serious medical conditions unrelated to COVID-19; their doctors determined that COVID-19 did not contribute to their deaths, therefore these are not classified as COVID-19 deaths.
Using the WHO clinical severity classification, there are 78% (n=35) cases in the asymptomatic and mild categories; 20% (n=9) in the moderate category; 2% (n=1) in the severe category and nil cases in the critical category. Anyone admitted to the hospital is tested before admission, therefore, a significant number of people are admitted to the hospital for non-covid health conditions, but incidentally, test positive due to the high amount of transmission in the community.
721 tests have been reported for July 3rd, 2022. Total cumulative tests since 2020 are 572,354 tests. The 7-day daily test average is 1,363 tests per day or 1.5 tests per 1,000 population.
The national 7-day average daily test positivity is 3.8% which is within the WHO recommendation of 5%.
For COVID 19;
As reported, we continue to see an increasing trend. Recent severe diseases and deaths have been seen only in those with severe comorbidities (underlying illnesses). Also, they are either unvaccinated or have not received the booster dose that would be appropriate given the well-known recommendation for those with severe comorbidities to have at least one booster dose if not both.
We also note an increase in cases admitted that are positive for COVID 19 and we are receiving reports of an increase in cases reported from workplaces. All the hospitals have been notified to reintroduce more stringent COVID safe measures. These include restricting visitors, more strict enforcement of masking and hand sanitization practices and to strengthen screening protocols. For workplaces, we strongly advise that COVID safe measures be more actively promoted and enforced by management.
It is important Community and Workplace leaders bring back many of the COVID safe measures that your community and/or organisation has learnt during the acute outbreak. We need to be able to live with COVID by reducing the risk of vulnerable people getting COVID and/or suffering from severe consequences. COVID safe measures prevent us from getting COVID and also reduce the risk of spread to the more vulnerable and less mobile in the community.
Vaccines have provided a level of protection from severe disease and death such that the increasing trends in cases remain less of a concern. However, if we do not take measures to reduce the risk of getting the virus, the small percentage of people that get the severe disease will be a big number of people seeking hospital care. A big number of people seeking hospital care will mean that they compete for hospital resources with those who need emergency care. Acute cases like heart attack patients, or road traffic accident cases will become more difficult to care for. Vaccination with COVID safe measures will keep the number of people needing hospital care very low and ensure that the health care load remains manageable.
We have maintained a number of public health mandates and measures that relate to vaccination and incoming travel. The Ministry of Health and Medical Services envision that the more the booster dose the better the level of protection, and the safer it will be to remove the remaining public health measures further. The Ministry is currently looking at 80% booster coverage for those over 18 years of age.
Anyone who is sick should not be attending work or school. If you have COVID-19 symptoms you must get tested for COVID-19. If you test positive- isolation is mandatory for 7 days.
The increasing trend in respiratory infections, especially in children remains an issue of concern in this current cold-weather season. This comprises a number of respiratory viruses that cause cold and flu symptoms. It has been expected that as restrictions intended to prevent transmission of COVID-19 were lifted (including mandatory masking, physical distancing, and school and border closures) other respiratory viruses that normally circulate would begin to re-emerge similar to pre-COVID levels, and possibly even at higher levels due to a decrease in population immunity to seasonal viruses, as cold/flu cases were low during the last two years.
We also note that we are in the middle of our chickenpox season, we have noted cases positive for measles and we have recorded cases of hand, foot and mouth disease; a disease that is caused by a family of viruses called enteroviruses. All these diseases can be mistaken for what many have read about monkeypox. We have yet to diagnose a case of monkeypox in Fiji. MOHMS have also released a number of advisories for the public. And we have released guidelines to all clinicians in the public and private sectors in order to facilitate early case identification and reporting.
As of the 04th of July, a total of 142,450 individuals have so far received booster doses. This represents 46% of those eligible for a booster dose.
Increasing Vaccine Booster Coverage Program
It is well documented that immunity against COVID-19 infection acquired from COVID-19 vaccination wanes over time. The effectiveness of protection against COVID-19 after a primary series of AstraZeneca vaccination is slightly lower than with other COVID-19 vaccine products, especially against the Omicron variant of concern. However, receiving a third dose (booster), especially of mRNA vaccines like Pfizer or Moderna, boosts immunity against infection.
There is also evidence that prior infection with a non-Omicron variant or the Omicron sublineages of BA.1 and BA.2 may not protect against infection with Omicron sublineages BA.4 and BA.5, which are now dominant in some countries- though some protection against severe disease is still expected. There is no evidence that BA.4 and BA.5 cause more severe disease than previous variants. The latest genomics sequencing results show that Omicron sublineages BA.1 and BA.2 are in circulation in Fiji, while BA.4 and BA.5 have not yet been detected.
This means that, once these sub-lineages enter the community, it is expected that people may get infected, even if they have been infected before; and while the risk of severe disease is expected to remain low in those who have had 2 doses and have no underlying illnesses, increased sickness may still have a negative impact on the workforce. And people with underlying conditions like diabetes, heart disease, kidney disease etc. will h. will continue to be at higher risk of severe disease and death.
These considerations, and the current noticeable increase in cases, indicate an urgency to increase our efforts to increase booster dose coverage. The return of most of the medical immunisation staff has also helped to ensure support for escalating our vaccine booster coverage program.
Based on this and international evidence the Ministry recommends the booster dose interval for eligible persons over 18 years be reduced to 3 months after the 2nd dose in recognition;
- of the risk of disease surge based on waning 2 doses of COVID-19 vaccine protection
- slow booster uptake
- increased international travel with the relaxation of border measures
- ongoing outbreaks in various parts of the world with an increase in Omicron sublineages that may evade infection-induced immunity from other variants
Hence, we urge the public to get booster vaccine doses with a list of vaccination sites provided daily by the MHMS. Currently, both Pfizer and Moderna are recommended for booster doses.
In order to optimise coverage, the aim of the booster campaign is to administer 250,000 doses of Pfizer vaccine to those who have completed the primary series (doses 1 and 2) > 3 months prior but have not yet received a booster dose. This requires a minimum of 32,000 doses to be administered weekly for 8 weeks from 1 June to 31 July 2022.
COVID-19 booster priority populations are;
- Persons over the age of 18 years who have completed their primary series > 3 months prior can receive their 1st booster dose
- Immunocompromised persons and those over the age of 60 years who had received the 3rd booster dose, may receive the 4th dose after a period of 4 months
- Health care workers, port staff, tourism and others who wish to receive a 2nd booster dose may receive it after an interval of 4 months from their first booster dose.
- Anyone over 18 years who have taken their 1st booster dose can receive a 2nd booster dose after an interval of 4 months.
Micro planning workshops commenced in the Central Division on 30th May 2022. Western and Northern Division will start on 6th June 2022. Follow-up supervisory visits will occur weekly until the end of June.
COVID 19 vaccination to the 5-11 years in Fiji.
The Vaccination Roll out will commence in the Central Division on Wednesday 6th July, followed by the Western Division then Northern together with the Eastern Division.
The Ministry of Health and Medical Services is committed to:
- Equitably allocating sufficient doses to vaccinate all the 132,893 children aged 5-11 in Fiji.
- Equitably track and position vaccine sites to ensure that eligible individuals can receive vaccines in a safe and timely fashion.
- Provide evidence-based, unbiased information on vaccine safety, physical distancing, and mask-wearing to maximize the impact of these vaccines.
The Fiji Action Plan for COVID-19 vaccination of children aged 5-11 is three- folds approach to:
(1) Identify and prioritize eligible individuals and communities,
(2) Engage those individuals and communities with a targeted outreach and communication plan and (3) administer the vaccines.
Administration of Vaccine
The Ministry of Health and Medical Services through the 22 Sub Divisions with our School Health Teams have been leveraged to carry out the planned Vaccination rollout.
All school sites have been contacted to be potential vaccination sites.
The Health Facilities will also host vaccine clinics, as well as Pfizer vaccine clinics on weekends and the School Holidays.
The Sub Divisional Mobile Teams will also implement a homebound vaccination program that will be available to ensure that homebound children aged 5-11 will have access to immunizations if not available through their Schools.
Sites that have been identified for the administration of the Pfizer-BioNTech vaccine include:
- Current Fixed MCH clinics operated daily for those children of 5-11 years who would want to access these facilities.
- Mobile vaccine clinics for the Early Childhood Education Centres.
The Vaccination Teams will be visiting the Schools to conduct vaccination according to the planned dates.
Other schools identified as priority community vaccination locations are the special schools that cater for children with special needs.
Opportunities may be offered to the sites that are hosting community events (sporting events, etc.)
The Consent Process
Consent is obtained through the Consent Form of a parent or guardian for allowing their child to receive the age-approved vaccination.
The consent process includes:
An onsite consent is provided by a parent or guardian who is physically present with the minor at the vaccine site. The parent or guardian will sign an appropriate vaccine administration Consent Form.
For Off-Site consent:
- A consent form can also be taken home by children to be signed by the parent or guardian
- A letter can also be written/typed and signed by the parent or guardian.
- The acceptance of a letter of consent must be documented by the Vaccination Team and the letter should be retained with the patient record.
- The presence of a support person will be accommodated at all vaccine sites
Consent and Vaccine Information Documentation:
The Consent Form includes information on demographics (name and DOB), questions asked by the parents or support person and a place for the parent/guardian’s signature. Your questions will be dealt with by the vaccine provider.
The Vaccination Card indicates approval to release identifiable information to medical providers, and a place for the vaccinator to note the date (1st and 2nd Dose), a batch number and the type of vaccine.
The Consent forms are accompanied by a vaccine information booklet.
Vaccination plans for the School holidays:
The Suva Sub Divisional Vaccination Team will continue opportunistic vaccination. These will be conducted beginning this Saturday. We will inform you through our Advisory of the site where vaccination may be accessed.
International communicable disease outbreaks
As previously mentioned, the Ministry’s Fiji Centre for Disease Control (Fiji CDC) and Border Health Protection Unit (BHPU) are monitoring international outbreaks of concern, which include Ebola Virus Disease in the Democratic Republic of Congo, Japanese Encephalitis in Australia, acute hepatitis of unknown origin in multiple countries, and Monkeypox in the United Kingdom and other countries. Where appropriate, specific interventions have been put in place or strengthened in response. The situation will continue to be monitored, assessed, and responded to on the basis of available scientific evidence, best practices, and advice from expert authorities.
We can confirm that the 3 cases under investigation for monkeypox have tested negative. Our current position is that while monkeypox spreads worldwide, the evidence remains that monkeypox does not spread easily between people unless there is close contact. It is also amenable to localised public health measures with minimal to low social and economic impact. At present WHO does not recommend that the Member States adopt any measures that interfere with international traffic for either incoming or outgoing travellers.
Person-to-person transmission may occur through;
- contact with clothing or linens (such as bedding or towels) used by an infected person
- direct contact with monkeypox skin lesions or scabs
- exposure to respiratory droplets eg coughing or sneezing
The Ministry of Health and Medical Services continues screening persons of interest and investigating cases that demonstrate symptoms similar to what is seen in monkeypox.
Monkeypox is usually a self-limiting illness, which means that most people recover with just supportive (symptom relief) treatment within several weeks. However, severe illness can occur in some individuals. We are also in discussions with development partners to see if we can preposition access to vaccines and medications used to treat monkeypox.
As previously mentioned, our response plan includes surveillance with rapid response and containment protocols. A key focus will be on ensuring that those suspected or confirmed to have monkeypox must be managed dignifiedly with no threat of stigmatisation. Each citizen’s duty to contribute to protecting Fiji must be the priority.
The Ministry has been working with communications and community engagement teams to produce public advisories to help arm ourselves with the knowledge to protect ourselves and to help reduce the chances of spread in our community. Infection prevention protocols have been put together at the border and in community facilities. Protocols have been initiated to maintain oversight over travellers from selected countries to ensure early diagnosis, treatment, and contact tracing. The public advisories have covered symptoms to enable the public to quickly recognize symptoms and seek medical care while preventing transmission to others.
All doctors and Nurses in the community need to ensure they are well informed of how cases present and be vigilant in helping to ensure cases are diagnosed early. The Ministry’s guidelines for early detection and response, as well as laboratory testing, have been distributed to all public and private clinicians.
Discussions with our reference laboratory in Melbourne are in place to ensure access to definitive tests. Our ongoing efforts to have genomic sequencing capability in the Fiji CDC will provide us with greater capacity to deal with infection threats now and in the future.
As we escalate our community-wide infection prevention and control measures, we are responding to current threats and creating community-wide resilience to upcoming threats. Our ongoing engagement in a healthy lifestyle to mitigate NCDs is also part of the overall focus on building back better and stronger.
The Ministry of Health and Medical Services will continue to disseminate more specific advisories over the coming weeks. Further updated knowledge about the monkeypox virus will be shared as they are known.
Ongoing Medical Recovery Efforts
With reducing COVID-19 cases and people presenting to health centres with acute respiratory illness, the MOHMS team is better positioned to focus more on health facilities and health care provision capabilities to mitigate against severe disease and death. This will include the ongoing community engagement and outreach program to facilitate early diagnosis and treatment in the community, and the maintenance of health facility readiness to provide treatment.
We have received a large number of drugs and consumables that have finally arrived and a nationwide deployment effort is currently underway to facilitate the delivery of these items to all our medical facilities. Also, a supply chain management digital platform has been launched and we expect to see improvements in the supply of consumables and medicines as a result of these initiatives.
Our command and operation centres have been repurposed to maintain a line list of vulnerable cases in the community and work on processes that will allow for more preemptive response and promote broader community resilience. These command centres and operation centres will also provide oversight on community surveillance indicators to ensure early and measured responses to future outbreaks.
We are also focused on carrying out general health service work more efficiently in all facilities, and a key part of our plan is to set up divisional mobile units to supplement facility-based general servicing capability and also work with private providers through a process for pre-qualifying contractors and/or suppliers for each subdivision.
The engagement of General Practitioners, Private Dental Practitioners, Private Medical Laboratories, and Private Ambulance providers to support our services in a public-private partnership arrangement is a strategy to help in our ongoing recovery efforts.
We also have reformulated a framework to better engage customer service initiatives in all health facilities and allow for senior managers to institute substantive actions and provide direct oversight over implementation plans. It will also allow the Ministry’s senior executives to track progress in implementation and ensure that annual operation plans reflect an evolving and progressive change narrative in the successive plans. These initiatives will also include the processing of internal communications to facilitate timely decision-making and action within the Ministry.