COVID-19 Update 17-11-2022
Last Updated on 3 weeks by Publishing Team
Thursday 17th November
Since the last update on 10/11/2022, we have recorded 20 new cases.
Of the 20 cases recorded, 16 cases were recorded in the Central Division; 3 cases in the Western Division; 1 case in the Northern Division with nil cases in the Eastern Division.
The national 7-day rolling average of cases as of 13th November is 2 daily cases.
The Central Division cases constitute 66% of the cumulative total cases nationally, with the Western division making up 28%, 4% in the Northern Division, and 2% in the Eastern Division.
The curve depicts weekly 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.
COVID Death Reports
We have no (0) new COVID-19 deaths to report.
Analysis of COVID-19 Deaths
Table 1: Death rates by Division
An analysis of the 177 deaths recorded since December 2021, shows that the Central 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 177 deaths since December 2021, the death rate adjusted per 100,000 population, has been highest in the age group 50 years and over. There were 10 deaths below the age of 19 years, 7 out of the 9 children had significant pre-existing medical conditions, and three (3) children had no known underlying medical condition.
Table 3: Deaths by Vaccination Status
Of the 177 COVID-19 deaths reported since December 2021, eight (8) deaths were in the population not eligible for vaccination (under the age of 12). An analysis of the 169 deaths in the vaccine-eligible population revealed that Fiji has a death rate of 11.7 per 100,000 population for fully vaccinated adults and 333.6 per 100,000 population for unvaccinated adults. This means that unvaccinated adults in Fiji have been dying at a rate 28.5 times higher than fully vaccinated adults. Individuals in the 12-17 age group who died were not vaccinated.
There has been a total of 878 deaths due to COVID-19 in Fiji. As of August 18th, 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 997 COVID-19-positive patients who died from other serious medical conditions unrelated to COVID-19; their doctors have determined that COVID-19 did not contribute to their deaths, and therefore these are not classified as COVID-19 deaths.
Currently, we do not have any (0) admissions as a direct cause of COVID-19. However, seven (7) admissions have tested as covid positive but are admitted for other diseases. Patients presented to the hospital are tested before admission therefore, a high number of people who are admitted for non-covid health conditions, test positive for COVID-19 due to the current level of transmission in the community.
Using the WHO clinical severity classification, there are 100% (n=7) cases in the asymptomatic and mild categories; with nil (0) cases in the moderate, severe and critical categories.
38 tests have been reported for November 16th, 2022. The total cumulative tests since 2020 are 664,856 tests. And the 7-day daily test average is 33 tests per day or 0.0 tests per 1,000 population.
The national 7-day average daily test positivity is 9.3%, which is above the WHO recommendation of 5%.
Given the very low number of reported cases, we were looking at reviewing our covid safe measures in larger hospital cases. This, however, will take a while as we have found benefits in terms of space management and infection risk reduction with the COVID safe measures in place. We will also need to ensure that we minimise the risk of a covid outbreak in critical care spaces which cater for many immunocompromised patients.
Furthermore, the emergence of more highly transmissible variants such as the XXB COVID variant reminds us of the need to maintain measures that will protect the vulnerable in the community. This means we need to maintain screening and COVID safe measures in hospitals and old people’s homes. Similarly, the vulnerable (old age, those with chronic disease and those going through an acute illness) need to take on personal COVID safe measures and support persons need to ensure their safety by policing the COVID safety measures around them. We are in the process of acquiring more rapid testing kits to help institute protocols to protect the vulnerable and to enhance our screening of border and hotel workers. The experience in the USA and European countries indicate a minimal change in hospital admissions for COVID-19 disease despite an increase in case numbers.
We emphasise the point that strengthening our ability to live with COVID means we remain vigilant, maintain community-wide adoption of COVID safe measures where appropriate and maintain the impetus for immunisation This is the only means to reduce the disease spread and protect those in the community who are less able to fend for themselves.
As such, the impact of immunisation is clearly demonstrated in our hospitalisation rates for severe disease which has decreased as reported by all the divisional hospitals. And we know that vaccination combined with COVID safe measures will help keep the healthcare load manageable. Based on the above data and reported global trends, expanding the vaccination coverage to children and increasing the uptake of booster doses will improve our ability to live with covid and ensure that we can continue to engage safely in the recovery of our economy and the health system.
Community and workplace leaders are encouraged to maintain many of the COVID safe measures that the community and organisation have learnt during the acute outbreak. This will help us to live with COVID while at the same time reducing the risk of vulnerable people getting COVID and/or suffering from severe consequences.
While we have maintained a number of public health mandates and measures related to vaccination and incoming travel, we envision that the more people get vaccinated with the booster doses, the better the level of protection, and the safer it will become to remove the remaining public health measures further. For this to happen, the Ministry is currently targeting 80% booster coverage for those over 18 years of age.
Also, anyone who falls sick should not be attending work or school, especially if they have COVID-19-like symptoms. You must get tested for COVID-19, and if tested positive, 7-day isolation is mandatory.
Ongoing Medical Recovery Efforts
Our ongoing medical recovery efforts remain on track with the support of a number of our development partners. The ongoing exodus of medical staff remains a challenge and we are supporting the development of a support cadre of workers by relooking at new programs that support lower-tier health cadres with shorter-duration training programs which at the same time provide alternative entry points to medical professions. We already have a community health worker program, we are reviewing a program for nurse aides, and also exploring a theatre technician training program to support our efforts to support broader access to safe surgery.
The Ministry continues to review and employ strategies to improve the working environment of our workforce. A survey of nurses in Lautoka and Labasa reported that the vast majority preferred the 12-hour shift because it came with more continuous days off. Nurses work for 2 or 3 days and get 3 to 4 days off at a stretch. We have since employed this staff rostering approach at appropriate locations, and continue to assess this arrangement to ensure safe working conditions for nurses and the patients they serve. There are staff shortages that entail some health workers staying long hours at work however, the recently reintroduced overtime pay and the time off in lieu conditions will help to mitigate this.
While we are dealing with the backlog in normative services related to the prolonged closure of normative functions. Clinicians have been tracking those on the backlog list for planned treatment including surgeries and other services, and we are working on improving communications in this area.
A key component of the ministry’s response is to support the remodelling of health care provision by strengthening digital support to evolve a network of command centres that will optimize network communication to maintain surveillance on key issues and ensure that action plans are implemented well to mitigate those issues. Quality care improvement is an important cornerstone in all action plans. A government-wide customer service initiative is also a key part of the command centre work plans. These initiatives will also include processing internal communications to facilitate timely decision-making and action within the Ministry. It will also allow the Ministry’s senior executives to track progress in implementation and ensure that the annual operation plans reflect an evolving and progressive change narrative in the successive plans.
After receiving and continuing to receive a large number of drugs and consumables we are working on a nationwide deployment effort to deliver these items to all our medical facilities. A digital supply chain management platform has been launched and we expect to see improvements in the supply of consumables and medicines as a result of these initiatives.
We are also focused on carrying out infrastructure improvements more efficiently for all health facilities, and our strategy includes the setting up of divisional mobile units to supplement facility-based general servicing and maintenance capability and also work with private providers through a process for pre-qualifying contractors and suppliers for each subdivision.
Furthermore, we continue to support the government’s initiatives for greater engagement between the public health sector and the private health sector. 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 will greatly assist our ongoing recovery efforts, and further strengthen healthcare services in Fiji. This is in line with the principle of private health sector engagement to complement and enhance public health sector service. The Fiji Medical and Dental Council is assisting in ensuring better oversight in the engagement between the public and the private sector.
In summary, we have evolved our remodelling plan such that our principle objective is that while we are working on improving health outcomes, we have a strong focus on improving the ability of our citizens to remain productive. This means that we focus on primary health care as the means to facilitate universal health coverage by prioritizing primary prevention and promoting ambulatory care. The measures mentioned above require us to demonstrate a narrative that investment in health means an investment in population productivity, and a greater capacity to take advantage of trade opportunities and thus support national economic growth. This approach will involve strategic private sector engagement and strengthening our digital backbone to form the basis for sustainable action plans that include quality care improvement as an important cornerstone. It requires that we sustain an ongoing multi-sectoral engagement and collaboration which is currently being actively promoted with other partner Ministries, based on lessons learnt from the Pandemic.
We have been reporting that 100% of our estimated adult population have received one dose and 95% have received the second dose. The vaccination of our target population has been progressing well with the 12 years and above coverage rate for Fiji being 99% for Dose 1 and 89% for Dose 2. Furthermore, as of the 17th of November, 168,965 (54%) booster-eligible individuals have so far received their 3rd dose while 27,876 individuals have been administered the 4th dose.
Increasing Vaccine Booster Coverage Program
We urge the public to get booster vaccine doses at the vaccination site closest to them and the list of sites is provided daily by the MHMS. Currently, both Pfizer and Moderna are recommended for booster doses.
To optimise coverage, our current target of the booster campaign is to administer 250,000 doses of the Pfizer vaccine to those who have completed the primary series (doses 1 and 2) three or more months prior but have not yet received a booster dose.
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
- Healthcare 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.
COVID-19 vaccination to the 5-11 years in Fiji.
Update on the Paediatric Pfizer Vaccination:
Both Central and Western divisions are continuing with the COVID-19 vaccination of the paediatric 5-11-year-olds. Parents are requested to ensure the Consent Cards are signed and sent to their child’s school.
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 a three-fold 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 to eligible children whose parents have consented.
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 vaccination sites.
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.
Other schools identified as priority community vaccination locations include the special schools that cater for children with special needs.
Opportunities may be offered to the sites hosting community events (sporting, 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:
Onsite consent to be 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 shall be documented by the Vaccination Team and the letter shall 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 parent/guardian 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.
A vaccine information booklet accompanies the Consent forms.