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COVID-19 Update

Thursday 24th November

Public Advisory

For COVID-19;

We are once again noting an increase in COVID-19 cases based on case numbers reported to us, positivity rates being compiled from hotel, airport and hospital workers and absenteeism rates from selected industries and schools. We have noted 18 admitted cases who have incidentally tested positive for COVID-19. Correspondingly, we are currently focusing on implementing COVID safe measures around those vulnerable to the severe effects of COVID-19. This includes escalating measures in hospitals, old people’s homes and facilities catering for disabled persons. As such we expect to escalate screening protocols and masking for staff, patients and visitors. Furthermore, visitor restrictions will be in place.

Consistent with the experience in other countries that have high vaccination rates, we anticipate a minimal increase in hospital admissions for COVID-19 disease despite increasing case numbers. While immune protection from the severe disease remains, there is expected to be some immune escape capability that makes the variant more transmissible.

For the general public, we are advising that COVID safe measures need to be instituted around the elderly, those with chronic disease, pregnant mothers and children with disabilities. This involves proper masking of those caring for vulnerable persons, safe physical distancing for those visiting them, and ensuring they engage in highly ventilated spaces when they venture out of their homes. It is important for those with chronic diseases to be on proper treatment that ensures the optimal control of the diseases they have. This means that diabetics need their blood sugar to be as near normal as possible, hypertensives need their blood pressure well controlled and those with cardiac conditions to be as symptom-free as possible.

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.

Prior to noting this increase we had initiated the rescinding of some COVID-related public health measures relating to nightclubs, churches, sporting events and high-risk businesses. The decision to relax public health measures is based on the low number of admissions and severe cases despite the current changes in case numbers. We believe that the planned relaxation of public health measures will not have any adverse effect in terms of the number of severe COVID cases we expect to see from the recent increase in case numbers.

LTDD

We have noted rising trends in cases of Leptospirosis and Dengue however our admission levels remain low and the mortality rate among admitted cases remains low. This is despite the fact that for most of this year our reported case numbers had remained near or slightly above the outbreak level. We acknowledge the efforts of our community leaders, community health workers and health workers in the primary health space for their efforts in facilitating early detection and treatment. Also, our divisional health teams with the support of staff from the National Disaster Management Team have been carrying out pre-emptive source reduction measures in selected hotspots over the last month.

Recent heavy rain and flooding have affected many areas and communities throughout the country. The Ministry is focussing on geographical areas of concern for the purpose of mobilising extra capability to help manage communicable disease outbreaks and also escalate the promotion of preventative measures.

To reduce your individual risk, it is important to understand that exposure to animals, soil, mud, and floodwaters during work or recreation activities increases your risk of infection.

Important prevention measures include wearing fully covered footwear at all times when going outdoors, avoiding wading or swimming in flooded waters, using clean fresh water to wash up after exposure to muddy waters, and keeping all food and drinks covered and away from rats. For workplaces, practise good personal hygiene at all times, cover cuts and wounds well, and use protective equipment, especially footwear when in flooded and/or muddy areas.

Early treatment can decrease the severity and duration of the disease. Please seek medical care if you have recently had contact with floodwaters, mud, or animals, and develop the following symptoms: fever, muscle pain, and headache. You may also have red eyes, loss of appetite, nausea/vomiting, dizziness, or feel weak.

Leptospirosis can be treated with appropriate antibiotic medications prescribed by a doctor if treatment is sought early. Danger signs for severe leptospirosis include shortness of breath, coughing blood, chest pain, yellow eyes/skin (jaundice), signs of bleeding (including unexplained bruising), decreased or increased urination, and difficulty staying awake. Severe leptospirosis is life-threatening, and anyone with these symptoms must be taken to the hospital immediately.

The Ministry has reported an outbreak of Typhoid in the Raranibulubulu community in Vanua Levu and sporadic cases in Navosa. Measures taken so far through outreach deployment of medical teams and the effective efforts of community leaders have controlled any escalation in case numbers. Typhoid fever is typically found in areas that do not have access to clean drinking water. We strongly encourage people who live in rural areas, informal urban areas, and any other areas where access to clean drinking water is limited, to boil all drinking water. We must all also continue to practise basic hygiene measures such as frequently washing hands with soap and water, especially after visiting the toilet and before eating or preparing food.

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 progress of our Private Public Partnership initiative involving Lautoka and Ba Hospital remains on track with the tertiary-level cardiac services being provided through the MIOT team. 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 principal 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.

COVID-19 Vaccination

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 24th of November, 169,174 (54.1%) booster-eligible individuals have so far received their 3rd dose while 28,069 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.