Last Updated on 6 months by Publishing Team
Monday 28th March
Engaging COVID safety without mandates or quarantine
The recent announcements by the Honourable Minister for Economy in relation to COVID-19 represent a change in the phase of our engagement in the promotion of COVID-safe measures. We have been using mandates on masking and other protective restrictions over the last two years to institute COVID-safe measures, thereby slowing transmission and protecting the vulnerable. However, now that we have a high two-dose vaccination coverage, and booster doses have been readily available for months, we recognize that at some point everyone must take individual responsibility for keeping themselves safe with the measures that are available and known to be effective. We currently are recording low numbers of cases and admissions in our hospitals. And we have not recorded a new COVID-19 death for an entire month. Therefore, we now leave it to you to assess your own level of risk and decide to continue to take measures such as masking and social distancing. For example, we know wearing a mask in public will lower your risk of getting infected, and it is now an individual choice that is recommended by the Ministry. If you are at higher risk of severe disease should you get infected with COVID-19, we strongly recommend that you continue to wear a mask in public, particularly in crowded indoor spaces.
The lifting of masking and other mandates, and easing of travel restrictions, is NOT a sign that the risk of outbreak and resurgence of COVID-19 is over. It is only a reflection of MOHMS ‘appreciation that all that can be done to engage the community to live safely with the risk of COVID-19 has been done. The impact of COVID-19 has been seen and the results of collective response have been experienced and reported.
The promotion of COVID-safe measures will now be pursued similar to how we advise healthy lifestyle measures for the prevention of non-communicable diseases, and how basic hygiene is promoted for the prevention of infectious diseases like typhoid fever. The measures that will continue in terms of prevention are the promotion of vaccination, personal COVID-safe hygiene habits, and workplace ventilation and air cleaning measures. We recommend everyone continue to employ COVID-safe measures to prevent infection and spread of infection: Frequently wash your hands or use an alcohol-based hand sanitizer, stay home if you feel sick, cover your mouth and nose with a tissue or the bend of your elbow if you cough or sneeze, wear a mask if you have any signs of a respiratory illness.
However, while we are now moving towards individual responsibility, we will keep in reserve the ability to reinstitute collective action in the future. The unfortunate fact is, that while many in Fiji and around the world are tired of COVID-19, the virus is not yet tired of us. Wishing it would go away will not make it a reality. The resurgence in COVID-19 in other countries is again a reminder of this fact. COVID is endemic to Fiji and is present in almost every country in the world, and as such the risk of resurgence will continue, with the highest risk to the unvaccinated, those with waning immunity, and those who have not had a vaccine booster dose. More importantly, the vulnerable among us will be susceptible to severe disease and death (even if they are vaccinated) when compared to the non-vulnerable group. Also, the non-vulnerable and mobile (e.g. young adults and adolescents) will always be able to transmit disease to the vulnerable. We expect that with the upcoming general elections, population mixing will be unavoidable.
A key part of the MOHMS strategy, moving forward will be to concentrate on health facilities and health care provision capabilities so as 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. Our command centres and operation centres have been repurposed to maintain a line list of vulnerable cases in the community and to 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.
As of 28th March, a total of 116,069 individuals have so far received booster doses. While members of the public have been advised to obtain their booster dose after at least 3 months from their second COVID-19 vaccine dose, we will shortly be advising a shorter interval period in recognition of the risk of disease surge. Moderna vaccine and Pfizer vaccines are both available for adult booster doses.
Our current booster program has been slowed down by slower uptake and deployment challenges relating to the need to deal with the current surge of leptospirosis, typhoid, dengue fever, and influenza we are facing Fiji-wide. The public is urged to get booster vaccine doses, and the list of vaccination sites is provided daily on the MOH webpage. The booster dose has been approved for deployment at a reduced post-dose 2 interval of 3 months compared to 5 months before. Given the competing issues, I have instructed teams to go back to health facilities and do targeted booster programs for the vulnerable and the willing and to focus on our 12 to 18-year-olds through the school vaccination program. Furthermore, we are close to opening an avenue to getting access to paediatric doses of vaccines.
We will continue to monitor the evidence on post-infection immunity based on quality data that is being generated globally. However, until we have a better sense of the role of post-infection immunity, the Ministry of Health will continue to define our level of protection based on vaccination numbers
Given the current stocks of Pfizer vaccine we have, we will be using Pfizer for the ongoing primary 2 dose schedule of children and adults and as the booster dose.
We are beginning to see a reduction in people presenting to health centres with acute respiratory illness, suspected leptospirosis, and suspected dengue fever, suggesting reductions in the current surge in outpatient cases. These declining trends of leptospirosis and dengue fever, despite the persistence of weather conditions conducive to their ongoing spread, are likely a result of the related public health measures that have been put in place. However, there remains the risk of disease resurgence if public health measures taken are not maintained.
The decline in cases has reduced the strain on our outpatient services, however, the Ministry will continue to work on measures to open more facilities with extended service hours, and to streamline outpatient services to help reduce waiting times. Many of our staff have returned from annual leave that had been deferred during the second and third waves of COVID-19, as well as sick leave during the recent increase in influenza. Also, adjustments have been completed in our outreach programs to deal with LTDD, and vaccination needs and staff have been freed up for outpatients services in health centres.
The Ministry is working with the Ministry of Economy in pursuing the engagement of General Practitioners, Private Dental Practitioners, and Private Medical Laboratories, to provide and support outpatient services to the general public in a public-private partnership arrangement. We see this engagement as a key strategy to improve surge capacity support.
Leptospirosis, Typhoid fever, and Dengue fever
The current wet weather around the country continues to promote the surge of our endemic climate-sensitive diseases, leptospirosis, typhoid, and dengue fever. Though we have noted a decrease in leptospirosis hospital admissions, we are also aware of continued heavy rain in parts of the country, particularly the Western Division. As such the medical advice we provide needs to be followed, while we continue to mount our public health and clinical response. Please heed our advice to protect yourselves and your loved ones.
Further data and updates on LTDD will be provided every Wednesday.
The leptospirosis bacteria is spread to humans through the urine of infected animals, such as cows, pigs, rats, and dogs. To reduce your individual risk, it is important to understand that exposure to animals, soil, mud, and floodwaters during work or recreational activities increases your risk of infection.
Important prevention measures include wearing full 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, practice good personal hygiene at all times, cover cuts and wounds well, and use protective equipment, especially footwear when in flooded and/or muddy areas.
We are also urging all parents and guardians to prevent children from playing in the mud or swimming in flooded rivers or creeks, and ensure that they wear shoes when outside.
Symptoms and treatment
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, 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, difficulty staying awake. Severe leptospirosis is life-threatening, and anyone with these symptoms must be taken to the hospital immediately.
The reports from the recent FEMAT outbreak response visits to the Navosa Subdivision and the Ra Subdivision have shown that when patients are seen early, and the appropriate treatment is provided, the patients were able to be treated successfully at home and not require admissions into the hospital. The number of people with severe disease and deaths was all significantly reduced. Therefore, we encourage those who are sick at home to seek treatment early so they can recover quickly from their illness.
Typhoid fever is typically found in areas that do not have access to proper toilet facilities and/or 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 practice basic hygiene measures such as frequently washing hands with soap and water, especially after visiting the toilet and before eating or preparing food.
The preliminary reports from our WASH projects in the Northern division have shown that when communities focus on ensuring good water supply, practising proper hand hygiene, having proper human waste disposal (hygienic toilet facilities), and with complete treatment of those with the disease, outbreaks of typhoid can be stopped in the community; and the overall prevalence of typhoid fever will decrease. Thus, we encourage all our communities to focus on clean and hygienic WASH facilities to stop the spread of typhoid fever in the community.
We continue to urge everyone to get rid of potential mosquito breeding places, such as empty containers inside and outside your homes that may collect water, including discarded tires, flower vases, and pot plant bases. Protect yourself from being bitten by mosquitoes by using mosquito screens in your homes, and mosquito repellents.