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COVID-19 Situation Update

Wednesday 02nd March

Transmission Update: Since the last update, we have recorded 62 new cases of which 55 new cases were recorded on 01/03/2022 and 7 new cases in the last 24 hours ending at 8 am this morning. Of the 62 cases recorded, 2 cases were recorded in the Central Division; 7 cases were recorded in the Western Division, 6 cases were recorded in the Northern Division, and 47 cases were recorded in the Eastern Division. The national 7-day rolling average of cases as of 26th February is 38 daily cases. In the 7 days until 01/03/2022, 35 new cases were recorded in the Central division, 22 new cases in the Western division, 12 new cases in the Northern Division, and 390 new cases in the Eastern Division. The Central Division cases constitute 68% of the cumulative total cases nationally, with the Western division making up 27%, 3% in the Northern Division, and 2% in the Eastern Division.

Deaths: The curves depict weekly COVID-19 deaths by division since May 2021. It indicates a surge from December-end 2021, which peaks by mid-January 2022. The 3rd COVID 19 wave is considered to have started around mid to late December 2021. (Note: Death notifications from within the last two weeks are still being received, therefore the graphs may alter slightly upon reporting). Analysis of Deaths in the Third Wave  Table 1: Death rates by Division Division Total COVID Deaths Deaths per 100,000 Central 61 15.2 Western 44 12.3 Northern 28 20.0 Eastern 5 13.0 An analysis of the 138 deaths recorded in the third wave shows that, while 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 Age Group Total Deaths Deaths per 100,000 population 0 – 9 6 3.3 10-19 2 1.3 20-29 3 2.1 30-39 4 2.9 40-49 6 5.8 50-59 18 19.8 60-69 27 51.9 70-79 42 187.5 80-89 23 408.8 90-99 5 961.5 For the 138 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 Age Cohort Total COVID deaths Total Vaccinated/ Unvaccinated Deaths per 100,000 Vaccinated Population Deaths per 100,000 Unvaccinated Population >18 130 55/75 9.5 175.1 15-17 1 0/1 0 6.6 12-14 1 0/1 0 2.5 Out of 138 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 132 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, a death rate of 9.5 per 100,000 population for fully vaccinated adults and 176.3 for unvaccinated adults was exhibited. This means that unvaccinated adults in Fiji have been dying at a rate 18.5 times higher than fully vaccinated adults during the current COVID-19 wave. Individuals of 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. New deaths to report There is no new COVID-19 death to report. There have been a total of 834 deaths due to COVID-19 in Fiji. Please note that 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. Therefore, as of February 24th, 2022, the national 7 days rolling average for COVID-19 deaths per day is 0.1, with a case fatality rate of 1.29%. We have recorded 899 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.

Hospitalization: There is a sustained downward trend in daily hospitalizations. Using the WHO clinical severity classification, a greater percentage, 75% (n=9) of the admissions of COVID-19 positive patients are categorised as asymptomatic and mild, 17% (n=2) is categorised as moderate and 8% (n=1) as severe with 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. The number of people being admitted because of COVID-19 remains low.

Testing: 151 tests have been reported for March 1st, 2022. Total cumulative tests since 2020 are 497,559 tests. The 7-day daily test average is 198 tests per day or 0.2 tests per 1,000 population. The national 7-day average daily test positivity is 12.6%. The high positivity rate is an indication of widespread community transmission.

Public Advisory:

Leptospirosis, typhoid fever, and dengue fever

As previously mentioned, the recent weather has resulted in conditions conducive to outbreaks of leptospirosis, typhoid, and dengue fever, which are climate-sensitive diseases endemic to Fiji. We are also aware of the recent weather reports predicting increasing rainfall over the next few days, and as such the medical advice we provide needs to be followed, while we continue to mount our public health and clinical response. We have especially noted increasing leptospirosis cases, hospitalisations, and deaths following similar weather events. Please heed our advice to protect yourselves and your loved ones.

Leptospirosis

Update:

There have been 567 confirmed cases of leptospirosis this year with outbreaks ongoing in all four divisions.

In the Western Division, there have been 236 cases, with 42% from Lautoka, 23% from Nadi, 17% from Ba, 9% from Tavua, 6% from Ra, and 3% from Nadroga/Navosa.

In the Central Division, there have been 193 cases, with 42% from Suva, 22% from Rewa, 13% from Serua/Namosi, 9% from Tailevu, 8% from Nasinu, and 6% from Naitasiri

In the Northern Division, there have been 122 cases, with 95% of cases from Macuata, 2% in Cakaudrove, and 1% in Taveuni

In the Eastern Division, there have been 16 cases from Levuka and Kadavu.

For hospital admissions so far this year there have been:

• 154 admissions in the West, with 42 new admissions last week.
• 86 admissions in Central, with 20 admissions last week. A particular concern has been an increase in children being admitted to CWM Hospital with leptospirosis, with 9 admitted over the weekend.
• 26 in the Northern Division, with 2 new admissions last week.
• 5 in the Eastern Division (4 in Levuka, and 1 in Kadavu), with no new admissions last week.

Sadly, there have been 3 more deaths caused by leptospirosis since the last update on 23/02/22: a 63-year-old from Nadi, an 8-year-old from Navua, and a 20-year-old from Taveuni. There have been a total of 23 deaths from leptospirosis this year, with 18 in the Western Division, 2 in Central, and 3 in the North.

While we have seen cases in all age groups. Cases remain predominantly in the 10-39-year-old age group, with more in males than females, and in people of the i-Taukei ethnicity.

Prevention

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.

Response

In response to the leptospirosis outbreak, the Ministry has mobilized FEMAT, first to Navosa, and now to Ra to assist the local medical teams in providing services and outreach to communities. Awareness messaging has also been distributed to the public through radio, television, print, and social media, focusing on prevention and early healthcare seeking for suspected cases. And our clinicians have had access to continuing medical education sessions remotely, or in person, by our specialist physicians from the divisional hospitals, to promote early diagnosis and treatment of people who may have leptospirosis.

Typhoid fever

There have been 44 cases of typhoid fever this year. The Central Division has recorded 14 cases, which is within the number of cases expected for this time of the year. The Northern Division has reported 6 cases (mostly from Bua), which is within the number of cases expected for this time of year. The Western Division has recorded 23 cases, with an increasing trend that has surpassed the outbreak threshold in the last 2 weeks. 10 cases were recorded in the last 2 weeks from Ra, Sigatoka, Nadi, Lautoka, and Ba.

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.

Dengue fever

There have been 633 confirmed cases of dengue fever so far this year, which is within the numbers expected for this time of the year. Central Division has recorded 166 cases, which is below the average cases expected based on the previous years’ data. The Northern Division has reported 153 cases, which is within expected levels. The Western Division is experiencing an outbreak, recording 249 cases, which is beyond the expected number for this time of the year. 49% of cases are from Nadi, 24% from Tavua, 12% from Ba, 9% from Lautoka/Yasawa, and 6% from Nadroga/Navosa. There have been 65 cases in the Eastern Division (95% Levuka and 9% Kadavu) with an upward trend noted.

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 repellants.

COVID-19 Vaccination

As of the 27th  of February, a total of 104,572 individuals have so far received booster doses. Members of the public are advised to obtain their booster dose after at least 5 months from their second COVID-19 vaccine dose. Moderna vaccine and Pfizer vaccines are both available for adult booster doses.

The Ministry of Health and Medical Services will continue to monitor the advisories on post-infection immunity based on quality data that is being generated globally

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.

Supporting International Travel

• Plan to remove 3-day hotel stay for fully vaccinated travellers from Travel Partner Countries.

Since the opening of international travel borders to travel partner countries travellers coming in from Travel Partner Countries have had to undergo an in-country test in Fiji on day 2 of stay in Fiji. To support this requirement, a 3-day hotel stay was mandated to minimize the risk of non-compliance to testing and to ensure that all positive tests were appropriately responded to while the traveller was locatable. To be clear, this 3-day stay in a Care Fiji Commitment (CFC) hotel was never a quarantine. The hotel stay is in place to facilitate the testing requirement on day 2 of arrival.

We have noted that while many countries have removed all forms of traveller sequestration, the in-country testing conditions continue. As such we are supporting current efforts to have more testing sites throughout Fiji to which travellers can book for testing, without requiring a hotel stay, as part of prior approval to come into Fiji. We are working together with the Ministry of Trade and Tourism and Ministry of Economy in the final phase of approving this in-country testing for international arrivals by private entities. These private entities will ensure that the test is available and the results will be reported back to Ministry of Health officials. They will also be mandated to report any international traveller who defaults from the mandatory testing. Any traveller defaulting a test will be subject to legal punitive measures.

• Ongoing Review of Non-Travel Partner Country Status

This ongoing effort is mediated through the Ministry of Commerce, Trade, Tourism and Transport, and the Ministry of Economy (COVID-19 Risk Mitigation Taskforce). Non-Travel Partner Status is assessed and graduated to Travel Partner status based on COVID-19 Transmission Data (cases, admission, and deaths), COVID-19 Community Surveillance data (Test per 1000, positivity rate), and ability to detect Variants (Access to genomic sequence capability). A list of Travel partner countries is available on the following link: https://www.mcttt.gov.fj/home/traveltofiji/international-travel/#b

POINT OF CARE TESTS

Rapid antigen point of care tests are tests that can be performed by health professionals, or trained persons under their supervision. This ensures a suitable health professional, or trained person under their supervision is available to ensure an adequate sample is collected, the results are interpreted correctly, and immediate clinical advice and treatment can be provided if required.

Conditions for the supply of COVID-19 Antigen Rapid Diagnostic Tests listed as Point of Care Tests

• Any person who imports and/or distributes the device shall only supply the device to one or more of the following:
  a. An accredited pathology laboratory
  b. A pharmacist who is registered under the Pharmacy Profession Act 2011 to practice pharmacy where:
  i. the pharmacist is responsible for performing or supervising the performance of the test; and
  ii. the pharmacist and any other person acting under their supervision to perform the test have received training in the correct use of the device and the interpretation of the test result;
  c. A health professional according to the interpretation in the Medical and Dental Practitioners Act where:
  i. the health professional is responsible for performing or supervising the performance of the test; and
  ii. the health professional and any other person acting under their supervision to perform the test have received training in the correct use of the device and the interpretation of the test result; and
  iii. the device is only used to test employees or contractors; or a patient under the direct care of the health professional;
  d. An organisation, business, or institution that employs or engages a health professional or a paramedic where:
  i. the health professional or the paramedic is responsible for performing or supervising the performance of the test; and
  ii. the person mentioned in subparagraph (i) and any other person acting under their supervision to perform the test have received training in the correct use of the device and the interpretation of the test result; and
  iii. the device is only used to test employees, contractors, or students of the organisation, business, or institution;e. A hospital or any public health facility
• The device must not be supplied for the purpose of self-testing.
• The distributor must maintain records that demonstrate the device has been supplied in compliance with these conditions.
• A list of all rapid antigen point-of-care tests approved for supply in Fiji is available on the MOH website and will be regularly updated as new tests are approved or if tests are canceled or withdrawn.
  RDT lists Point of Care

  Adapted from COVID-19 rapid Antigen Point of Care Testing: Guidance for implementation and checklist for businesses, 2022, Therapeutic Goods Administration, used with permission of the Australian Government
  https://www.tga.gov.au/sites/default/files/covid-19-rapid-antigen-tests-guidance-and-checklistbusinesses.pdf

  RAPID ANTIGEN SELF-TESTS (HOME USE TESTS)

  These are tests that can be used unsupervised at home without the involvement of a health professional. The person collects the sample, performs the test, and interprets the results by themselves.

  IMPORT and DISTRIBUTION of SELF-TEST

  1) A list of all COVID-19 rapid antigen self-tests (home use tests) that are approved for supply in Fiji is available on the Ministry of Health website along with the manufacturer’s instructions for how to use the tests.
  RDT list of Self-Test

2) This list is regularly updated as new tests are approved or if tests are canceled or withdrawn.

3) No import permit is required for the import, export, or distribution of Self-Test kits in the list, however,

4) An import permit may be required for a Self-Test kit not yet included in the list.

5) Self-Test or Home use Test kits can be purchased from pharmacies or from any other retail outlet that stocks the test.

6) All distributors of self-tests should supply the device in accordance with the conditions of the manufacturer

7) The distributor must also maintain records relating to all supplies of rapid antigen self-tests and be able to provide this information when required.

8) Companies, businesses, organisations, or institutions can purchase rapid antigen self-tests for their workers to use at home or on-site.

9) Businesses that choose to use a COVID-19 rapid self-test do not need to comply with the requirements for supervision of testing.

10) It is important that any business considering implementing rapid antigen testing takes into consideration the implications of testing in these environments, including:

• processes to maintain the confidentiality of patient information
• a procedure for possible closure of the business and isolation of staff if a positive result is received from a rapid antigen test, and
• any Ministry of Health directions around rapid antigen testing and reporting of positive test results.

11) For any positive result, follow the Ministry of Health’s advice on what needs to be done next.

12) Do not just repeat the test in the hope of the second test being negative.

13) If symptoms persist or a person still feels unwell despite obtaining a negative result with a self-test, contact the nearest healthcare facility for a PCR test.

Disposal of Self-Tests or Home-use Test

1. Follow the instructions provided with the home use test on how to dispose of it. Some tests come with a plastic bag for placing the contents of the swab etc. into before placing this in the household rubbish bin.
   Adapted from COVID-19 rapid Antigen Point of Care Testing: Guidance for implementation and checklist for
   businesses, 2022, Therapeutic Goods Administration, used with permission of the Australian Government
   https://www.tga.gov.au/sites/default/files/covid-19-rapid-antigen-tests-guidance-and-checklistbusinesses.pdf
2. If no bag is provided, place the used items from the test into a small plastic bag which is then sealed. This bag should then go straight into another bag which should be sealed and then disposed of in the household rubbish.
3. Wash hands thoroughly after disposal in line with good COVID safe practices.
4. The distributor must also maintain records relating to all supplies of rapid antigen self-tests and be able to provide this information to the overseas supplier.

COVID-19 Situation Update

Monday 28th February

Public Advisory:

Leptospirosis, typhoid fever, and dengue fever

The next update on the leptospirosis outbreak will be published in the statement on Wednesday. However, reports are indicating increasing hospital admissions for cases of severe leptospirosis in the Western Division, and also now in the Central Division. Cases remain predominantly in the 10-39-year-old age group, with more cases in males than females, and a majority of cases in people of the i-Taukei ethnicity.

As mentioned in the previous updates, the new area of concern is the Ra Medical area where we have noted a marked increase in cases and hospitalisations.  We have increased support to the Ra Subdivision Medical Team by mobilising a FEMAT team to man Rakiraki Hospital while the Ra Medical subdivision team will conduct outreach services to villages and communities in the Ra province. Suspected cases will be counselled on ongoing care and the severely ill will be transferred to the hospital to receive the appropriate treatment. The community outreach teams will also review chronic medical cases and update their management. Environmental Health Officers (EHOs)have also been brought in to work with the communities in escalating cleanup efforts that will help to control the population of communicable disease vectors such as mosquitoes, rats, and other rodents in affected areas. EHOs also assist to educate the communities on the risk of exposure to floodwaters and to discourage our people from playing in flooded areas and muddy places that increase their risk of contracting leptospirosis and other water-borne diseases.

Recent floods have affected many areas and communities throughout the country. The Ministry is focussing on geographical areas of concern for the purpose of mobilizing 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 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, 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, 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 Ministry has so far recorded a lower number of cases of Typhoid fever than anticipated for the current period as in previous years. 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.

Recent increases in reported cases of Dengue fever from around the country remain a serious concern. We continue to urge everyone to get rid of potential mosquito breeding places, such as empty containers outside your homes that may collect water, including discarded tires. Protect yourself from mosquitoes by using mosquito screens in your homes, and mosquito repellants.

Vaccination

As of the 27th  of February, a total of 103,101 individuals have so far received booster doses. Members of the public are advised to obtain their booster dose after at least 5 months from their second COVID-19 vaccine dose. Moderna vaccine and Pfizer vaccines are both available for adult booster doses.

The Ministry of Health and Medical Services will continue to monitor the advisories on post-infection immunity based on quality data that is being generated globally

Supporting International Travel

• Plan to remove 3-day hotel stay for fully vaccinated travelers from Travel Partner Countries.

Since the opening of international travel borders to travel partner countries travelers coming in from Travel Partner Countries have had to undergo an in-country test in Fiji on day 2 of stay in Fiji. To support this requirement, a 3-day hotel stay was mandated to minimize the risk of non-compliance to testing and to ensure that all positive tests were appropriately responded to while the traveller was locatable. To be clear, this 3-day stay in a Care Fiji Commitment (CFC) hotel was never a quarantine. The hotel stay is in place to facilitate the testing requirement on day 2 of arrival.

We have noted that while many countries have removed all forms of traveller sequestration, the in-country testing conditions continue. As such we are supporting current efforts to have more testing sites throughout Fiji to which travellers can book for testing, without requiring a hotel stay, as part of prior approval to come into Fiji. We are working together with the Ministry of Trade and Tourism and Ministry of Economy in the final phase of approving this in-country testing for international arrivals by private entities. These private entities will ensure that the test is available and the results will be reported back to Ministry of Health officials. They will also be mandated to report any international traveller who defaults from the mandatory testing. Any traveller defaulting a test will be subject to legal punitive measures.

• Ongoing Review of Non-Travel Partner Country Status

This ongoing effort is mediated through the Ministry of Commerce, Trade, Tourism and Transport, and the Ministry of Economy (COVID-19 Risk Mitigation Taskforce). Non-Travel Partner Status is assessed and graduated to Travel Partner status based on COVID-19 Transmission Data (cases, admission, and deaths), COVID-19 Community Surveillance data (Test per 1000, positivity rate), and ability to detect Variants (Access to genomic sequence capability). A list of Travel partner countries is available on the following link.

COVID-19 Situation Update

Friday 25th February

Transmission Update: Since the last update, we have recorded 35 new cases of which 24 new cases were recorded on 22/02/2022 and 11 new cases in the last 24 hours ending at 8 am this morning. Of the 35 cases recorded, 10 cases were recorded in the Central Division; 3 cases were recorded in the Western Division, 4 cases were recorded in the Northern Division, and 18 cases were recorded in the Eastern Division. The national 7-day rolling average of cases as of 19th February is 23 daily cases. In the 7 days until 22/02/2022, 46 new cases were recorded in the Central division, 17 new cases in the Western division, 11 new cases in the Northern Division, and 23 new cases in the Eastern Division. The Central Division cases constitute 68% of the cumulative total cases nationally, with the Western division making up 28%, 3% in the Northern Division, and 1% in the Eastern Division.

Deaths: The curves depict weekly COVID-19 deaths by division since May 2021. It indicates a surge from December-end 2021, which peaks by mid-January 2022. The 3rd COVID 19 wave is considered to have started around mid to late December 2021. (Note: Death notifications from the week 27/01/22 onwards are still being received, we are currently on week 20/02/2022, therefore the appearance of the graph from week 27/01/22 may change slightly). Analysis of Deaths in the Third Wave  Table 1: Death rates by Division Division Total COVID Deaths Deaths per 100,000 Central 60 14.9 Western 44 12.3 Northern 28 20.0 Eastern 5 13.0 An analysis of the 137 deaths recorded in the third wave show that, while 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 Age Group Total Deaths Deaths per 100,000 population 0 – 9 6 3.3 10-19 2 1.3 20-29 3 2.1 30-39 4 2.9 40-49 6 5.8 50-59 18 19.8 60-69 27 51.9 70-79 42 187.5 80-89 22 391 90-99 5 961.5 For the 137 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 Age Cohort Total COVID deaths Total Vaccinated/ Unvaccinated Deaths per 100,000 Vaccinated Population Deaths per 100,000 Unvaccinated Population >18 129 55/74 9.5 173.9 15-17 1 0/1 0 6.6 12-14 1 0/1 0 2.5 Out of 137 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 129 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, a death rate of 9.5 per 100,000 population for fully vaccinated adults and 173.9 for unvaccinated adults was exhibited. This means that unvaccinated adults in Fiji have been dying at a rate 18.3 times higher than fully vaccinated adults during the current COVID-19 wave. Individuals of 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. New deaths to report There are seven new COVID-19 deaths to report from the period 24th January – 9th February 2022. Please note that these deaths are reported today due to the recent issuance of death certificates. The Ministry of Health and Medical Services carried out a detailed investigation for all COVID -19 deaths before the release of information. The first COVID-19 death to report is of an 89-year-old male from the Western Division, who died at home on 24/01/2022. He was not vaccinated. The second COVID-19 death to report is of a 2 month-old male infant from the Western Division, who died at home on 25/01/2022. The infant had been sick for 2 days prior to his death. As per protocol, a COVID-19 test was performed when he was brought to the Lautoka Hospital, confirming a positive result. His hospital records reflected a congenital medical condition (from birth), which when assessed by doctors, had contributed to the severity of his illness. He did not belong to the vaccination eligible population, hence was not vaccinated. The third COVID-19 death to report is of a 36-year-old female from the Western Division, who died at home on 25/01/2022. She had predisposing medical conditions which were assessed to have contributed to the severity of her illness. She was fully vaccinated. The fourth COVID-19 death to report is of a 72-year-old female from the Western Division, who died at home on 26/01/2022. She was not vaccinated. The fifth COVID-19 death to report is of a 78-year-old female from the Western Division, who died at home on 03/02/2022. She was fully vaccinated. The sixth COVID-19 death to report is of a 68-year-old male from the Western Division, who died at home on 08/02/2022. He had predisposing medical conditions which were assessed to have contributed to the severity of his illness. He was fully vaccinated. The seventh COVID-19 death to report is of a 63-year-old female from the Western Division, who died at home on 09/02/2022. She was not vaccinated. There have been a total of 833 deaths due to COVID-19 in Fiji. Please note that 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. Therefore, as of February 17th, 2022, the national 7 days rolling average for COVID-19 deaths per day is 0.3, with a case fatality rate of 1.29%. We have recorded 891 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.

Hospitalization: There is a sustained downward trend in daily hospitalizations. Using the WHO clinical severity classification, a greater percentage, 75% (n=12) of the admissions of COVID-19 positive patients are categorised as asymptomatic and mild, 6% (n=1) is categorised as moderate and 19% (n=3) as severe with 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. The number of people being admitted because of COVID-19 remains low.

Testing: 277 tests have been reported for February 24th, 2022. Total cumulative tests since 2020 are 496,558 tests. The 7-day daily test average is 168 tests per day or 0.2 tests per 1,000 population. The national 7-day average daily test positivity is 9.7%. The high positivity rate is an indication of widespread community transmission.

Public Advisory:

Leptospirosis, typhoid fever, and dengue fever

The outbreak of leptospirosis in the Western Division continues, with 162 cases in total, of which 97 cases were reported in the last week, indicating a distinct upward trend. There are  25 admissions currently in all the hospitals in the West, of which 11 are in Lautoka hospital non-ICU wards and 7 are in the ICU ward requiring ventilation. The 11 admissions in non-ICU wards also include 4 cases that were previously in the ICU ward. The Lautoka team estimated that in the recent past, at least 70% of admissions to ICU have been due to leptospirosis. Cases have been predominantly in the 1 – 39-year-old age group, 61% male and 39% female, and 79% in the i-Taukei population.

The increasing hospitalisations and deaths caused by leptospirosis in the Western Division are of great concern. Sadly, 17 people have died of leptospirosis in the Western Division this year.

Our outreach team to Navosa is currently wrapping up operations this week following a successful campaign in the Navosa medical area. The new area of concern is the Ra Medical area where we have noted a marked increase in cases and hospitalisations.  We will be establishing support to the Ra Subdivision Medical Team on Monday by mobilizing a FEMAT team to look after Rakiraki Hospital and get the Rakiraki hospital team to conduct outreach services to bulk up primary health care services in the community. This will improve their ability to access hard-to-reach communities affected by recent floods and designated as red zones. Suspected cases will be counselled on ongoing care and the severely ill will be transferred to the hospital to receive the appropriate treatment. The team will also be able to review chronic medical cases and update their management. COVID immunisation and booster doses together with the catch-up immunisation campaign for children will run as a parallel program, together with a Social Welfare support program. Environmental Health Officers have also been brought in to work with the community in escalating cleanup efforts that help to control the population of communicable disease vectors such as mosquitoes, rats, and other rodents in affected areas.  Community engagement efforts are also in place measures to educate the community on the risk of exposure to floodwaters and to discourage our people from playing in flooded areas and muddy places that increase their risk of contracting leptospirosis and other water-borne diseases.

There has been a public request that the Ministry of Health should provide a breakdown of which areas in the division are considered red zones for these climate-sensitive diseases so as to help people be on the lookout especially if they are planning to visit certain communities. We need to be clear that the floods have affected all areas of the west. We are looking at geographical areas of concern for the purpose of mobilizing extra capability to help manage the outbreak and also escalate the promotion of preventative measures. To reduce your individual risk, it is important to understand that the risk to humans is mediated by greater occupational and recreational exposure to animals, soil, mud, and water.

Important prevention measures include wearing full covered footwear at all times when going outdoors, avoiding wading or swimming in flooded waters, regular use of clean fresh water to clean up, especially after exposure risk in flooded and/or muddy areas, and keeping all food and drinks covered and away from rats. For workplaces the importance of controlling pests, practising good personal hygiene, using 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, 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.

For typhoid fever, we have seen case numbers less than expected for the current period. We are hopeful that this is the impact of the WASH (Water, Sanitation and Hygiene) initiative that has been ongoing since tropical cyclone Yasa and Ana. Typhoid fever is typically found in areas that do not have access to clean drinking water such as rural areas and urban informal settlements. We strongly encourage people, especially those 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, but especially after visiting the toilet and before eating or preparing food.

Dengue cases are also within expected numbers however recent increases in cases do represent a serious concern. We continue to urge everyone to get rid of potential mosquito breeding places, such as empty containers outside your homes that may collect water, including discarded tires. You must also prevent yourself from being bitten by mosquitoes through the use of mosquito screens in your homes, and mosquito repellants.

Vaccination

We have completed our current stocks of AstraZeneca and we will get more stocks in the next 6 weeks. Meanwhile, we will continue to deploy Moderna and Pfizer as primary doses for children and adults, and booster doses for adults.

The booster dose program began at the end of November 2021. As of the 25th  of February, 101,807 individuals have so far received booster doses.

Many questions have been received on the role of post-infection immunity in defining our COVID-protected population. Then immunity gained through vaccination remains the only means by which we can measure immunity and therefore refine public health measures in the face of the ongoing risk of variant development and therefore future outbreaks. The Ministry of Health and Medical Services will continue to monitor the advisories on post-infection immunity based on quality data that is being generated globally

Living with COVID 19

The majority of new cases reported today are from the maritime islands and reflect ongoing transmission. There are 7 delayed death reports. This serves as a reminder that the COVID 19 remains a concern for Fiji.

We should be wary of efforts to remove all public health measures too soon. Globally, there are ongoing risks of variant development and therefore the escalation of the epidemic in Fiji. Building national resilience to living with COVID 19 is crucial. This requires 2 important strategies from a health program perspective.

1. More balanced use of public health measures.

Hand washing and cough etiquette are immovable as public health measures. Regular hand sanitization and coughing/sneezing into a tissue or handkerchief, or the bend of your elbow, are healthy habits that protect yourself and others from COVID-19 and other infectious diseases. Isolating yourself, or staying away from others, when you are sick with any respiratory illness is also a good habit to protect others, especially the vulnerable.

Masking, physical distancing, and ventilation are 3 measures that must constantly be present, but there is some flexibility in increasing 2 others when one of the measures becomes difficult to apply. Whatever the scenario, an effective mask must be kept close to you at all times. The current masking requirement that wearing a mask that covers your nose and mouth is mandatory in all public places for everyone aged 8 and over, including in public service vehicles remains in force. The Ministry of Health and Medical Services is looking into a list of exemption criteria; however, we expect that this list will not be exhaustive and we hope to leave some space for a common-sense approach to evolve.

In a setting where physical distancing of 2 metres is more difficult, then increasing ventilation and more strict masking practice will be needed even more.  A well-ventilated indoor space refers to an indoor space wherein there is a good movement of outside air coming into the space, and inside air is going out. A suboptimally ventilated space is bad for many reasons aside from COVID, however, in this scenario, the physical distancing rules will increase and masking is more necessary. For custodians of workplaces, houses of worship, and the like, balancing the relationship between ventilation, physical distance, and masking is the only way to ensure that services are COVID safe and can be customized to the principle of living with the virus. SOPs need to be configured to all activities that occur in your work or worship space in order to be COVID Safe resilient. We all want to mitigate the risk of unsustainable sick leave levels every time we get a variant, and more variants will come. Mitigating the risk of people getting sick is the best way to reduce further the risk of severe disease and death beyond the protection afforded by vaccination. Promoting good COVID safe principles in a common-sense approach is the best way to start.

2. Protecting the Vulnerable

We have highlighted how severe comorbidities and poor health-seeking behaviour have vastly contributed to severe outcomes in the COVID outbreak. We need to build resilience in the face of an endemic problem. Based on the lessons learned from the deaths, we need to:

• Prevent all preventable chronic diseases of which NCDs are the most prominent
• Promote the better control of controllable chronic diseases of which NCDs are the most prominent, and
• Build stronger support for better health-seeking behaviour, especially among the vulnerable amongst us

We are urgently reviewing and strengthening our public health measures to find, stop and prevent health threats wherever they arise. Our sub-divisional health teams have been reminded to review and strengthen their community surveillance program and line list management of vulnerable persons.

However, the impact of these efforts cannot be sustained unless we get a broad level of support from the community in implementing the above 3 strategies, and at the same time reducing the transmission of COVID-19 to protect our vulnerable populations. Maintaining the Vaccine Plus approach remains critical.

Thank you Serua- Namosi Province says the Minister for Health and Medical Services.

About 140 participants from the Serua Namosi Province including Beqa and Yanuca took part in a Covid-19 Community Engagement Workshop held at the Pearl Resort in Pacific Habour on Monday 21/2 and Tuesday 22/2/2022. The participants comprise village nurses, turaga ni koro, mata ni tikinas, Red Cross officials together with the Roko Tui and Provincial Administrator of the province.

The aim of the workshop was to capture and document the participants’ experiences, their successful stories, their challenges, and the action they took during the Covid-19 pandemic.  Dr. Ana Maisema the General Manager Incidental Management Team (IMT) says that the document produced after the ‘two-day workshop would be an important one to IMT and the Ministry as it would serve as a reference point on how we can better prepare and coordinate for any future pandemic.

The Minister for Health and Medical Services Hon. Dr Ifereimi Waqainabete whilst opening the workshop stresses to the participants the impact of their roles and responsibilities as they are the eyes and ears of government on the ground and without their combined efforts, our beloved Fiji would not be able to restore the sense of normalcy we enjoying today and on behalf of government I just want to say thank you all.

The workshop was funded by the World Bank Covid-19 Emergency Response Project Unit.