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COVID-19 Situation Update

Saturday 01st January 2022

Tests

As of today, rapid antigen tests conducted in the Ministry of Health and Medical Services health facilities are being added to testing numbers and test positivity calculations going back to December 23rd. Prior to this, only PCR tests were reported, though recently, rapid antigen test positives were also reported, and used in test positivity calculations. Furthermore, negative PCR test results from one lab were not being received nor added to the test count, while their positives were being reported. As test positivity is calculated by dividing positive tests by total tests, this resulted in test positivity being reported as higher than the actual. This has now been corrected. Nevertheless, it should be noted that test positivity remains high and the trend of test positivity remains the same as it continues to increase along with case numbers.

Epidemic Outlook:

The Ministry of Health continues to monitor the outbreak using indicators such as daily case numbers, hospitalizations, test positivity, and deaths.

Occupancy rates in health facilities, the occupancy rate of ICU beds, death rates, and vaccination coverage are indicators to monitor our health response capacity. While we see a low trend across indicators from our health facilities with increasing vaccination coverage for adults, 15-17-year-olds, and 12-14-year-olds in Fiji the current escalation of cases indicates a need for increased readiness and response levels for severe disease and hospitalization.

COVID-19 cases are increasing rapidly globally and especially so in Australia, and the European and Americas region, and throughout Africa.  The new highly transmissible variant Omicron is contributing significantly to this increase. As such, we anticipate an increasing number of cases from border quarantine facilities. Increased and sustained surveillance and testing at our borders, communities, and maritime islands are vital to monitor and detect COVID-19 cases for early intervention.

There is an increasing number of cases in all divisions which is anticipated to continue to increase, demanding ongoing surveillance for early intervention to mitigate COVID-19 risks.

Public Advisory:

The Ministry of Health and Medical Services has documented a resurgence in COVID-19 cases throughout Fiji while our hospitals are recording a lower than expected number of hospitalizations from the virus. The majority of individuals testing positive in medical facilities had presented for non-COVID medical problems and were found to be positive while undergoing routine screening as all admissions to the hospital are currently tested for COVID-19. It is likely that this is the impact of the vaccination and booster doses in preventing hospitalization, severe illness, and death. Our briefings have also revealed that almost all the cases turning positive have minimal symptoms and remain stable

Our contact tracing investigations reveal that the additional protection that vaccines provide against infection is evident. However, some recent events of excessive crowding in maritime vessels, sporting events, and social gatherings are proving to be superspreader events contributing significantly to the sharp surge in cases.

The overall goal of the MOHMS COVID-19 pandemic response and recovery is to suppress ongoing community transmission to a level that will minimize hospitalization, severe illness, and deaths, as well as minimize severe societal disruption. We are prioritizing the promotion of individual COVID safe measures (vaccination, masking, physical distancing, avoiding crowds, hand hygiene), followed by settings-based measures (social gathering restrictions, indoor capacity restrictions, ventilation, and curfews). We would like to avoid population blanket measures such as lockdowns, which we used earlier in this pandemic, as such measures have also negatively impacted our communities on other fronts.  In our own recent experience, such measures have limited scope in the control of the spread of COVID-19 in Fiji. In addition, with more than 92% of adults in Fiji vaccinated, and with the added natural immunity expected from the large number of people who were infected during the last wave on Viti Levu, we are no longer the COVID-naive population that we were before. The immunity that has been built through vaccination, and prior infection, is evidently having a significant impact in reducing severe disease in this third wave.

We will continue to work towards suppressing community transmission because we know that even if the proportion of severe cases relative to all cases is less in this third wave, a smaller percentage of severe disease in a larger number of cases will still result in a large number of sick individuals admitted to hospital, which could still overwhelm the health system’s capacity to manage. For now, we have a window of opportunity to prevent such an occurrence. This will entail adherence to COVID safe measures and having in place measures that ensure that all those vulnerable to severe disease are adequately monitored, tested, retrieved, and effectively managed in a timely manner before their conditions worsen. The latter needs the cooperation and support of community networks in formal and informal community settings and business settings, working in tandem with the Ministry. It requires that a register of vulnerable persons is established and kept in each of the settings mentioned and leaders in these settings set up a means by which vulnerable persons are checked on. If they do not feel well, they should be tested early and if positive, the nearest medical team is informed so that measures are put in place to ensure early access to medical treatment with any early signs of deterioration.

The 2 covid related deaths reported today highlight the need for such vigilance in persons with significant underlying medical conditions, especially if they are elderly.

We are seeing an increase in cases in the maritime islands and this was expected given the opening of maritime travel and the many social media postings of crowding in maritime vessels and in social gatherings. Medical Teams and supplies are being set up and being deployed to maritime islands communities reporting a surge in positive cases.

Reports of transmission to medical staff as well as staff in other workplaces are increasing, and as such isolation and quarantine measures will impact workplace outputs. The scientific basis for defining contacts and the conditions of quarantine and isolation has not changed. We note that some health authorities overseas are reducing the duration of quarantine and isolation periods. The rationale and evidence in support of these less stringent conditions are context-specific and as such we are reviewing our protocols which we will be communicating soon. All business and commercial entities need to be aware that the situation is continuously changing.

The Ministry of Health and Medical Services has also discussed with the Ministry of Education, Heritage, and Arts the current plans for school opening. We have consulted with the World Health Organisation, and UNICEF, reviewed all the evidence and taken into account our current situation, and we support the planned reopening of schools scheduled for the 4th of January 2022. We will continue to monitor our community surveillance parameters and work with the Ministry of Education to facilitate the safe opening of schools.

Our medical teams have continued to work day and night, and through the public holidays, providing healthcare to the sick, facilitating logistical requirements of medical supplies at the frontline, moving medical teams to areas of disease transmission, providing testing, continuing vaccination booster doses, protecting aged care homes, facilitating outreach to remote settings, establishing medical and community-based line lists that ensure timely follow-up of high-risk individuals, setting up intermediate care facilities with appropriate standard operating procedures, in addition to delivering normative medical care. All these activities have now escalated significantly with this new wave of the virus. At the same time, we are updating our contingency plans to be able to effectively respond to any adverse climatic weather conditions, under COVID safe conditions.

While we have also recalled targeted health staff who are on annual leave, we are very mindful of the fact that many of our staff are tired and in need of rest and recuperation. As such, senior managers have been instructed to be judicious in the deployment of staff for the various activities that need to be implemented. We have reminded all medical teams to remain professional at all times irrespective of the ongoing stressors of the pandemic and difficult individual situations. And we are committed to supporting our teams through these difficult times.

As Permanent Secretary, I am confident that our plans to mitigate this 3rd wave and the potential health impact of any severe adverse weather condition is sufficient. However, our ability to scale up these plans in a timely manner will be dictated by the impact of these natural events and will remain challenging. The need for community-wide support in terms of adherence to COVID Safe measures, instituting measures to deal with the risk of flooding and other impacts of adverse weather conditions, and facilitating ongoing vaccination is urgent and essential.

We need our people to develop and inculcate safe COVID habits into their daily living to safely navigate the current pandemic without relying on mandates and rules to do so. Enforcing settings-based measures and enforced rules are just one of many ways to promote a message to build better population-wide COVID safe habits. These COVID habits will also protect us from many other debilitating and deadly respiratory infections.

COVID-19 Situation Update

Wednesday, 29th December

Epidemic Outlook:

The Ministry of Health continues to monitor the outbreak using indicators such as daily case numbers, hospitalizations, test positivity, and deaths.

Occupancy rates in health facilities, the occupancy rate of ICU beds, death rates, and vaccination coverage are indicators to monitor our health response capacity. While we see a low trend across indicators from our health facilities with increasing vaccination coverage for adults, 15-17-year-olds, and 12-14-year-olds in Fiji the current escalation of cases indicates a need for increased readiness and response levels for severe disease and hospitalization.

COVID-19 cases are increasing rapidly globally and especially so in Australia, and the European and Americas region, and throughout Africa.  The new highly transmissible variant Omicron is contributing significantly to this increase. As such, we anticipate an increasing number of cases from border quarantine facilities. Increased and sustained surveillance and testing at our borders, communities, and maritime islands are vital to monitor and detect COVID-19 cases for early intervention.

There is an increasing number of cases in all divisions which is anticipated to continue to increase, demanding ongoing surveillance for early intervention to mitigate COVID-19 risks.

Public Advisory:

The assessment of the Ministry of Health and Medical Services is that the current increase in COVID-19 cases represents the beginnings of the third wave of COVID-19 in Fiji. This may be a resurgence of the endemic Delta variant, however,  we are also working on the assumption that the Omicron variant is already here, and is being transmitted within the community. We expect that genomic sequencing results of COVID-19 positive samples sent overseas will confirm this in due course. Should this wave be driven by the Omicron variant, based on what we are seeing overseas, we should expect a large number of cases, and we will also expect that infections will occur in vaccinated persons and those who have previously been infected with the Delta variant. However, it is important to remember that those who are vaccinated or had booster doses are far less likely to become sick enough to require hospitalization. The main focus of our vaccination program is preventing severe illness and death, which will also help to limit the strain on our medical services. Any additional protection that vaccines can provide against infection is an added bonus.

The three divisional hospitals are reporting an increase in positive cases admitted to the hospital, however, none of the cases so far are presenting with COVID-related medical problems. They are being admitted for other medical conditions and are testing positive during mandatory testing for all admissions to the hospital.

The overall goal of the MOHMS COVID-19 pandemic response and recovery has always been to minimize severe illness and deaths. This goal remains, along with reducing severe societal disruption as a result of the COVID-19 pandemic our priority is the promotion of individual COVID safe measures (vaccination, masking, physical distancing, avoiding crowds, hand hygiene), followed by settings-based measures (social gathering restrictions, indoor capacity restrictions, ventilation, and curfews). We intend to avoid population blanket measures, like lockdowns, as much as possible as, almost two years into the pandemic, such measures are damaging to our community on many different levels, and in our own recent experience, have limited value in controlling the spread of COVID-19 in Fiji. Also, with more than 91% of adults in Fiji vaccinated, plus added immunity expected due to the large number of people that were infected during the last wave on Viti Levu, we are no longer the COVID-naive population that we were before. The immunity that has been built through vaccination, and prior infection, is expected to have a significant impact on reducing severe disease in this next wave.

We are expecting cases to be reported in the maritime islands given the opening of maritime travel and the many social media postings of crowding in maritime vessels and in social gatherings. These maritime islands, and the Northern Division, were largely spared the Delta outbreak that affected Viti Levu earlier this year. The main advantage in these islands and the Northern Division is that >80% of the adult population have been vaccinated plus a significant number of children above 15. They have also been recently vaccinated and as such waning immunity may be less of an issue. Therefore, we expect that there is a high level of protection against severe disease and hospitalization in the Northern Division and maritime islands. Medical Teams and supplies are being set up and prepositioned for deployment to Maritime Islands.

We are expecting that transmission to medical staff and staff in other workplaces will begin to increase, and isolation and quarantine measures will impact workplace outputs. Based on the current evidence, both quarantine (for close contacts of cases) and isolation (for positive cases) will be for 10 days, and there is no need for exit testing unless a close contact becomes symptomatic during quarantine.  The conditions for quarantine and isolation remain the same. We are aware that there are some authorities overseas who are reducing the duration of quarantine/isolation. The rationale and evidence in support of these less stringent conditions are context-specific, and may not yet be appropriate for our setting. We are reviewing the evidence, and our specific context, and will announce any changes accordingly.

All leave for medical staff in the North will be deferred from tomorrow onwards to support the need for extra staff in health facilities.

We have reminded all medical teams to remain professional at all times irrespective of the ongoing stressors of the pandemic and difficult individual situations. And we are committed to supporting our teams through these difficult times. The teams will focus on identifying, protecting, and monitoring the vulnerable and escalate care as required. This will include the focus on booster doses, protecting aged care homes, outreach to remote settings, line listing and follow-up of high-risk individuals, and setting up intermediate care facilities with appropriate standard operating procedures.

At some point, we will need people to develop safe COVID habits to safely navigate the current pandemic and not rely on mandates and enforced rules. Enforcing settings-based measures and enforced rules are just one of many ways to promote a message to build better population-wide COVID safe habits. We are hoping that in due course these COVID safe measures will become habits, as they also protect us from a wide range of respiratory infections.

COVID-19 Situation Update

Monday 27th December

Epidemic Outlook:

The Ministry of Health continues to monitor the outbreak using indicators such as daily case numbers, hospitalizations, test positivity, and deaths.

Occupancy rates in health facilities, the occupancy rate of ICU beds, death rates, and vaccination coverage are indicators to monitor our health response capacity. While we see a low trend across indicators from our health facilities with increasing vaccination coverage for adults, 15-17-year-olds, and 12-14-year-olds in Fiji the current escalation of cases indicates a need for increased readiness and response levels for severe disease and hospitalization.

COVID-19 cases are increasing rapidly globally and especially so in the European and Americas region and throughout Africa.  The new highly transmissible variant Omicron is contributing significantly to this increase. As such, we anticipate an increasing number of cases from border quarantine facilities. Increased and sustained surveillance and testing at our borders, communities, and maritime islands are vital to monitor and detect COVID-19 cases for early intervention.

There is an increasing number of cases in all divisions which is anticipated to continue to increase, demanding ongoing surveillance for early intervention to mitigate COVID-19 risks.

Public Advisory:

Cases of COVID 19 continue to be identified among travelers into Fiji. All these cases were in fully vaccinated individuals who tested negative on their 3-day pre-departure PCR test and are currently in isolation within hotels, with protocols that have been well-rehearsed in the lead up to border opening and continue to be overseen by MOHMS in the Western Division. All their positive samples will be sent to our partner laboratory in Australia for genomic sequencing. As previously mentioned, if a variant is transmissible enough, stringent border and community measures will only delay the inevitable entry and spread of current and future variants of the COVID-19 virus. To protect ourselves, our loved ones, and our country, we must all get vaccinated when it is our turn and continue to be strict with our covid safe measures.

We are expecting escalated levels of community transmission to be more evident over the ensuing weeks. We are working on the assumption that the Omicron variant is already in Fiji and is being transmitted within the community. We expect that genomic sequencing results of positive samples sent overseas will bear this out.

The widespread community transmission of COVID-19 in the North is evident. This was expected when borders between Viti Levu and Vanua Levu were opened as the North was largely spared the Delta outbreak that affected Viti Levu earlier this year. The main advantage in the North is that >80% of the adult population have been vaccinated plus a significant number of children above 15. They have also been recently vaccinated and as such waning immunity may be less of an issue. Therefore, we expect that there is a high level of protection against severe disease and hospitalization in the Northern Division. Unfortunately, among the unvaccinated, it is unlikely that there is a significant level of “natural immunity” or immunity acquired after infection and thus they remain more vulnerable to severe effects of COVID 19 infection. We also know that immunity may wane faster in some vulnerable people, especially the elderly. Therefore, booster doses for those who were vaccinated earlier in the program, and for vulnerable groups, are essential.

We are also aware that there is an increase in evidence of positive cases in the community within Viti Levu. The feedback from hospital admissions is that we noticed an increase in COVID positive tests even though none of the cases so far are presenting because of COVID disease.  This is an indication of escalating levels of infection in the community. The widespread infections that occurred during the outbreak earlier this year, and high levels of vaccination, in Viti Levu are expected to be protective, however, it is expected that waning immunity levels will be more of an issue.  Vaccine booster doses for those 5 months beyond their second dose is essential.

In Suva, we currently have defined 65 active cases however we are sure that this is an underestimate and there are many more. We have been informed that there was a particular restaurant in which there was a Christmas party and 4 attendees have been found positive. We are currently doing our usual contact tracing operations; however, we are grateful that a number of attendees, some of whom are symptomatic have presented themselves for testing. This is not unexpected as covid safe measures with vaccination reduce the risk of getting infected but do not remove that risk. Current indications are that all those who tested positive are stable and that all attendees of the function were fully vaccinated. We remain very confident that there are other events and gatherings happening throughout the weekend and expect cases to escalate. We also expect that if fully vaccinated many of these persons will have significant protection against hospitalization and severe disease.

The possibility of reintroducing earlier curfews, placing more restrictions on gatherings, and escalating further our masking mandates is always under consideration, however, we plead with the public to demonstrate good sense and apply these restrictions on yourselves without the need for directives and strong enforcement actions to remind you of the COVID Safe measures.

Moving forward, in dealing with the current situation the Ministry of Health and Medical services will:

1. Continue to focus on vaccination, suppressing transmission, protecting health services, and monitoring the key indicators (cases and transmission/testing and test positivity/severity/hospitalizations/deaths) to inform local decision-making and adjust divisional and sub-divisional action plans.
2. Continue to roll out the booster dose program for everyone over the age of 18.
3. Continue to test if you develop any COVID-19 like symptoms that include any of the following: cough, runny nose, nasal congestion, sneezing, fatigue/extreme tiredness, loss of taste or smell, headache, aches, and pains, sore throat, fever, diarrhea, red eyes, skin rash. Please visit a screening clinic nearest you OR call 158.
4. Testing will be prioritized for high-risk individuals; vulnerable and symptomatic persons and household contacts. This includes people over the age of 50 years, with underlying health conditions: diabetes, heart disease, kidney disease, asthma, are obese or are pregnant.
5. Our contact tracing protocols are being escalated, therefore, please keep your careFIJI app switched on when you are out of your house and scan your QR code when entering or leaving any premises
6. Both quarantine (for close contacts of cases) and isolation (for positive cases) will be for 10 days duration and there is no need for exit testing unless a close contact becomes symptomatic during quarantine.
7. In all the divisions we are setting up intermediate care facilities to cater to those high-risk individuals who are stable but need facility isolation to ensure better monitoring.
8. We are deploying more human and other medical resources to the North with particular emphasis on ensuring reserve capacity with PPEs, Oxygen, and Oxygen delivery capacity, and essential medicines and consumables needed for management of cases.
9. We have in place measures to reduce the risk of people with severe COVID-19 dying at home, or coming to a medical facility in the late stages of severe illness. We do this by:

• Strengthening our ability to register positive cases and vulnerable persons on our line listing,
• Ensure awareness of the signs and symptoms of severe disease, and facilitate support by us or other personnel to detect early evidence of severe disease
• Admit vulnerable positive persons to intermediate care facilities if they cannot be well observed in the home setting.
• Strengthening our ability to provide outreach care and case retrieval

These measures however will require extra resources over and above what we have and as such we will continue to work with our community engagement and various community groups to provide support

The Health Ministry and the health care staff in the North have escalated the measures in place aimed at protecting residents of Vanua Levu from the severe effects of COVID-19. Our health care workers are now on-call to protect lives and mitigate community transmission. They are aided by other government officials from various government agencies in the north in tracing contacts, caring for patients who develop severe disease, and monitoring individuals under isolation. We need the public to cooperate with health care workers and adhere to our COVID safe measures to ensure that this surge in COVID-19 positive cases in the Northern Division is managed and contained.

As for the rest of Fiji, please practice responsible social gatherings and diligently adhere to the COVID-19 safe measures. Be wise about your social gatherings, and postpone them if you can.  During these pandemic times, it is best that you remain at home and celebrate with your loved ones, rather than gather in large numbers and potentially put at risk the vulnerable members of your families; including those who are unvaccinated. We must all assume that those around us are COVID-19 positive and so we must protect ourselves at ALL times.

Public Advisory

26th December. 2021

The Ministry of Health & Medical Services has noticed that there has been a recent spate of cases of accidental Insecticide poisoning in the community reported from within Viti Levu and Vanua Levu which has resulted in near fatalities with cases requiring ICU care due to respiratory failure. This is from using insecticide concentrates that contain organophosphates e.g MAPA DIAZINON 60. Large doses of organophosphates can also harm people and other animals and poisoning can occur when you’re exposed to them for too long or at high levels.

The initial reports indicate that for most of those admitted the main factor was improper use of pesticides to deal with bed bugs with either the pesticides being used in poorly ventilated spaces and/or the space is not aired out well before reentry. The danger of an entire family being exposed overnight has also been seen and likewise, also people underestimate the dangers of using reconstituted insecticides in domestic settings.

The public is strongly advised to please read carefully the instructions, use protective gear when mixing and dispersing insecticides and if used indoors, ensure the indoor space is well aired out before being re-engaged. Better still get a professional to fumigate your home.

After using insecticides in indoor settings, evidence mild or early symptoms include impaired, blurry vision, stinging eyes, runny nose, watery eyes, excess saliva, headache, nausea, muscle weakness, muscle twitching, and agitation.
Evidence of dizziness, disorientation, coughing and wheezing, difficulty breathing, drooling or excessive phlegm, muscle twitching and tremors, muscle weakness, fatigue, severe vomiting and diarrhea, and involuntary urination and defecation is considered moderate symptoms.

Severe cases will have confusion, agitation, convulsions, excessive body secretions, including sweat, saliva, mucus, and tears, irregular heartbeat, collapse, respiratory depression or arrest, and coma.

Whilst early medical intervention can save lives, prevention is far better than the cure.

27^th December 2021

Public Advisory for residents of Vanua Levu

If you are in Vanua Levu and develop any symptoms of COVID-19, visit a screening clinic nearest you to be checked and tested by our medical teams, or call 158 for screening clinic information.

Symptoms of COVID-19 include any of the following: Cough, runny nose, nasal congestion, sneezing, fatigue/extreme tiredness, loss of taste or smell, headache, aches and pains, sore throat, fever, diarrhea, red eyes, skin rash.

Testing will also be prioritized for high-risk individuals (If you have any symptoms and are over the age of 50 years or you have underlying health conditions such as diabetes, heart disease, kidney disease, asthma, are obese, or are pregnant), vulnerable and symptomatic persons, and household contacts.

As well as getting tested you must isolate yourself from others if you have symptoms or you have had contact with someone confirmed as a case of COVID-19.

For those on home isolation, you are to ISOLATE from others including other members of your household for at least 10 days. Stay at home. As much as possible, maintain a physical distance of 2m between yourself and other members of your household, and wear a mask that covers your nose and mouth. Drink plenty of fluids, and take paracetamol for pain and fever.

Most importantly, watch for severe COVID-19 symptoms.

Severe COVID-19 is a medical emergency, and a delay in receiving appropriate medical treatment reduces your chance of recovering from the disease. You do not need to have a positive test result to watch out for these symptoms. We need all Fijians to know the severe symptoms of COVID-19, which include the following:

•             Difficulty breathing
•             Persistent pain or pressure in the chest
•             Severe headache for a few days
•             New confusion, inability to wake or stay awake
•             Pale, gray, or blue-colored skin, lips, or nail beds

Call 158 if you experience severe COVID -19 symptoms.

For individuals in other parts of Fiji: 

Please call 158 or go to your nearest screening clinic for testing if you have any symptoms of COVID-19. If you do leave your home to go to a screening clinic: please wear a mask that covers your mouth and nose, keep at least 2 meters between yourself and others outside your household, wash your hands with soap and water frequently, or use a hand sanitizer. Download and activate the CareFIJI app on your phone, and avoid using public transport.

Call 158 if you have been in contact with someone confirmed as a case of COVID-19.