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COVID-19 Situation Update

Wednesday 23rd 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 weeks 27/01/22 onwards are still being received, we are currently on week 14/02/2022, therefore the appearance of a downward trend on the graph from week 27/01/22 may not be accurate. There are deaths from the Western Division currently under investigation for the same period hence, the death rate for the division may increase). 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 37 10.4 Northern 28 20.0 Eastern 5 13.0 An analysis of the 130 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. (Note: There are deaths currently being investigated from the Western Division for the same period, therefore the rate for the division may increase). Table 2: Deaths by Age Group Age Group Total Deaths Deaths per 100,000 population 0 – 9 5 2.7 10-19 2 1.3 20-29 3 2.1 30-39 3 2.2 40-49 6 5.8 50-59 18 19.8 60-69 26 50.0 70-79 41 180.0 80-89 21 373.2 90-99 5 961.5 For the 130 deaths in the third wave, the death rate adjusted per 100,000 population, has been highest in age groups 50 and onwards. There were 7 deaths below the age of 19 years, 6 out of the 7 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 >18 123 52/71 9 163.2 15-17 1 0/1 0 6.6 12-14 1 0/1 0 2.5 Out of 130 COVID -19 deaths reported in the third wave, five (5) deaths were in the population not eligible for vaccination (under age 12). An analysis of the 125 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 9.0 per 100,000 population for fully vaccinated adults and 165.5 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 no new COVID-19 deaths to report today. There has been a total of 826 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 0.4, with a case fatality rate of 1.29%. We have recorded 879 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, 84% (n=11) of the admissions of COVID-19 positive patients are categorised as asymptomatic and mild, 8% (n=1) 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: 226 tests have been reported for February 22nd, 2022. Total cumulative tests since 2020 are 496,126 tests. The 7-day daily test average is 161 tests per day or 0.2 tests per 1,000 population. The national 7-day average daily test positivity is 10.5%. 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 test positive cases recorded so far this year. There have also been 110 cases in Central, 67 in the North, and 8 cases in the Eastern Division. 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. There have been 108 leptospirosis admissions in the West this year. An increasing trend is noted, with 17 cases two weeks ago, and 42 admissions last week. 27 hospital admissions have been reported at Rakiraki hospital, with 19 of these admissions in the last week. Ba hospital has recorded 19 admissions, with 5 in the last week. Nadroga/Navosa subdivision has had 14 hospital admissions, with 5 in the last week. Nadi hospital reported 9 admissions, with 5 in the last week. And Tavua subdivision with 5 hospital admissions, including 4 in the last week. There have been 52 leptospirosis admissions to Lautoka hospital, including transfers of patients admitted at the above-mentioned subdivisional hospitals.

Sadly, 17 people have died of leptospirosis in the Western Division this year, with 1 more death since the last update on 21/02/22.

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 mobilizing support to the Ra Subdivision Medical Team to meet the escalated need of accessing 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, practicing 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 23rd  of February, 98,683 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

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 the 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.

COVID-19 Situation Update

Monday 21st February

Public Advisory:

Leptospirosis, typhoid fever, and dengue fever

We have an outbreak of leptospirosis in the West and the Central Division, an increasing trend of leptospirosis in the North, and dengue fever in the Western Division. These are both climate-sensitive diseases that are endemic to Fiji.

For leptospirosis, most of the cases are in the West, with Lautoka hospital recording a total of 63 hospital admissions. Of these admissions, 39 cases were admitted to Sub-Divisional Hospitals and 24 cases in Lautoka hospital. Even more concerning is that we had 12 admissions to Lautoka hospital over the weekend of which 9 were admissions to the Intensive Care Unit. We also have a smaller leptospirosis outbreak in the Central Division with 4 admissions to the hospital and none of these current admissions needing ICU care. Labasa hospital has currently had 9 admissions for leptospirosis.

There have been 5 more leptospirosis deaths since the last update on February 16th, with 4 deaths in the West (from Bukuya, Tavua, and Rakiraki) and 1 in the Northern Division (from Macuata). 3 of the people who died were in their 20s; 1 was in their 30s; 1 was in their 50s. This brings to a total of 19 deaths nationally, with 16 deaths in the West, 1 in the Central Division, and 2 in the North this year.

As previously reported, delay in accessing care has been noted to contribute significantly to these adverse outcomes.

The clinical and epidemiological data indicate that males and young adults aged 20-49 years high-risk groups, and young iTaukei males are overly represented in cases and severe outcomes. The disease however can however infect anyone as the risk is mediated by greater occupational and recreational exposure to animals, soil, mud, and water. Of particular note is the playing of sports on muddy flood-affected grounds. Other risk factors include farming, working outdoors or in abattoirs; living in households that have rats living nearby; raising pigs at home, or the presence of pigs in the community.

Members of the public must understand that to prevent leptospirosis, one should avoid wading or swimming in flooded waters, wear shoes when outside, and keep 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 had 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 practice 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.

Our outreach team to Navosa is currently wrapping up operations this week. The team was able to facilitate access into poorly accessible areas affected by floods and designated as red zones. Suspected cases were counselled on ongoing care and sick ones were transferred to the hospital to receive the appropriate treatment. They were also able to review chronic medical cases and update their management. COVID immunisation and booster together with catch-up immunisation was run as a parallel program together with a Social Welfare support program. Environmental Health Officers were also brought in to assist with coverage of the areas of need.

Vaccination

We have completed our current stocks of Astrazeneca and we will get more stocks in the next 6 weeks. 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 21st of February, 97215 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 a vaccination program 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

We need to 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 a 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 customised 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.

COVID-19 Situation Update

Friday 18th February

Public Advisory:

Leptospirosis, typhoid fever, and dengue fever

With the recent heavy rains and flooding in parts of Fiji, we anticipate an increase in leptospirosis, typhoid and dengue fever, as these are climate-sensitive diseases that are endemic to Fiji.

In Fiji, leptospirosis is endemic and is common in both rural and urban areas where there is exposure to the urine of animals such as rats, pigs, cows, and dogs, and where there is frequent flooding, or poor drainage, resulting in people walking through muddy ground or waters. Every year we get an increase in cases noted during the wettest months from November to April. The clinical and epidemiological data indicate that males and young adults aged 20-49 years high-risk groups, and young iTaukei males are overly represented in cases and severe outcomes. The disease however can however infect anyone as the risk is mediated by greater occupational and recreational exposure to animals, soil, mud, and water. Of particular note is the playing of sports on muddy flood-affected grounds. Other risk factors include farming, working outdoors or in abattoirs; living in households that have rats living nearby; raising pigs at home, or the presence of pigs in the community.

Members of the public must understand that to prevent leptospirosis, one should avoid wading or swimming in flooded waters, wear shoes when outside, and keep 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.

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 who live in these areas, and any other areas without access to clean drinking water, 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.

The WASH (Water, Sanitation and Hygiene) initiative to provide safe drinking water, proper sanitation facilities, and a hygienic environment and livelihood to people including especially the promotion of hygiene among food handlers has been an ongoing program since tropical cyclones Yasa and Ana.

Although Dengue case numbers are within the expected numbers expected for this time of the year, in the Western Division, where we are starting to see an increase after the recent heavy rain and floods, therefore, 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.

The Ministry of Health and Medical Services Communicable Disease Committee has been activated and is assisting the Divisional Command Centres in responding to cases of leptospirosis, typhoid, and dengue fever, including raising awareness amongst the public and providing refresher training for medical professionals in primary care for early diagnosis and treatment.

Additionally, we have deployed specialist outreach teams to areas that are viewed as difficult to reach and at risk. We have a FEMAT team deployed to Navosa, and a mobile team led by our Hon Minister will visit communities on Kadavu island over the next few days as part of the Ministry’s community engagement strategy.

Vaccination

The booster dose program began at the end of November 2021. As of February 18th, 96,118 individuals have so far received booster doses of the Moderna and 397 individuals have received the Pfizer booster COVID-19 vaccine. For the month of February, a further 175,558 have become eligible for booster doses. We are targeting to cover all these eligible individuals in the days ahead. Please come forward to get your booster (3rd dose) vaccine if you are aged 18 or over and it has been at least 5 months since your second dose.

Increasing our vaccination coverage for the last 8% of our adult population remains a challenge, despite the increased risk of severe outcomes in this group. We remain gravely concerned that we continue to receive requests for vaccine exemption from persons with medical comorbidities, especially NCDs; their medical condition is an indication for vaccination, and granting the exemption is not an option for any qualified medical person.

During this third wave, unvaccinated deaths in the vaccine-eligible population are occurring at 17 times the rate of vaccinated deaths. This is a strong indication that many of the unvaccinated deaths in the vaccine-eligible population were preventable. I strongly urge anyone who hasn’t been vaccinated to get vaccinated now because COVID-19 is here to stay, and Omicron will not be the last variant. And if you are vaccinated, but know someone who isn’t, please also encourage them to protect themselves by getting vaccinated.

The Vaccine Plus Approach

We have had inquiries from the public on further relaxation of personal covid safe measures such as masking. As I have mentioned in the past, COVID-19 is not going to have a clean pandemic endpoint where we close off all chains of transmission and drive cases to zero. COVID-19 has an endemic endpoint, and in Fiji, as is with the rest of the world, societies will have to adapt to living alongside COVID-19 by making some deliberate choices about how to coexist.

The endemic disease does not mean unmanaged disease. Our current tracking indicates ongoing consequences especially for the vulnerable in society and the delays in seeking and reaching care is a major factor. We also have the global risk of variants developing elsewhere and spreading to Fiji.

The Vaccines Plus approach is the only means available to us. Until the consequences of COVID-19 are comparable to daily normal risks and the global threat of resurgence is low, the need for masking mandates to facilitate a public health imperative will still be needed.

So, while we have a high level of vaccination we continue to emphasize ventilation, masking, physical distancing, cough/sneeze etiquette, hand washing, and isolating from others if you have symptoms.

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 you 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. When one of the measures becomes difficult to apply, implementation of the other two measures must be further escalated. Whatever the scenario, an effective mask must be kept close by you at all times. The current masking requirement of 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 has published a list of circumstances where a person is exempt from wearing a mask.

In a setting where physical distancing of 2 metres is 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 poorly ventilated closed space is bad for many reasons aside from COVID-19, 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. 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.

COVID-19 Situation Update

Wednesday 16th February

Public Advisory:

Leptospirosis, typhoid fever, and dengue fever

With the recent heavy rains and flooding in parts of Fiji we anticipate an increase in leptospirosis, typhoid and dengue fever, as these are climate-sensitive diseases that are endemic to Fiji.

For leptospirosis we have recorded 179 cases nationally since the beginning of the year, of which the Central division reported 65, the Eastern division 3, the Northern division reported 38, and 73 cases have been reported from the West. Case numbers are above the expected numbers for this time of the year in the West and Central Division. There is also an increasing trend noted in the North. Hospital admission and deaths data indicate that most of the hospital admissions and deaths are in the Western division. There have been 14 deaths, with 12 in the Western Division, 1 in the Central Division, and 1 in the Northern Division. The majority of hospital admissions in the Western Division are from Ba, Nadroga/Navosa, Rakiraki, and some parts of Lautoka. The majority of admissions in the Central Division have been from Serua/Namosi, Wainibokasi and Tailevu. As previously reported, delay in accessing care has been noted to contribute significantly to these adverse outcomes.

In Fiji, leptospirosis is endemic and is common in both rural and urban areas where there is exposure to the urine of animals such as rats, pigs, cows, and dogs, and where there is frequent flooding, or poor drainage, resulting in people walking through muddy ground or waters. Every year we get an increase in cases noted during the wettest months from November to April. The clinical and epidemiological data indicate that males and young adults aged 20-49 years high-risk groups, and young iTaukei males are overly represented in cases and severe outcomes. The disease however can however infect anyone as the risk is mediated by greater occupational and recreational exposure to animals, soil, mud, and water. Of particular note is the playing of sports on muddy flood-affected grounds. Other risk factors include farming, working outdoors or in abattoirs; living in households that have rats living nearby; raising pigs at home, or the presence of pigs in the community.

Members of the public must understand that to prevent leptospirosis, one should avoid wading or swimming in flooded waters, wear shoes when outside, and keep 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 reported 30 cases since the beginning of the year of which 11 were from the Central Division, 14 in the Western Division, and 5 in the North. Case numbers of typhoid fever are below the expected numbers for this time of year. 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 who live in these areas, and any other areas without access to clean drinking water, 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.

The WASH (Water, Sanitation and Hygiene) initiative to provide safe drinking water, proper sanitation facilities, and a hygienic environment and livelihood to people including especially the promotion of hygiene among food handlers has been an ongoing program since tropical cyclones Yasa and Ana.

There have been 213 cases of dengue fever reported, which is within the expected numbers expected for this time of the year. However, 100 of these cases are in the Western Division, where we are starting to see an increase after the recent heavy rain and floods, therefore, 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.

The Ministry of Health and Medical Services Communicable Disease Committee has been activated and is assisting the Divisional Command Centres in responding to cases of leptospirosis, typhoid, and dengue fever, including raising awareness amongst the public and providing refresher training for medical professionals in primary care for early diagnosis and treatment.

Additionally, we have deployed specialist outreach teams to areas that are viewed as difficult to reach and at risk. We have a FEMAT team deployed to Navosa, and a mobile team led by our Hon Minister will visit communities on Kadavu island over the next few days as part of the Ministry’s community engagement strategy.

Vaccination

The booster dose program began at the end of November 2021. As of February 14th, 94,566 individuals have so far received booster doses of the Moderna and 60 individuals have received the Pfizer booster COVID-19 vaccine. For the month of February, a further 175,558 have become eligible for booster doses. We are targeting to cover all these eligible individuals in the days ahead. Please come forward to get your booster (3rd dose) vaccine if you are aged 18 or over and it has been at least 5 months since your second dose.

Increasing our vaccination coverage for the last 8% of our adult population remains a challenge, despite the increased risk of severe outcomes in this group. We remain gravely concerned that we continue to receive requests for vaccine exemption from persons with medical comorbidities, especially NCDs; their medical condition is an indication for vaccination, and granting the exemption is not an option for any qualified medical person.

During this third wave, unvaccinated deaths in the vaccine-eligible population are occurring at 17 times the rate of vaccinated deaths. This is a strong indication that many of the unvaccinated deaths in the vaccine-eligible population were preventable. I strongly urge anyone who hasn’t been vaccinated to get vaccinated now because COVID-19 is here to stay, and Omicron will not be the last variant. And if you are vaccinated, but know someone who isn’t, please also encourage them to protect themselves by getting vaccinated.

The Vaccine Plus Approach

We have had inquiries from the public on further relaxation of personal covid safe measures such as masking. As I have mentioned in the past, COVID-19 is not going to have a clean pandemic endpoint where we close off all chains of transmission and drive cases to zero. COVID-19 has an endemic endpoint, and in Fiji, as is with the rest of the world, societies will have to adapt to living alongside COVID-19 by making some deliberate choices about how to coexist.

The endemic disease does not mean unmanaged disease. Our current tracking indicates ongoing consequences especially for the vulnerable in society and the delays in seeking and reaching care is a major factor. We also have the global risk of variants developing elsewhere and spreading to Fiji.

The Vaccines Plus approach is the only means available to us. Until the consequences of COVID-19 are comparable to daily normal risks and the global threat of resurgence is low, the need for masking mandates to facilitate a public health imperative will still be needed.

So, while we have a high level of vaccination we continue to emphasize ventilation, masking, physical distancing, cough/sneeze etiquette, hand washing, and isolating from others if you have symptoms.

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 you 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. When one of the measures becomes difficult to apply, implementation of the other two measures must be further escalated. Whatever the scenario, an effective mask must be kept close by you at all times. The current masking requirement of 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 has published a list of circumstances where a person is exempt from wearing a mask.

In a setting where physical distancing of 2 metres is 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 poorly ventilated closed space is bad for many reasons aside from COVID-19, 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. 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.

COVID-19 Situation Update

Monday 14th February

Public Advisory:

Vaccination

Increasing our vaccination coverage for the last 8% of our adult population remains a challenge, despite the increased risk of severe outcomes in this group. While we will continue to do our part to promote and deploy vaccines, community support is necessary to sustain the impact of our efforts especially to the vulnerable within this 10%. We remain gravely concerned that we continue to receive requests for vaccine exemption from persons with medical comorbidities, especially NCDs; their medical condition is an indication for vaccination, and granting the exemption is not an option for any qualified medical person.

During this third wave, unvaccinated deaths in the vaccine-eligible population are occurring at 17 times the rate of vaccinated deaths. This is a strong indication that many of the unvaccinated deaths in the vaccine-eligible population were preventable. I strongly urge anyone who hasn’t been vaccinated to get vaccinated now because COVID-19 is here to stay, and Omicron will not be the last variant. And if you are vaccinated, but know someone who isn’t, please also encourage them to protect themselves by getting vaccinated.

The booster dose program began at the end of November 2021. As of February 14th, 91,414 individuals have so far received booster doses of the Moderna and 60 individuals have received the Pfizer booster COVID-19 vaccine. For the month of February, a further 175,558 have become eligible for booster doses. We are targeting to cover all these eligible individuals in the days ahead. Please come forward to get your booster (3rd dose) vaccine if you are aged 18 or over and it has been at least 5 months since your second dose.

Leptospirosis, typhoid fever, and dengue fever

With the recent heavy rains and flooding in parts of Fiji we anticipate an increase in these endemic climate-sensitive diseases. After the recent floods, we are starting to see more people admitted for leptospirosis into our hospitals in the Western Division and the intensive care unit at Lautoka Hospital.

Since January we have confirmed 74 cases, however, there are many more who were diagnosed clinically. The 3 divisional hospitals have reported 28 admissions with 19 in Lautoka Hospital alone. A total of 11 deaths have been reported, the youngest was 6 years old and the oldest was 56 years, and most of the deaths were in Itaukei males between 16 to 35 years of age. Delay in accessing care has been noted to contribute significantly to these adverse outcomes.

Members of the public must understand that to prevent leptospirosis, one should avoid wading or swimming in flooded waters, wear shoes when walking outside, and keep all food and drinks covered and away from rats.

Also, early treatment can decrease the severity and duration of disease and this entails initiating antibiotic treatment as soon as possible without waiting for laboratory results. With the widespread rain and flooding around the country, the public is requested to please consult a doctor early if you are sick, especially if you have a fever and remain unwell for more than 3 days and don’t seem to be responding to outpatient treatment.

The Ministry of Health and Medical Services has convened the Communicable Disease Committee, which will assist the Divisional Command Centres in responding to cases of leptospirosis, typhoid, and dengue fever, including raising awareness amongst the public and providing refresher training for medical professionals in primary care for early diagnosis and treatment.

Additionally, we have deployed specialist outreach teams to areas that are viewed as difficult to reach and at risk. We have a FEMAT team deployed to Navosa, and a mobile team led by our Hon Minister will visit communities on Kadavu island over the next few days as part of the Ministry’s community engagement strategy.

The Vaccine Plus Approach

We have had inquiries from the public on further relaxation of personal covid safe measures such as masking. As I have mentioned in the past, COVID-19 is not going to have a clean pandemic endpoint where we close off all chains of transmission and drive cases to zero. COVID-19 has an endemic endpoint, and in Fiji, as is with the rest of the world, societies will have to adapt to living alongside COVID-19 by making some deliberate choices about how to coexist.

The endemic disease does not mean unmanaged disease. Our current tracking indicates ongoing consequences especially for the vulnerable in society and the delays in seeking and reaching care is a major factor. We also have the global risk of variants developing elsewhere and spreading to Fiji.

The Vaccines Plus approach is the only means available to us. Until the consequences of COVID-19 are comparable to daily normal risks and the global threat of resurgence is low, the need for masking mandates to facilitate a public health imperative will still be needed.

So, while we have a high level of vaccination we continue to emphasize ventilation, masking, physical distancing, cough/sneeze etiquette, hand washing, and isolating from others if you have symptoms.

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 you 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. When one of the measures becomes difficult to apply, implementation of the other two measures must be further escalated. Whatever the scenario, an effective mask must be kept close by you at all times. The current masking requirement of 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 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 poorly ventilated closed space is bad for many reasons aside from COVID-19, 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. 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.