Local and regional news reports about the Covid situation - and Fiji realises that actually NCDs are responsible for more than 80 per cent of deaths

29 January 2022

The Ministry of Health’s Dr Sarah Habu says up to 3,234 people have been vaccinated since community vaccinations started on Monday.

The change in approach to the vaccination program was implemented because of community transmission in Honiara, and the need to reduce crowds gathering at a single site.

Dr Habu says the areas that have been visited and vaccinations administered are the Lord Howe settlement, Fiji quarters, Namoruka in White River, Rove, Lau valley, Fishing village and Jackson ridge.

Dr Habu says that turnout so far has been good, and it is encouraging to see pregnant mothers coming forward.

There are now a combined total of 38 hotspots identified by the Ministry of Health throughout Honiara and parts of Guadalcanal.

Those living in these areas are advised to limit movements. The general public is advised to keep away from these areas until the extent of the spread is identified.

The Health Ministry will provide updates to the general public on further community vaccination programmes.?

At the national referral hospital (NRH) staff are putting in place measures to control the spread of COVID-19 amongst staff and patients.

To date over 100 staff at the NRH have tested positive for COVID-19 and have been stood down from duties.

The Chief Executive Officer at the NRH Dr George Malefoasi has said several measures are being put in place, not only to track the spread of the virus but also to manage it.

“Chain of infection could be patient to staff, or staff to staff. These lines of infections are being looked into, and there are measures to limit exposure.

“Basic measures are being done like hand washing, sanitizing, social distancing and personal protection equipment,” Dr Malefoasi said during the Health Ministry’s talkback showy on Friday.

?“Additional measures such as decontamination in the morning, lunch and evening is also being done, and soon we will also do hospital wide fumigation.”

He said staff at the NRH are also operating in bubbles, meaning medical teams are being rostered in groups, who do interact with each other.

Dr Malefoasi has mentioned one of the challenges faced by the NRH is that there are too many guardians, which has led to overcrowding and may have contributed to the spread of the virus.

He says the NRH has implemented several measures to control the movement of guardians in and out of the NRH.

The Ministry of Health and Medical services will be installing additional health emergency phone lines to cope with the surge in COVID-19 cases in the capital.

The Permanent Secretary Pauline McNeil has said with support of Our Telekom they will be installing additional public health emergency phone lines, but admits even that may not be enough.

She has said the surge in COVID cases will result in some delays, as health and emergency workers are stretched.

Health workers have faced the brunt of the outbreak, with more than 100 testing positive for COVID-19 and have had to be stood down from official duties.

The national referral hospital’s (NRH) emergency department has implemented an emergency workflow to try and cope with the influx of patients.

The NRH CEO, Dr George Malefoasi, says tents are being setup outside the hospital to handle initial screening of patients and testing.

He remarked there is also a waiting area for results, with standard patient admission processes following if one is tested positive.

Dr Malefoasi says that with the current Covid transmission at the hospital there will be delays, but says such delays are for the safety of both patients and staff at the hospital.

He is has also encouraged those that are after routine checkups found to have mild symptoms to go to the clinics at Rove and Kukum.

The Technical advisor at the Ministry of Health and Medical services, Dr Yogesh Choudhri, says there will be restrictions after lockdown is lifted 6pm this evening.

Dr Yogesh was speaking during the health’s talkback show on the national broadcaster yesterday.

He said movements will be restricted to those leaving their homes to get groceries and medical care.

Restrictions will also apply to those who can open business and shops, so the people who work in businesses and shops have to be fully vaccinated.

People who are allowed to come out should also be fully vaccinated with two doses.

“Wearing of mask will be mandatory if you come out of your house, we are still seeing community transmission, so even if the lockdown is open community transmission will still be happening,” Dr Yogesh said.

“It was heartening to see people wearing masks before the lockdown, but the social distancing is always an issue.”

He says in terms of public transportation those that operate and use such service must be fully vaccinated.

Access to government buildings and services will also be restricted, with only those that are fully vaccinated allowed entry.

Dr Yogesh says these are the sorts of restrictions that will be expected once the lockdown is lifted, and to expect other restrictions as further assessments are made.

Meanwhile in offshore news today, Saturday, New South Wales has recorded 49 new Covid-19 deaths but the number of people being treated in the state's hospitals and intensive care units has continued to plateau.

A total of 2693 people with the virus are in the state's hospitals, of which 186 are in ICU.

There were 13,354 new cases recorded in the reporting period, of which 5426 were from positive rapid antigen tests and 7928 were from PCR swabs.

NSW Health said 37.5 percent of the population had received their booster shot.

The?state yesterday?recorded 70 fatalities, although 35 of those were historical deaths which occurred at aged care facilities.

There was a delay in reporting the deaths to NSW Health.

Today's daily death toll is the state's second highest since the start of the pandemic, after yesterday's total.

The number of people being treated for Covid in hospital and in intensive care dropped slightly from the previous reporting period.

Premier Dominic Perrottet yesterday said the state was "tracking within capacity".

Hospital admissions have plateaued over the past week, as predicted, and modelling released yesterday by the NSW government showed the number of seriously ill people in ICU had been below "best case" scenarios.

Although hospital rates have been bouncing around slightly, NSW Health deputy secretary Susan Pearce said a decline was expected next week.

"They might not follow a lovely curve, and it may be a bit lumpy but we do expect that in the coming week we will start to see some declines," she said.

NSW Health Minister Brad Hazzard told the ABC yesterday he would like to see the third jab, currently being given as a booster, essential for people to be considered fully vaccinated across Australia.

He said this policy change would have to be made by national Cabinet and was not sure why there had not been any progress on the issue yet.

"I'm not part of national Cabinet, but I understand that most of these things require a range of medical expert input," he said.

Victoria reports 31 deaths

Victoria has reported 31 more Covid-19 deaths, as hospitalisations continue to fall.

There are 953 Covid-19 patients in Victorian hospitals, down from 988 on Friday.

Of those in hospital, 114 patients are in intensive care and 39 are on ventilators.

The state has reported 12,250 new Covid-19 infections that came from 6244 PCR tests and 6006 rapid antigen tests.

It takes the official number of active cases in the state to 79,836, well down from figures of more than 200,000 in mid-January.

Around 37 percent of Victorians adults have now received at least three doses of a Covid-19 vaccine.

While the government and epidemiologists believe Victoria is past the main peak of Omicron infections, cases are expected to rise when students return to classroom learning on Monday.

Health officials are urging parents to get children aged five to 11 years vaccinated before school begins and the government has opened more pop-up vaccination clinics across Victoria.

Looking specifically at New Zealand, what can New Zealand learn from the Omicron outbreak in Australia?

Omicron has ripped through the Australian states of New South Wales and?Victoria, exposing testing regimes, decimating supply chains and causing the?country's deadliest days?of the pandemic despite high vaccination rates.

So is that New Zealand's fate as well?

RNZ spoke to a trio of experts in Australia who say Aotearoa can and should do better.

When Omicron arrived in Australia in late November, governments followed through on plans to relax restrictions.

University of Sydney epidemiologist Alexandra Martiniuk said that was the first mistake.

"If we had gone a bit lower and slower on our curve we would've put the pressure on our systems over a longer period of time - yes, but it would've been slower so we probably would've experienced less of the crises we did experience and importantly, this is hypothetical I suppose, more people might have been saved."

As the pressure built on the health system due to the number of cases, it affected the quality of care across the system.

It also removed vast numbers out of the workforce as they isolated awaiting test results or from infection itself.

The key to suppressing the curve was:

·???????getting vaccinated and a booster as soon as possible

·???????wearing a quality mask

·???????thinking about physical distancing and preferably meeting people outdoors

·???????scanning in

·???????getting tested and isolating if symptomatic.

New Zealand epidemiologist Tony Blakely, from the University of Melbourne, agreed and said the elderly and at-risk needed to exercise extra caution over the coming weeks and months.

About half of New Zealand's population was likely to contract Omicron during the outbreak and that was okay, Blakely said.

The key to minimising death and disruption was about who caught it and when.

"The two tricks are: having accepted that burden of infection coming through, to squash it and spread it out over time so it doesn't overwhelm health services. And the second is to try to tip away the infections from the people who have the highest risk of morbidity and mortality. So people who have comorbidities, are immunocompromised or who are elderly," he said.

In essence, the pair believed New Zealand should look to prolong the outbreak, which might sound counter-intuitive, but a steady stream of cases over months was going to be better than a flood over weeks. Much in the same way the tide coming in over six hours did not cause a problem, but a tsunami did.

Another thing on Aotearoa's side was the rate of Delta.

Australia was still dealing with 1300 cases a day of the far deadlier variant when Omicron arrived.

Blakely said as a result Australia had been fighting two epidemics.

"It's utterly clear - Omicron is less severe than Delta. The vast majority of people who get Omicron don't even know they've had it - they're asymptomatic.

"Yes there will be deaths - that's unfortunate. But it's a lot less than had it been Delta with this amount of infectiousness.

"Data is patchy - but in New South Wales two-thirds of people in ICU were Omicron, which means one-third were Delta and probably half of all deaths two weeks ago in New South Wales were among people with Delta. So what's happened? Delta is perhaps only 2-5 percent of all infections out in the community but because it's that much more serious at every step - converting you from asymptomatic to symptomatic, symptomatic to quite sick, quite sick to going to hospital, hospital to ICU, ICU to death - at every point along the way it means even though Delta is a tiny proportion of infections out in the community it's causing a reasonably large fraction of all the hospitalisations and deaths."

So what does that mean for New Zealand?

"The lesson here for New Zealand is keep Delta squashed down," Blakely said.

As Omicron spiralled in the community, contact tracing should focus on Delta cases, he said.

He described the New Zealand government's plan to deal with Omicron, released earlier this week, as brilliant.

"I really like the way that they've laid out what's going to happen and how close contacts are going to change, the number of days will get less as you go through before you can go back to work - it's exactly like I would've designed it if I'd been asked to design it. It's very good."

However, a degree of flexibility was needed as the pandemic had shown it could throw a curveball even at the best-laid plans.

Stock up on supplies, meet loved ones

Australasian Epidemiological Association president Brigid Lynch said it appeared Omicron was potentially as severe as the wild variant identified in Wuhan in late 2019, but far more contagious.

However, unlike in early 2020, there were effective vaccines that drastically curbed serious illness and death.

Far more was also known about the virus' transmission.

?To that end?high-quality masks, especially inside, and quality ventilation could reduce transmission, Lynch said.

"Workplaces and settings like education and aged care; we really should have had good ventilation measures - HEPA filters and things that will improve the air quality. Those are things that will be important going forward over the next few years."

A large and readily available supply of rapid antigen tests could also help in reducing transmission in high-risk or high-density settings, like schools, aged care and health facilities.

Martiniuk said another thing for people to consider now ahead of widespread infection and while time was still on your side was to get ready at home.

Putting some pre-prepared meals into the freezer, stashing some electrolyte drinks and having enough paracetamol and ibuprofen for a week might make the difference between a testing or a terrible time at home with the virus - especially if people had children to care for and consider as well.

Now was also the time to do some last-minute things for self-care, she said.

"It's silly but it's actually quite useful, but now is the time to go get your haircut, to go see your loved ones in aged care residences, to get your kids together with their friends - still outdoors preferably, to get a doctor's appointment for your chronic illness that might need a prescription refill.

"Get it all done as if you're going on a big vacation because in a month or two if cases are very high, those are the kind of things you won't want to be doing."

But all three epidemiologists agreed - while Omicron was already here, New Zealand did not need to suffer its worst effects.

Healthy eating to control NCDs related illnesses. Photo. RNZ.

?In Fiji the government has come to a disturbing realization that at least 70 percent of the Fijian population who had Covid-19 when they died were also suffering from a chronic disease, health authorities said.

And the majority of these cases were non communicable diseases or NCDs.

Health Secretary Dr James Fong said the government would now change its focus to addressing the NCD situation in earnest.

He said this was important because the most recent medical data pointed to the need to protect the most vulnerable in Fiji.

Dr Fong said the shift in strategy meant the government would need to keep better track of patients on record and keeping the rest of the population healthy.

"Our data show that we are through the worst of this third wave," he said.

"Our employers can also vouch for this given the decreasing of Covid-related absences from work.

"All that said, our Covid-safe measures must continue in the near term to protect those most vulnerable.

"We have seen relatively low rates of hospitalisations and deaths in this wave due to our high rate of vaccination and have not had to create any extra space in our treatment facilities or mortuaries," Dr Fong said.

But among the fatalities recorded, Dr Fong said there was a clear trend "most are unvaccinated, suffer from serious comorbidity, and die while at home.

"This trend tells us that the next stage of our response involves a more holistic view of the medical realities the nation faces."

NCDs worsen Covid-19 and inflict a far higher toll on the country "than the virus ever could."

According to Ministry of Health records, NCDs are already responsible for more than 80 percent of deaths annually since July 2020.

"After nearly two years of non-stop Covid-19 coverage, I fear that this issue - which is by far and away from the number one killer of our people - has become secondary in our national discourse.

"But the suffering it creates is not second to any threat our people face to their well-being."

In 2020, 5,700 Fijians died from NCDs like diabetes, stroke, heart disease, and the ministry of health has listed tobacco use, Physical Inactivity, Unhealthy diet and alcoholism as the major causes of NCDs in Fiji.

"NCDs are deadly on their own - but Covid-19 can turn them into more efficient killers.

"NCDs and other comorbidities also complicate our ability to precisely determine the causes of death.

Sources – Solomon Times Online and Radio New Zealand

View of Honiara.

Comment

It is encouraging to note that more people are coming forward to get vaccinated in the Solomon Islands, but the trend needs to increase more intently.

While all government efforts are rallied in the Solomon Islands to combat the Covid threat the realization that NCDs are a serious threat to health at home and contribute to many deaths annually should not be sidelined, just has Fiji has come to learn – and reportedly changed health tactics to give more attention to NCDs and the serious illnesses being experienced.

Yours sincerely

Frank Short

www.solomonislandsinfocus.com

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