The crisis in Papua New Guinea is a reminder that the virus will keep wreaking havoc until the whole world is vaccinated.
The emergency rooms are heaving, health care workers are falling sick, and misinformation about the coronavirus is running rife. It has all left Papua New Guinea, an island nation just north of Australia, in the grip of a deadly crisis, as a tripling of infections over the past month has swamped an already fragile health care system.
The wave of cases, which authorities have described as a "major epidemic," most likely began in February. About 70 per cent of symptomatic patients are testing positive — among the highest rates in the world. Of the country's 39 deaths from the virus, 30 have happened in the past six weeks, and the number is expected to swell. Confirmed infections have passed 4,100, after having remained at zero through June, though the actual number of cases is believed to be far higher.
The toll on health workers has been severe. About 10 per cent of workers have tested positive at the country's major hospital, in Port Moresby, a city of 380,000 people that has been hit hardest. In field hospitals, workers, sweating beneath protective equipment, are rushing between beds to tend to the dying.
"We fear that we are going to fill all these beds and then we will have nowhere else to continue to care for Covid patients," said Mangu Kendino, an emergency physician and the chair of the Covid-19 committee at Port Moresby General Hospital. "We're tired, we're exhausted, we're fatigued."
A year into the pandemic, countries around the world are entering a new phase as they vaccinate growing shares of their populations and reopen schools, restaurants and offices. But the crisis in Papua New Guinea is another reminder that the global emergency is far from over — that the virus will continue to wreak havoc and sow death until the entire world is vaccinated, a prospect that may be years away.
The situation in the island nation is exactly what public health experts have warned of as wealthy countries buy up the world's vaccine stockpiles and put the pandemic largely behind them, while smaller and poorer nations are left with cap in hand. After having largely avoided severe outbreaks for many months, Papua New Guinea is now experiencing harrowing scenes not unlike those in Italy early in the pandemic. This month, one patient, suffering an asthma attack, died in a hospital parking lot.
"They have challenges accessing health care at the best of times," said Rob Mitchell, an emergency physician specialising in triage in the Pacific. "I fear that the current case numbers are just the tip of the iceberg."
It is unclear why Papua New Guinea is just now being hit with a severe outbreak. It has an especially young population, and some experts speculate that the virus could have been circulating more widely all along, but that many cases were asymptomatic or mild and went undetected. Others say it could be a result of public apathy about rules like wearing masks and practicing social distancing.
"When the pandemic was first announced by the WHO and we went into lockdown, the government reacted pretty quickly," said Dr. William Pomat, the director of the PNG Institute of Medical Research. But late last year, he added, "many of us became very complacent. A lot of the things we were supposed to be doing, we didn't do anymore."
As infections flare, doctors are working overtime, trying to keep up with a demand that they expect will only increase in the coming weeks. In Port Moresby, the capital, stadiums have been converted into temporary field hospitals, and existing hospitals are stretched to capacity.
"The Covid centre in Port Moresby is full; our field hospital is almost full," said Gary Nou, an emergency physician helping to lead the government's response to the pandemic.
In one of the field hospitals, Nou said, he and others, dressed in full protective equipment, often work in humid conditions as they struggle to keep their patients cool and hydrated. "As soon as you walk off the floor, you're drenched in sweat," he said. "When we are at maximum, our toilet facilities are stretched to the limit, and waste disposal is stretched to the limit. Every day is a challenge."
At the nearby major hospital, some wards have been converted to accommodate patients with Covid-19, but doctors say they remain worried that there will not be enough beds. Doctors and nurses are having to extend shifts as their colleagues become infected. More than 120 staff members have so far tested positive for the coronavirus, a spokeswoman for the hospital said, adding that the numbers were increasing daily.
In response, Australia has donated 8,000 doses of the AstraZeneca vaccine, as well as protective equipment and ventilators. It has also deployed a small team to the country.
Fearing spread of the virus, the Australian authorities have ramped up efforts to vaccinate the population of the Torres Strait Islands, an archipelago bordering northern Australia and Papua New Guinea. Most of the islands are part of the Australian state of Queensland.
"They're our family. They're our friends. They're our neighbours. They're our partners," Scott Morrison, Australia's prime minister, said last week. "This is in Australia's interests, and it is in our region's interests."
Covax, a global health initiative designed to make access to inoculations more equal, began rolling out doses of vaccines to developing nations last month, and it has said it will deliver 588,000 to Papua New Guinea by June.
But in some cases, wealthier nations have failed to honor contracts, reducing the number of doses the initiative can buy, Dr. Tedros Adhanom Ghebreyesus, the director of the World Health Organisation, said in a statement last month. He warned that the pandemic would not end until everyone was vaccinated.
"This is not a matter of charity," he said. "It's a matter of epidemiology."
Until then, officials in Papua New Guinea will be left to combat not only the virus itself but also a tide of misinformation about the virus and the vaccines, carried largely through social media channels.
"Even for the educated health worker, it's causing a lot of doubt," said Nou, the Port Moresby-based physician, who has conducted a survey of health care workers' views about the pandemic. He said that some in the country believed that the virus was a hoax, or that people on the island were immune, or that it might be safer to contract the virus than to be vaccinated.
With the country now waging an all-out battle against the coronavirus, some public health experts worry that the redirecting of resources could come at a lethal cost to those with other severe health conditions, such as malaria or tuberculosis. Papua New Guinea has some of the highest rates of tuberculosis in the world.
"It's not good enough to just respond to Covid and then have someone die of another cause," said Dr. Suman Majumdar, an infectious diseases specialist at the Burnet Institute, an Australian medical research facility. "We have feared the worst," he added, "and this is happening."
Written by: Livia Albeck-Ripka
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