By Professor Glen Mola
Now, we actually have the COVID 19 epidemic in Port Moresby (27.7.20).
Now that we have started to test people with respiratory symptoms and fever we are detecting many cases of community transmission.
The figure is 62 as of this morning, and all of the last 50 cases have been in the NCD. The next step is that the virus will get into a settlement.
Then there will be panic as many people start to get sick and a few will die. The people in that settlement will scatter to get away from the virus and take it with them to other settlements. And so it goes and we then have a city wide epidemic, - probably by the end of August.
Some people will then run away from Moresby and they will take the virus to their Central province villages and other provinces.
And, do we then there will be epidemics in rural areas and other provinces - probably by September.
Our strategy at the moment is to try and contain the infection where we find it, - by testing, quarantining patients, their contacts and health staff.
This strategy will become inappropriate by next month as the epidemic becomes generalised in the city, the rural areas and other provinces.
In Port Moresby there are about 500,000 people. If half of them get the COVID19 (250,000) then about 30,000 will get symptoms (mostly a mild infection the common cold), but about 12,000 will get seriously ill (short of breath and in need of medical assistance – with oxygen therapy etc.) and about 2000 will die.
This could all take place over the space of two months. This will overwhelm the health services (including the PMGH morgue), challenge the ability of the NCDC to dispose of the dead and possibly cause some social chaos and breakdown in law and order.
The Rita Flynn field hospital is already more than half full; we need to think now what we are going to do when it is full and over-flowing. But clearly we should stop flying dead bodies around the country – sorry about traditional custom on this one: in an emergency some things just have to change.
It is really difficult to know what the right policy path to follow is – but it would be better if we can flatten the curve as much as possible so that the epidemic works itself out over a longer period of time – eg the 12,000 sick people and 2000 deaths are spread over 6 months rather than 2 months.
So, all the usual advice should be followed more carefully and diligently – we used to wash our hand 2-3 times per day, now it should be 20-30 times per day! Social distancing as much as possible. Stay at home most of the time, and not just roam around (bus-ride).
Face masks when we are out of the house, and self-isolating when we ever get a fever or cough. But I know a lot of this advice is almost gratuitous for those who live in settlements where there are 10-20 people sleeping in the same house (or under the house) and there is no readily accessible running water etc.
However, alcohol needs to go away. I hear that many guys are drunk and loud (and engage in brawls) in the settlement below my house on a nightly basis. This kind of behaviour will lead to faster transmission and more difficulty for those who become ill.
What about the health services and health workers.
I think we should:
1. Allow everyone over the age of 60 years and anyone with co-morbidities to take retirement;
2. Any health worker who feels that they cannot do their normal work in the circumstances of the epidemic should also be permitted to retire or take leave (use up any credits and then go on leave without pay if they do not wish to come back to work at the end of their leave credits);
3. The COVID19 field hospitals should be expanded as the need arises, and adequate numbers of health staff be deployed to work in them. [In the past hundreds of nurses have applied for the few positions that are advertised, so there is apparently no shortage of nurses looking for work;
4. The rest of the health service should continue to work ‘as normal’: ie deal with the sick kids, the pregnant women, the other medical problems, the surgical cases (trauma, appendicitis etc.), but we stop doing non-essential stuff – like cosmetic surgery, infertility, minor ailments that a self applied bandage or Panadol can deal with. If we do not do this, there will be many more deaths from pregnancy problems, ordinary illnesses like pneumonia, TB and gastro etc than there will be from COVID19; and,
5. And although on a population basis there will be more deaths than usual, individual health workers (aged less than 60 and with no co-morbidities) should not be too fearful for their themselves and their families as the risk of death for a health young person is less than 1%.
We have learned to deal with other serious health threats in PNG – like TB and HIV which have case fatality rates higher than COVID19. Let’s learn to deal with this one. We really have no choice.
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