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Is PNG sleepwalking through the pandemic?

Waiting room at Mt Hagen hospital (Mark Dozier  AFP)
Waiting room at Mt Hagen hospital (Mark Dozier,  AFP)

| Radio New Zealand Pacific

AUCKLAND - The heat on Papua New Guinea's hospitals appears to have eased, but some worry the country could still be asleep to the full extent of its Covid-19 outbreak.

Earlier this year, soaring case numbers stretched PNG's health system and workforce to the limit.

But senior clinicians in Port Moresby say the rates of transmission and admission to hospital for the virus have dropped significantly over recent weeks.

The trend of less cases and hospital admissions has come as a relief to PNG's chief of medical emergency services, Dr Sam Yockapua, who previously warned about the risk of focussing too much on Covid-19 and ignoring other pressing co-morbidities in the country.

"The rate of transmission and admission has gone down significantly in the last three to four months. And the numbers do not lie."

He said PNG had not been able to enforce lockdowns like New Zealand or Australia, and had to live with the disease.

Covid-19 is now considered by some in PNG as simply another disease alongside others at large, including malaria, tuberculosis, typhoid, cholera and even polio.

"I think we should stop punishing ourselves and keep living," Dr Yockapua said, adding that sections of the population may have developed herd immunity.

This theory was rejected by his colleague Professor Glen Mola, head of obstetrics and gynaecology at Port Moresby General Hospital, who said the problem was health authorities had little handle on how many people have Covid-19.

For instance, he said the Institute of Medical Research in the town of Goroka had done around 2,800 Covid-19 tests since January.

"Only 2,800 tests in the whole of the five million people in the Highlands, and 468 of them were positive; that's about 18%. But we have no idea who that 18% are, we just don't have that information."

PNG's health system is under-resourced and often lacking in basic supplies. Many communities live in remote regions, and sick people often do not present to health clinics for treatment.

Professor Mola said cause of death was not routinely recorded in PNG.

So far, PNG's National Pandemic Response Controller has reported 192 deaths from just over 17,800 confirmed cases.

The positive cases are now reported in a small dribble, a far cry from the surge that began in February when around a thousand cases were confirmed each week for the next several months.

However, clinicians in Port Moresby, the epicentre of PNG's outbreak, report the health workforce has bounced back to its pre-outbreak levels.

Port Moresby General Hospital senior oncologist Peter Olali said many health workers had been infected, and some had died. But now it was feeling quieter on the Covid-19 front.

"We have not really seen any numbers, not just rising, but in terms of very sick ones related to Covid and all that. We haven't really seen deaths in the country and here in our hospitals," he said.

"We're not really hearing [about Covid-19 related sicknesses] from the provincial hospitals as well."

Some national leaders have recently challenged health officials' warnings about the dangers of Covid-19, even touting what they claim to be natural immunity in Papua New Guineans.

Professor Mola cited the example of a prominent Highlands MP who claimed a spate of deaths in his province was not linked to the virus

"So he said last week: 'I've had to pay for ten funeral expenses (haus krai)', but none of them have died from Covid, he said.

"How on earth does he know? Has he tested all the bodies, has he done a verbal autopsy? How on earth does he know that they haven't died from Covid?" Professor Mola said.

Testing for the virus was scaled back by PNG's pandemic response authorities in June, as they shifted their focus to vaccination.

Vaccination has moved slowly, in no small part because misinformation about the safety of vaccines is rife and has created great hesitancy. The government has focussed on vaccinating key frontliners such as health workers.

Professor Mola said students starting as new medical staff at the hospital this week were offered a choice of the AstraZeneca vaccine donated through the Covax facility, with Australia's help, or the Sinopharm vaccine from China.

"So we ask them all of course, you're all vaccinated, aren't you? Because you're not coming into our clinical space unless you are. And there were two who were not vaccinated," Mola explained.

"I said, well okay, you can go and do something else or you can get vaccinated. So they both decided to go and get vaccinated."

If outbreaks in neighbouring countries like Indonesia and Fiji were anything to go by, PNG remains highly vulnerable to Covid-19, particularly if the Delta strain of the virus is left unchecked.

Several cases of Delta recorded in PNG last month were quickly isolated.

But without more testing and information on infections and deaths, PNG health authorities cannot be sure of the extent of the situation they are really dealing with.


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Kindin Ongugo

As a doctor working in Australia I just see all the reasons why Covid should have behaved like an atomic bomb in PNG knocking down people like flies but fortunately has not.

You talk about sanitation, social distancing, self-quarantine and there is almost nil chance of these behaviours in PNG.

There is overcrowding, people sharing smoke and betelnut spits everywhere and access to water is a big issue, all the right ingredients for Covid to thrive. It is a real mystery there is really no medical disaster with Covid in PNG.

I have to agree with Dr. Yockapua that there must be some herd immunity from Covid or a related coronavirus.

Minimal interference with the initial virus would have led to less new variants and less damage overall.

This comment disregards what expert medical advice ells of the PNG Covid outbreak.

Until yesterday nearly 18,000 Covid infections and nearly 200 deaths had been reported in PNG. Medical experts say official statistics are not accurate because of unidentified deaths, sick people not seeking treatment, low levels of testing, poor data gathering. These figures are said to “dramatically underestimate” the severity of the problem with only 0.3% percent of the population is vaccinated.

Many health workers and other educated people are propagating misinformation. Complacency has been reported even among medical workers. The UN notes that a majority of people in remote areas are ignorant of the virus.

It is possible that previously PNG’s young population may have partially insulated it from the crisis, but the Delta variant in PNG since late July is more dangerous to young people. PNG is now experiencing an upsurge in cases.

The authoritative Centers for Disease Control & Prevention (CDC) in the USA report a “very high level” of Covid in PNG and advise people to avoid travelling there. CDC says even fully vaccinated people may be at risk for getting and spreading Covid.

The United Nations calls the Covid outbreak in PNG “devastating” and says “resistance to Covid prevention is a deadly risk”. Meanwhile, the health system is stretched to breaking point and few people follow public health precautions.

Irrespective of their personal opinions it is imperative to PNG that educated people do not spread information they have not verified from a reliable - KJ

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