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PNG’s first major COVID-19 spike has come from within its health system

For months, Papua New Guinea has avoided a large-scale coronavirus outbreak, but in the space of two weeks things have changed.

Until mid-July, only 11 cases had been recorded in the country. Then on July 16, a new case was discovered.

It was a lab technician — who had reported a fever, muscle aches, a cough and runny nose. They’d been working at a COVID-19 testing lab.

It prompted 37 staff at the lab to get tested. That was when three more cases were announced.

The acting Secretary of the Health Department said he was “saddened” to declare all the new cases were staff of the Central Public Health Laboratory.

The lab sits in the country’s biggest hospital, Port Moresby General.

In the days that followed, more cases were discovered at the hospital and in the health department. Staff and patients. Then family members.

It has put health officials in a tough position, being at the epicentre of the country’s most significant outbreak just as the significantly under-resourced system prepares to handle escalating coronavirus cases.

A ward in Port Moresby Hospital with women on beds
The recent outbreak in PNG started in a lab responsible for identifying COVID-19 cases.(Supplied: ChildFund)

PNG now has more than 70 cases and has recorded two deaths

But the fear is now over how much further that could rise, especially given the mystery of how that first lab technician contracted the virus.

The major hospital at the centre of the outbreak

As the initial cases were identified, “chaos” was reported at the Port Moresby General Hospital, with patients suffering other illnesses being turned away.

“The first 24 to 48 hours was a bit rough, but now we have everything back to normal.”

A man wearing a green island print mask stands in front of a podium with a microphone
Prime Minister James Marape said lab staff had access to personal protective equipment.(Supplied: Ekarvilla Keapu/ PNG Prime Minister Photographer)

Prime Minister James Marape said he has “demanded” a full inquiry into the cluster from the health department, but insisted lab staff had personal protective equipment (PPE).

“Those in the frontline say they did their absolute best in protecting themselves,” he said.

“We will ensure that going into the future, stricter compliance to safety gear and protocol is adhered to and our own health workers, their health isn’t compromised.”

But in the aftermath of the outbreak, some nurses at the hospital have raised concerns about a shortage of PPE, with one telling the ABC that staff were being asked to reuse their masks.

Dr Molumi said the hospital had enough PPE in stock.

“We exactly know what type of PPE and how much we require every day, as per our roster,” he said.

“It’s just that staff sometime overlook their stock, they don’t go and pick it up, but we make sure it’s available all the time.”

Dr Molumi also said the hospital has been preparing for COVID-19 for five months and does have processes in place, “but when people fear they forget all of the processes that have been set in place”.

He said meetings with senior hospital staff had been held to review processes at the hospital “given the situation what has transpired in the last two weeks and we fixed up what has gone wrong.”

The World Health Organisation will be involved in monitoring and evaluating infection control measures at the hospital to allow improvements.

Precautions have also been taken. The hospital went into “emergency mode,” after the initial cases were identified having to scale down services while it cleaned.

Improving infection control and protecting other critical services, like emergency surgery, in the country’s biggest referral hospital is vital.

“It will be mandatory PPE for all staff, it will be enforced,” Dr Molumi said.

“Unlike, it has been left as a circular direction given, but we have not really enforced it in making sure that it has happened.”

A large tent has been set up outside in the car park to triage patients, so that people with possible symptoms can be sent to an isolation facility that has been set up at a sports stadium called Rita Flynn.

But the spread among hospital workers and within the broader health sector has continued.

The ABC understands the COVID-19 National Control Centre had to be fumigated after two coronavirus cases were detected among staff, including one of the Health Minister’s advisors.

Concerningly, a health worker flew from Port Moresby to the second biggest city of Lae, where he then showed symptoms and tested positive.

He had attended a workshop with 74 health workers in that city who all had to be isolated and tested. So far no-one else has tested positive.

Fears over unknown community transmission

What initially began as just a few cases has quickly turned into a dangerous outbreak.

PNG’s COVID-19 emergency controller David Manning has said coronavirus is now “widespread” in Port Moresby.

A man wearing a cap and sunglasses points a temperature at a woman wearing a bright top and skirt near a fence.
Observers say they are unsure of the scale of community transmission in PNG.(Facebook: Justin Tkatchenko MP)

The question of how the original lab technician came into contact with the coronavirus remains.

“We clearly have a situation of local transmission in Port Moresby,” Sean Casey, the then Incident Manager for the World Health Organisation in PNG told the ABC.

“At the moment we still don’t have very large scale testing in the city, so we don’t really know what the scale of transmission is.”

The lab techs and health workers, who are well educated about coronavirus, were always going to be far more likely to identify possible symptoms and get tested than many other parts of the population.

It is apparent that coronavirus has been circulating in Papua New Guinea, undetected, for some time. The infection source of several isolated cases recorded before the recent cluster in Port Moresby were never identified.

While health data in the country can be unreliable, there is so far no evidence of a significant increase in respiratory cases or deaths.

But for a country that has about 5,000 hospital beds for a population of more than eight million people, the blatant community transmission now on display is deeply concerning.

Mr Marpae said “global modelling” suggested the case numbers could be in the thousands, but there were few details given of the modelling used.

“The high probability [is] that in Port Moresby alone, there could be a possibility of more than 5,000 to 10,000 people who already have COVID-19 in our city,” he said.

So far about 10,200 tests have been conducted in the country, but that is ramping up with testing centres, including the first drive through facility, being established.

Yet as the cases begin to escalate, there are fears the hospital systems will not be able to cope.

From the outset, PNG has been honest about the fact its health system cannot handle a pandemic scale outbreak.

“If this goes out of control, then it’s going to flatten our hospitals and clinics,” Dr Molumi said.

“We don’t have the capacity to take care of so many people at the same time and that is a very big fear of ours.”

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