For almost a year, PNG appeared to escape the worst ravages of the coronavirus pandemic, but the numbers now coming out of Port Moresby General Hospital are staggering and frightening.
Of everyone currently being tested for COVID-19 at the country’s largest hospital, 42 per cent are returning positive results.
A growing number of hospital workers are also infected: 114 staff members — about 10 per cent of the workforce — have contracted the virus.
But the hospital’s chief executive, Dr Paki Malumi, believes most of his employees contracted the coronavirus in the community, rather than at work.
“We have widespread community transmission, not only in [the capital] but across the country, it’s just that we’re not doing enough testing,” he told the ABC.
Now, two huge tents are being set up in the usually busy hospital carpark. A few hundred metres up the road, beds are being rolled onto an indoor basketball court.
As COVID-19 cases in Papua New Guinea surge, Dr Malumi hopes these measures will ensure it keeps functioning.
“We’re getting about 10 cases every day coming into the emergency department with COVID-19,” he said.
As cases have risen to crisis point, the country’s hospitals — which are already largely understaffed, underfunded and over capacity — have been pushed almost to breaking point.
Australia is stepping up its response, with plans to send medical workers to assist and supply an immediate 8,000 doses of vaccines for frontline workers.
But health workers say more still needs to be done by authorities in PNG to try to stem the transmission rate and prevent a catastrophe.
A four-week national isolation strategy will begin on Monday, which will see schools close and travel between provinces restricted.
A full lockdown is being avoided because of the crippling economic impact it would have.
Misinformation and scepticism about COVID-19 are rife in PNG, so getting public buy-in will take work.
After seeing little impact of the virus during the initial outbreak and faced with a raft of other widespread health and social concerns, for many people coronavirus isn’t a priority.
How national grief may have triggered a superspreading event
After avoiding a major outbreak for almost 12 months, a worrying rise in cases began in February.
But at the same time as the country reached a tipping point, when action was needed to try to slow the spread, PNG’s beloved founding father Grand Chief Sir Michael Somare died.
The death of the revered first prime minister not only pulled public and political attention from the coronavirus spike, it also seemingly stalled some restrictions being introduced, so as to not prevent the public from gathering to mourn.
Tens of thousands of people have gathered to farewell Sir Michael in recent days, sparking fears cases will surge further in coming weeks.
“The Grand Chief is a special exception, in my view. What has happened, has happened,” Prime Minister James Marape said in response to a question from the ABC about the delay in restrictions.
“But as a Government we’re not backing off [from implementing new restrictions].”
Attempting to stop people coming together to pay tribute to Sir Michael, who is seen as the father of modern Papua New Guinea, would have been incredibly difficult.
Was the coronavirus spreading undetected?
PNG’s young average population, early border closures, low testing rates and the fact many people are less likely to seek help for health conditions have all been attributed to the apparent low prevalence of coronavirus in the country until now.
Anna Maalsen from the World Health Organization in PNG said it is likely the surge is the country reaching “critical mass” of cases.
“We’ve had ongoing community transmission here in the National Capital District since August last year and that’s been bubbling away there,” she told the ABC.
“We had some modelling done that took into account movement around the country during the Christmas period, as people returned home to provinces … and I think that’s where we’re starting to see the acceleration of transmission.”
The average Papua New Guinean is 22 years old, and that has also been credited with a high prevalence of asymptomatic cases, which accounted for 60 per cent of confirmed infection at the start of the year.
While the majority of cases are still mild, as the infection spreads, it is reaching the elderly and those with co-morbidities. There has now been a jump in serious cases and deaths.
More people are coming to health workers with symptoms, which has triggered more testing and investigation.
“In general, we’re still doing low testing around the country, we still have some provinces who are not testing at all,” Ms Maalsen said.
Papua New Guinea has experienced seven consecutive weeks of increasing cases, with 2,658 officially recorded since the pandemic began — 1,791 of those have been recorded since the start of February.
Authorities have said that the current death count of 36 could also be an underestimation because of a lack of testing.
The need to quarantine health workers, even with mild cases, has also forced hospitals across the country to close some services.
The surge has prompted concerns among some that a new, more virulent strain of the virus has entered the country, or that it could even be mutating within PNG.
“PNG has been sending samples for genomic sequencing and to date, we have no indication that we have other variants here,” Ms Maalsen said.
“We are seeing an increased in moderate and severe illness in capital and increase in deaths, but we can’t say for sure if that’s an indication of any variants in the community or it’s just there’s greater awareness of signs and symptoms.”
More sequencing is being done on samples from PNG.
Australian medical workers to arrive in PNG
An isolation centre is already up and running at a sports facility in Port Moresby and another is being set up in the gym of an aquatic centre near the hospital.
That will allow mild and moderate cases to be kept out of the busy hospital, preserving it for severe cases. Some people are also being asked to isolate at home.
Australia will be sending emergency medical teams, or AUSMAT teams, with a small forward-planning group expected within days.
With only an estimated 500 doctors for a population of nine million people, additional support will be needed.
“It’s very difficult to predict when and where that support will be required,” Ms Maalsen said.
“Certainly we’re looking at the trends in cases where we’ve had significant mass gatherings around the country.”
Work has already begun at different sites around the country to ensure PPE is in place, isolation facilities are ready and rapid test kits are provided to try and speed up the current slow result turn-arounds to allow early isolation of patients.
But the country’s pandemic controller concedes some provinces are under-prepared. PNG’s complex governance system has made a coordinated approach difficult.
Vaccines ‘not a silver bullet’
Papua New Guinea was one of the last countries to sign off on the regulatory approvals needed to bring in vaccines under the global COVAX facility.
The initiative was set up by the World Health Organisation and the Bill & Melinda Gates Foundation to ensure vaccines are available to both higher-income and lower-income countries.
Fiji, which has no community transmission, had received its first batch before the PNG Government had even signed the required documents.
The process could have started at the end of last year. But at that stage, PNG politics was in turmoil, with an unsuccessful bid to oust the Prime Minister in full swing.
Despite being given priority status under the COVAX program, four to six weeks is needed to bring in the vaccines, meaning they will not arrive until the end of March or start of April.
Australia’s donation of 8,000 vaccines to be offered to frontline workers, are expected to arrive next week.
It is also trying to get an additional one million doses released from the European Union, but it’s unclear when they would arrive.
Mass vaccinations in PNG will pose logistical difficulties and distrust of the vaccine in the country will also need to be overcome.
Prime Minister Marape has offered to receive the injection first to give confidence to the others.
While the vaccines are welcomed, health workers say more still needs to be done to enforce rules like social distancing, staying home and mask-wearing, to try to slow transmission rates.
Many businesses and offices in the capital have been enforcing mask wearing for several months, but concerns remain about busy public buses, markets and small trade stores.
“We’re working through how best members of the disciplinary forces, as well as other community volunteers, can enforce this in the city,” pandemic controller David Manning said.
Anna Maalsen said vaccinating health workers was a top priority, but she warned they should not be thought of as “silver bullet”.
“The clinical care is the end of the line, so having those measures will be really helpful in decreasing transmission and that’s what we need to be doing,” she said.
While health workers describe a crisis, across Port Moresby life has largely continued as usual, with few visible signs of a dramatic shift in the coronavirus situation.
“Some degree of enforcement is needed,” Port Moresby General Hospital CEO Dr Malumi said.