Reports indicate that COVID-19 started spreading in China, Wuhan in November of 2019. At that point, few countries were worried, including the Maldives which sees its hefty share of Chinese tourists throughout the year.
Most countries saw the virus and devastation that wreaked havoc across Hubei province as a Chinese problem or an Asian one at that. Most Governments were slow to take action and have paid for it with the lives of tens of thousands of their citizens who succumbed to the virus. The Chinese Government, amidst a lot of false starts, which included silencing doctors who sounded the alarm, put a full lock-down on Wuhan on 23rd Jan 2020.
Prior to China’s lock-down, on the 20th of January, the Maldivian Health Protection Agency (HPA) warned of the possibility of importing the virus that was spreading like wildfire in Wuhan. HPA via a press release advised people travelling to and living in the region to exercise caution and to seek a doctor if symptoms occurred.
On the 22nd of January, the Maldivian Government started taking its first measures against COVID-19 by screening passengers at the Velana International Airport (VIA), the country’s main air transportation hub.
On the day of lock-down in Wuhan, as things had finally reached the stage which had warranted the Chinese Government to take action, HPA stated that no passenger at that point in time had been identified as a carrier of the virus through the airport screening in place. HPA also noted that they were carrying out further assessments and recording travel history of passengers where needed.
The Maldives had its fair share of scares even at that point. On 30th of January, a 20-year-old Maldivian, who travelled back from China, suspected of being infected with COVID-19 was quarantined at K. Funadhoo for further tests and observation. He later tested negative for the virus.
In the highly globalized world we live today, it is improbable to believe that borders would prevent a virus from propagating and finding hosts elsewhere. In Europe, Italy reported its first COVID-19 infections around 31st of January 2020, with the first two cases confirmed in Rome. In addition to this, France and Germany also started reporting their infection numbers going up around the same time.
The Maldives imposed its first travel ban effective 4th of February, to and from China. This followed the World Health Organization (WHO)’s declaration that COVID-19 was a public health emergency of international concern on the 30th of January. More bans were to follow in late February and throughout March, the 2nd travel ban being on Iran, effective 26th of February, as infections reportedly rose in country (44 cases were reported on 27th February).
Though Italy was reporting record numbers of infections at that point; 400 cases (a 25 per cent surge in 24 hours) on the date the ban came into effect for Iran, no travel ban was put in place on arrivals from Italy to the Maldives at that point in time. By the 6th of March, 26 countries had reportedly imported infections from Italy.
Maldives Reports Its First Case:
On 7th of March, two foreign employees at Lhaviyani Kuredhu Resort tested positive for the virus, the index case being an Italian tourist who tested positive for COVID-19 upon return to Italy. Consequently, Government finally imposed the travel ban on Italy on 8th of March. To-date, 73 per cent of foreigners who tested positive in the Maldives have been Italians.
As Europe became epicenter of virus and numbers started peaking across the world, travel bans were imposed in the Maldives throughout March. Bans were issued on Germany, Spain, & France effective 15th of March, Malaysia and the United Kingdom (UK) on the 17th of March, and a ban on issuance of on-arrival visa to Maldives on the 27th of March. The first local to test positive for COVID-19 was also on 27th of March, an imported case from the UK.
Government Ramps Up Response:
As the virus spread relentlessly across the world, the Government started ramping up its response internally by closing Government offices on the 17th of March, with consecutive extensions ending on the16th of April. This has been further extended now with the 24-hour lock-down in place. Government offices have remained closed for over a month at this point. Schools too have remained closed since 15th of March, in addition to congregational prayers being banned since 18th of March.
By the end of March, number of positive cases in the Maldives stood at 18, with two of the infected having flown back to Italy on the day of confirmation of their test results, i.e. 27th of March. These two tourists were onboard a vessel known as Island Safari 1, where two tourists had previously tested positive on the 15th of March. Government maintained that the two remained asymptomatic at the time of travel, and that the samples were taken from the two for research purposes.
27th of March also saw the first local test positive for COVID-19, a Maldivian who returned from UK and was quarantined at Holiday Island Resort. Since then, four Maldivians who tested positive for the virus have a similar travel history as per details released to the public.
By the end of March, possible clusters stood greater than 54, most of them centered at resorts and/or safaris, with few inhabited islands in the mix where guesthouse tourism is practiced. As spread mainly seemed contained, with various progressive actions taken by HPA to prevent importation of infection to inhabited islands, a false sense of security permeated throughout the country, which perhaps helped lead to the current state of events that we are observing today.
Even though Government imposed curfew hours effective from 2nd of April for certain set time periods, this was soon lifted on the 9th of April. Government’s rationale behind the curfew hours imposed was to observe and prepare for a situation that may eventually require enforcement of a 24-hour lock-down in the city. Even with lifting of the curfew hours, on 10th of April, the Public Health Emergency which was declared on the 12th of March was extended till the end of April.
There was a gap of 12 days between the last two imported cases turning positive; returnee from UK on the 1st of April and returnee from Philippines on the 12th of April. In between, on 6th of April, Dr. Nazla Rafeeq from HPA announced the Government’s intention to carry out a survey to rule out community spread of virus. Dr. Nazla further detailed that 500 samples would be taken from across the Maldives, in addition to the surveillance mechanisms that were already in place to rule out community spread of COVID-19.
At that point in time, a huge percentage of Government’s efforts were focused on repatriating Maldivians stranded in foreign countries facing hardship due to spread of COVID-19 in those regions. At the same time, Government had also started releasing resort and safari employees observing quarantine, and testing them prior to release. 9,660 employees who had been quarantined at resorts and/or safaris had been released by the 13th of April according to the statistics published by the National Emergency Operations Centre (NEOC). The number of repatriated Maldivians in quarantine facilities stood at 962 on the 14th of April.
At every press conference, members from HPA & Spokesperson Mr. Mohamed Mabrook Azeez kept reiterating the need for observing social distancing to flatten the curve. Somehow, as time went by, and infections were only reported at resorts or were seen to be imported cases already observing quarantine periods at isolated resort facilities, the seriousness with which the public seemed to take the message declined. This was evident by the numbers of people crowding the streets towards the latter half of the “stay at home” period imposed by the Government. It is also to be noted that there was a notable lack of enforcement in place to ensure that people were observing guidelines.
Our failures in policy implementation has always stemmed from lack of enforcement: ours is not a society that observes rules and/or guidelines in place out of own good will. While awareness was ramped up and continued at a pace that the Maldivian public has probably never seen in their lifetime, it must be noted that awareness still remains one of the biggest challenges to overcome in public health crises across the world. Without proper enforcement (which was questioned about often at pressers) and infections seemingly contained, it is my belief that members of public who saw little danger community spread becoming reality, increase.
Though HPA used social media platforms and other mediums to make the public aware, few also seemed to understand the gravity of the issue at hand; the highly elusive nature of the virus, the lengthy incubation period associated with the virus, the number of false negatives in testing, the asymptomatic carriers of the virus, the super spreading events, and the toll infection numbers take on the health sector of countries.
I would always argue that preventing importation of virus to the Maldives would have been the most ideal; this required travel bans earlier than was imposed, especially from regions where the numbers were increasing exponentially. However, our economic policies dictated otherwise. Next remained containment of the virus from spreading in Male’; this was what the Technical Advisory Committee (TAC) and health officials have all been working tirelessly for all these days.
The first local to test positive (C-0021) on the 15th of April, signaled that community spread in Male’, the most densely populated urban center of Maldives was now a reality. 31 positive cases have since been identified in three different clusters. If the current trajectory holds, Dr. Sheena Moosa’s projections that were shared with the public on the night of April 17th may be realized by the end of the month. Each and everyone of us at this point, remains a suspected carrier of the virus.
Current spread indicates a slip-up somewhere; in contact tracing (contacts being less than truthful), a patient with longer than average virus incubation period, an asymptomatic, the public’s sense of complacency with the stay at home directive, and/or a patient with milder symptoms who failed to be picked up by the surveillance mechanisms in place. In all probability, the index case of the clusters in place may be impossible to find at this point.
Foreigners who have tested positive for COVID-19 upon leaving the Maldives could also have contributed. The Fellaini case is one, and though contact tracing and testing were carried out and infections ruled out, the probability for this still exists given the many unknown variables of the virus. The case of two Italians from Island Safari 1 is also troublesome, followed by a Turkish national who worked and traveled between Raa Bodufushi Resort and Joali Maldives Resort in the country. He tested positive upon return to Turkey as per information released by NEOC.
Given the increase in numbers of positive cases by the day, authorities may soon be forced to move from the stage of containment and delay to mitigation, the idea being to provide hospitals with the support they need to maintain essential services as virus spreads, and help those who are ill to reduce the overall impact of the disease on society.
Our health sector’s ability to cope with a massive outbreak would be minimal, with 905 doctors and 2,970 nurses active in the field. While mass and widespread testing is the ideal response at this point, our capacity in that regard also remains limited.
Numbers reported in the media makes it difficult to discern whether the testing kits cited are COVID19 specific or for isolating existence of a coronavirus in the patient, upon which the COVID-19 specific test is carried out. Mr. Mabrook outlined at the presser held on the 19th of April that we still have 3,500 testing kits available, and that 20,000 testing kits from China (half of which is from Chinese Government and the other half from Jack Ma) are incoming, along with another 5,000 from WHO, which is yet to be received.
In the meantime, our duty as the public remains and is more crucial than ever at this juncture;, staying at home and observing guidelines as set by HPA is our responsibility, to aid health professionals working tirelessly and risking their own lives to do the impossible at this point. With Ramadan just around the corner, their work would be all the more exhausting as the numbers peak in the coming days.
My prayer is that this horror which we find ourselves in pass soon.
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Source URL: Medium