With a population of 53,127 located on 70 square miles of land, and a challenged and epidemic-weary medical system, the capacity of the Republic of the Marshall Islands (RMI) to successfully mitigate a COVID-19 pandemic is very low. In recent times, dengue, flu, zika and chikungunya have been widespread, difficult to contain quickly, and likely to be recurrent.
Against this backdrop, the government and people of RMI have had to develop a national strategy for preventing the introduction of the COVID-19 virus. As of the first week of April 2020, the RMI remained one of only a few countries in the world without a reported case of COVID-19, thanks largely to the actions of the national government. Between 24 January and 2 April, the RMI has issued eleven Health Travel Advisories & Restrictions (HTAR), with most tightening the restrictions of the advisories they have replaced.
The first HTAR released on 24 January mandated all incoming travellers to complete a special health clearance before or on arrival in the RMI to assess for signs and symptoms of exposure to COVID-19. It also mandated that all travellers arriving from or transiting through the People’s Republic of China (PRC) must (with no exceptions) spend 14 days in a country not affected by COVID-19. The second HTAR, released on 31 January, banned travellers arriving from the PRC, Macau, and Hong Kong arriving either by sea or air. It also suspended all official government travel to the three countries.
On 7 February, RMI President, David Kabua, signed a proclamation declaring a state of national emergency due to COVID-19. The proclamation ordered that all government ministries, departments, and agencies, the private sector, and stakeholders work in unison to plan and coordinate an immediate national preparedness response through the National Disaster Committee (NDC). Situation reports have since been released almost daily. Radio stations regularly play messages about safe practices to combat COVID-19 and share emergency contact numbers.
Since 5 March, the RMI has reported two suspected COVID-19 cases. Both were tested and returned negative results. Nonetheless, all international travellers were banned from entering the RMI until 22 March. Subsequent advisories extended this date first to 5 April, and then to 5 May.
Since 70–80 per cent of the RMI’s food and supplies arrive via sea, the ninth HTAR reduced the minimum required number of days at sea prior to arrival from 30 to 14 days for container vessels and tankers. Already, delays in the supply of imported food and other necessities are being experienced.
The national College of the Marshall Islands (CMI) voluntarily created a quarantine site at their Arrak campus, and has relocated 36 students and approximately 20 employees from their Arrak to Uliga campuses (almost 30 miles apart on Majuro Atoll).
The Ministry of Health and Human Services (MOHHS) rushed to build a COVID-19 isolation ward. Designed with eight isolation rooms, the new ward is nearing completion and should be operational by July 2020. Outreach by MOHHS senior administrators and medical staff also include roadshow-type meetings at selected community locations. Information about COVID-19 and safe practices (such as regular handwashing), and emergency contact numbers, are included during these information-sharing sessions.
The public school system and private schools within the RMI have also taken decisive measures to prepare students in the case of confirmed COVID-19 cases. One- to two-week spring breaks have been used to thoroughly clean school buildings including sanitising and decontaminating regularly used areas and surfaces like doorknobs or handles, walls, faucets, tables and counter tops, and so on. Where budgets allow, extra handwashing sinks have also been installed. The local Environmental Protection Authority initiated the drive for bucket with faucet water containers for schools and homes that cannot not afford additional hand basins. Classes at elementary and high schools, and the College of the Marshall Islands, continue as normal. The University of the South Pacific Marshall Islands campus is currently in its third week of an extended semester break.
Two chartered flights in the last week, one Fiji Airways, the other Nauru Airlines, landed in Majuro to pick up Mormon missionaries and Australian citizens respectively. Both were closely monitored to ensure no human-to-human contact took place during the evacuation operations.
While large gatherings of over 20 people are strongly discouraged, church services and ilomej (funeral gatherings) continue as normal. Social distancing, the use of face masks and gloves, and safe, hygienic practices punctuate social discourse. Overall, the RMI continues to operate as normally as possible, but with travel banned and trade down, parts of the private sector are suffering. Nevertheless, business as usual continues for most workplaces, on the proviso that, should at least one COVID-19 case be confirmed within our borders, educational services, businesses and employment places will lockdown and preventative practices immediately implemented.
Regional events have also necessitated quick action. On 13 March, the RMI government was informed that Xavier High School in Chuuk, Federated States of Micronesia was ending the Spring semester early and sending students home. Eighteen Marshallese students disembarked from the commercial carrier United’s16 March flight. Under a strictly monitored operation, the students boarded a bus on the tarmac and were taken straight to the Arrak campus quarantine facility. Three nurse practitioners lived with the students for 14 days, monitoring their temperatures and noting any other unusual symptoms. Four other females and an infant were quarantined at Arrak campus. All were discharged on 31 March with no COVID-19 cases reported. On Good Friday, 10 April, a seaman was admitted to the Arrak campus quarantine facility to complete the mandatory 14-day quarantine period for incoming travellers.
The RMI’s approach to COVID-19 has and continues to be underscored by caution. Not having any confirmed COVID-19 cases in the RMI is likely due to the singular determination of the RMI government to keep our borders closed.
This post is part of the #COVID-19 and the Pacific series.