How the Commonwealth of the Northern Mariana Islands stalled COVID-19 for 22 months and managed its first significant community transmission.

Objective: The Commonwealth of the Northern Mariana Islands (CNMI) is a remote Pacific island territory with a population of 47 329 that successfully prevented the significant introduction of coronavirus disease (COVID-19) until late 2021. This study documents how the response to the introduction of COVID-19 in CNMI in 2021 was conducted with limited resources without overwhelming local clinical capacity or compromising health service delivery for the population. Methods: Data from COVID-19 case investigations, contact tracing, the Commonwealth's immunization registry and whole genome sequencing were collated and analysed as part of this study. Results: Between 26 March 2020 and 31 December 2021, 3281 cases and 14 deaths due to COVID-19 were reported in CNMI (case fatality rate, 0.4%). While notification rates were highest among younger age groups, hospitalization and mortality rates were disproportionately greater among those aged > 50 years and among the unvaccinated. The first widespread community transmission in CNMI was detected in October 2021, with genomic epidemiology and contact tracing data indicating a single introduction event involving the AY.25 lineage and subsequent rapid community spread. Vaccination coverage was high before widespread transmission occurred in October 2021 and increased further over the study period. Discussion: Robust preparedness and strong leadership generated resilience within the public health sector such that COVID-19 did not overwhelm CNMI's health system as it did in other jurisdictions and countries around the world. At no point was hospital capacity exceeded, and all patients received adequate care without the need for health-care rationing.

Establishing a National Emergency Medical Team (EMT) in the Federated States of Micronesia (FSM)

Background/Introduction:The Federated States of Micronesia (FSM) is a Pacific Island nation of just over 100,000 people, with 607 islands spread over an ocean territory of over 2.5 million square kilometers. The nation is regularly struck by disasters and outbreaks - most recently Typhoons Wutip and Maysak, which affected populations on hundreds of islands. To strengthen rapid response to future emergencies, the FSM Government, with support from WHO, Japan, and USAID, is now developing a national Emergency Medical Team.1Objectives:To describe the development of FSM’s national EMT.Method/Description:FSM’s EMT development began with a workshop facilitated by WHO in November 2019, with participants from the National Department of Health & Social Affairs (DHSA) and representatives from all four of FSM’s State Health Departments. A national EMT focal point was jointly hired by WHO and FSM’s DHSA, a Technical Working Group was established, and SOPs developed. WHO initiated procurement of a tailored Pacific EMT cache for FSM’s EMT, along with other Pacific EMTs. FSM’s EMT development has been slowed by COVID-19, but there are plans to train team members from the country’s four States to be ready for self-sufficient national deployments by early 2023.Results/Outcomes:With support from partners, FSM is developing a self-sufficient national EMT capable of rapid response across hundreds of islands spread over a vast ocean territory.Conclusion:FSM is strengthening readiness for future emergencies by developing a national EMT capable of rapid response to the most remote and austere post-disaster conditions, including throughout its remote outer islands.

Adapting In-Person National Emergency Medical Teams (EMT) Introductory Training to a Virtual, Storytelling (Talanoa) Format for Pacific Island Countries and Areas (PICs)

Background/Introduction:Many Pacific governments have committed to establishing deployable, self-sufficient national EMTs following recent tropical cyclones, measles outbreaks, and the COVID-19 pandemic. However, for much of the COVD-19 pandemic, PICs have closed international borders limiting in-person team member training.Objectives:To develop a remote, interactive EMT training series to engage current and prospective EMT team members in the PICs during the COVID-19 pandemic.Method/Description:From July through September 2021, WHO hosted a weekly webinar series to introduce the concepts of the EMT Initiative to current and prospective EMT team members in the PICs. The sessions utilized Pacific deployment experience using faculty from EMTs in Australia, Fiji, New Zealand, Papua New Guinea, Solomon Islands, Tonga, and Vanuatu.Results/Outcomes:Attendees from over 23 countries from across the Pacific and other areas of the world participated in the 11 sessions, with a total of over 300 individual participants. The average number of participants per sessions was 85. Feedback was sought after every session. The most significant adaptation of the sessions from the feedback was incorporating the Pacific tradition of talanoa, or storytelling, into the sessions.Conclusion:Adapting the session plans to incorporate the talanoa style of communication in the Pacific created an environment of learning from colleagues throughout the Pacific and increased participant engagement in the virtual setting. The webinar series provided knowledge of EMT basics and increased engagement and excitement in the establishment and continued growth of EMTs in the Pacific.

Tonga’s National EMT Response to the Hunga-Tonga Hunga-Ha’apai Volcanic Eruption and Tsunami

Background/Introduction:The Tonga Emergency Medical Assistance Team (TEMAT) responded to the Hunga Tonga-Hunga Ha’apai (HTHH) volcano and tsunami in early 2022. The HTHH volcano erupted violently on January 15, 2022 triggering a tsunami that struck many of Tonga’s 169 islands.1 84% of the country’s population was affected.2 Tonga’s undersea internet cable was cut, stopping most communication. At the time of the eruption/tsunami, Tonga was COVID-19-free with its borders effectively closed, forcing reliance on national emergency resources, including TEMAT.Objectives:Describe TEMAT’s response to the 2022 HTHH volcano eruption and tsunami.Method/Description:TEMAT deployed four rotations of clinical and public health teams in response to the eruption/tsunami. Team members included clinicians from the Ministry of Health, with logistics support from His Majesty’s Armed Forces. TEMAT carried out emergency assessments, facilitated medical evacuations, aided in the evacuation of an entire island’s population, and provided essential health services.Results/Outcomes:From January 17 through March 4, 2022, TEMAT cared for 381 patients including patients with non-communicable diseases (>50), psychosocial complaints (39), communicable diseases (27), and traumatic injuries (13). The team supported five referrals to higher level care, conducted patients home visits, aided in health center repairs, and responded to a boat sinking during their deployment.Conclusion:TEMAT’s deployment demonstrates that deployment-ready and self-sufficient national EMTs are essential for response to sudden-onset disasters in vulnerable countries. A trained and well-prepared national EMT can respond independently, quickly, and effectively to emergencies, despite limited resources and high-impact events.

Establishing a National Emergency Medical Team (EMT) in Papua New Guinea (PNG)

Background/Introduction:Papua New Guinea (PNG) is a Pacific nation of over nine million. It is one of the world’s most diverse nations, with over 800 languages and geographic diversity that includes both tropical islands and highland mountains. Located on the Pacific “ring of fire,” PNG is regularly struck by disasters and outbreaks. The COVID-19 pandemic triggered multiple deployments of international EMTs to PNG, which were coordinated through a national EMT Coordination Cell. To strengthen rapid, national response to future emergencies, the PNG Government through its National Department of Health is now developing the “PNG EMT.”Objectives:To describe the development of the PNG EMT.Method/Description:PNG’s national EMT development was inspired by multiple international EMT deployments, including the 2018 Highlands earthquake and multiple COVID-19 deployments. With support from WHO, PNG’s National Department of Health led EMT coordination efforts in those responses, and recognized the need for similar capabilities to be developed for national response.Results/Outcomes:To develop the PNG EMT, a focal point was appointed, a national technical working group was formed, and SOPs have been drafted with support from WHO and partners. In consultation with PNG and other Pacific EMTs, WHO is procuring a tailored Pacific EMT cache, including items specifically selected for PNG’s diverse geographic and climactic environments. PNG plans to train team members and be ready for self-sufficient national deployments by late 2022.Conclusion:PNG is strengthening readiness for future emergencies by developing a national EMT capable of rapid response to challenging and austere post-disaster environments.