The heat on Papua New Guinea's hospitals appears to have eased, but some worry the country could still be asleep to the full extent of its Covid-19 outbreak.
Earlier this year, soaring case numbers stretched PNG's health system and workforce to the limit. But senior clinicians in Port Moresby say the rates of transmission and admission to hospital for the virus have dropped significantly over recent weeks.
A health worker takes a swab from a man to test for Covid-19 at a makeshift clinic in Port Moresby in April. Photo: AFP
The trend of less cases and hospital admissions has come as a relief to PNG's Chief of Medical emergency Services Dr Sam Yockapua, who previously warned about the risk of focussing too much on Covid-19 and ignoring other pressing co-morbidities in the country.
"The rate of transmission and admission has gone down significantly in the last three to four months. And the numbers do not lie."
He said PNG had not been able to enforce lockdowns like New Zealand or Australia, and had to live with the disease.
Lack of data a concern
Covid-19 is now considered by some in PNG as simply another disease alongside others at large, including malaria, tuberculosis, typhoid, cholera and even polio.
"I think we should stop punishing ourselves and keep living," Dr Yockapua said, adding that sections of the population may have developed herd immunity.
This theory was rejected by his colleague Professor Glen Mola, the head of obstetrics and gynaecology at Port Moresby General Hospital, who said the problem was health authorities had little handle on how many people have Covid-19.
For instance, he said the Institute of Medical Research in the town of Goroka had done around 2800 Covid-19 tests since January.
"Only 2800 tests in the whole of the five million people in the Highlands, and 468 of them were positive; that's about 18 percent. But we have no idea who that 18 percent are, we just don't have that information."
PNG's health system is under-resourced and often lacking in basic supplies. Many communities live in remote regions, and sick people often do not present to health clinics for treatment.
Professor Mola said cause of death was not routinely recorded in PNG.
A waiting room at Mount Hagen Hospital in the Western Highlands Province of Papua New Guinea. The country's health system is poorly resourced. (File photo). Photo: AFP/ Marc Dozier
So far, PNG's National Pandemic Response Controller has reported 192 deaths from just over 17,800 confirmed cases.
The positive cases are now reported in a small dribble. A far cry from the surge that began in February when around a thousand cases were confirmed per week, and for the next several months.
However, clinicians in Port Moresby, the epicentre of PNG's outbreak, report the health workforce has bounced back to its pre-outbreak levels.
Port Moresby General Hospital senior oncologist Peter Olali said many health workers had been infected, and some had died. But now it was feeling quieter on the Covid-19 front.
"We have not really seen any numbers, not just rising, but in terms of very sick ones related to Covid and all that. We haven't really seen deaths in the country and here in our hospitals," he said.
"We're not really hearing [about Covid-19 related sicknesses] from the provincial hospitals as well."
Ill-informed
Some national leaders have recently challenged health officials' warnings about the dangers of Covid-19, even touting what they claim to be natural immunity in Papua New Guineans.
Professor Mola cited the example of a prominent Highlands MP who claimed a spate of deaths in his province was not linked to the virus
"So he said last week: 'I've had to pay for ten funeral expenses (we call them haus krais)', but none of them have died from Covid, he said.
"How on earth does he know? Has he tested all the bodies, has he done a verbal autopsy? How on earth does he know that they haven't died from Covid?" Professor Mola said.
AstraZeneca vaccines supplied by Australia arriving in PNG in March. High rates of vaccine misinformation has contributed to slow vaccination rates in the country. Photo: AFP
Testing for the virus was scaled back by PNG's pandemic response authorities in June, as they shifted their focus to vaccination.
Vaccination has moved slowly, in no small part because misinformation about the safety of vaccines is rife and has created great hesitancy. The government has focussed on vaccinating key frontliners such as health workers.
Professor Mola said students starting as new medical staff at the hospital this week were offered a choice of the AstraZeneca vaccine donated through the COVAX facility, with Australia's help, or the Sinopharm vaccine from China.
"So we ask them all of course, you're all vaccinated, aren't you? Because you're not coming into our clinical space unless you are. And there were two who were not vaccinated," Mola explained.
"I said, well okay, you can go and do something else or you can get vaccinated. So they both decided to go and get vaccinated."
If outbreaks in neighbouring countries like Indonesia and Fiji were anything to go by, PNG remains highly vulnerable to Covid-19, particularly if the Delta strain of the virus is left unchecked.
Several cases of Delta recorded in PNG last month were quickly isolated. But without more testing and information on infections and deaths, PNG health authorities cannot be sure of the extent of the situation they are really dealing with.