An Australian doctor in Tonga warns that its too early for children to return to school tomorrow because we do not know for certain if the recent arrivals in Tonga were free of the virus or just had no symptoms. “If they did pass it to people they have contacted, those contacts may still be incubating the disease,” he said.
Dr Russ Schedlich a retired Australian specialist medical adminstrator wrote to Matangi Tonga Online tonight, after he learned that the Tonga Government was relaxing the lockdown restrictions and reopening schools and public transport tomorrow, Tuesday, April 14.
“As a minimum, it is my professional view that until such time as an in-country COVID-19 testing capability has been established and commissioned the ban on public buses, and the closure of schools and other educational institutions should be continued.
“To relax these restrictions now risks an outbreak of the disease, with potentially terrible consequences given the limited ability of the Tongan health system to cope with large numbers of seriously or critically ill patients,” he advised.
The Prime Minister's Office on Saturday, while renewing the National CoViD-19 Restrictions Notice, relaxed some of the restrictions to include education and bus services in "essential services under the order of in Public Places Act”. The PM also allowed all building and construction activities, domestic public transportation and the courts and tribunals to resume operation in Tonga.
Dr Schedlich wrote:
Lockdown — Should schools go back and buses be on the road?
“I am a recently retired Australian specialist medical administrator with experience in statewide management of pandemics when I worked for Queensland Health in 2009. I am currently staying in Tonga.
“I have been watching with interest the developing COVID-19 pandemic and the response by governments around the world. In recent weeks I have reviewed over 100 scientific papers on all aspects of the virus, the disease, the pandemic, and government responses.
“I have been particularly interested in the media reporting of the arrangements put in place by the Tongan Government to reduce the risk of the virus entering Tonga and circulating in the community. The public health response around quarantining, case isolation and contact tracing has been very good.
“I applaud the Government’s decisions to stop cruise ship arrivals in March, close its international borders (on 23 March) and to introduce a lockdown on 29 March. The initial scope of the lockdown was broad but sensible.
It is now just over three weeks since the border was closed, and two weeks since the lockdown commenced.
The decision this weekend to relax some of the lockdown restrictions and to reopen schools is premature and I believe increases the risk that the virus may appear in the community.
“I presume that these decisions are based on a belief that there is no COVID-19 virus in Tonga. In the absence of in-country testing that is a most unwise belief.
“The incubation period for COVID-19 is up to 14 days, and there is very good evidence that transmission to other people can occur in the days preceding the development of symptoms. There is now also very good evidence that a substantial proportion of cases have no or very few symptoms. This seems to be particularly true in children, and it has also been shown that both asymptomatic cases and children can pass the disease on to others: in Tonga that particularly exposes the elderly and those with risk factors to disease.
“And as we have also seen, some cases are quite mild during the early part of their illness, only to become critically ill very quickly at about the 10-day mark.
“We do not know for absolute certainty whether any of the recent arrivals in Tonga (who have all passed their 14-day quarantine period) were or are free of the virus (they were reportedly “well”, but were not tested), or whether they may have asymptomatically passed it on to their family or other contacts who may now be incubating the virus. If they did pass it to people they have contacted, those contacts may still be incubating the disease.
“We also do not know whether workers who have managed the limited aircraft movements at Fuaʻamotu, or whether the pilots and stevedores who have been handling cargo ships in Nukuʻalofa port have come into contact with the virus, even if they may have been meticulous in their precautions.
“The individual risk of transmission occurring in the any of the above circumstances is, of course, small; but the more such potential contacts happen the greater the risk.
“In the absence of in-country testing, clinicians will have no way of quickly knowing whether or not a person who presents with a suspect respiratory illness has COVID-19. This has ramifications in relation to how such a patient is managed, and how their contacts are followed up. It creates major resource and risk issues, as treating clinicians and public health staff are “flying blind”.
“In these circumstances, the lifting of restrictions on public transport and schools makes no sense. Neither of these services is able to manage any realistic form of physical distancing. Buses in Tonga are notoriously overcrowded, and to meet the 1.5m rule they would have to operate with no more than seven or eight passengers. That is uneconomic for the operators and will not happen. Schools will also not be able to maintain social distancing, either in the classroom or on the playground.
“At some point, the lockdown and associated physical distancing will need to be relaxed and eventually lifted. Policy-makers also will need to decide what sort of testing regime needs to be in place to allow the safe lifting of the lockdown and the opening of the borders.
“But now is not the time to further lift the lockdown restrictions. As a minimum, it is my professional view that until such time as an in-country COVID-19 testing capability has been established and commissioned the ban on public buses, and the closure of schools and other educational institutions should be continued.
“To relax these restrictions now risks an outbreak of the disease, with potentially terrible consequences given the limited ability of the Tongan health system to cope with large numbers of seriously or critically ill patients.”
Dr Russ Schedlich MB BS, MPH, FRACMA
Tofoa, Tongatapu, Kingdom of Tonga;