Tonga has declared a Public Health Emergency Order to be prepared to fight COVID-19.

COVID-19 was also declared as an Emergency Notificable Condition under the Public Health Act 2008.

The two declarations were announced by the Prime Minister Hon Pohiva Tu’ionetoa this afternoon, 13 March, giving more power to the Ministry of Health to contain COVID-19, should it reach Tonga.

The Declaration of an Emergency Notificable Condition outlined that COVID-19 is to be identified by four notifiable conditions including suspected case; probable case; confirmed case of COVID-19; and contact to any of these three notifiable conditions.

This declaration commenced on 12 March  and remains in force until 12 September, applied to all land and sea areas of Tonga.

Powers

The Declaration of a Public Health Emergency Order gives the Ministry of Health more power in imposing conditions such as stopping mass and social gatherings, such as drinking kava clubs. It is effective between 12 March and 12 June, and  applies to all land and sea areas of Tonga.

This means the general public is to “cooperate, assist and adhere” to all the Ministry of Health’s instructions and plans to prepare, prevent and respond to the threat of COVID-19, and to maintain business continuity where possible.

In addition, all emergency and authorized officers identified or appointed under the Act, can carry out their response “in accordance with general recommendations by the Ministry of Health and the World Health Organization” and exercise their duties, responsibilities and powers.

Current global COVID-19 situation

As of 12 March, WHO Director General Tedros Adhanom Ghebreyesus said there are 77 countries and territories with no reported cases, and 55 countries and territories that have reported 10 cases or less. Tonga is one of the 77 countries with no cases.

The DG stressed to these countries that “you have an opportunity to keep it that way. Prepare your people and your health facilities”.

“Second, detect, prevent and treat,” he said.

“You can’t fight a virus if you don’t know where it is. That means robust surveillance to find, isolate, test and treat every case, to break the chains of transmission.”

Worldwide, WHO says 15% of confirmed COVID-19 cases are severe cases requiring oxygen, and 5% are critical infections requiring ventilation and intensive care.

Reports on countries with large outbreaks such as Italy, say their health system is struggling to keep up with the large amount of people who require intensive care at the same time.

While no one in Tonga has COVID-19, if a large number of people should catch the virus in Tonga at the same time, especially given Tonga’s high rate of people with non-communicable diseases such as diabetes, how can our health system cope?

Intensive ward capacity

When asked at the press conference, Ministry of Health CEO, Dr Siale ‘Akau’ola did not specify how many intensive care beds are in Tonga's hospitals. But he said when looking at intensive care and management, “that is something that we will have to customize for our capacity”.

“So, it’s something that we have to talk within our team and I don’t think we should look at it and compare it to other countries. I think for us as a developing country we should do what is practical, what is feasible and what can get results. And I think that’s how we should approach this.”

However, he believed that 98% of people [with COVID-19] do recover from the virus.

He said they "are ready for a limited number of places at the moment. But of course, we are preparing for a worse case scenario. I think for now we are not happy with preparing for small numbers".

“I think as a Ministry we have to prepare for more difficult scenario. But I think that the way support is coming in is timely. We don’t have a case yet but the supplies are coming in as we speak. I think we are ready.”

Tonga’s first suspect case last week, resulting in a negative COVID-19 test, enabled health staff to treat the person, putting into practice what they learned from World Health Organisation specialists who were in the country at the time.

Dr Siale said that health staff responded well and WHO were happy with what they saw.

Containment

In trying to contain the virus, the CEO felt Tonga’s small size is an advantage.

“In bigger countries like America you can see how difficult it is because it is so big.”

“I feel if the virus does come to Tonga, it will be easy for us to contain it. And this declaration will support the containment process.”

Minister for Health, Hon ‘Amelia Tu’ipulotu said while they understand global [health] resources are limited, “we are very lucky that personal protective equipment is due to arrive either tomorrow, over the weekend” to support their work.

She said work will also be completed over the weekend on the quarantine space at Taliai Camp.

“Containment is important if a case should come to Tonga.”

“It is important for the people of Tonga to work together as we are already used to working together, and under this declaration the people of Tonga has to work with us, the doctors and the Ministry of Health.”