By Giff Johnson
The Marshall Islands is fast-tracking quarantine facilities and safety supplies for health workers to prepare for what health authorities believe is an inevitable arrival of the Covid-19 coronavirus.
"The World Health Organization is telling us it's great being protective (of our borders), but what will you do with 200 cases of Covid-19?" said Marshall Islands Health Secretary Jack Niedenthal.
"The coronarivus is coming like a freight train. We have to anticipate it like it is coming."
Mr Niedenthal conceded the Marshall Islands was currently not ready to deal with the possible spread of Covid-19 in the western Pacific nation of 55,000.
"We're not ready, but we are going fast," he said.
The government was fast-tracking the construction of an eight-room isolation facility at Majuro hospital for possible future coronarivus patients. The contract was awarded Wednesday and work started Saturday on the project.
In the meantime, Mr Niedenthal said the College of the Marshall Islands was assisting the Ministry of Health and Human Services to reconfigure facilities at its rural Arrak Campus to be used as an isolation area for "patients under investigation."
Additional supplies of gear needed to protect health workers working with contagious patients had been ordered and was expected to arrive next week.
On Friday the Ministry of Health issued its fifth coronavirus travel advisory, and its second of the week, which added four countries to the three from which travel was initially banned a month ago.
Currently, the Marshall Islands bans people travelling from China, Macau, Hong Kong, Japan, South Korea, Italy and Iran.
It had also halted ship visits from those nations unless they met a 30-day quarantine period prior to arrival.
This led to a regularly scheduled Swire container vessel being denied entry late last week, and fears of possible food shortages in the wake of the 30-day entry requirement for container ships - virtually all of which come out of China or South Korea.
After instituting a ban Wednesday on travellers from Japan, the Ministry of Health was confronted by the arrival of pilots and flight attendants who are based in Japan on Friday night's regular United Airlines flight.
The airline's system for flight crews who come from Guam, where the United Airlines Island Hopper flight originates four days a week, was to sleep over at a local hotel in Majuro, and return to Guam on the next day's flight, while Hawaii-based crews who over-nighted the previous day, fly the plane from Majuro to Honolulu, the final leg of the service.
Entry of a Japan-based flight crew violated the updated travel advisory, forcing government authorities into hasty negotiations with United Airlines corporate office in the United States to deal with the situation.
By Friday, the Ministry of Health, with input from the US Centers for Disease Control and the World Health Organization, set up a protocol for the flight crew: quarantine at their local hotel, with the requirement that each take their temperatures twice daily and report the results to a designated doctor.
"We don't want essential services to stop," said Mr Niedenthal. "It was either set up a special protocol for the flight crews or no airline service."
In the meantime, local business people were attempting to develop a plan that would eliminate person-to-person contact with crews on container ships so that the 30-day quarantine period could be relaxed or eliminated.
"At last week's Chamber of Commerce meeting, I said 'show us the protocols to prevent people-to-people contact," said Mr Niedenthal.
"You figure it out and we'll look at anything you come up with."
In the wake of last Wednesday's business meeting, members of the chamber were talking with the Marshall Islands Ports Authority, Majuro Stevedore Company, shipping companies, and immigration, customs and quarantine - all of whom would need to agree to temporary arrangements to solve the human contact issues.
It could be critical to continuous flow of imported goods, since the majority of the country's population depended on container ship deliveries of food for survival.
"Swire accounts for almost half of the cargo coming into Majuro," said local businessman Ben Chutaro after the Swire vessel was prevented from arriving last week.
"We have to make sure we have a steady supply chain."
Compared to the earlier SARS virus, the Covid-19 had a significantly lower death rate, at about two percent compared to 10 percent with the SARS outbreak of 2003-04.
But a high malnutrition rate among young children and a large percentage of the adult population with compromised immune systems due to a high incidence of diabetes, hypertension, chronic hepatitis B and other illnesses, had heightened concern from health authorities about the potential impact of the coronavirus in the Marshall Islands.
An outbreak of influenza last November and December sent hundreds of people to the hospital for treatment, with Majuro hospital's emergency room looking like "a war zone," Mr Niedenthal said.
He praised health staff and other government agencies for their aggressive and ongoing action in dealing with an extended dengue fever outbreak as well as ramping up measles vaccination campaigns, preventing the latter disease from entering the country despite cases in neighbouring islands.
He called the efforts "impressive" and pointed out as soon as they heard about the new coronavirus developing in China in December the started drawing up plans.
"We are doing a lot to prepare (for the coronavirus)."