Papua New Guinea declares state of emergency after first coronavirus case | The Guardian.
[Mon 23 Mar 2020 03.12 GMT]
A foreign mine worker is confirmed as the country's first case, as Guam records the Pacific region's first Covid-19 death.
Papua New Guinea’s prime minister James Marape has declared a state of emergency for 14 days after the country confirmed its first case of Covid-19. Photograph: Mike Bowers/The Guardian
Supported by Judith Nielson Institute.
Kate Lyons, @MsKateLyons, writes:
Papua New Guinea will enter into a two-week state of emergency on Tuesday after the country confirmed its first case of Covid-19, as the Pacific region recorded its first death from the virus.
The Papua New Guinea government confirmed late on Friday evening that its first case of coronavirus is a foreign mine worker who entered the country on 13 March and travelled to Lae.
Announcing the confirmed case on Friday night, the prime minister, James Marape, said: “Our team were able to trace all his steps and contacts in country and from present indications the 10 or so persons he came in contact with have not shown signs and symptoms but are all under observation for our national safety.”
Marape said that though there was no evidence of community transmission so far, the country would declare a state of emergency for 14 days, beginning on Tuesday 24 March.
The measures to be introduced include stopping all domestic flights, further to a previous ban on incoming international flights; no movement from one province to another for a 14-day period except for approved cargo, medicine and security personnel; the bringing froward of school holidays to start on Monday 23 March; all non-essential workers to stay at home; and for all people who arrived in Papua New Guinea from 7 March to report in to a government hotline.
The state of emergency in Papua New Guinea – the largest Pacific Island nation – comes as cases have spread across some countries in the region over the weekend.
On Sunday, Guam confirmed the first death in the Pacific from Covid-19, of a 68-year-old woman, who was the relative of someone who had recently returned to Guam. The woman had “multiple co-morbidities”, said Dr Mike Cruz, who is leading the coronavirus response in the US Pacific territory. Guam has 15 confirmed cases of the virus, the most of anywhere in the Pacific.
Fiji confirmed its second case of Covid-19, and its first case of human-to-human transmission over the weekend, after the mother of a flight attendant, who was confirmed as being the country’s first case, also tested positive for the virus.
There are huge fears across the Pacific region about countries’ ability to cope with the outbreak of coronavirus. Many Pacific nations face huge public health challenges, including outbreaks of mosquito-borne illnesses such as malaria and dengue fever. Papua New Guinea is grappling with cases of polio and drug-resistant tuberculosis and a devastating measles outbreak last year led to more than 80 deaths – mostly of infants – in Samoa.
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The Doctor Who Had to Innovate or Else | The Atlantic.
[MARCH 18, 2020] Conor Friedersdorf writes:
As the United States braces for the peak of the coronavirus pandemic, not knowing exactly when it will come, how severe it will be, or how short hospitals will be on intensive-care-unit beds and ventilators, the story of the Danish physician Bjørn Ibsen and his many helpers could not be more timely. Patients in dire condition survived because he innovated during an emergency, because agile hospital administrators recognized the value of an insight and scaled up its application in real time, and because hundreds of people volunteered their labor to provide care.
The story begins in 1952, when Copenhagen suffered a polio outbreak. Within a few weeks, Blegdam Hospital admitted more than 300 patients who were suffering from temporary paralysis that prevented them from breathing properly. At first, doctors didn’t fully understand their condition.
The fatality rate exceeded 85 percent.
Ibsen was a Danish-born anesthesiologist who had spent time at Massachusetts General Hospital before returning to his home country. He hadn’t been involved in treating the initial cases in the outbreak. But he attended an emergency meeting of physicians at the hospital, where, according to historical accounts, Ibsen hypothesized that insufficient oxygen and a buildup of carbon dioxide was killing patients.
Vivi, a 12-year-old girl, was sweating, gasping for air, and on the verge of death when he recommended that she be treated in a different way: As was sometimes done in the operating room, they should perform a tracheotomy and force oxygen into her lungs using “manual intermittent positive pressure ventilation”––in other words, pump oxygen by hand for every breath she needed. While this was a radical new approach, the dearth of other options overcame resistance to the idea. A surgeon performed the tracheotomy. At first, Ibsen was unable to force air into the patient’s lungs, but after administering a general anesthetic he did so successfully.
Soon Vivi regained consciousness and her fever fell. It seemed that the radical new approach actually worked. But how to apply it to a sudden influx of patients when each required someone sitting at their bedside 24 hours a day, hand-squeezing oxygen into their lungs as often as they needed to breathe?
Enter the helpers. The hospital soon organized shifts of perhaps 1,500 volunteer medical students, later augmented by dental students. They worked under hundreds of nurses, some semiretired. “The medical students worked 6 or 8 hour shifts so that three or four shifts were needed,” the respiratory physiologist John B. West recounted in a 2006 journal article. “It is daunting to think of the responsibility of these students who were essentially ventilating blind with only the patient’s appearance to guide them, at least in the initial stages.”
This went on for months. So many severe cases arrived that polio patients needing ventilation took up three floors of the hospital. Once the new methods were adopted, the mortality rate fell to 26 percent. Ibsen’s innovative treatment would be used in other hospitals, and it soon spurred advances in mechanical ventilators. The approach had broader consequences, too. Ibsen saw the general usefulness of putting dire cases that required care by multidisciplinary medical teams in one place.
“After the polio outbreak had subsided, Ibsen was offered a job at Copenhagen's Kommunehospital, where he was asked to supervise surgical patients in the recovery room and the wards,” the science journalist Stephen Pincock recounted in The Lancet. “Ibsen turned the surgical recovery ward into a unit where all types of patients could receive critical care … This was the world's first dedicated intensive care unit.”
Practitioners of intensive-care medicine credit him as a founding father. R. V. Trubuhovich of Auckland Hospital in New Zealand credited Ibsen with being “foremost in advocating a separate location to be established in hospitals where intensive care management could be supplied to the critically ill.”
The COVID-19 pandemic will generate many more patients over a longer time horizon, and differ from the 1953 polio epidemic in many ways besides. Still, Ibsen’s example is inspiring. Few at that Copenhagen hospital could have known at the time that their deeds would echo down through the decades as their collective success inspired imitators and advances that transformed medicine. May any of us put in a position to serve similarly in this pandemic succeed as admirably.
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CONOR FRIEDERSDORF is a California-based staff writer at The Atlantic, where he focuses on politics and national affairs. He is the founding editor of The Best of Journalism, a newsletter devoted to exceptional nonfiction.
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