Rajesh Pandav is the WHO Representative to the Democratic Republic of Timor-Leste
In Timor-Leste, the last confirmed case of COVID-19 recovered on May 15, 2020. The majority of 24 confirmed cases was in well-defined clusters in government identified quarantine centres. All have made an uneventful recovery. There have been no deaths due to coronavirus in the country. The expanded testing strategy does not indicate community transmission at this stage. So far, a combination of smart immigration strategy, mandatory quarantine in re-purposed hotels identified by the government and expanded surveillance with in-country testing capabilities has kept the virus at bay. This is a commendable achievement. However, this is just an interlude. The fight against COVID-19 is not yet over.
Cases are increasing globally. New countries including low and middle income countries in Asia and Africa are emerging as ‘hotspots’. However, the most critical concern for Timor-Leste is its shared land border with Indonesia. The greatest risk of importation of new cases is from entry from across this border. It is therefore imperative that Timor-Leste remains alert and keep the guard up. Covid-19 is unsparing as can be seen in the pattern repeated in cities and countries the world over. If proper attention is not paid to prevention and containment it explodes suddenly.
It is time to reflect, on what Timor-Leste has done so far and what needs to be done.
Timor-Leste has seen support and involvement from the highest levels of government to ensure a robust response to this unprecedented crisis. The Prime Minister’s Office provided overall supervision. The Integrated Crisis Management Centre had high level representation from related Ministries.
The government of Timor-Leste has introduced a series of interventions at speed and scale to prevent further spread and community transmission of coronavirus. Entry into Timor-Leste remains restricted and ‘managed’. Isolation facilities have been identified and rapidly upgraded to care for COVID-19 patients. Health workers, support staff and emergency responders have been trained in managing cases while protecting themselves. In-country laboratory testing has been introduced, surveillance capacity expanded and a web-based surveillance system established. The health response is being led by the Ministry of Health, supported by partners and organized along the nine pillars recommended by the World Health Organization.
WHO provides technical and logistical support. It has collaborated with UN agencies and bilateral partners to provide supplies, testing kits, medicines, equipment and infra-structural upgrades.
In fact, following the first confirmed case on 21 March 2020, Timor-Leste has gone from a country that lacked national Covid-19 testing capacity, had no identified isolation and quarantine facilities and limited surveillance capacity to one with in-country testing, functional Covid-19 isolation and quarantine facilities, staff rapidly trained in infection control and patient management, a gradual increase in PPE stocks and active surveillance capabilities all within a matter of 5-6 weeks.
However, it is difficult to mount an effective response without support from the people.
The government has constantly engaged to build their trust so that communities adhere to the restrictions. A cash transfer is being provided to support families through these difficult times. Border communities and village chiefs have been helping with community surveillance by providing immediate information about illegal entries along the porous border with Indonesia so that health officials can take timely action.
Timor-Leste has to continue aggressively pursuing the ‘test, treat, isolate, trace and quarantine’ policy as recommended by WHO. A surge in cases is likely to overwhelm a a fragile health system. At the same time continued efforts are required to improve the quantity and quality of isolation and quarantine facilities. It is important to further strengthen the laboratory testing capacity and surveillance capability. Concerted efforts should continue to ensure that other essential health services do not suffer due to pandemic control. As border restrictions are relaxed, surveillance needs to be enhanced. It is important to closely monitor the land border and other points of entry. Equally important is to engage with communities so that they have accurate information and feel supported and secure.
It is important to remember that fight against virus is not Government’s alone. Each member of the community has a role in themselves and their families by taking appropriate precautions: regular and frequent hand washing; avoid touching eyes, nose and mouth; avoiding large gatherings; keeping physical distance; wearing a mask in settings where physical distancing is difficult and following good respiratory hygiene. Stay home and self-isolate even with minor symptoms such as cough, headache, mild fever, until you recover. If feeling unwell with fever, cough and difficulty in breathing, seek medical attention– so that appropriate assessment and testing can take place, if needed. It is also important that communities seek information from credible sources such as the Ministry of Health or the WHO. (*)