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Kosrae not yet ready for the repatriation of FSM citizens

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TOFOL, Kosrae (FSM Information Services) — From July 13 to 15, 2020, the Covid-19 Task Force of the Federated States of Micronesia worked in tandem with the Covid-19 Task Force of the State of Kosrae to conduct a series of readiness assessments, tabletop, and simulation exercises to determine Kosrae’s current capacity and prevention measures for when FSM citizens residing in Kosrae are repatriated.

On July 16, the FSM and Kosrae Covid-19 Task Forces developed action plans complete with recommendations on how to fill the gaps identified in the exercises. This release will describe the strengths and recommendations for improving the point of entry, the quarantine site, and the isolation area, as well as overarching recommendations to be addressed prior to Kosrae’s opening for the repatriation of FSM citizens.

Citizens only interested in knowing when Kosrae State is ready to open are advised that the simulation exercises demonstrated sufficient gaps that no date can yet be identified.

“In our first day of meetings,” said  Carson K. Sigrah, governor of Kosrae State, in the debriefing on July 17, “I mentioned that we were working on a timeline to start thinking about opening our borders to accept our stranded citizens. The timeline was next week’s flights on Wednesday and Thursday. Evidently, I think we cannot meet that timeline according to the assessment that’s been done.”

The Kosrae State Airport is the point of entry for repatriating FSM citizens. Strengths include that the setup for the screening area is simple, that risk communication messages were clearly announced via megaphone, environmental decontamination was conducted thoroughly, the ambulance was

well-equipped, and the structure for the screening station is an open area with natural ventilation.

“Kosrae State is very smart with its point of entry,” said Dr. Eunyoung Ko, the FSM’s country liaison officer with the World Health Organization.

“Kosrae’s policy of not allowing check-in luggage simplifies the process significantly. The exposure time and exposure place are quite minimal. If you impose this on the passengers, it would be hard on a personal level but from a technical point of view it’s positive.”

Recommendations for improving Kosrae’s point of entry include finalizing standard operating procedures focusing on repatriation, including the use of personal protection equipment or PPE, such as who, how, when, what, and where to don and doff. It was noted that all staff  working at the point of entry should get trained or retrained in PPE. “I am sad to say this,” Dr. Ko said, “but most of the point of entry workers failed in how to properly wear PPE and how to take off the PPE. I think it’s probably one of the priorities in the coming weeks.”

 

A first-responder watches as the ambulance approaches to pick up the simulated person under investigation.

 

Simulated passengers stand in line; notice the absence of luggage — this is intentional, as Kosrae State will prohibit checked-in baggage as a protection mechanism. FSMIS photos

Kosrae High School is the designated quarantine site for repatriating citizens arriving from Covid-19 affected jurisdictions but not showing any symptoms of the coronavirus.

Strengths include that the quarantine site is very close to the hospital and police station; that it is well contained; that facilities are wheelchair accessible; that rooms are well ventilated; that it is possible to segregate symptomatic and asymptomatic individuals by assigning them rooms on different floors; and that the rooms are structured in such a way where families can stay together.

It was noted with appreciation that the quarantine site allows for exceptional amounts of open space and sunshine in a secured, grassy common area.

Recommendations to improve the quarantine site include assigning an overall site manager, and focal points responsible for all teams. There should be efforts to reduce crowding (such as at common areas e.g. the bathrooms and shower rooms), and SOPs in place to sanitize common areas every couple hours. It is recommended that all rooms have appropriate furnishings, and good access to WiFi/phone.

“Fourteen days of quarantine can be emotionally exhausting and, speaking frankly, very boring,” said Dr. Eliaser Johnson, the FSM’s national epidemiologist. “WiFi access will go a long way to keeping quarantined citizens feeling connected to their families and their community.”

The isolation area at the hospital has two isolation rooms ready to use, Covid-19 testing equipment setup, tested, verified, validated, and ready to use, designated staff (nurses and clinicians) identified to manage the unit, and clinical management guidelines in place. Posters and signs at the hospital’s entrance and throughout are informative and highly visible.

“The risk communication is good,” said Margaret Baekalia-Santos, the FSM’s microbiologist. “They’re putting up posters and signage to alert the general population of the [coronavirus], so that’s a good form of communication…. Also, we can do contact tracing if we have multiple cases, and we can isolate patients if we have a case. These are the strengths, but there are also a lot of gaps.”

Recommendations for improving the isolation area include ensuring better organization and management of rapid triage; training of ventilator use for doctors and nurses; continuous management and infection prevention control trainings for all healthcare workers; complete triage and isolation ward, including constructing plexiglass on the doors, designating separate areas for donning and doffing PPE, and constructing a walkway with a roof from the triage to isolation ward. It was emphasized that color coding and zoning contaminated areas from clean areas, and the risk appropriate PPE requirement thereof for the triage, isolation ward, morgue, and laboratory is highly  important.

“Don’t forget to color code — your red zone, your yellow zone, and your green zone,” said Baekalia-Santos.

There are four overarching recommendations that the national and state task forces agreed must be addressed prior to the repatriation of citizens.

The first of these overarching recommendations is to improve communication flow, with clear role delineations and accountability of the Incident Command System players; this can be demonstrated through additional simulation exercises.

The second of these overarching recommendations is for Kosrae’s Department of Health Services, in collaboration with the Disaster Coordination Office, to oversee and coordinate the implementation of the recommended actions from the assessment report.

The third of these overarching recommendations is for Kosrae State’s Covid-19 SOPs to be endorsed by the state task force and shared with the national task force.

The fourth of these overarching recommendations is for Kosrae State, before making a decision on the when and how of repatriation, to conduct a reassessment to verify the implementation of the recommended actions from this assessment report.

“In other words,” said Livingston A. Taulung, chair of the FSM Covid-19 Task Force, “Talk to each other; work together to fill the gaps, and once you think the gaps are filled test them by reassessing them.”

At the conclusion of the debriefing, Governor Sigrah said it was his view that the FSM Covid-19 Task Force ought to stay in Kosrae State a few days longer, so as to assist with necessary capacity-building. This view was echoed by the Arthy G. Nena, lt. governor of Kosrae, and by Aren B. Palik, senator-at-large representing Kosrae in the 21st FSM Congress. David W. Panuelo, president of the FSM, accepted this request, and the FSM Covid-19 Task Force will extend its stay in Kosrae until Wednesday, July 22.

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