Search

Problem: Coronavirus disease 2019 (COVID-19) was declared a pandemic on 11 March 2020. Severe illness requires intensive care facilities, which are limited in smaller, resource-constrained settings. Context: Maldives and Trinidad and Tobago are small island developing states with comparable climates. Similar to island nations in the Western Pacific Region, they are prone to natural disasters and so engage in planning and preparedness activities on an ongoing basis. This paper describes the initial measures taken by both countries during the first wave of COVID-19, from March to May 2020. Action: In both countries, multisectoral high-level leadership allowed for timely and decisive actions. Early school closures, early border closures and early lockdowns were enforced. Mandatory mask wearing and physical distancing were instituted. Cases and contacts were isolated in facilities away from public sector hospitals, and isolation was implemented at the government's expense. Volunteers were trained to manage dedicated hotlines. Additionally, the governments held daily press briefings. Outcome: During the first wave, Maldives contained its epidemic to one geographical cluster; Trinidad and Tobago successfully avoided community spread, thus averting an overwhelmed health system. Discussion: Diligent contact tracing with quarantine implemented at the government's expense successfully minimized spread in both countries. Small countries need volunteers to help with activities such as contact tracing, and recruiting and training volunteers before a health emergency occurs is key. Lessons learned from the experience of Maldives and Trinidad and Tobago could serve as a model for other small island developing states, including those in the Western Pacific Region. [ABSTRACT FROM AUTHOR]

As tourism is the mainstay of the Maldives’ economy, this country recognizes the importance of controlling mosquito-borne diseases in an environmentally responsible manner. This study sought to estimate the economic costs of dengue in this Small Island Developing State of 417,492 residents. The authors reviewed relevant available documents on dengue epidemiology and conducted site visits and interviews with public health offices, health centers, referral hospitals, health insurers, and drug distribution organizations. An average of 1,543 symptomatic dengue cases was reported annually from 2011 through 2016. Intensive waste and water management on a resort island cost $1.60 per occupied room night. Local vector control programs on inhabited islands cost $35.93 for waste collection and $7.89 for household visits by community health workers per person per year. Ambulatory care for a dengue episode cost $49.87 at a health center, while inpatient episodes averaged $127.74 at a health center, $1,164.78 at a regional hospital, and $1,655.50 at a tertiary referral hospital. Overall, the cost of dengue illness in the Maldives in 2015 was $2,495,747 (0.06% of gross national income, GNI, or $6.10 per resident) plus $1,338,141 (0.03% of GNI or $3.27 per resident) for dengue surveillance. With tourism generating annual income of $898 and tax revenues of $119 per resident, results of an international analysis suggest that the risk of dengue lowers the country’s gross annual income by $110 per resident (95% confidence interval $50 to $160) and its annual tax receipts by $14 per resident (95% confidence interval $7 to $22). Many innovative vector control efforts are affordable and could decrease future costs of dengue illness in the Maldives. [ABSTRACT FROM AUTHOR]