As a remote nation in the Pacific, the Marshall Islands had been almost completely spared from Covid-19, with only a handful of cases being recorded during the pandemic, with no community transmission detected.
But in just over a week, more than 4,000 people have tested positive for a population of about 60,000, including the country’s Secretary of Health and Human Services, Jack Niedenthal. He provided updates on Facebook, saying 75 percent of those tested in Majuro, the capital, had Covid, “an incredibly high positivity rate.”
In an interview on Tuesday, Mr Niedenthal said there was some panic and concern as the islands, about halfway between Hawaii and the Philippines, hadn’t registered a single Covid case last year.
“So people were like, ‘Hey, these guys really know what they’re doing,'” he said. “The problem is that people started to travel, they missed their loved ones, some leaders traveled.”
When life started to return to normal, it was impossible to keep the virus out, he said. Mr Niedenthal expected the number of cases to continue to rise given the dense population. “The next three to four days are going to be pretty tough,” he said.
Hundreds of health workers are among those infected. At the hospital in Majuro, vaccinations were halted because almost the entire team was absent, most of the medical record keepers were absent and the cleaning staff had been reduced to one person, he said.
On Aug. 10, Mr Niedenthal called health workers back to work even if they tested positive, saying they would be screened and would not interact with patients. He said it was a drastic measure that has been “taken all over the world and in the Pacific as the number of Covid viruses is rising rapidly and we have no other choice.”
Hospital admissions and deaths tend to lag behind the number of cases, but as of this week there have been few serious cases, including six deaths.
The population is highly vaccinated: 72 percent are fully vaccinated in Majuro and 61 percent have boosters, according to government data. The Marshall Islands closed their borders in early March 2020 and took more drastic measures than their neighbors at the time. It was one of the last places on Earth to receive the first cases, as two travelers were quarantined before spreading it in October 2020.
Niedenthal said the first known cases of the current outbreak were among a group of teens who had no travel history or known contact with someone who had been quarantined. “So we knew we were in trouble because they came from a crowded community,” he said.
He said people have been concerned in recent days, but there was a strong sense of community in the islands. “It’s not like panic in the US, where everyone buys toilet paper,” he said.
And unlike the start of the pandemic, the islands now have access to Covid treatments, such as Paxlovid, an antiviral drug shown to prevent severe Covid cases, shipped by the US government. Representatives from the US Centers for Disease Control and Prevention have arrived on the island in recent days to help with the response.
Other governments have contributed: Taiwan donated thousands of masks, protective gowns and other hygiene products, while American Samoa sent shipments of Paxlovid. The Australian government has provided protective equipment, test kits, masks and face shields.
Angeline Heine Reimers, a government employee in Majuro, said it had become almost “inevitable” to get the virus. Many people live in multi-family homes, she said, adding that 15 of the 16 people living in her home had contracted the virus.
“The good thing is we were all vaccinated,” said Ms Heine Reimers, 46, adding that each of their cases had been mild. Many Marshallese live with comorbidities that put them at greater risk if they get sick, and the Marshall Islands have one of the highest rates of diabetes in the world, according to data collected by the World Bank. “Everyone is just really scared,” said Ms Heine Reimers.
Marie Davis Milne, the mayor of Ebon Atoll, about 240 miles southwest of Majuro, said authorities were trying to prevent the spread of the virus by blocking most planes and ships traveling between neighboring islands.
She said she had volunteered at testing sites on Majuro in recent days, where some people had waited for hours under the hot sun. “Even when it rains, they don’t move,” said Mrs. Davis Milne. “They don’t want to lose their place in line.”
Jenny Gross and Livia Albeck-Ripka reporting contributed.