Norfolk Island is experiencing its first Covid outbreak, with spiralling case numbers forcing more than 10% of the population into isolation and raising concerns about the local health system’s reliance on medical evacuations.
Deep in the Pacific Ocean, the external Australian territory about 1,500km off the coast of the mainland had gone the duration of the pandemic without recording any local Covid transmission, until the final days of last year.
On 30 December, its first cases of Covid were recorded, weeks after the territory reopened to tourists from Queensland and New South Wales where Covid transmission has soared.
Less than a week later, 35 locals have now tested positive for the virus, with more than 200 of the island’s roughly 2,000 residents forced to isolate.
In response, authorities have suspended tourism again, initially for two weeks, to allow its health system “to manage the current level of Covid cases in the community without additional cases from visitors arriving on the island”.
As most PCR tests have to be sent to labs offshore, the majority of diagnoses are via rapid antigen tests. The prominent variant on the island has yet to be confirmed, though authorities say it appears to be the Omicron strain.
More than 95% of the population has received two doses of Covid vaccine. However, a local resident with knowledge of the health system raised concerns about the capacity for local treatment, and a lack of a contingency plan if the outbreak worsens.
“People will end up dying probably. It’s a pity that it had to end up this way. They had two years to prepare,” the resident, who did not want to be named given the island’s small population, said.
Norfolk’s only hospital has just seven beds – one of which can be used for patients requiring acute care and ventilation – and the small health practice shares a building with the island’s only aged care facility. There is just one permanent doctor on the island. “The hospital was built in the 1940s, and it looks and runs like it was built in the 1940s,” the resident said.
The median age of residents at the 2016 census was 49, compared to the national average of 38. The resident said many suffer from existing health conditions. More than 32.6% of the population is older than 60.
“It’s a very vulnerable population … and once they’ve got an infection in the hospital, they won’t have any hospital for non-Covid patients. It’s also a problem because it’s next to aged care, and once it gets in there it’s like a death sentence,” said the resident with knowledge of the health system.
“Medevacs” to the mainland are frequent for broken limbs and other common injuries, and happen “at the drop of a hat” when conditions worsen, the resident said. Evacuations range from approximately $35,000 to $80,000 per medevac, a department of infrastructure spokeswoman said.
Since Norfolk Island lost the right to self-governance when the Australian government abolished its parliament in 2015, health and education services had been supported by New South Wales.
However, from 1 January this transitioned to Queensland, meaning that medical evacuations will now take residents to be treated in that state.
Eric Hutchinson, the administrator of the island appointed by the Australian government and a former Liberal MP, said the medical evacuation process takes about five hours. But he suggested the island would not rely on evacuations as the Omicron variant of Covid stretches hospitals on the mainland.
“We do realise that at the moment, a number of hospitals [on the mainland] have their own challenges. We’re trying to avoid medical evacuation,” Hutchinson said.
For now, Queensland Health is providing remote care to Covid patients isolating in their home on the island, in what is termed a “virtual hospital”. None are in the hospital, which Hutchinson said was because authorities were trying to avoid admitting patients due to the proximity of beds to the aged care facility.
“That obviously presents a risk.”
Hutchinson acknowledged the island’s vulnerability to the virus, but insisted that preparations over the past 18 months had put it in a better position to respond.
“It’s quite evident that what is happening on mainland Australia is justifiably concerning for the people of Norfolk, as we are an isolated community with limited medical resources and an older population.”
He also acknowledged that while there were plans for a new hospital in coming years, the island’s current facility meant the community was “still dealing with old infrastructure” when they access healthcare.
However, Hutchinson stressed that “at this point in time we’re alert, not alarmed”.
It is also understood that some in the community – specifically descendants of Bounty Mutineers and their Tahitian brides who settled on Norfolk from Pitcairn Island – are reluctant to leave the island for medical evacuation because they want to be buried there.
Hutchinson acknowledged this connection many residents have, but suggested this was no different to other parts of regional and remote Australia. “If in the unfortunate event somebody has to be taken off the island for treatment, their bodies would be repatriated,” he said.
Guardian Australia contacted Metro North Health, the section of Queensland Health that provides assistance to Norfolk Island with questions about contingency plans for the island if the outbreak deteriorates.
A spokeswoman said it is continuing to monitor high risk patients remotely and provide advice for local public health measures.
“Metro North Health will continue to support Norfolk Island as required, with medical evacuations to the mainland set to continue if needed.”
