By: SIJK

Epidemiological Brief Nº4: 10 May – 16 May 2021

A regular brief edited by: (1) Pilar 3 and 5 of the Ministry of Health (as part of the Task Force for the Prevention and Mitigation of Covid-19 Outbreak, Integrated Centre for Crisis Management, Situation Room), (2) Intituto Nasional de Saúde, (3) World Health Organization, (4) AusMAT, (5) Menzies School of Health Research; (6) National Centre for Immunisation Research and Surveillance.

Cumulative cases: 4,458 (1,231 cases since last report).

Data current as at 16 May 2021.

1.     Epidemic curve

The epidemic curve shows the total case numbers for each day, in the green bars (measured against the y-axis on the left hand side of the graph). The blue line shows the cumulative total case numbers (measured against the y-axis on the right hand side of the graph), which have risen now to 4,458 since the beginning of the global pandemic (as at 16 May, 2021). The steep rise in the curve shows that the total case numbers are rapidly increasing, as transmission continues within the community.

2.     Hospitalisations and mortality

Approximately 15% of cases diagnosed in Timor-Leste between 10 May 2021 and 16 May 2021 were symptomatic, which is an increase from 7% at the beginning of April 2021. Since 1 March 2021, there have been 92 people with COVID-19 who have required hospitalisation. Hospitalisation numbers only include those with moderate, severe and critical disease, who need treatment in specialised healthcare facilities for COVID-19.

This graph shows the cases that have needed hospitalisation since March 2021 in green bars. The blue line shows the cumulative number of people who have needed hospitalisation.

As case numbers increase, the number of people who require hospitalisation will also increase as will deaths. There have been 10 people who have died with COVID-19 including 5 who died since the last report.

3.     Incidence rate estimates

The incidence rate measures the number of confirmed cases in a population, per day, and is usually measured as cases per 100,000 people per day. This graph shows that the notification rate (or incidence rate) changes from one day to the next, but is trending up. This is most obviously seen for Dili, which is represented by the solid red line. The average daily notification rate for Timor-Leste over the past 7 days (10 May

– 16 May, 2021) was 13.3 cases per 100,000 population per day, compared to 8.5 cases per 100,000 population per day in the previous reporting period.

The rate of infection in the Municipality of Dili is highest with a rate of 41.9 cases per 100,000 per day in the last week, compared to 27.8 case per 100,000 population per day in the previous reporting period.

The increased incidence seen during this reporting period, relates to transmission that occurred up to 14 days prior to the notification of cases, because of the incubation period of the infection.

In comparison, the average daily notification rate over the past 7 days for different countries are listed below:

• Brazil 29.4 cases per 100,000 population per day
• India 25.7 cases per 100,000 population per day
• Portugal 3.5 cases per 100,000 population per day
• Indonesia 1.6 cases per 100,000 population per day

4.     Prevalence estimates

Over the last week, the proportion of tests that were positive has increased from 13% to 19%. The prevalence of COVID-19 in Dili can be estimated, based on the proportion of people who test positive for COVID-19 when they are tested before travelling to leave the sanitary fence. In the six days from the 10 May – 15 May 2021, there were 3,101 people tested for this purpose; 499 (16.1%) were positive. This can be used to estimate prevalence, and a calculation of 95% confidence intervals, suggests the current prevalence of COVID-19 in Dili is between 14.8% and 17.4% (last week it was between 9.9% and 12.2%).

Based on an estimated population of 352,553 in Dili, and the lower estimate of prevalence, it is estimated that there are at least 50,000 people in Dili who have COVID- 19 at the moment.

5.     Vaccination update

As at 16 May 2021, there have been over 43,000 doses of COVID-19 vaccine given in Timor-Leste. Following the second shipment of AstraZeneca vaccines, phase 2 of the rollout which started on 10 May 2021 has seen 14,900 more people in Dili municipality vaccinated with their first dose. The current vaccination phase is especially targeting older people (aged over 60 years) and adults with underlying health conditions as these people are most at risk of suffering from severe COVID-19. Phase 2 of the rollout

has commenced in Dili, because the incidence of COVID-19 is highest there. However, vaccination is planned to continue in Dili and other municipalities, firstly targeting older adults, those with underlying health problems, essential frontline workers, and then all other people aged 18 years and above.

6.      Prison outbreaks

During the past week, an outbreak of COVID-19 was recognised at the Becora Prison. A total of 220 cases were diagnosed, out of 557 people (40%). There was one death. An outbreak was also identified in the Suai prison, where 37 out of 131 people (28%) have been diagnosed with COVID-19.

7.     Recommendations and public health actions

On 12 May 2021, mandatory confinement in the municipality of Dili was extended for two more weeks. Sanitary fences remain in place for municipalities of Dili, Baucau and Covalima

Maintaining the sanitary fence helps to identify asymptomatic cases and prevent transmission from municipalities where the incidence is high, to municipalities with lower incidence. Application of a sanitary fence should be considered for other municipalities with a high incidence of COVID-19 cases.

Transmission rate can be reduced by effective public health and social measures, including the use of masks, hand washing and physical distancing. Measures which limit physical interactions, travel and mass gatherings, have been shown to be effective in many countries around the world in reducing the transmission of COVID-

19. The beneficial effects of these measures may be difficult to see, because case numbers will still rise while there is ongoing transmission. They will not rise as quickly as they would if the public health measures were not in place, and there would be a higher risk of the health system being overwhelmed resulting in more severe cases and deaths.

Vaccination will also decrease transmission. Programs should target vaccination of vulnerable groups in Timor-Leste, commencing with elderly and those with underlying health conditions.

People who have any symptoms of COVID-19 should be tested as soon as possible, so that those at highest risk of transmitting to others can be identified and isolated and so that medical aid can be given to those who require it.

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