Dr Meru Sheel is an infectious disease epidemiologist and a Westpac Research Fellow with a passion for improving the health outcomes of marginalised populations. This work takes Meru to different parts of the world in response to infectious disease outbreaks and emergencies.

In late January 2020, Meru was deployed to Tonga to the World Health Organization’s (WHO) Country Office in Tonga through the WHO Global Outbreak Response Network to support the Tonga Ministry of Health with their response to the 2019 measles outbreak, which had resulted in over 650 cases in a country of 100,000 people.

Within 48 hours of arriving, however, her role pivoted as the number of cases of COVID-19 in China were increasing. This meant Tonga and countries around the world had to prepare in case the outbreak spread within the Western Pacific region or globally.

^{Dr Joseph Takai from the Tonga Ministry of Health providing COVID-19 situation update at a public information session. Credit: Dr Meru Sheel.}

You had to change your focus in the field to COVID-19, what actions did you take?

As an epidemiologist, my role was to assist with controlling the measles outbreak, including investigating measles cases and vaccination activities. Given that I was already on the ground, I stepped into the role of also supporting the Government’s preparedness activities for a COVID-19 disease outbreak. In that capacity I acted as the country focal point with support from the WHO Division of Pacific Technical Support in Fiji.

What did this response involve?

I supported the Ministry of Health activate a preparedness response plan as outlined by the WHO. This plan has a number of key pillars that we worked towards. One of the first steps was to bring together a national committee across all sectors of the Ministry of Health. National coordination is one of the most important aspects of outbreak response as it provides a common platform for planning, tracking progress, and raise any issues in implementation.

Another immediate step was to implement screening measures at the country’s points of entry (airports and sea ports). Within a few days, the Ministry of Health implemented measures to identify people at the border if they present with symptoms and provide information on what to do if they developed symptoms of the disease.

Surveillance is another pillar, which means monitoring the disease and ensuring anyone with suspected symptoms can be identified early. We know that early detection of infected people can prevent community-wide spread and help reduce the number of cases of severe disease.

We also focused on operational planning for laboratory testing, community engagement and risk communication, infection prevention and control, ensuring adequate supplies of personal protective equipment are in place to ensure healthcare workers are protected, management of cases in health facilities, to name a few. The planning and response will evolve as time goes on.

Pacific Island Countries are separated by large distances, connectivity is challenging, and resources are limited in terms of the response ‘architecture’ and public health professionals, so it is really important that we have early systems in place.

^{Dr Meru Sheel (front left) working with colleagues from the Tonga Ministry of Health on their COVID-19 preparedness activities. Credit: Dr Yutaro Setoya, WHO Country Office, Tonga.}

How has the measles epidemic impacted the COVID-19 response?

The response to the measles outbreak has better equipped the country to respond to COVID-19, and lessons learnt from responding to measles will be invaluable in preparing for this and future outbreaks. The Government is motivated and passionate about strengthening their preparedness and response capabilities, and the national coordination team is supporting this. The country might not see a COVID-19 case, but they are working very hard to ensure they are ready if they do.

What was your memorable experience of working in Tonga?

Tonga has a fantastic Ministry of Health and an incredibly dedicated and humorous team. Many of the people I was working with had multiple roles, and had already been working on the measles outbreak for some time before I arrived. This continued response has been incredibly fatiguing on their health system and health workers, so I was glad to surge their capacity and enable their efforts to prepare the country for this outbreak. I am looking forward to working with them over the coming years strengthening our collaboration and friendship.

Despite the long days – we had lots of laughs and I have many wonderful heart-warming memories and stories that I continue to cherish.

** Dr Meru Sheel was deployed to Tonga from 22 January – 16 February 2020.

** Tonga is a Polynesian kingdom of more than 170 South Pacific islands of which 36 are inhabited and has a population of 100,651 people. Over 85% of people live on the main island of Tongatapu and neighbouring island of Vava’u. The capital is Nuku'alofa, Tongatapu where the Ministry of Health is headquartered.