Issue 38: It's good to be small or an island (until it isn't)

Most of the jurisdictions that remain untouched by the coronavirus are either small states or remote islands. But when the virus arrives, the advantage can become a liability

Today’s briefing is by Sebastian Muermann (SM), a graduate student at the Max Bell School of Public Policy. His work experience in international relations brought him to live and work on St. Helena, a remote island community in the Southern Atlantic. There, he learned about biohazards and the fragility of isolation. He is currently riding out the pandemic in Montreal.

The St. Helenian Port Authority: one of only two access points to the island.

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THE CORONAVIRUS HAS NOW SPREAD TO MORE THAN 170 COUNTRIES and infected almost 5 million people worldwide, but a handful of isolated nations remain seemingly untouched by the pandemic - for now. Stark geographic differences in the access to resources have come to the fore during the COVID-19 pandemic. As raised in several previous articles in this series, the challenges of geography and travel are all too apparent during this crisis, in Canada, and around the world. 

A common thread for many of the COVID-19 mitigation success stories has been the early curtailing of travel into vulnerable communities. Winners here are hamlets, islands, and isolated communities who have few access points, or who have historically relied on careful screening for biological transfer for wildlife protection and infectious disease risks. 

According to global data compiled by Johns Hopkins University, 18 of the 193 UN member nations have yet to report a single case of COVID-19. A significant proportion of those countries are one of two things: remote jurisdictions, or island nations. Many combinations thereof end up being in the South Pacific, such as Samoa, Tonga and Vanuatu.

Relatively larger countries like Iceland, New Zealand, and Taiwan have been hailed for their swift interventions to prevent the spread of the pandemic, and in some cases, have completely avoided shutting down their economies. Key interventions to combat the spread have included mandatory temperature checks at airports, and specialized transportation for food and other imported goods. 

While not every country has the good fortune to be small, an island, or both, there are nevertheless lessons that more landlocked states can learn from their successes. But with good fortune comes great risk, and when the virus does eventually arise, the small size and isolation can quickly become a vulnerability.

Lessons from Small States 

  • Having few access points centralizes responses to physical travel. Iceland and Taiwan have only 4 international airports apiece, and few ports of entry via sea. Focusing on these transit hubs, supporting them with funding for point-of-entry staff and/or strengthening infrastructure needs to become increasingly important for governments. 

  • Practices like contact-tracing are made easier by physical limitations of space in small communities. Quite frankly, when there are not a lot of places to go, public health efforts can be more effective. 

  • 7 of the world’s 10 least-visited places, per UN data, are free of COVID-19. These islands can track the few visitors that arrive, and accord them the particular attention that is required. 

Vulnerabilities for Small States

  • Island nations are perhaps the original self-isolators. However, self-isolating in a remote community isn’t always easy. Complex familial interdependencies often replace formal supports that are not available, such as healthcare networks, mail delivery, and proxy shopping for bulk essentials in urban areas. Informal networks that predate COVID-19 are difficult to replace safely and quickly, and can lead to faster spread when viruses inevitably enter a community. 

  • Isolated states are highly vulnerable to the economic and trade shocks that are the result of global shutdowns. Food shortages and limited internet access were common problems prior to COVID-19, and have only been exacerbated by it. 

  • It is a myth that no harm will come to these distant places. Many are actively preparing for their first case, but quite often these are countries with one hospital, no ventilators, and shortages of medical staff, let alone the PPE to protect them.

In the small south-Atlantic island of St. Helena,  one of the most remote contexts on the planet, isolation is nothing new. Only recently having acquired an airport (which is now shut down), the island previously relied on a sole monthly cargo/passenger ship service, which was meticulously inspected after each trip for fear of the spread of non-endemic pathogens. It was a regular occurrence that you could spend several months of unintentional isolation when ship service was cut off, and currently, such a period currently lingers on in the anticipation of COVID-19. 

Today, the island is considering ways to best cope with reopening transit networks with South Africa, its closest neighbour. Unfortunately, this decision is largely out of the Saints’ hands, as not many other options for the singular transit and food import channel exist. 

In the end, many remote and isolated communities in Canada will face similar challenges. To the north, Yukon is now shifting focus to preventing COVID-19 from entering from other provinces and territories. Concerns are especially acute given the shortage of PPE in rural communities and the median age of the population. For coastal islands, Vancouver Island, PEI, and Newfoundland were all early adopters of contact tracing, and have now lowered their ‘community spread’ to zero new cases.

More and more thought needs to be given to domestic travel implications as community spread becomes a larger phenomenon, and hard-hit pockets reveal several vulnerabilities in the diverse healthcare support systems in the country. Small states may be spared the brunt of the novel coronavirus to date, but the pandemic is global. The potential for COVID-19 to reach small states call for increased international vigilance. (SM)

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Policy for Pandemics is produced and edited by Andrew Potter and co-edited by Charlotte Reboul and Paisley Sim (bios here) If you have any feedback or would like to contribute to this newsletter, please send an email to andrew2.potter@mcgill.ca