The epidemiology of the COVID-19 pandemic in the small, low-resource country of Timor-Leste, January 2020 – June 2022

Abstract

Timor-Leste, a small, mountainous half-island nation which shares a land border with Indonesia and which is 550 km from Australia, has a population of 1.3 million and achieved independence for the second time in 2002. It is one of the poorest nations in Asia. In response to the global coronavirus disease 2019 (COVID-19) pandemic, the Timor-Leste Ministry of Health undertook surveillance and contact tracing activities on all notified COVID-19 cases. Between 1 January 2020 and 30 June 2022, there were 22,957 cases of COVID-19 notified which occurred in three waves, the first which was delayed until April 2021 (community transmission of B.1.466.2 variant following major flooding), followed by waves in August 2021 (B.1.617.2 Delta variant transmission) and February 2022 (B.1.1.529 Omicron variant transmission). There were 753 people hospitalised due to COVID-19 and 133 deaths. Of the 133 deaths, 122 (92%) were considered not fully vaccinated (< 2 COVID-19 vaccines) and none had received boosters. Timor-Leste implemented measures to control COVID-19, including: rapid closure of international borders; isolation of cases; quarantining of international arrivals and close contacts; restrictions on internal travel; social and physical distancing; and, finally, a country-wide vaccination program. The health system’s capacity was never exceeded.

Assessing System Performance of Maternal and Child Health Care During Covid-19 Pandemic in Community Health Center- Comoro Dili Timor-Leste

“…[26] The situation was worsening during 2021 due to community transmission of Delta and Omicron variant in the country caused many deaths and hospitalization. [21]This finding of maternal and child health services disruption was similar with research findings from many developing countries in Asia and Africa region. [3] [10] [11] [12] [13].…”

“…The interruption of services delivery in Timor-Leste may be caused by many reasons including lockdown restriction and mandatory stay home order implemented in the country from April 2020 to November 2021. [20] [21] Interviews with healthcare providers and clients from study in Ethiopia highlighted several barriers to service utilization during COVID-19, including fear of disease transmission, economic hardship, and transport service disruptions and restrictions. [11] Kapoor and collaegues.2022, in their study found a causal link between restrictions and health service utilization and call for policy makers in low- and middle-income countries to carefully consider the trade-offs of strict lockdowns during future COVID-19 waves or future pandemics.…”

“…One of the reason among others is because they were infected with COVID-19, especially during the second and third wave caused by Delta and Omicron variant. [21] During the periods of COVID-19 pandemic many health care professionals were trained and relocated to COVID-19 treatment centers to provide care to COVID-19 patients and increase their chance to get infected. [20] [21] In Timor-Leste, HCWs were at the high risks of getting infected compare to the general population.…”

“…[21] During the periods of COVID-19 pandemic many health care professionals were trained and relocated to COVID-19 treatment centers to provide care to COVID-19 patients and increase their chance to get infected. [20] [21] In Timor-Leste, HCWs were at the high risks of getting infected compare to the general population. Evidence from seroprevalence study among HCWs indicating a significant sub-clinical infection among HCWs early in the local outbreak.…”

“…However, the strict lockdown and mandatory stay home measures have negatively impacted essential services delivery. [21] Two nationals' studies focusing on services delivery component of MCH during COVID-19 pandemic reveal contradictory results of the disruption of MCH services. [22] [23] So far there is no study commissioning to assess health system readiness for delivering MCH services in Timor-Leste.…”