Image Courtesy: Wikimedia Commons
Article 13/2022
Mauritius represents a unique and fascinating case study into how a country efficiently managed the COVID-19 pandemic in the early stages, only to have all its hard-won gains nullified through poor policymaking, hubris on the part of the government, and a failure to learn from the mistakes of other countries in dealing with the pandemic.
In theory, Mauritius, an island nation of approximately 1.2 million people in the Indian Ocean, was ideally poised to deal with the pandemic effectively. Mauritius boasts a robust public health system comprising public hospitals, clinics, and sub-centres located across the island. The Ministry of Health, under which the public hospitals and clinics operate, offers free healthcare to Mauritians irrespective of income status. The Ministry of Social Security maintains a home-doctor program that recruits private doctors to visit a fixed number of patients every month. The patients eligible for a free home-doctor visit by the MSS are over 70 years and suffering from pre-existing conditions. Citizens above the age of 80 automatically qualify for a home doctor irrespective of health. Mauritius has several hospitals and clinics that are adequately staffed by competent generalists, nurses, and specialists trained in France and India in the private sector.
The pandemic reached the shores of Mauritius in the second week of March 2020. Before the first ten cases were registered, the government declared a complete and total lockdown except for essential services. For the first two weeks of this lockdown, even the grocery stores and hypermarkets were shut down, with people being forced to depend on small village grocers for their needs (if they lived in the vicinity). The government’s aim at that time was zero COVID, and it was determined to achieve this goal.
On the 1st of April 2020, grocery stores and hypermarkets were opened with an alphabet system. People with surnames starting with the letters A to F were allowed to shop on Mondays & Thursdays, while those with the letters G to N were allowed to shop on Tuesdays and Fridays with the rest being allowed to shop on Wednesdays and Saturdays. Contact tracing was robust and prompt. Infected patients were taken to quarantine facilities and kept under observation. Moderately ill patients were kept in dormitories and isolation wards, while sicker patients were admitted to the ENT hospital for treatment. Private hospitals and clinics were forbidden from treating COVID-19 positive patients. Despite the government’s best efforts, the country recorded ten deaths during the lockdown. The government continued to extend the lockdown till the 1st of June despite no new cases being reported in May. From the second week of March till the end of May, Mauritius recorded only 336 cases. Even on the 1st of June, the lifting of the lockdown was partial, with restaurants open only for takeaway and strict social distancing norms in place. Gyms, beaches, places of worship remained closed, and all public gatherings were forbidden.
During this time, Mauritius also launched a Work Access Permit that required employers to apply on behalf of their employees for the latter to return to the office physically. Employers had to justify why it was essential for employees to be physically present at the office to receive the permit. Fearing job losses and mass layoffs, the government initiated the wage assistance scheme for all private-sector employees. Employers could apply for the government to pay their employees their full salaries up to a cap in this scheme. Employees making more than MUR 50,000 per month were not eligible to apply, and the government’s cap on salaries was kept at MUR 25,000 per month per employee. The government also paid out a monthly salary to self-employed individuals who applied. Citizens working in the informal sector such as street hawkers, maids, and other day labourers, were paid a monthly stipend. Ultimately, these schemes proved futile as companies laid off close to a hundred thousand employees once the lockdown was lifted.
The government lifted the lockdown in full on the 1st of July 2020. However, the borders to Mauritius remained closed, with only repatriation flights being operated by the national carrier. Air Mauritius declared insolvency to make matters more complicated as soon as the lockdown was announced and was promptly put in administration. The government-appointed administrators envisioned a significant restructuring of the national carrier with massive layoffs. This led to protests and disputes at the labour ministry and the courts, with pilot’s unions, cabin crew unions, and ground crew unions filing cases to save their jobs. The government in its 2020 budget, made it easier for private-sector employers to lay off employees by amending existing labour laws. Employees, irrespective of their duration of service, could now be paid one month’s severance and terminated unless stated otherwise in their contracts. This sparked a wave of anti-government protests, which failed to persuade the government to amend the new law.
The hardest-hit sector was the tourism sector, accounting for 25% of the Mauritian GDP. Tourists were effectively banned, with any travelers coming to Mauritius needing to quarantine for two weeks at their own cost. The government only permitted Mauritian citizens stuck abroad, tax-paying residents, and immediate family members of tax-paying residents to return to Mauritius. As a result, the bulk of employee layoffs was in the tourism sector. The government was forced to continue to bail out the hotels and the wider tourist industry at large, putting a massive strain on the budget.
However, the means justified the end, as Mauritius was COVID-free throughout the rest of 2020, all the way until March 2021. Quarantine measures were strict, with passengers testing positive in quarantine taken immediately to health facilities and treated. Mauritius became a true island paradise in a world ravaged with COVID-19, with horrific death tolls in Europe and America. Building on this, the government even launched a remote work visa that allowed people to live in Mauritius for a year and work remotely if they could pay for their stay. The lure was a COVID-free island paradise in the Indian Ocean where people could live safely, without fear of contracting COVID-19.
March 2021: Apples and the Jaishankar Variant
By 2021, COVID-19 variants, notably the UK, South African, and Brazilian, were the strains of concern around the world. Mauritius continued to operate with strict two-week quarantines for travellers to the island, and hence the government was not overly concerned with these variants.
In February 2021, the foreign minister of India, His Excellency S. Jaishankar, visited Mauritius with a delegation of businessmen and bureaucrats. The goal of this visit was to offer Mauritius lines of credit for defense spending, infrastructure projects, inaugurate the new Indian High Commission, and re-affirm Mauritius’ long-standing friendship with India. While the visit was a diplomatic success, the events that transpired next brought to light the deep anti-India sentiment present across the island.
Not long after the visit, Mauritius recorded a couple of cases of COVID-19 on the island. Media reports on contact tracing pointed to workers of an import/export company called Surat Foods. It was speculated that a couple of the employees picked up COVID-19 handling goods on a ship that had travelled to Mauritius from South Africa. At this time, the fake news apparatus went into full swing. Articles began appearing all over social media platforms and WhatsApp that the virus was brought to Mauritian shores by the Indian delegation that travelled with His Excellency S. Jaishankar. One of the delegation members allegedly visited the warehouse of Surat foods to buy apples as he was hungry and infected the workers there.
The government then cracked down on ‘fake news on the outbreak of COVID-19 in Mauritius’ without explicitly stating what it was cracking down on. A couple of arrests were made and reported widely in local media. Editorials in the papers rightly identified the anti-India sentiment as the root cause of this news. Around this time, India had started supplying COVID-19 vaccines to Mauritius. India provided 200,000 doses of Covishield and 200,000 doses of Covaxin before the second wave set in halting vaccine exports in totality. These vaccines were a combination of gift and commercial sales. The editorials stated that there was no money to procure vaccines and other medical equipment from India. However, with the purchase of vaccines and medical equipment from other countries, there was a distinct possibility of considerable kickbacks to middlemen.
Once again, with cases rising above ten, the government instituted a second lockdown. This time around, the government created contamination zones across the island, with entire areas being sealed off to the rest of the island if a cluster of cases were detected in those areas. This would have been effective had other measures been implemented, but pandemic fatigue had long since set in. Work Access Permits were offered liberally to non-essential companies, and malls and other shopping were kept partially open following the alphabet system. While the government re-launched the wage assistance scheme, the existing strain on the budget forced it to allow businesses to stay open, even in a limited manner, to prevent more closures and job losses.
Despite its best efforts, the government failed to return to its much desired zero COVID goal. There were many contributing factors to this. The first was COVID-19 fatigue among the population. Fear of COVID-19 among Mauritians had reduced over the year, with more people accepting that COVID-19 was here to stay and that they had to learn to live with it. The second was the lockdown in and of itself, which was poorly executed. The government could ill afford more layoffs and faced intense pressure from small, medium, and large businesses. While the wage assistance scheme was reinstated, business owners argued that simply paying for salaries was no longer viable in the short or long term. The government failed to confirm or deny whether the variant circulating in Mauritius was the Delta variant to compound the problem. This was likely the case, given the many cases detected throughout. The country saw more than 336 domestic cases within the first three weeks, surpassing the total number of cases in the first lockdown.
Realising that zero COVID-19 was no longer possible and in desperate need of investment and tourism, the government began a phased unlocking. Despite the number of daily cases increasing, the government pushed through with the gradual lifting of the second lockdown. With India no longer selling vaccines, the government purchased six hundred thousand doses of Sinopharm from China. With an eligible population of around one million, this meant that Sinopharm would vaccinate 33% of the population. The government also received vaccine grants under COVAX and had begun early negotiations to purchase Pfizer and J&J vaccines.
The government ambitiously pushed forward with its vaccine program, hiring doctors from the private sector to serve as vaccinators on contract. The goal was to get 80% of the population vaccinated, especially those working in the tourism, healthcare, and hospitality industries. With the vaccination program in full swing, the government announced that vaccinated tourists could enter Mauritius without quarantine as of the 1st of October 2021. Tourists had to have a negative RT-PCR report 72 hours before arrival and would have to consent to an RT-PCR at the airport on landing and a rapid antigen test on the fifth day. Unvaccinated tourists would have to mandatorily complete a two-week quarantine at their own cost.
The stage was set for Mauritius to open up to the world as COVID-19 numbers continued to climb menacingly.
October 2021 to December 2021: The Tsunami
Mauritius had its first real COVID-19 wave when the borders opened to tourists. Contrary to popular belief, this was not due to tourists bringing in COVID-19 from their home countries but from poor management of the pandemic, in a time when leadership and guidance was needed the most. As the cases mounted, the government ran out of facilities to quarantine infected patients. With no other option, home isolation was announced in September of 2021, with only severely symptomatic patients eligible for admission in the hospital. The government then hastily announced the creation of a Domiciliary Medical Unit, comprising of doctors hired from the private sector on a contract basis to manage COVID-19 patients at home.
The private sector, which included hospitals, clinics, and even GP clinics were strictly forbidden from treating COVID-19 patients, despite the willingness of private providers to step in and support the government. The reliance on the DMU proved challenging for the government as several doctors quit, sometimes in the middle of the month, citing long work hours, the need to drive long distances, and not enough benefits such as fuel reimbursement and so forth. To make matters worse, only one public hospital was allowed to treat COVID-19 patients, the ENT hospital. Built with aid from India, the ENT hospital was never meant to serve as a pandemic hospital. Within a matter of days, the ENT hospital was wholly overwhelmed with beds, ventilators, medication, and, most importantly, staff in very short supply. Patients admitted to the ENT hospital were in extremely critical condition and had to wait hours, sometimes days, for treatment. Family members were forced to supply medication and other essential items to patients inside the hospital.
The government held back information on the seriously ill and the deceased regarding whether this group of patients was vaccinated or not. The government also did not disclose which vaccines were taken. Some private reporting and word-of-mouth messaging indicated that most of the vaccinated population that was seriously ill or died were recipients of Sinopharm. This information aligns with events that have transpired in countries that have vaccinated a large majority of their citizens with Sinopharm and/or SinoVac. The government understandably did not want to jeopardise relations with a third country by providing details of vaccinations taken. That having said, the government did not place further orders for Sinopharm but instead began negotiations to purchase Pfizer and J&J vaccines. These vaccines would be given as primary doses as well as boosters. The Pfizer vaccine would also be used exclusively for teenagers.
Around this time, the government’s contact tracing team could no longer cope with the rising number of cases and started declining visits to people reporting COVID-19 symptoms requesting testing. This led to an inevitable catastrophe. Patients who owned a car or had families that owned a car could go to a private or public hospital and get tested. Others had to rely on public transport like buses and the Metro to get to a hospital. Inevitably the death toll began to climb, with case numbers increasing to around 200 to 300 new cases per day. The government had to open up the wards in other public hospitals to cope with the deluge of COVID-19 patients seeking admission. As panic buying began en-masse, the country began to experience shortages in paracetamol and antibiotics.
Only two private labs offered RT-PCR testing in Mauritius, one located within a hospital and the other a stand-alone provider. Within a month of the COVID-19 wave, public hospitals were overwhelmed with large queues of people waiting for hours to be tested. At this time, the hospitals shifted from RT-PCR to Rapid Antigen testing, unable to process the sheer volumes of people coming to get tested. People seeking an RT-PCR test had to drive to one of the two private labs and wait in line or their vehicles. Stories of long traffic jams and queues outside these labs circulated quickly enough. As a result, many people experiencing COVID-like symptoms chose to isolate themselves at home without testing, resulting in the number of cases being exponentially higher than what was being reported.
Government reporting of COVID-19 cases showed a steady decline in this period, with cases falling from 300 a day to around less than 50 a day. These numbers were met with extreme skepticism across the island as most people were well aware that the actual number of new cases per day was likely higher by a factor of ten. Anger against the government began to rise as the death toll increased. Stories began to circulate in the local media of secret convoys taking bodies to a burial site in the north of the island, with protests breaking out in the villages and towns nearby.
The government worked very hard to overcome vaccine hesitancy. Over a hundred large billboards had come up across the island, paid for by various advocacy groups, advocating for the right to refuse the vaccine. The government barred unvaccinated people from restaurants, bars, malls, cinema theatres, and other public places to combat this. This was in line with France’s health pass strategy, which the government sought to emulate.
Mauritius existed in two realities simultaneously. One was an island open to tourism, with minimal COVID-19 curbs in place. The other, a country was grappling with a brutal wave that at one point was killing around 20 odd patients a day, a large number for an island of just 1.2 million people. Towards the end of November, the virus was everywhere, infecting the poorest of the poor to the wealthiest men and women on the island. Unable to access private medical care, even while willing to pay for it, resentment against the government grew. This forced the government to officially allow private healthcare providers to start treating COVID-19 from the 1st of December 2021.
January 2022 and Beyond
Towards the middle of December, cases began to fall across the island, with a corresponding drop in the death toll. Faced with pressure from the opposition, the government revised the toll of the infected and the deceased, citing that positives detected through rapid antigen testing were not counted earlier but were not being counted due to updates in guidelines from the World Health Organization.
The government now mandates that for a person to be considered ‘fully vaccinated’ the third dose is mandatory. Options available are Pfizer’s vaccine for those over the age of 40 and J&J’s vaccine for those under 40 years. This was deemed necessary given the expected wave of Omicron cases in Mauritius. In December, the government closed the borders to South Africa and 14 other African countries when the Omicron variant was first detected and reported. On the 7th of January 2022, the government lifted the ban on travel from these countries. This was considered a prudent decision for two reasons. One, South African expats are amongst the largest investors in Mauritius. The second was that the Omicron variant had spread worldwide, including Europe, to which Mauritian borders remained open.
The one decision the government made in the middle of December 2021 remains a mystery. This decision was to ban the importation of Rapid Antigen tests into Mauritius. RAT tests are known to provide false negatives occasionally and are not 100 percent accurate. Still, they offer a good measure for people to test themselves at home, in real-time, without the need to visit a private lab, thereby not infecting other healthier people. While RAT tests continue to be available on the island, supply is limited to a handful of importers and distributors. This has led to speculation that the government seeks to control the importation of RAT tests instead of a total outright ban to benefit only certain special interest groups.
Conclusions
Mauritius had ample time to learn from the mistakes of other nations and make adequate preparations. The government’s belief in a zero COVID-19 plan was not rooted in logic or pragmatism. No country in the world has managed to remain COVID-19 free despite draconian efforts imposed by some. The government could have created a digital infrastructure between the first and second waves to ensure secure online payments, thereby encouraging a home-delivery ecosystem that is sorely lacking in Mauritius.
The government could have also learnt from the devastation of the second wave in India and prepared for COVID-19 wards with oxygen beds and ventilators for the sickest of patients. Instead, the government put its faith in the second lockdown, hoping that it could theoretically achieve zero COVID once again. The government vacillated between two extremes; the first was to save lives with zero concern for the economy, and the second was to save the economy. The decision to allow private providers to treat COVID-19 as late as the 1st of December 2021 defies logic and is the cause of much resentment amongst the population. The decision to ban the import of rapid antigen tests is seen as a naked attempt at cornering the market on these tests by a few elites close to the government.
Hailed in 2020 as a visionary for applying a draconian lockdown, the government of Mauritius is now seen as incompetent and corrupt. To add to the people’s woes, the fuel price was increased from MUR 44 to MUR 55 over the last twelve months. The government had also instituted a COVID-19 solidarity levy in 2020, taxing the top income earners with an additional tax which varies between 10% to 25% depending on the level of income. This has alienated much of the business elites that supported the current government.
The government could have also created a telemedicine portal and recruited doctors from the private sector for the portal. This would have allowed doctors to triage cases based on severity and recommend admissions or at least interventions at home by the DMU if patients got sicker. This would have been most useful for COVID-19 positive patients suffering from pre-existing conditions and co-morbidities.
Salaried professionals and businesspersons alike have concluded that they are now bearing a disproportionate burden of the government’s COVID-related welfare schemes and bailouts through increased taxation and fuel hikes. There is now serious talk of leadership change in the next election. Still, there does not seem to be a viable opposition candidate at the time of writing that can challenge the incumbent effectively.
With the Omicron variant now sweeping the world, it is only a matter of time before Mauritius is caught up in another brutal wave. With the government now making a booster shot compulsory to classify as ‘fully vaccinated’ and given that Omicron is said to be less lethal and severe than other variants, the hope is that the next wave will bring fewer hospitalisations and deaths. Until then, Mauritius has elected to live in an alternate reality, where tourists continue to pour in and the island remains open for business, with many people relegating the horrors of COVID-19 to the past.
(The views expressed does not reflect the views of C3S)
