Community cases of Covid-19 in Niue have jumped from four to 17 since the first cases were reported last Thursday.
Auckland University Faculty of Health and Medical Sciences associate dean Pacific Sir Colin Tukuitonga has been advising the Niue government on its health response throughout the pandemic.
"It is a dramatic rise but most of those cases are mild and they are isolating at home so they haven't put too much pressure from a clinical point of view but obviously general support and information would put some sort of pressure on the staff," Tukuitonga said.
Community transmission in Niue was likely as the latest cases were from different households but a link had not yet been confirmed, he said.
"They were fortunate, they had two years of Covid-19 free status where they were able to vaccinate everyone and build an isolation facility. They have used the time well and I think with the support from New Zealand, Niue is as best prepared as they can be."
Tukuitonga said additional support from New Zealand following the departure of a medical assistance team may be needed.
"They have not made a call for additional assistance, there is a [New Zealand] colleague, a public health medicine doctor there at the moment who is helping out. My understanding is if the number of cases continues to rise it will put pressure on the system," he said.
Talks have been held around the possibility of support from the Pasifika Medical Association, sending in workers from New Zealand.
"For additional nurses with clinical experience looking after sick people in primary care, public health nursing, primary care doctors, a GP and possibly specialist staff for those who are really sick who are in hospital."
"I suspect that there is community transmission going on, it is just that those links have not been established and it may take a while for that to happen," Tukuitonga said.
Seventeen active community cases have been recorded so far, reported on the Niue government Covid-19 website.
The cases are from different households and four of the cases are not linked to the border.
Minister of Health and Acting Premier Sauni Tongatule said it indicated the possibility of community transmission.
All visitors arriving in to Niue are given a 'Niue Travel Pass' and 'Rocksafe App' link to scan in to all businesses. Photo: Supplied / Niue Tourism / Gaye Wood
"We strongly advise the public to limit interactions and movements outside their households," Tongatule said.
Tukuitonga said it was just the nature of Covid-19, "regardless of how good your preparation and protocols are in place this is bound to happen".
Prepare for the worst, hope for the best
Tukuitonga said Niue was as prepared as it could be and he hoped the best case scenario played out.
"The best case scenario is more cases who are mild to moderate. The worst case scenario would be seeing more cases needing ventilation and intensive care. You are not going to need too many cases like that before the health system would struggle," he said.
Niue remains under Covid-19 alert code red. "There will be no lockdown in place as we take action to mitigate or minimise the impact of the disease in our communities as much as possible," Tongatule said.
Wear a mask, avoid gatherings, if you have symptoms stay home and get tested, Niue government advised.
"The best thing people can do at the moment is to lay low and not to go to gatherings if they don't have to," Tukuitonga said.
Niue Tourism destination manager Gaye Wood said tourists were still welcome. Locals were cautious but happy to receive guests.
"From a travelling perspective it means all of the services are still operating, there are no changes to that, they are just asking passengers to take care," Wood said.
All visitors arriving in to Niue are given a 'Niue Travel Pass' and 'Rocksafe App' link to scan in to all businesses.
Wearing face masks is strictly enforced by all cafes, restaurants, tourism services, shops and the service station.
Boxes of face masks are also available at shop and service entrances, should a visitor have inadvertently forgotten to bring one.