Eighty-seven crew members and passengers have been placed into isolation on four inter-island ships in Fiji, health authorities said.
They are the latest group amongst more than 4000 COVID-positive people to have been turned away from hospitals because there are not enough beds.
Fiji's chief medical adviser, Jemesa Tudravu, said the health ministry has set up a homecare support system for those isolating on the ships and at home.
This includes delivering food and medical supplies to the ships.
Dr Tudravu said the ministry is also monitoring people at home with follow-up telephone calls.
Yet, more pressure is mounting on the Fijian government to impose a national lockdown amid the worsening COVID-19 crisis in the country.
Over 16,000 people infected with the virus are in isolation - with over a quarter of them at home.
Despite calls from the opposition and civil society groups in Fiji, the Prime Minister says he will not enforce a national lockdown because it will only cripple the economy and impact jobs.
Frank Bainimarama maintains a complete shutdown of the main island Viti Levu would affect Fijians living in informal settlements and who are reliant on daily wages.
The government is also concerned the tens of thousands of people who live in these informal settlements - where most of them are within the containment/red zones - would not be able to access essential services during any lockdown.
But a New Zealand-based COVID-19 modelling expert says Fiji should have a national lockdown.
Professor Shaun Hendy said a lockdown is a logical way of trying to get the virus under control, and New Zealand should be helping out financially.
"We should be looking at helping them with financial assistance to ensure that their economy can weather this. Whether they have a lockdown or not.
"It is going to be a very very difficult period for them in terms of their economy and of course their healthcare system is already under extreme stress."
New Zealand should be moving faster to get Fiji the AstraZeneca vaccine, professor Hendy said.
New Zealand has pledged 500,000 doses of vaccines to Fiji, and Foreign Minister Nanaia Mahuta said both the AstraZeneca and Moderna vaccines are due to be sent to the Fijian capital, Suva, from next month.
"By our calculations of those vaccines that have been pledged and committed, they may not have to draw on the full 500,000 doses however they are still for Fiji at this stage."
The New Zealand Government is still awaiting approval from Medsafe for the vaccine.
The Pasifika Medical Association of New Zealand said there was a real need for more outside medical staff on the ground in Fiji.
Its chief executive, Debbie Sorensen, said colleagues in Fiji had been telling her they are exhausted and overworked.
She said New Zealand has sent PPE and other equipment, but the health system in Fiji now needs hands-on help.
"They are probably in desperate need now for actual human bodies to help them respond and talking with our health professional colleagues, doctors and nurses in Fiji, they tell us they are very tired. That they have been working virtually without a break and really could do with extra support."
Sorensen said New Zealand had sent a significant number of medical staff to Samoa during the measles epidemic there and Fiji just needs to make a formal request for help.
About 20 medical specialists from New Zealand and Australia are in Fiji helping their colleagues there.
Christchurch anaesthetist Wayne Morriss said doctors and nurses there were working incredibly hard, often seven days a week.
The NZAUSMAT teams have been helping Fijians to improve systems so the hospital can manage severely ill COVID-19 patients as well as people who need urgent surgery, like emergency caesareans.
Over the past two weeks, some less sick COVID-19 patients were moved from the hospital to the national gymnasium in Suva, where they could be monitored but transferred back to the hospital if needed, Dr Morriss said.
There were also clinics at a sports arena and tents outside it.
Getting the whole country vaccinated was critical, and it was going very well so far, with about 80 percent of people having their first dose of the AstraZeneca vaccine, Dr Morriss said.
He said Fijian health authorities were doing their best in trying circumstances, but the situation was grim.
"It's been a really sophisticated response from the Fijian health authorities, but I think that this sort of outbreak would stretch any health system. We're obviously very worried about the increasing number of cases and deaths, and it's fair to say it's really stressing the system."
As the outbreak grew in Fiji and a cluster of cases emerged among health workers the main hospital in Suva, the Colonial War Memorial Hospital, was restricted to almost exclusively COVID-19 patients.
But this has had a serious impact on the rest of the health system, Dr Morriss said.
"The main hospital was effectively closed down a month ago... to patients other than COVID cases, and we know there are ongoing health needs even during a pandemic.
"So there's still lots of patients with medical or surgical problems that need treatment."
The purpose of the Medical Assistance Team is four-fold, he said.
"We are assessing the capacity of the main hospital and will assist with re-opening it for non-COVID patients.
"We've also been asked to support the Fiji Emergency and Medical Assistance Team which is currently working in the Vodafone Arena, and for the next couple of days the National Gymnasium is also going to be opened to take moderately sick COVID patients.
"Those patients will be monitored so that if they deteriorate they will be transferred for more advanced care, to the Colonial War Memorial Hospital.
"The fourth area the team are working on is advising Fijian health authorities to upgrade health workers' PPE.
"The other area that is really important is infection prevention and control, so that's the use of PPE and other measures to reduce the spread of infection within the health facilities. It's really important that the staff and the patients have faith that the PPE and other equipment is going to keep them safe."
Mandatory vaccination
With no change to its strategy to combat the pandemic, the Fijian government has embarked on a 'mandatory vaccination' campaign instead.
Workers have been told they must be fully vaccinated by November or face losing their jobs.
The head of Fiji's vaccination taskforce, Dr Rachel Devi, says with the widespread transmission of the virus on the main island of Viti Levu, priority will be given to pregnant women.
Dr Devi told a recent panel discussion on Fiji that people need to get vaccinated and practise COVID-safe measures to help in the fight against the coronavirus.
A total of 428,524 Fijians (73 percent) of the target population have received their first dose of the AstraZeneca vaccine, while 90,531 (15.4 percent) have got both jabs.
Fiji's daily average test positivity rate is now at 29.7 percent - the World Health Organization threshold is 5 percent.
There are over 16,000 active cases in isolation, with more than 160 deaths reported.
RNZ
