A place in the U.S. with no coronavirus? Look to American Samoa

The coronavirus death toll in the United States is climbing past 70,000, with thousands of new cases every day. But there is still one part of the country without a single confirmed case, much less a fatality: American Samoa, a palm-fringed Polynesian archipelago that has sealed itself off for nearly two months from the outside world.

Other U.S. islands lost their early battles to keep the infection out. But American Samoa’s success so far has been no accident, public health officials say. The territory moved swiftly to halt nearly all incoming flights, rapidly boosted testing capability and took advantage of social distancing strategies that had already been adopted in response to a measles outbreak at the end of last year.

The enduring trauma of the 1918 influenza pandemic, which left American Samoa relatively unscathed but wiped out a fifth of the population of neighboring independent Samoa, has also influenced aggressive anti-contagion moves at each stage of the crisis.

“Life in our bubble is somewhat unique compared to the rest of the world,” said Bishop Peter Brown, leader of the Roman Catholic church in American Samoa. Church services were quickly shut down when the coronavirus began its spread across the United States, he said.

Schools had been preparing to emerge from a measles closure in effect from December through early March when a “continuing” public health emergency was declared, effective on March 23.

“Apart from that, life is pretty normal, but supplies are somewhat sparse with shipping restricted,” Brown said. He added that many American Samoans were anxiously following the surging death toll on the mainland. “They need the help more than us,” he said.

The 55,000 people in the territory have been allowed to go to bars, nightclubs and restaurants, albeit in smaller numbers over the past month, with a limit of 10 customers at a time. Civil servants are working part time but have not stopped going into offices. The largest private employer, a tuna cannery with more than 2,000 workers, has continued to hum along.

In telephone interviews, text messages and social media postings, people in American Samoa described experiencing a surreal mixture of relief, isolation and apprehension over what the future holds for the territory, which lies about 1,600 miles from New Zealand and 2,200 miles from Hawaii.

“Since flights were suspended in March, the silence of the skies is eerie,” said Monica Miller, the news director at an operator of radio stations in the territory.

Eying the spread of the virus in parts of Asia, Gov. Lolo M. Moliga moved assertively weeks before some of his counterparts elsewhere in the United States to shield his constituents from the pandemic.

In early March, Moliga halted the territory’s two weekly flights to and from Hawaii, then did the same with flights to Apia, the capital of neighboring Samoa. Since then, one of the territory’s only lifelines is a cargo flight arriving with medical supplies and food once a week from Hawaii.

The territorial government also quickly formed a coronavirus task force in March, introducing a variety of moderate social distancing measures in addition to the church and school closures. For instance, public gatherings in bingo halls and theaters were suspended, and the territorial correctional facility was closed for visitation.

At the time, anxiety was running high over the potential for the virus to devastate American Samoa. Large parts of the population grapple with conditions that could heighten the risk of dying from COVID-19, such as diabetes, hypertension and obesity.

Moreover, the territory has a shortage of medical workers and only one hospital, the Lyndon B. Johnson Tropical Medical Center, with capacity to treat about 10 coronavirus patients at a time.

When suspected cases began emerging in March, officials expressed fear about having no way to analyze coronavirus tests except by submitting them to the nearest American public health laboratory, thousands of miles away in Hawaii, and waiting for the results.

“It was a really frightening and scary time, like flying blind in a storm,” said Larry Sanitoa, a member of the Fono, American Samoa’s bicameral legislature, and chairman of a nursing home called Hope House.

None of the tests came back positive. But tension over a sense of helplessness was building in the territory, which the United States annexed in 1900 while assembling an empire in the Pacific; Germany, then New Zealand, took possession of neighboring Samoa, part of the same archipelago.

The people of the territory are U.S. nationals, not citizens, meaning they can fight in the armed forces and live in the rest of the United States. But they are ineligible to hold many public jobs and cannot vote for president or run for office outside American Samoa.

In a letter to President Donald Trump in March, Moliga, the Democratic governor, said the territory needed assistance and was doing its part to help other Americans, including the hundreds who were aboard the Norwegian Jewel cruise ship when it was allowed to refuel in American Samoa after being turned away at ports in Fiji and French Polynesia.

Since then, the territory has obtained at least $35 million of federal aid to deal with the pandemic, along with more than 1,000 test kits and a machine to analyze them.

Iulogologo Joseph Pereira, the head of American Samoa’s coronavirus task force, said the dozens of tests performed since the machine arrived in mid-April were all negative.

With those results and no signs of local transmission of the virus, the territory remains the only part of the United States that is not under a major disaster declaration. Pereira said the territory’s response to recent disease outbreaks — Zika in 2016, dengue in 2017 and 2018, and measles in 2019 — influenced decisions early in the crisis.

“We’ve been preparing for the big one for some time,” he said.

Health officials were already on high alert after the measles outbreak in December, and watched with some horror as 83 people, the vast majority children younger than 5, were killed by the disease in neighboring Samoa.

Swift action during that outbreak prevented deaths from measles, evoking for many in American Samoa the response to the influenza pandemic a century ago. At that time, New Zealand, which ruled what is now independent Samoa, allowed the virus to spread. The flu killed about 8,500 in the colony in just two months.

In contrast, the naval governor of American Samoa isolated the territory, much like leaders are doing now. American Samoa was one of the few places in the world to emerge from the 1918 pandemic without any flu deaths.

“Stringent measures kept American Samoa free of deaths then, and we cannot afford to deviate from the same today,” said Tamari Mulitalo Cheung, a writer who teaches at American Samoa Community College.

Being a far-flung archipelago in the Pacific may help. Other places in Oceania that have taken measures similar to American Samoa, including the Solomon Islands, Vanuatu and independent Samoa, also remain among the world’s few places without confirmed coronavirus cases.

The virus has reached other parts of the United States in the Pacific, though with less devastating effects than parts of the mainland. Guam has had five deaths, while the virus has killed 17 people in Hawaii and two in the Northern Mariana Islands.

In Puerto Rico, the most populous U.S. territory, the virus has killed 99 people. Early action by Puerto Rican authorities, including imposing curfews and shutting businesses, is thought to have staved off a much higher death toll.

At this point, some in American Samoa are urging the authorities to relax some measures.

In a session of the legislature last week, Vice Speaker Fetu Fetui noted that he had already seen crowds at banks, restaurants and government offices. He questioned whether distancing measures were being broadly enforced, and called for an easing of restrictions.

There are also a few exceptions to American Samoa’s self-isolation. In addition to the cargo ships that are still allowed to dock and unload at the port, a private jet carrying three engineers for StarKist was permitted in April to land at the airport in Pago Pago, the capital, for repairs at the tuna cannery. The engineers had previously tested negative for the virus, said Pereira of the task force.

He insisted that the authorities were “erring on the side of caution.” Last week, the governor said that current restrictions would be maintained at least until June.

More American Samoans live outside the territory, in places like New Zealand, Hawaii and the mainland United States, than in the territory, making the travel restrictions especially challenging for families that find themselves separated.

“It’s extremely difficult,” said Eddie Vaouli, 42, an American Samoan who has been stranded in Hawaii since March 20. “It’s expensive in Honolulu.”

Some in the territory are also dealing with financial fallout. Donna Gurr, the owner of the largest flower shop in American Samoa, said her business volume had declined by about 50% since the distancing measures were introduced. Her store relies heavily on sales of leis for church services every Sunday.

Still, Gurr said she approved of the government’s pandemic response. “When and if this virus arrives, it will be devastating on us,” she said.

Going further, Gurr said she did not feel too isolated at the moment. “Maybe it hasn’t been long enough,” she said. “If this lasts for a year I could feel different. But right now, I feel safe and secure.”