The remarkable spread of the Covid-19 Omicron variant globally appeared to play out for the Marshall Islands, Kiribati and Palau in different ways this week.

Although tests have yet to confirm the variant in these three island nations, Hawaii, Fiji and Guam - where repatriation groups are staged by the three countries, respectively - all have confirmed the presence of Omicron, which is driving record-setting Covid case numbers in Hawaii and elsewhere.

While the Marshall Islands remains Covid-free and has never had community transmission, both Palau and Kiribati reported their first Covid cases in the community over the past week.

Over one-third of the 84 people scheduled to fly to Majuro and Kwajalein as part of Marshall Islands government and US Army repatriation groups earlier this week tested positive for Covid-19 in Honolulu quarantine and were not allowed to board United Airlines and Army flights to the Marshall Islands. Ten of the 44 in the scheduled Army repatriation group and 20 of the Marshall Islands group of 40 were bumped from the flight - a total of 30 people, the most-ever positive cases in groups quarantining in Honolulu for travel to the Marshall Islands, according to the Ministry of Health and Human Services.

In the meantime, as a smaller new group was arriving on Kwajalein to start a two-week quarantine this week, the three border cases of Covid-positive Army personnel tested negative after two weeks of quarantine, and were declared not contagious and released.

These three who tested positive in quarantine at Kwajalein in early January were the country's first border cases in over a year, sparking widespread community concern.

This worry about coronavirus appears to have caused a large increase in demand for Covid booster vaccines among adults in Majuro and Ebeye.

"We are seeing a bump in vaccination straight from when the border cases were announced and the week after," said Dr Frank Underwood, director of Public Health. Immunization data provided by the ministry bears this out.

Between 31 December and 7 January, only 132 adults obtained booster vaccines. But from 7 to 18 January - the period when the border cases were identified - 1937 adults received their booster shots.

Meanwhile, in Kiribati, there is local transmission from a charter flight that brought 54 people from Fiji last week Friday. Despite two weeks of quarantine in Fiji and three negative Covid tests there, 36 of the 54 passengers tested positive for Covid after arrival in Kiribati Friday. The Kiribati President's office announced earlier this week that a security guard involved in Kiribati's repatriation quarantine operation was also infected and had two contacts, who are all also now in quarantine. Families of these three are in home isolation, and contact tracing is ongoing to attempt to limit community spread.

This development has forced Kiribati to change its alert level, and institute many new restrictions for the country. While school is continuing, the government announced a halt to large gatherings such as church services and kava drinking.

In Palau, community spread is increasing as a result of many dozens of Covid positive cases among travelers arriving into Palau, which does not require quarantine either in Guam or after arrival in Palau. Palau's Ministry of Health at mid-week reported that over 600 people were in quarantine and positive case numbers were increasing daily, although there were no hospitalizations due to Covid-19. The rapid spread of Covid in once Covid-free Palau has resulted in suspension of all in-school teaching for at least two weeks, a ban on visitors to the Belau National Hospital, and restrictions on community gatherings.

Palau newspaper Tia Belau in Thursday's edition carried a banner headline: "Healthcare services impacted by Covid-19 spread," which described reduced hours of medical services due to many health workers getting Covid and being forced to isolate themselves instead of working.

In other Covid-Related news:

The Solomon Islands joined Palau and Kiribati in losing its status as a Covid-free nation when Prime Minister Manasseh Sogavare on Wednesday this week announced: "I am sad to inform you that we have a community transmission in Honiara." The government announced a "lockdown" for Honiara starting at 6pm. By Thursday, it was reported that the number of positive cases in the community had quickly climbed to several dozen.

Papua New Guinea confirmed its first case of the Omicron variant earlier this week, and government authorities said that although this case is in an incoming traveler, they expect there is already community transmission of Omicron. PNG has had community transmission of other Covid variants since last year.

Two of the three hospitals in the Pacific region that service Marshall Islands medical referral patients have suspended service because of heavy Covid patient loads. In addition to Hawaii hospitals, which last week suspended medical referral services for Marshall Islands patients, Philippines hospitals have now halted referrals. This means that medical referrals can now be sent only to Taiwan. But the halt by United Airlines to service to Majuro because of unsafe conditions in the main airport terminal puts a temporary hold on all medical referrals for lack of an international carrier serving the nation's capital.