TT Medics Weigh in on Health Care

T&T’s medical fraternity (of more than 5,000 doctors) is a front line partner with Government amid the coronavirus pandemic of epic proportions equal to the deadly Spanish Flu (mutating from birds and pigs) of 1918 that infected an estimated 500 million people (one in three people on earth) and killed some 50 million worldwide.

As COVID-19 (mutating from bats to civet cats) rages a century later, it has infected over three million people, killed over 220,000 and threatened over 195 million jobs worldwide (May 1, 2020). Humans are increasingly isolated amidst the spectre of disease and death and connected only by machines.

Like all pandemics, this will end, but how, and at what cost, will depend on to what extent we allow scientists, epidemiologists, virologists, doctors and health care workers to take centre stage.

The following is an amalgam of opinions (gathered online and by phone) of 14 T&T based general practitioners, specialists and surgeons in our public and private health sectors who have elected to remain anonymous.

Everyone interviewed supports social distancing, agrees with the lockdown measures taken by Government, and believes the testing performance by the Caribbean Public Health Agency (CARPHA) is “poor” at best.

Who is the most susceptible to COVID-19?

Everyone. It is spread through small droplets from the nose or mouth when a person with COVID-19 coughs or exhales.

These droplets land on objects and surfaces around the person. Other people catch COVID-19 by touching these objects or surfaces, then touching their eyes, nose, or mouth. People can also get COVID-19 if they breathe in droplets from a person with the virus who coughs out or exhales droplets. Hence social distancing. COVID- 19 is asymptomatic, highly infectious and tragically follows a Nazi-like trajectory as if pursuing a cruel natural selection agenda, killing the most vulnerable. It’s killing the elderly; it’s killing people from poor communities prone to hypertension, diabetes, cancer and obesity, unable to afford isolation.

It’s even killing young, healthy people who don’t fall into any of these categories. Finally, it is killing those unable to adapt to change and call the pandemic a conspiracy, the religious leaders who encourage worshippers to assemble and the “protesters” who deliberately expose themselves and others to the deadly virus. It will kill the vulnerable, the poor and the people who don’t understand that life will never be the same again, not until there is a vaccine that would take a minimum of 18 months to get to us.

Meanwhile, the World Health Organisation has warned us that countries worldwide must be prepared for a second or third wave of the coronavirus.

As I write (April 29), T&T has conducted 1,683 tests, with 116 positive cases, 72 discharged, and only eight deaths. We are second in the world only to Vietnam in our ability to roll back lockdown COVID-19 measures according to a study by Oxford University.

Is it time to open up the economy?

No. The Health Minister has clearly said that cases #115 and #116 were from the local spread, that is they had no history of foreign travel and the Government was going to “ringfence the primary, secondary and tertiary contacts” and ensure those people stay home. The coronavirus is very much still around in T&T. It takes one asymptomatic person with COVID-19 to infect thousands, as was the case in South Korea where patient #31 accounted for 80 per cent of cases in the entire country. She disobeyed the stay-at-home order and despite her fever attended two church services and had buffet lunch at a hotel. Within a day the infected count skyrocketed past 1,000, a more than 30-fold increase in a week that prompted the Government to raise its health alert to the highest level. If we get a similar super spreader, we won’t be able to cope. We have about 100 ICU beds (many occupied) between Port-of- Spain and Mount Hope. We are on a thin edge. If we open, you can get 20 severely ill people in a day. We could have 50 deaths.

Without ICU beds people will die. In the big countries they can expand ICUs. We cannot. Just look at the Spanish flu. As they let go from the first one, the second wave came and mashed up everyone and 50 million people died.

That’s what we mean by flattening the curve. If we jump the gun and open the economy before we test adequately, we will get a spike. It will backfire and we will have to close for longer. The world is expecting a second wave. That’s why California closed its beaches weeks ago. Japan eased up and is closing again.

We run the risk of drowning in a second wave. In Ecuador, the health system was overwhelmed and they were storing bodies in hospital bathrooms. You can say it’s nothing till it hits with a second wave as many people are asymptomatic, which is what happened in 1918. The virus is here until there is a vaccine.

Why is the medical fraternity so concerned about testing?

It’s the only way to contain the virus. Testing, tracing, isolating. We have tested only 0.1 per cent of the population. People are so worried about ending up in the Couva or Caura institutions they are not reporting symptoms. We are the only people in the world enforcing institutional quarantine for everyone who is tested positive. In the US and Australia, they are encouraging home quarantine and only those with complications go to the hospital. Without testing, we can’t act. Only a few countries like New Zealand and South Korea can claim to be relatively virus-free. South Korea tested just about everyone. New Zealand has done a mass amount of testing.

Do you think that by May 15 all criteria (widespread testing, tracing) will be met for opening the borders?

No. Despite the success of lockdown, the current numbers should not give us a false sense of safety. Everything will depend on the promised random testing. If they pick up a few cases, the lockdown will be rolled over till the end of May and the borders will not be reopened. Airline travel will be difficult.

Apart from the experience of maintaining social distancing, the droplets of the virus can live for a few hours in an aerosol and the whole plane can get it.

When should schools be reopened?

If there are no cases, we could take a bigger bite in September. Schools can open, but everyone will have to wear a mask until there is a vaccine. Social distancing will remain.

It will take one case in the school for the entire school to be infected. Schools can be breeding grounds for the spread and should be reopened only after a period of continuous testing, which is grossly lacking to ensure there is no community spread.

Opening schools should be contingent on the fact that the curve has flattened. Schools will open, but children will have to wear masks.

A T&T Manufacturing Association survey shows that 36 per cent of businesses in T&T have terminated full-time employees and 55 per cent have terminated part-time or contractual employees. People in T&T are hurting economically. Families are suffering, the lines of those needing food are longer. What if by May 15 there are no community cases? How should we ease out of lockdown?

The Government has a balancing act to facilitate the reopening of the economy while mitigating the health risk. The truth is, COVID has backed the world into a corner. It’s not a 50-50 thing. It’s a “you do this or else” situation.

The virus isn’t giving us different avenues. The significant economic and social impact needs consideration which some say outweigh the health-care risk. Opening up too quickly may mean a spike of infection due to asymptomatic spread/contact with COVID-19 cases which could mean a longer lockdown and a further economic setback.

There should be a staged re-entry of society, starting with essential businesses such as groceries, government offices, etc.

If the virus is contained, businesses will open with modified social distancing. Food establishments will open, but only takeaways will be allowed. There will be augmented work structures and shift systems in place.

People will be required to wear face masks in public. Modified social distancing is expected to continue with augmented work structures and shift systems in place.

It won’t be business as usual for a long time. When you are sitting in a restaurant for two to three hours, you can get it, circulating air, talking loudly, a person is taking orders, we can’t help but touch table, plates, picking up the menu. A few 100,000 droplets can sit on a pinhead.

“Everyone now asks: When will things get back to normal? But, as a physician and researcher, I fear that the resumption of normality would signal a failure to learn. We need to think not about resumption but revision.”

—Dr Siddhartha Mukherjee, The New Yorker, April 2020