By Dr. George Roberts
As predicted, we have not had the dreaded surge of COVID-19 in Antigua. Nor do I think it is likely to come for now. We are now on a 12-hour curfew.
What is the desired result?
A considerable amount of time, effort, and money has been expended to acquire materials and equipment in preparation for the surge. Money will now need to be found to replace the loss of income from tourism, our primary money earner. Don’t get me wrong. It was essential to be prepared. The decision makers could not gamble with people’s lives. We now, however, face a Herculean task to keep our economies afloat and our people fed over the next year.
Most of the Caribbean COVID-19 cases have been traced to imports. These cases do not seem to have blossomed into widespread infections and body bags as has been the case in London and other places. Why is this? There are a number of possible reasons.
It is almost certain that the closed borders, contact tracing, social isolation and other public health strategies have helped to control the spread of the virus.
Local conditions including time of year, geography, population density, living conditions may well be adversely affecting virus longevity and contagiousness, and maybe even the severity of the resulting infections.
For those who are calling for more testing I ask for whom and for what? There are two types of tests. Antigen tests are relevant in the early stages of the infection and may indicate active infection. Antibody tests check to see if the patient has had infection in the past and hopefully may indicate at least partial immunity.
So do we do antigen testing for everyone even without symptoms? Seems like a waste of scarce resources to me. Most cases will recover without symptoms and testing them will not significantly affect their treatment. So this test should rightly be reserved for those who are symptomatic and who have high exposure (like health professionals).
The antibody test will indicate prior infection and possibly immunity. It will take a lot of resources (which the government professes not to have) to do widespread testing to find out what we know already. Yes, we know already. Here’s how.
Data suggests that COVID-19 severely affects 5% of those infected. We have had a closed community for some time now. In this time Antigua has had less than 10 cases requiring hospitalization. If we calculate this as being 5% of cases, this works out to being a total of 200 persons. Our population is 100,000. Even if we posit that the infection may have a lower percentage of severe cases because of aforementioned factors, there would still be a significant difference in the numbers. And the picture is similar in other Caribbean territories.
So, we are predominantly COVID virgins. If someone enters the community with the active virus we can have an infection surge. If we travel to New York or some other place where it is endemic, we may be susceptible to infection if exposed.
The whole idea of the isolation measures was to flatten the curve so that medical services would not be overwhelmed. We were too efficient, helped, as I continually assert, by our local conditions, and so the disease incidence seems for now to be far within the capabilities of the local health services. Following from this, a progressive relaxation of the restrictions, while continuously monitoring the disease prevalence, would seem appropriate. This seems basically to be the strategy of the powers that be.
The alternatives would be to continue the lockdown for the next year or so until a cure or vaccine is found, an economically unpalatable option, or to open the borders, putting the majority of the population at infection risk.
I firmly believe that the course of COVID infection in our community will not be as lethal as in the USA and Europe, but we cannot become complacent. More of us will contract the virus, and some may die, no matter what is done. It is important that we all recognize this. That is the nature of the beast.
So I generally agree with and support the measures being taken. A cautious relaxation of curfews, through strict hygiene and physical distancing practices will need to be maintained especially for the elderly and ill. This needs to be combined with ever vigilant monitoring for the menacing second wave. The biggest challenge will be when and how to open the borders. It is difficult to see how to avoid mandatory testing and/or quarantine for all travelers until the vaccine or cure is found.
I think that this is an ideal opportunity to practice real Caribbean cooperation. If we can come to a point of mutual COVID comfort where we all have the pest under control, we could have a mutual COVID ‘immigration’ status where clearance into one country will be acceptable for the others in the region. A type of Caribbean COVID oasis. This would facilitate intraregional travel, tourism and trade, and be the basis for the regional import substitution which many are now realizing is essential for our security.
So stay safe and separate. I look forward to gradual easing of restrictions, especially beach access. I will address that specifically shortly.
2 responses to “Medical Musings: COVID-19 and the Caribbean”
http://antiguaisland.blogspot.com/2020/04/open-up-island-respected-doctors.html?m=1
Same way you need to prepare for a surge, is the same way you need antigen testing to establish baselines for a ‘new’ virus. If millions can be spent in Margetson, why can’t thousands be spent in antigen testing a wider pool of persons until some real thresholds can be established?
We don’t have all the answers, we never will, but we can make better sense and spend cents that really count.
Problem is, now some things aren’t making sense and we are spending plenty senselessly. In a few months, money will not be flowing again. . . economies take time to recover.
Lets also prepare for the hurricane season while we hope for the best and prepare for the worst. May we continue to find ways to cope, ways to live, ways to conquer.