Terrence Deyalsingh, Minister of Health

On March 12, 2020, the first case of COVID-19 was confirmed by the Ministry of Health (MoH) in Trinidad and Tobago. Two hundred days later, COVID-19 cases have soared above 4,000, and our death toll has reached an astounding 71. Our new normal in September 2020 now looks like what we considered a dystopian future from a January 2020 perspective.

From an unprecedented lockdown which has cost the country billions (and counting), to the new normal of mandatory face masks, social distancing, and limits on crowds—how did we get here?

Through the numbers: T&T’s COVID-19 journey to community spread

Between March 12 to July 20, 2020, T&T progressed through “Phase One,” characterized by health officials as mostly imported cases from returning and repatriated nationals. There were also a few cases of local spread, generally primary contacts of returning nationals or healthcare workers interacting with COVID-19 positive patients.

During this period, T&T recorded 137 cases, with two larger imported clusters. On March 17, a group of nationals, who were stranded on the ill-fated Costa Favolosa cruise, were repatriated and placed directly into quarantine at Camp Balandra. Sixty-eight nationals were part of the first group, with three individuals who returned on their own accord, totalling 72. Of these, 52 tested positive. Another cluster of twelve originated from a group of nationals repatriated on the Enchantment of the Seas.

On July 21, T&T’s tides began to turn with case 139, marking the beginning of “Phase Two.” It was the first patient for which a source of infection was not known. Two days later, case 141, a minor, became the second patient with no known source of infection and was not linked to case 139.

Cases of local transmission, where the source of the disease was unknown, began to rapidly increase, with total COVID-19 cases reaching 132 by the end of July.

The total cases increased thirteen-fold by the end of August, from 132 cases to 1,759 cases in one month.

On August 6, T&T was officially classified by the World Health Organization, per the recommendation of the Ministry of Health, as having clusters of cases. Eleven days later, on August 15, the Ministry of Health has made the request, per the Chief Medical Officer, to PAHO for Trinidad and Tobago to be classified as community spread.

As of September 27, T&T has recorded 4,312 cases—more than doubling in less than one month.

In Phase One, the majority of positive cases fell between ages 55 and 70. In Phase Two, the demographic shifted markedly younger, with now most positive cases between 25 and 49.

Flattening the

(active cases) curve

With a controlled entry and quarantine protocol during Phase One, T&T successfully flattened our curve, with zero active reported on June 8. However, as the number of cases rose dramatically in Phase Two, so did our active cases. Yet, some major changes were implemented to prevent the overburdening of the parallel healthcare system, which consequently reduced our active caseload.

Initially, all patients who tested positive for COVID-19 had to enter mandatory state quarantine, to the ire of several, prompting a few lawsuits against the CMO. However, as cases increased by the hundreds, when active cases were nearing 1,200 on August 26, the CMO instituted home quarantine for cases that are asymptomatic or mild. These “community cases” were under the supervision of the respective county medical officers or health.

Until August 26, 2020, all COVID-19 positive patients had to test negative to be discharged and were removed from the active cases of the Ministry of Health press releases. However, advances in understanding how COVID-19 leaves the body prompted the Ministry of Heath to move to a discharge based on a patient’s symptoms (or lack thereof) rather than having a negative PCR test. On August 27, this change in discharge criteria, there was a 402-patient spike in the number of persons discharged and considered recovered from COVID-19.

Then, on September 17, the Ministry of Health first reported patients in-home quarantine that were considered recovered, resulting in a 665-patient removal from our active case count.

At its peak, T&T had 2,459 active cases on September 16, spread across various medical and step-down facilities, as well as home quarantine. Since September 11, T&T’s active cases have not dropped below 2,000, excluding September 17 with a brief drop to 1,900.

T&T’s COVID-19 victims

To date, COVID-19 has claimed 70 lives across T&T, with two deaths recorded in Tobago and sixty-eight in Trinidad.

Early on during Phase One, there were eight COVID-19 related deaths, all recorded within twelve days between March 26 through April 6. According to the Chief Medical Officer (CMO), Dr Roshan Parasram, all eight deaths were people over 55 and had pre-existing health conditions.

The death toll in Phase Two has been far more significant.

T&T’s COVID-19 death toll soared in tandem with our case count, increasing by 62 people between August 14 and September 27. Similar to Phase One, nearly all patients who have died have been over the age of 55 with comorbidities. These comorbidities or pre-existing conditions are typically diabetes, hypertension, and a minority of cases, obesity, and kidney disease, according to the Ministry of Health.

As of September 18, when sixty deaths were recorded, demographic data from the Ministry of Health show men accounting for 83.3 per cent the death toll, while females accounted for 16.7 per cent.

This is generally in line with global trends where males have been disproportionately affected by COVID-19.

The shift to the new normal

On March 11, the World Health Organization declared COVID-19 a global pandemic. One day later, the Ministry of Health confirmed T&T had its first COVID-19 patient. Already uneasy about international developments, life in T&T was about to change drastically.

By the end of March 2020, schools were closed for the remainder of the school term. Bars shortly joined with an indefinite close, and restaurants had halted in-house dining. Then came the border closures. Religious gatherings, social gatherings, beach limes, a trip to the river, and even to the cinema were no more. By March 26, the Prime Minister asked all non-essential workers to stay at home, and on March 30, all non-essential businesses were closed until April 30.

As a brief light at the end of the tunnel, on May 9, Prime Minister Dr Keith Rowley announced the phased reopening of the country, following the first meeting of T&T’s economic recovery team.

“As we monitor, if the numbers are just as good as now, we will take steps to advance the phases.” Trinidad and Tobago made it to the end of our phased opening, with a sense of normalcy by the end of June with even beaches and restaurants briefly reopening.

Then came Case 139. Now, the end of September 2020 looks remarkably like the end of March. Bars, beaches, rivers, cinemas, gyms remain closed. But you can still go to a restaurant but not dine in. You can still go to the mall, but our new normal includes mandatory masks, sanitizing your hands upon entry, and remaining six feet away from everyone else.

While the source of infection is important epidemiologically, for the general population, the virus is still here, and it is not going anywhere, anytime soon. Follow the regulations for your safety—mask up, sanitize, and social distancing.