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Medical personel in the COVID-19 tent at the Port-of-Spain General Hospital, yesterday.

The COVID-19 pandemic has been with Trinidad and Tobago since March 12, 2020, and in that time knowledge of the virus has grown exponentially so much so that vaccines have been developed and are now widely available locally.

However, while the country had enough doses in its possession to reach herd immunity and virtually squash its outbreak, only 42 per cent of the population has made full use of the jabs despite a widescale national rollout.

There has since been no shortage of arguments coming forward against taking a jab. But now with a possible fourth wave of infection on the horizon with the Delta variant, people need to get vaccinated now according to experts.

Very few die from COVID-19

Almost every conversation to encourage COVID-19 vaccination has centred around its ability to help prevent hospitalisation, death and to reduce the risk of transmission. However, with only around three per cent of known infections resulting in death locally, death appears to be a rare possibility- not enough to warrant taking a vaccine that some believe “was developed too fast” despite the almost ad nauseum pleas by health and medical experts.

While the incidence of fatality may seem small to the untrained eye, this sole data point of focus ignores the fact that COVID-19 isn’t a pleasant experience for even milder infections and can have lasting effects on its victims.

“Looking at the death rate alone is really a tiny, tiny portion of what the impact of COVID is,” the T&T Medical Association (T&TMA) PRO Dr Keegan Bhaggan explained.

To begin with, suffering from COVID-19 is no walk in the park for those who have even mild to moderate symptoms. But apart from the suffering that comes while infected, there are also lasting effects on all those who would have been infected- regardless of symptom severity.

“The vast majority of patients, including patients who had a mild or almost asymptomatic course of illness do find long term effects. Sometimes it varies from mild to more severe. There are patients who have long-term lung diseases right now as a result. There are patients who suffer with prolonged fatigue for many many months. they may even link chronic fatigue syndrome as a chronic outcome of having a COVID-19 infection,” Dr Bhaggan said.

He said some of these subsequent effects could even be life-long in some cases.

Citing studies in the United Kingdom, internal medicine specialist Dr Joel Teelucksingh explained that around 20 to 30 per cent of all those infected with COVID-19 will have these lingering symptoms.

This, he said, “affects your job, school or the quality of life.”

Healthy people can survive

Up to Monday, 65.1 per cent of fatalities locally were among those over 60 years of age. This statistic has led many who focus on the death rate that it’s mainly deadly to the elderly and that the young and healthy have a better chance of survival. While it may be true that the younger and healthier have a better fighting chance at not dying, it’s not guaranteed. An unfortunate example is 20-year-old Abdullah Hassim. A healthy young man at the prime of his life, Hassim suddenly and mysteriously fell ill and died in his mother’s arms on June 5. It was later discovered he had COVID-19. This isn’t an uncommon occurrence according to Dr Teelucksingh who said seemingly well patients can suddenly and rapidly get severely ill.

“Some persons have minimal symptoms while their oxygen or the oxygen saturation levels continue to decline. These are known as “happy hypoxics” until there is a sudden decompensation and the requirement for ventilation,” he said.

On May 30, a renowned Laventille drummer without any known comorbidities, Larry Haywood also rapidly and suddenly decompensated and died gasping for air at his home.

Professor of Critical Care Medicine at the University of the West Indies, Professor Hariharan Seetharaman said healthy people are turning up in the “makeshift” Intensive Care Unit for COVID-19 patients at the Eric Williams Medical Sciences Complex where he has worked for the past 20 years.

“I know of at least three people who were completely healthy…they didn’t have any other illness at all…they succumbed to the illness,” he said.

He said he even lost a healthy 29-year-old relative to the disease in India.

“It is not that youngsters are immune (to death),” he said.

Rare for children to get severely ill or die

Children have been a unique point of contention for many when it comes to the pandemic. As of August 6, 3,497 children contracted COVID-19; 1,305 were between ages 0 to 9 and 2,182 were between the ages of 9 to 19. Since the pandemic began, there were four children under the age of 19 succumbed to the disease. They are indeed less likely to become severely ill or die after contracting COVID-19, but the disease still poses a great threat to them.

“We’ve had those who come into the hospital with more vomiting and diarrhoea, with wheezing, respiratory illnesses on the mild side and then we have the moderate and severe side,” president of the Paediatric Society, Dr Virendra Singh said.

“We are also getting quite a lot of neurological dysfunction among children and we feel that we might be getting some flare-ups of autoimmune conditions too…so we seeing some children who getting pretty unwell and do require hospitalisation.”

There were at least two instances in the recent past where the Ministry of Health revealed several children were fighting for life in the Intensive Care Units.

Severe infection in children can result in high and long-lasting fevers and joint pain among other symptoms.

“Some of them actually get cardiac dysfunction and some of them get neurological dysfunction so meaning you get things like really bizarre behaviour changes associated with things like motor paralysis,” he said.

These conditions, he said, has been witnessed locally in severe cases of COVID-19 in children.

Much like an adult, the initial infection is only part of the picture when examining COVID-19’s effect on this demographic. Contracting the disease can lead children to develop Multi-system Inflammatory Syndrome in Children (MIS-C), which while treatable, Dr Singh said they may never fully recover from.

“Because of the novelness of the condition we still don’t know about reverse (its effect). Reverse means get rid of all symptoms and signs. You can certainly get rid of the acute symptoms that is the standard treatment the cardiology colleagues will do,” he said.

“But reverse? I can’t say. We’ve been able to babysit them and reverse a lot of the acute symptoms but whether it’s long-term reversal- we don’t know with COVID.”

There have been at least 55 children to develop this condition to date following COVID-19.

Dr Singh explained acute symptoms of MIS-C include cardiac and bowel dysfunctions and severe skin rashes while the more long term effects also include “some cardiac dysfunction”.

What does “severely ill” entail?

Severe illness has been used to describe more extreme cases of COVID-19. But what does that mean? According to Dr Teelucksingh, severe illness is a painful experience for those who reach that point.

Patients who become severely ill with COVID-19 may begin with a fever, cough, shortness of breath as initial symptoms, according to Dr Teelucksingh.

“About a week later when this intense inflammatory cytokine storm occurs in the person and the shortness of breath increases, this struggle to get oxygen has been compared to trying to breathe underwater with a straw,” he said.

“There’s a narrowing of the airways, the air sacs become filled with mucus, fluid or puss, and there may be blueness to the fingertips, the tongue and the lips as a result of the reduction in oxygen levels and the person cannot talk. The use of muscles of breathing in the neck, the abdomen- the person is unable to talk in full sentences, the pulse rate increases, the blood pressure falls, there is lethargy because of the work of breathing.”

After all this, he said a patient then becomes confused and slips into a coma.

“These are the signs and symptoms of incipient respiratory failure before the person is even admitted to an intensive care unit or ventilated.”

Delta spike imminent

All of the experts interviewed agree that vaccination is the only way to prevent not only the immediate effects of COVID-19 but to avoid the longer-lasting ones. However, according to the Medical Association’s PRO, another COVID-19 spike appears to be in the making and time is of the essence.

“We do the see the signs of that increase in patients coming to the red zones as well as in the numbers of new cases showing up. This is something we would expect to see before a larger increase would occur,” Dr Bhaggan said.

He attributed this to the introduction of the more infectious and deadlier Delta variant into the population which is now widely circulating.

“Eventually that crosses a particular threshold and you will then see a sudden spike which is what we would see with every outbreak as we saw earlier in the year and that happens very quickly,” he said.

“The signs are there that’s what is coming.”

Dr Bhaggan said it’s been witnessed in every country where the Delta variant was detected.

He said the population needs to capitalise on this calm before the storm and get vaccinated.

“The only action we have now than we had before is vaccination. All the actions we have already been taking with washing hands, wearing face masks and social distancing has taken us as far as we can go,” he said.

However, he admits it they may not be fully vaccinated by the time the spike comes.

“Getting vaccinated now is not going to protect you from the virus that might affect you in the next couple of weeks because it takes time for your body to develop that immune response. However, even a single dose will offer you more protection than no vaccination at all. So you still have the possibility of having a less severe of an outcome,” he said.

Statistics emerging from the Ministry of Health indicate that 96 per cent of the patients currently fighting for life in Trinidad’s ICUs are not fully vaccinated. It also said that 94.1 per cent of all hospitalised COVID-19 patients between July 22 and October 6 were also unvaccinated.

Overflowing ICUs near

The need to protect against severe infection is even more critical now that there are almost no ICU spaces left in the parallel healthcare system for COVID-19 patients. On Monday, Principal Medical Officer of Institutions Dr Maryam Abdool-Richards warned only three spaces were remaining across both islands with nine COVID-19 patients warded in the ICUs of traditional hospitals. As of yesterday, only one additional space opened up in Tobago.

According to Professor Seetharaman’s estimates, the point of overflowing ICU’s is near.

“I am getting a Deja vu that in a couple of weeks if the trend doesn’t go down again we may have to reach a point where people will be in the tent and waiting to get into an ICU,” he said.