The clock is ticking on Trinidad and Tobago’s healthcare system.
Amid a third COVID-19 wave and a record 31 deaths yesterday, if current trends continue, the parallel healthcare system will be overwhelmed in a matter of days, Prime Minister Dr Keith Rowley warned last night during a 47-minute address to the nation in the COVID response.
“As such, this will manifest in our inability to provide care, not only to our COVID-19 patients, but to our other patients accessing general medical care and emergency care. I caution you today that, while we’re doing all that we can to prevent this, our healthcare system is under imminent threat.”
Rowley said he’s still hoping to reopen beaches for Christmas and would give the numbers a couple of weeks to see where they are going. If there is no further significant deterioration, reopening could start with early morning hours from 5 am to 12 noon.
“We have reached a critical crossroad in the management of the COVID-19 pandemic in T&T. Based on the increasing number of COVID-19 cases over the past weeks, and with no decrease in sight, the number of deaths has continued to increase with dozens of persons losing their lives on a daily basis.”
The Health Ministry – which itself is closed for sanitisation today – yesterday reported 624 new positive cases among T&T’s total 68, 288 cases since March 2020 and there were 527 people in hospitals. There’s been a total of 2,040 deaths so far, including 31 deaths yesterday alone. The figure of 31 surpassed the last highest figure – 28 – recorded last Saturday. Another child also died yesterday and 14 babies under one year have been reported among patients in the last three months.
Rowley said, “(Yesterday) We mourned the loss of over 2,000 of our citizens who succumbed to a virus over the last 18 months. The trauma has been protracted and relentless as we confirm almost 700 new infections each day and provide care for over 500 COVID patients in our almost filled hospitals.
“Even as I was preparing this presentation (Wednesday night), I received the depressing news that a new variant has appeared in Botswana, which some scientists are already saying could be worse than nearly anything else about and it may even become vaccine resistant.”
In T&T, Rowley said the current seven-day rolling average of positive cases, as of November 22, 2021, is 518 cases per day. He said the trend indicates an established upsurge in the transmission of COVID-19 in the population, with seven consecutive weeks of upward-trending totals.
Rowley said the parallel healthcare system now has 16 facilities (9 hospitals and 7 step-down facilities). As of November 2, the parallel hospital bed capacity now stands at a total of 999 beds, 898 in Trinidad and 101 in Tobago.
Against the backdrop of the current epidemiological climate as at November 22, he noted:
* Hospitalisations have been on the rise, with 539 persons as of November 22,d 2021, (an increase of 105%, from the low of 263 persons on October 15).
* Total hospital occupancy was at 65%; while ICU occupancy stood at 86% (61 of 70 ICU beds filled in Trinidad and 5 of 7 beds filled in Tobago.
* An additional 64 individuals – 17 of them requiring intensive care management – are currently awaiting transfer from Emergency Departments in the traditional healthcare system, to the parallel healthcare system.
* Of note 84% (54/64) of the individuals awaiting transfer are not vaccinated (including 100% of the 17 awaiting ICU).
He said vaccination, in collaboration with public health measures, continues to be a powerful combination and vaccines continue to be highly effective at preventing hospitalisation and death.
“Fully vaccinated people with breakthrough infections from this variant appear to be infectious for a shorter period.”
Little change in public behaviour
But Rowley added, “Unfortunately, it seems that we have been desensitised and the population is no longer stirred to wise action by this alarming trend. There is little change in public behaviour and attitude, as well as a drastic reduction in the rate of vaccination, even in the face of increasing COVID-19 deaths.
“There is also a lot of information that many persons hide their condition, refuse to be tested or isolate when they know that they are sick if only to be allowed to circulate as normal. This is exactly the environment in which the virus will thrive and show up in our intractable daily numbers and our overflowing hospital wards.”
“I tonight appeal to families to support one another and help out so that infected members can isolate to reduce the chances of the virus spreading among family members and the general public. Quarantine works, vaccines work, mask-wearing and sanitising works. Adopt them to save a life, even your own.”
He said Government has done all it can to ensure vaccines are readily available.
“We’ve brought vaccines to you, where you are. Yet, we’ve observed only an incremental change in the vaccination rate of about 0.1-0.2% of the general population on a daily basis. Get vaccinated. Encourage others …. while it may not prevent you from getting infected, it would almost certainly keep you out of the hospital wards.
“Even as we continue to expand our public healthcare capacity, we will soon reach the limit of our ability to provide care for those who are ill if we do not make drastic changes now. Our healthcare system is finite and we will be forced, once again to pull resources from non-COVID-19 sites into the parallel healthcare system. The elasticity and resilience of this system has seemingly given the population a false sense of complacency.”
He said Government has already signalled to the population that it’s escalating the emergency response levels in the public healthcare system and has alerted supporting agencies of the potential need for reinforcements.
“We would do well to ponder on what the next phase of the COVID-19 response might look like if we continue on this trajectory. As with any emergency response, as the demand on healthcare resources increases, we may have no choice but to redirect our efforts from providing the highest level of care to a few, to providing the greatest good for the greatest number of persons.”
He noted pandemic devastation in international and regional countries and harsh measures they’ve adopted to deal with COVID’s effect.
“I mention these situations and decisions, so that if it ever gets to the point where we have to adopt any of these additional measures, it will not be because we are incompetent, arrogant, dictatorial or anti-democratic. It would simply mean that our situation demands it and we do live on planet earth where COVID-19 is attempting to reign predominate.”
As at September 2021, he said Government had spent $509.7 million on the national COVID-19 response.
“At no point do we intend to concede that this fight with this virus is beyond us and is therefore unwinnable. We will fight it and keep adjusting as required even as the virus keeps mutating.”
Decision on beaches soon, no Carnival street parades
PM Rowley also reiterated that Government will not shut down the economy again, as it did last year into this year to prevent the rapid spread of the disease.
“I want to re-emphasise at this juncture that we intend to keep on fighting this virus whilst fighting to preserve our key economic activities which we need to maintain livelihoods. We will try to prevent devastating restrictions and will resort to such measures only as a last resort when all else become impotent,” he said.
“We will continue to keep our economy open. There have been a number of demands for further opening up of the few areas which are still under restrictions. Much as I would like to open up beaches and rivers, as I wanted to do a few weeks ago, the current situation militates against that.
“I did say earlier I’m hoping that we could open beaches for Christmas. I’m still on that. I will give the numbers a couple of weeks to see where they are taking us and if there is no further significant deterioration, we could start with early morning beach openings from say 5 am to 12 noon. We should be able to have therapeutic dips at dawn without the parties at afternoon and sunset.’’
He added, “Very soon the Christmas season and its festivities will be upon us. We will want to have a good Christmas but we must be particularly careful to not let that Christmas be the event that pushed us over the edge.
“I know you will want your family with you. Make plans to have your family as a “safe zone.” Aim to celebrate in safe zones. Get your family protected by vaccination. Protect your elderly and comorbid members from you. Try and avoid a funeral for Christmas. Act now! Get vaccinated.”
He said Government had also received good advice, after extensive consultation, about Carnival.
“Carnival 2022 will not see street parades, unvaccinated gatherings and wild public partying but there is room for safe zone, venue-specific events where some elements of the festival can be sampled as a Carnival microcosmic mosaic with a difference,” Rowley said.
Citing citizens’ resilience, he added, “Painful and distressing as this situation is, now is not the time to concede defeat in any way. Now is not the time to get tired, careless or carefree. Hope is good and luck is welcome but they are no substitute for being sensible or reasonable.
“Now more than ever, we must not lower our guard but instead commit to fight this scourge with everything at our disposal, not the least of which are the vaccines we have and the personal responsibility we must adopt. The virus has pushed back and today we must stand and hold the line.’’
PM cites other countries’ COVID response
* New Zealand – with 83 per cent vaccinated requiring vaccine passports for participation in activities from December 2nd, requiring teachers and workers in the health/disability sectors to be fully vaccinated and keeping borders closed to most international travellers until April 30.
* Australia – vaccinations mandatory for high-risk aged-care workers/employees in quarantine hotels. Western Australia requires mining, oil and gas exploration employees to have their first dose by Dec. 1 and be fully vaccinated by Jan 1, 2022.
* In the USA where COVID-19 is surging in 30 states – all federal workers and contractors ordered to be vaccinated. Mandate for private-sector workers to be vaccinated or tested weekly will be enforced from Jan. 4, 2022. The US government also requires employers with 100 or more employees to get employees vaccinated by January 4th and require unvaccinated employees to produce proof of negative test results weekly.
* Canada – placing unvaccinated federal employees on unpaid leave, requires COVID-19 shots for air, train and ship passengers. All of its 338 lawmakers must be fully vaccinated against COVID-19. Any core federal public servants – including members of the Royal Canadian Mounted Police – unwilling to disclose their vaccination status or be fully vaccinated will be placed on administrative leave without pay from November 15.
* Barbados – with 50% vaccination level has a 9 pm-5 am curfew.
* Antigua – with 57 % vaccinated where ages 12-18, who are unvaccinated, cannot attend school. Unvaccinated government employees must remain away from work without pay. State of Emergency until December 22nd.
* Jamaica – has 9 pm-5 am curfew until December 9, plus limits on gatherings.
* Guadeloupe – has “an explosive situation” following a week of violent protests over vaccine mandates which exclude the unvaccinated from many normal activities.
* France – required all healthcare and care-home workers, home aids and urgent care technicians to have had at least their first shot by Sept. 15; around 3,000 workers were suspended for failing to comply. Those aged 65 and above must present proof of a booster shot from mid-December for health passes that give access to restaurants, trains and planes to remain valid.
* Switzerland – requires people entering bars, restaurants and fitness centres to show a COVID-status certificate providing proof of vaccination, recovery from infection or a negative test result.
* Italy – made COVID-19 health passes mandatory for all workers. Those unable to show proof of vaccination, a negative test or recent recovery from infection would be suspended without pay and face a fine if they try to keep working. Health workers, including pharmacists, who aren’t inoculated could face suspension without pay for the rest of the year.
* Austria – placed millions not fully vaccinated in lockdown from Nov. 15. It banned the unvaccinated from places, including restaurants, hotels, theatres, ski lifts. Austria will also make vaccination against COVID-19 compulsory from February 1. There will be penalties for people still refusing the jab after that.
* Latvia – banned lawmakers who refuse the COVID-19 vaccine from voting and docked their pay. On Nov. 4, it allowed businesses to fire workers who refuse to either get vaccinated or transfer to remote work.
* Singapore – from December 8 will no longer pay the COVID-19 medical bills for people “unvaccinated by choice.”