Prof Terrence Seemungal

CHAIRMAN: Prof Terrence Seemungal

WHY are so many people dying from Covid-19 in Trinidad and Tobago?

Prof Terrence Seemungal, chair of the Prime Minister-appointed committee tasked to investigate this, told the Express yesterday that by the end of the week of their probe the country will have answers.

“We are going to do our best. I know the deadline is short, if it wasn’t urgent I guess they would have given us a long time, we are going to meet the deadline and we have some competent people on board. We could always strategise and do the most important things. We will have a report ready by the end of the week,” he said.

Asked whether he himself had questions about the Covid-19 death rate, Seemungal responded, “I think people on a whole would like to get an objective view on what’s happening and I think that’s the purpose of the committee. By the end of the week, I’m sure you will have all the answers.”

The five-member team will hold its first formal meeting today, he said.

Seemungal is the Dean at the UWI Faculty of Medical Sciences.

The other committee members are:

• Prof Emerita Phyllis Pitt-Miller—Consultant Anaesthetist and Intensive Care Specialist, Former Dean, Faculty of Medical Sciences, (UWI)

• Dr Anton Cumberbatch, Public Health Specialist and Former Chief Medical Officer (CMO).

• Dr Vidya Dean, Consultant Anaesthetist and Intensive Care Specialist

• Prof Donald Simeon, director, Caribbean Centre for Health Systems Research and Development, Professor of Biostatistics and Public Health Research, Faculty of Medical Sciences (UWI).

Pressed with further questions, Seemungal said he could not say anything or have a position until he has looked at the data.

Report to be made public

On Saturday, Prime Minister Dr Keith Rowley announced the appointment of the committee as he lamented that some people were of the view that the standard of care at the hospitals is the reason for the high numbers of Covid-19 deaths being recorded.

The Prime Minister said some people, including members of the Opposition and trade unions, have been challenging the veracity of the statistics and information health officials have been providing.

Rowley said the committee members will “go into our healthcare system, examine it and at the end of the week, as long as they don’t ask for more time... they will report back to the Government and I give the country the assurance that as soon as I get that report, whatever it contains, it will be made public,” he said.

He said this will guide the people away from believing that health care in the hospital is substandard and contributing to the deaths.

Seemungal said the team will do what they must to find the answers.

“I’m a doctor, I have been wearing PPE (personal protective equipment) for the past year to see my patients,” he said.

Asked if the team was being paid, he said “it never occurred to me to ask”, but added he assumed it was a voluntary position.

Questioned if he will have additional support staff, he said he has written to the Health Ministry requesting this.

“Yes, I have sent a note to the ministry for them to address those issues for me, which they will, they will do that by tomorrow (Monday),” he said.

The committee has seven days to investigate and submit their report to Rowley on January 24.

Terms of reference

The release accompanying the committee’s terms of reference released by the Office of the Prime Minister last Saturday states that, as of January 11, 2022, Trinidad and Tobago had recorded 3,102 deaths out of 97,897 positive cases.

It said the case fatality rate (CFR) in Trinidad and Tobago has varied over the course of the pandemic ranging between 6.2 per cent (130 cases, eight deaths) in the first wave April 2020 to a low of 1.0 per cent on August 27, 2021.

A case fatality rate of 0.032 or 3.2 per cent has been recorded as at that date.

“This indicates that for every 100 persons infected with the Covid-19 virus, three persons succumbed as a result of the disease. Out of the 3,102 deaths, 175 (5.6 per cent) of those fatalities were fully vaccinated while 2,927 (94.4 per cent) were not fully vaccinated or unvaccinated.

“These deaths would have occurred in both hospitals and at home. The records suggest that approximately 94 per cent of deaths occur in hospital in the system with the remaining six per cent occurring at home. Total deaths of those fully vaccinated as at January 12, 2022 was 177 (5.7 per cent).”

The following is the committee’s scope:

1. To identify the profile of the patients who died from Covid-19 by:

a. Number and types of comorbidities including obesity

b. Ethnicity

c. Age

d. Gender

2. To review the definition of “Covid-19 Death” used by the Ministry of Health for consistency with World Health Organisation (WHO) guidelines and standard practice; and comment on the different methodologies for calculating case fatality rate (CFR) and make recommendation for the appropriate methodology for Trinidad and Tobago.

3. Examine the Admission, Discharge and Transfer (ADT) policy and procedure to determine the impact, if any, on clinical outcome.

4. Determine if the treatment and management protocols adopted by the Hospitals are consistent within WHO guidelines and international best practice, with access to adequate:

a. Levels of Staffing appropriate in a mass response to a global pandemic;

b. Essential Medicines;

c. Laboratory and Diagnostic Imaging Services;

d. PPE; Oxygen; other.

5. Review the standards of care of Covid-19 patients, based on acuity, for uniformity and consistency within and across hospitals in the regional health authorities (RHA).

6. Identify any other factors that may affect clinical outcomes including, but not limited to:

a. sub-optimal home treatment, for e.g., utilising non-WHO-approved therapeutics;

b. delayed presentation to health facilities;

c. efficiency of the transfer system in transporting patients from home to hospital and inter-hospitals in the RHA health network.

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