Dr Roshan Parasram

‘No response’: Dr Roshan Parasram, Chief Medical Officer.

IT is time to behave as though everyone you meet has COVID-19.

It’s for your own protection.

That is what the country’s Chief Medical Officer (CMO) Dr Roshan Parasram is advising people to do in public spaces in the coming weeks.

But there’s a problem with Trini­dadians. Dr Parasram feels the social distancing message is not resonating with citizens.

In an interview yesterday with the Sunday Express about the COVID-19 threat, and how people are reacting to it, he said: “For some reason, the necessity of an individual response is not registering. There is a State response but as it stands, it’s about an individual response to get past this. This is why we have used the Public Health Ordinance.”

“I don’t think there is enough concern on the part of the general population. I assumed two COVID-­19 deaths (at the time of this interview) would have a different response, but I am not seeing that happening,” he said. “The next 14 days are critical on whether we flatten the curve or we have a spike.”

As the country’s coronavirus cases climb—there were 76 yesterday with three deaths—the only thing that can halt the spread is to stop moving, Dr Parasram believes.

“We are fighting a virus we cannot see. It is being moved by people and contact,” he again emphasised.

In the coming days, the number of cases will steadily increase, given the influx of almost 20,000 nationals from New York, Miami, the United Kingdom and some Caricom countries before T&T’s borders were closed on March 23.

To date, community spread has not begun and it’s why Dr Parasram is keen to drill this point home.

At news conferences over the past two weeks, he has stated the need for people to self-isolate, practise good hygiene and good common sense in public spaces.

But on Thursday, when Prime Minister Dr Keith Rowley announced that from midnight tonight, non-essential services will be shut down until April 15, a panicked public started shopping.

On Friday and yesterday, there were long lines in groceries and pharmacies, despite a notice by the Supermarkets Association that supermarkets would remain open as they were regarded as essential businesses.

Dr Parasram, a career public servant who was appointed CMO in 2017, was not pleased about people panic-buying.

The masses of people were not practising social distancing and it was this weekend, the Ministry of Health articulated that T&T was at a tipping point.

Tipping point

“We are trying to avoid a spike. Our best chance of continuing and dealing with this is to restrict movement,” he said.

Dr Parasram said T&T has been monitoring COVID-19 since it exploded in Wuhan, China, in ­December.

He observed that China implemented a strict lockdown of Wuhan to contain the virus and in January, T&T became the first country in the western hemisphere to ban travel from China.

In justifying this action to the Pan American Health Organisation (PAHO), Dr Parasram said his reasoning was the spread from those areas, given the large number of Chinese nationals in T&T, and the fact that there is still no known treatment for COVID-19.

The risk to T&T was great, he said.

Planning began in earnest to prepare the country from that time on.

And it started with beds and the build-out of a parallel health care system.

“We didn’t have capacity in the present system to deal with the impact of COVID-19. And we didn’t have the capacity like in China to build a hospital very quickly.

“And as was shown in China, the virus quickly outstripped the present capacity.

“In January, we began to look for ventilators and shore up assets in public health. We were fortunate to have the Couva Hospital and the Arima Hospital almost completed,” he said.

Dr Parasram described the response to COVID-19, as proactive and measured.

United States President ­Donald Trump said yesterday he was considering imposing a quara­ntine on New York, in a bid to slow the spread of the coronavirus.

The UK is now on lockdown.

By comparison, Dr Parasram believes this country’s approach was always ahead.

All about funding

Questioned by the Sunday Express on why the public health response to COVID-19 superseded the regular day-to-day health response to citizens, Dr Parasram said it was all about funding.

“In pandemics, there is a fluidity of funding that had not occurred prior. Usually, we would get the same amount every budget,” he said.

Last week, Health Minister Terrence Deyalsingh said the Government would provide $157 million to support the COVID-19 fight.

The money will be used for consumables, to build the human resource capacity, infrastructure and equipment over the next three to six months.

The North Central Regional Health Authority (inclusive of the Couva and Caura hospitals) was allocated $129.9 million; the Eastern Regional Health Authority, $6.2 ­million (inclusive of the Camp Balandra facility which cost 85,000 a month); the NWRHA, $16.6 million; and the SWRHA, $4.5 million.

“This is going to be a marathon. This will cover the first few miles of marathon. We will come back to Cabinet if we need further financing,” Deyalsingh had said.

Parasram acknowledged that in building out the capacity for the public health response, the ministry was able to pull in doctors who graduated from The University of the West Indies (The UWI) and weren’t able to get work in the public service.

He pointed out some of them would have gained employment with the Arima hospital and, eventually, Point Fortin and the Sangre Grande hospitals.

In the past few weeks, doctors got jobs to handle phone hotlines and retired medical practitioners were called out to offer support.

For the moment, every COVID-19-positive patient is under isolation at hospital, but that will change when the numbers increase.

“There will come a time when only severe COVID-19-positive cases will be isolated in hospital. The ones who are not severe will have to be at home in isolation,” Dr ­Parasram said.

The unexpected

With front-line workers around the world catching COVID-19, Dr Parasram said he’s also concerned about his personal health.

“I am concerned. Everyone in T&T should be concerned,” he said. “We are doing everything we can to minimise risk, even to sharing a pen in the office.”

In T&T, the Ministry of Health is adopting the protocols outlined by the World Health Organisation with a tailoring of cultural values, including how to handle a COVID-19 death.

“It remains extremely rigid,” he said. “The reality is that once a patient dies of COVID-19, the body is placed in a bag and then a casket to the funeral home, to the grave or crematorium. There in no viewing of the body.”

Last week at a news conference in Port of Spain, Dr Parasram said a deceased patient could still spread the disease.

He said at this point, it’s difficult to put a date on when things will ­return to normal.

“As long as our borders are closed, we will be okay. I am not sure how long they can remain closed, but once we can contain and manage what’s already in, we should be able to get through this,” he said.

Timeline

• December 2019—COVID-19 detected in Wuhan, China.

• January 30, 2020—The T&T Government took the decision to impose travel restrictions on anyone who had been in China for a 14-day period prior to their arrival in T&T. Any non-national who had been in China for a period of 14 days prior to their arrival in T&T would not be permitted entry, and any national or resident who fell into this category would be quarantined until it was clear they were not affected by COVID-19.

• February 27, 2020—The Government added Iran, South Korea, Italy, Singapore and Japan to the list of designated countries that T&T would not permit non-nationals or residents entry to Trinidad and Tobago if they had been in any of these countries for 14 days prior. An interministerial committee was set up to report to the Minister of Health and Minister of National Security.

• March 10, 2020—Spain, France and Germany were added to the list of designated countries with travel restrictions.

• March 12, 2020—T&T’s first COVID-19 case was confirmed.

• March 13, 2020—Prime Minister Dr Keith Rowley announced the closure of schools for one week.

• March 16, 2020—Dr Rowley said that from midnight March 17, T&T would restrict all entry for the next 14 days except for nationals, with exemptions that can be granted in certain circumstances (example, members of Carpha). Cargo ships will be allowed to dock, but crews restricted from disembarking. All schools and places of learning will remain closed until April 20. All bars to remain closed and no in-house dining for the next 14 days. Religious bodies asked to limit gatherings.

• March 23—All borders closed.

• March 30—All non-essential businesses closed.

Dr Parasram’s bio

Qualifications

• MBBS (The UWI);

• Post-grad diploma and Master’s in Public Health (University of London, London School of Hygiene & Tropical Medicine);

• Fellow of the Royal Society of Public Health (FRSPH, UK);

• Certificate in Public Procurement Law and Practice (York University, Canada).

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