Please stay home.
Health officials have taken to literally begging on national television for compliance with the public health measures implemented to slow the spread of Covid-19 as Trinidad and Tobago now faces rapidly increasing daily infections, deaths and the possibility of the parallel health system being overwhelmed in a week.
As people continue to congregate in those public spaces still available for service, including at supermarkets, Principal Medical Officer of Institutions at the Ministry of Health, Dr Maryam Abdool-Richards, yesterday pleaded for adherence on behalf of the ministry and frontline healthcare workers who have been fighting the pandemic for over a year.
She said at yesterday’s virtual Covid news conference: “We would like to implore, I am begging on behalf of the Government, on behalf of all frontline workers who have been working tirelessly since February of last year, on behalf of the Ministry of Health and Ministry of National Security, for all members of the population to please adhere to the Covid-19 mitigation measures, Covid-19 prevention measures, please let’s avoid commingling.”
Younger people who believed themselves immune were warned that they are not, as Abdool-Richards reported ongoing increases in infections and deaths in the 30-year age group among people with no co-morbidities or pre-existing medical conditions.
She warned that at the current rate, the parallel system set up in March 2020 to treat Covid-19 will be at full capacity in seven days.
Frightening increases in the rates of occupancy were seen overnight, she said, except for a decrease in the Intensive Care Unit (ICU) from 50 per cent to 40 per cent that was not due to patient recoveries, but to deaths.
“On Monday, our overall hospital occupancy was 48 per cent. On May 4, we saw an increase to 50 per cent, and yesterday afternoon we had an increase to 58 per cent,” Richards stated, noting this represented a two per cent increase, followed by an eight per cent increase. These increases are in spite of measures to increase the capacity of hospital beds. Our ward occupancy rates have increased within 24 hours from 50 per cent to 60 per cent, which is a ten per cent increase,” she said.
Abdool-Richards also warned that in treating Covid-19, “a bed is not simply a bed”, as it requires personnel who need personal protection equipment (PPE) to work, and she reminded of ongoing challenges in global supply chains for these and medicinal supplies. The authorities can’t stress enough that the Covid-19 battle takes place not only on the frontlines of the health system, but also from within the national community, via responsible behaviour and adherence.
Younger infections, deaths
T&T was also now witnessing increased infections and deaths in younger people, as well as a worsening of the actual conditions of hospitalised patients.
Abdool-Richards addressed footage of “limes” and gatherings shown by the media, and stated: “On the media on Monday evening, we were very concerned over scenes on Ariapita Avenue. There were congregations of persons, the improper use of face masks, and this was aired on mainstream media, this is not hearsay.”
It was at this point that Abdool-Richards begged for compliance, and said “commingling and congregating are the dirtiest words in the health sector” right now, as these actions continued to be the main driver in the spread of Covid-19. “Young people, we’re seeing deaths, and sudden deaths, from the 30s onward. Please don’t think you’re immune,” she said. “This concept of a bubble that I’ve been hearing touted around does not work, different persons from different households carry different exposure risks.”
The reasoning among some young people was that they were liming with the same group of persons. However, they are also interacting with others at supermarkets and workplaces, which means they actually have “a different level of exposure”.
“Young people tend to have mild or no symptoms. You could be a carrier of Covid-19 and you will take this to your friends’ home and to your friends’ parents’ home. Let’s please avoid this congregation and commingling or gathering of persons,” Richards said.
Responding to media questions later on, head epidemiologist at the ministry Dr Avery Hinds said no correlation has been shown between increased infections and deaths among younger people and the presence of the P1 Covid-19 variant (Brazilian variant), which is now part of T&T community spread.
He said the statistics may be reflective of the fact that there is a viral surge under way and more people are simply being infected.
Abdool-Richards also stated that the clinical pattern, or clinical course for patients, which is how patients are treated in the hospitals and the severity of their conditions, “has become worse”.
“We have seen a trend in which persons with mild or less critical illness are being hospitalised for up to five days, or somewhere between the range of three and five days,” she said. People are also presenting with increased illness at the treatment centres, she said, “and are requiring ICU and HDU (High Dependency Unit) care”.
Data from May 1 has been showing that such patients require anywhere between 12 and 21 days of hospitalisation in the HDU, which increased overnight from 40 to 70 per cent.
“The demand for hospital beds has been increasing,” Abdool-Richards said, adding that this resource is now very limited. She added: “A bed consists of the nurses, the doctors, the supporting staff... for example, lab services that have to do laboratory tests on a daily basis, the provision of personal protective equipment, the face masks, etc. Additionally, limiting factors include the medication to treat patients.”
She made a plea for the country’s ambulance services, stating, “We do not want to overwhelm our ambulance services. If you have a relative or if you yourself require hospitalisation for a condition like a heart attack, we would not want the ambulance services to be overwhelmed by transporting Covid-19 patients.
“So again, I would like to remind the population that a bed is not simply a bed.”
Abdool-Richards said the ambulance service was close to being overwhelmed last Thursday night.
The Ministry of Health activated an additional 115 beds and transitioned the Augustus Long Hospital from a “suspected cases hospital to a confirmed case hospital”, as of May 1, she reminded.
“We are imploring the population to decrease this demand for beds by basically adhering to public health interventions,” she said, stressing that as of 9 a.m. yesterday there were 316 patients in hospital, representing “a significant increase from the 264 patients previously”.
“At this current rate and given our hospital occupancy levels, we will run out of hospital beds or use all our hospital beds within seven days. And this really defeats the purpose of the parallel healthcare system,” she said.
There are now 542 beds available with supporting staff, she said, adding that “if all things are equal”, in that the healthcare staff continues at the current numbers, with all supportive and other equipment in place and ambulance system is not overwhelmed, “we will have only 226 spaces available, which gives us seven days to full occupancy”.
Abdool-Richards said 14 per cent of people confirmed as Covid-positive go on to require treatment in a hospital centre, and “only six per cent of those persons are discharged on a daily basis”.
“And I would like to bring the point of the gravity of the situation in terms of the number of days that someone stays in hospital. It’s not a two-day turnaround—it can be anywhere between five days and 21 days, sometimes even longer.”