Dr Roshan Parasram

Peak of epidemic’: Dr Roshan Parasram

Trinidad and Tobago is now at the height of the spike.

That spike, says Chief Medical Officer (CMO) Dr Roshan Parasram, is T&T’s deadliest third wave of Covid-19.

He predicts that it’s going to get worse before it gets better.

For now, T&T is in the middle of a 21-day cycle of restrictions first introduced on April 29, with varying adjustments thereafter to stem the increasing caseload which has been accompanied by multiple daily deaths, even as high as 21 last Thursday.

Prime Minister Dr Keith Rowley yesterday announced a state of emergency, without qualifying the duration, with a curfew from 9 p.m. to 5 a.m., to further support the public health measures in place.

The goal is to stop the movement of the virus.

Parasram, in an in­terview with the Sun­day Express on Friday, said the measures in place need at least two more weeks to determine if they are effective or not.

But the country’s situation is grim (the death toll has been climbing—it was 107 for the month of May up to yesterday), caseloads are averaging in the hundreds daily and the parallel healthcare system is practically at capacity.

“We are at the peak of the epidemic in Trinidad and Tobago. We are at the peak of the third wave right now,” he said.

The latest public health regulations were introduced on April 29, with further restrictions being ­added weekly.

The restrictions are the same now as existed in March 2020, with minimal variance, Parasram said.

“The measures that we have in place, just putting it in perspective, if you compare it to the second wave that we had in Trinidad, we’re seeing quite a larger number of people presenting themselves to the facilities for testing, hence the reason I think the actual numbers of positive tests.

“What we’re also seeing is a greater number of those positive people needing to be hospitalised is somewhat greater than the second wave as well,” he explained.

The variant

At yesterday’s news conference, epidemiologist Dr Avery Hinds said T&T’s positivity rate is now at 43 per cent for every 100 people who are tested.

Is it being driven by the Brazilian P1 variant which is in community spread?

Parasram acknowledged that the P1 variant is part of the mix and it is easier to transmit.

As it stands, there have been 40 cases of the P1 variant, with the other cases being the Wuhan strain.

As for deaths? Which ones have been attributed to the Wuhan strain and how many are from the P1 strain of Covid-19?

“We would have tried to take some samples in the recent past. When I spoke to the CMOHs (county medical officers of health)—they report the deaths and they do the cumulative research with the vari­ants—they have said to me about a week ago they had not noted any deaths that came up as a variant of concern. So out of the people who have died, they have probably been the original (Wuhan) strain circula­ting in the country prior to that,” he said.

Parasram explained that a patient with the P1 variant would have been aware and monitored by the CMOH as they would have had a different discharge criterion.

“So out of the 40 that we would have had so far, they didn’t note any deaths out of that lot,” he said.

Out of the overall death toll, Hinds said 65.3 per cent were men compared to 34.7 per cent for women.

Parasram said five per cent of positives will require intensive care or high-dependency unit care.

“Once you go into ICU (intensive care unit), forgetting Covid, for any disease, you’re usually at a very critical stage of your management. Having a respi­ratory disease which is infectious in nature, there’s no specific treatment at this point in time. It is difficult. We have to support persons as long as we can. And once you get to ICU stage, you’re likely to have a high degree of mortality, that is what is to be expected,” he said.

So which is the dominant strain in T&T now?

Parasram noted a study was being done by The University of the West Indies (The UWI) to determine the types of variants circula­ting in the region.

“It is a research-driven study, the numbers are relatively small; we’re not going to send every positive to them. So it is really a handful of samples that we can send based on their capacity for testing, so upwards of about 380 samples would have been up to about a week ago.

“I think the concern of the coun­try is, and from an epidemiological perspective, whether the ­dominant strain is indeed P1 or is it the Wuhan strain, and to answer that question, it requires that a large number of samples be tested and sequenced, which UWI may not have the capacity to do at this time. So it might be something that is ­difficult to ­answer,” he said.

Pandemic fatigue

Parasram noted in the country’s fight against Covid, its medical staff have also been suffering pandemic fatigue.

“We have a healthcare workforce that is finite and we have been working tirelessly, around the clock, for over a year, and the healthcare workers, again, they have provided yeoman human service to this country. And none of them have backed down from the challenge of working with Covid-19. They have set themselves apart from the rest, I mean, they’re certainly in the top line of healthcare workers in the world.

“It has been our strength to have that parallel system and have it manned in such a way, but we are at a point now in this epidemic that this system is being tested to the highest level, based on the number of cases we have every day, a number of people being admitted to hospital.

“The only way we can get that down is to get the total number of cases down, and we require all persons in society to play their part as groups. I think everyone needs to stand in solidarity together to get this thing under control,” he said.

How sustainable is the parallel healthcare system?

“Forgetting financial resources, what is finite really is the human resource required to sustain it. We can find more spaces overnight, I could find a large auditorium, for example, we could put cots in it, we can have all of that, but we won’t be able to staff it and the issue is becoming staff,” he said.

He noted there are Cuban nur­ses in the system already.

“Everyone across the world is fighting their own battle with this pandemic, so people are not sending their staff, as they would have been before the pandemic, out to other countries because they themselves are fighting it as well; we saw in the US and UK what happened.

“So they require all hands on deck for their country as well. So it is not as readily available as one would think. And then, of course, you have quarantine taking place and all of that. We have to be careful looking at the appearance of introducing variants of concern, again, when we move people in,” he said.

On balance, the job is now ­focused on lives rather than livelihoods. “I think from a health perspective, we have to do what we think is best to preserve and protect life first. The other arms of the Government need to come into play and make a decision otherwise. From a health perspective, we make our decisions purely based on what we think will be the best impact in terms of decreased number of deaths and decreased number of cases.

“And, of course, the Prime Minister and other members of the Cabinet will lend their advice as to what should and shouldn’t be acceded to in terms of what we recommend. But from a health perspective, we need to keep our focus on control­ling the pandemic,” he said.

Follow public health guidelines

With variants a cause of concern, Parasram wanted to stress that the public health measures put in place should work if people adhered to them.

“For this virus to move, it needs to have a person that is infected or it needs to have a susceptible host. Therefore, once you put a barrier between those two, whether it be distance, whether it be masking, a combination of both and, of course, the other guidelines—staying at home while you’re ill—you will stop breaking that chain of transmission, and that’s what we’re trying to do by adherence to the measures.

“The more of the population that adheres to the measures, the greater you will see that decrease in the number of cases on a day-to-day basis and even on a weekly basis.”

He said: “At this point, what we have noticed however is that, of course, there still continues to be a lot more movement than we would have anticipated at this point in time. We need to wait for the length of time when the measures were implemented (to pass), which was May 8, and the 14 days to really see the impact of that second set of measures.

“We’re hoping that into next week, we’ll begin to see some slowing from the measures put in place on the 29th to give us that blunting of the pandemic that we hope to see,” he said.

What accounts for most testing now? the Sunday Express asked.

Parasram pointed out in August 2020 there was a policy in place that anyone who was tested positive was admitted to the hospital.

“That policy has now changed. It means that you can be diagnosed and stay at home. I think people had trepidation with being tested and of course being whisked away, even if you have mild symptoms, and going into isolation for quite a long time, usually 14 to 21 days.

“But there’s now concern for your personal health and a lot of people seem to want to know if they have Covid, so there is a level of concern here that was probably not there in the earlier epidemic of 2020,” he said.

Parasram wanted to emphasise that the P1 variant is seeing a lower level of symptomatology in the early days and he urged hypervigilance.

“I think we can get there as well but we need to get everyone wearing the masks, everyone working together to get that solidarity,” he said.

• Part 2 of the interview tomorrow: The facts about vaccination and uniting to fight Covid-19.

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