SIX WEEK STRATEGY FOR SUCCESS IN ST. LUCIA AGAINST COVID-19
By Dr.Amanda King MBBS (UWI), FRCP (Glas.), FACS, SLMM
The WHO warned several months ago that poorer countries with inadequate health care systems were particularly at risk and would have difficulty coping with COVID-19. We are fortunate in St. Lucia that our first case was diagnosed on March 13th 2020, 3 months after China and 1- 2 months after Europe. We have seen the devastating effects of the virus as it crippled the Italian health service killing over 25.000 thousand people thus far, and has kept marching on through Europe, the United Kingdom and the USA. These countries have robust health care systems, financial resources and safety nets that small island developing states like ours do not have.
It is still not clear how COVID-19 behaves. The only treatment is supportive. There is as yet no proven medication or vaccine, we do not know how long one is contagious or if one is immune after infection. However we do know certain things: 1. It is a respiratory virus with a median incubation period of 5 days. The maximum incubation period is 14 days. 2. It is a novel virus and therefore we are all susceptible. 3. R0 is 2.4. This means that 1 patient is expected to infect 2-3 people. The number of infected cases increases exponentially without measures. R0 can be reduced to <1 with distancing and masks. 4. Until there are zero cases the curve will continue or recommence, the so- called second wave. Japan!!
St. Lucia appears to have relatively few cases- only 15 positive tests so far. This number is obviously less than the actual number, which we do not know since we have significantly limited testing. Testing itself is imperfect. There can be 30% or greater false negatives which may give a dangerous sense of security.
The Government has shown good leadership in containing the virus with early closure of schools and then closure of non-essential businesses. The SLMDA assisted the early distancing effort by advising health providers to continue care via teleconsulting and only doing face to face consults when necessary. This was in an effort to “Be the change we want to see” in the community. Individual doctors were able to convince the Ministry of Health and the public of the importance of wearing masks when they must be outside of their homes, and to initiate local manufacturing and home production of cloth masks. We took the
initiative based on the experience in Asian Countries in particular, in spite of WHO’s stance. These measures have served us well, but as Larry Brilliant, epidemiologist said in his interview with the Economist,” laissez-faire transmissibility, or a Swisscheese-like transmissibility with holes in it with people going to beach parties, while everybody else is at home with a mask and gloved and huddled in a backroom- these holes will lead to increased transmissibility”1. This is what is happening in St. Lucia today and will prolong our battle with COVID.
St Lucia is one of three countries that have gone green on” worldometer”. This indicates that all infected cases have recovered. It is important for us to eliminate the virus in St Lucia and unlike most other countries we have the opportunity to do this. Countries like the UK, which are experiencing an exponential increase in cases due to late intervention, according to Imperial College London predictions, will now have to wait a year to eighteen months for a vaccine to prevent COVID. Meanwhile thousands of lives will be lost.
We can eliminate COVID in 6 weeks, which represents three incubation periods, if we distance effectively and wear masks. This has health and economic benefits. Elimination means we can all emerge in 6 weeks and go back to unrestricted local economic activity, reopen schools and socialise, keeping borders closed.During this time we will learn what interventions work best and avoid wasting money on unproven medication and equipment use. Without effective elimination of the virus the war will be protracted with tremendous loss of life and devastation of the economy. Why would you choose for someone to be very ill or die when one can prevent it in the first place!
Benefits of the six week strategy
Individual Health- Physical distancing is proven to stop the virus. This means fewer people will become ill and die or develop chronic respiratory, cardiovascular, kidney disease and psychological illness as a consequence. This will reduce personal cost and cost of work disability as well as health care costs to Government now and tax payers in the long term.
Health care system- Proper physical distancing means we not just “flatten the curve but squash it”, as New Zealand is aiming to do.2 We will avoid the mayhem and carnage that has occurred in New York. It gives us time to improve the infrastructure at our respiratory hospital, acquire tests, PPE and other essential equipment. Less utilisation of the health care system for COVID, fewer hospitalisations, means less expenditure. Also health providers are particularly vulnerable, in Italy accounting for 15% of those infected. We cannot afford to lose our health care workers. Who will care for us?
Professor Neil Ferguson’s team at Imperial College London has calculated mathematical models for most countries of the world. He projected for St. Lucia, 5557 hospitalisations and 1064 deaths without preventive measures. If 75% of the population practice physical distancing, deaths can be reduced to 58 and with our discipline we can do better than this!
Stimulation of the economy- Tourism is St. Lucia’s main source of jobs and income, accounting for 65% of GDP. COVID however has halted global travel and this is predicted to be for at least 6 months. As St. Lucia’s Minister of Tourism said, tourists will be more fearful of disease in the future and will want to travel to “safe” destinations. We could be first on the list of safe countries if we take serious action now and eliminate this virus. We need to prepare for a niche market including eco and village tourism.
This is a war and we must behave as such. All we need right now is food, water, electricity, shelter. I understand that Government, our utility companies, and banking institutions are making provision for much of this. This is crucial. We in St. Lucia have the capacity to feed ourselves. We need to get busy planting, and checking on our neighbours to ensure everyone has what they need. It is heartening to see generosity at work at all levels already. During the next 6 weeks we can and must work. According to the World Bank,”to respond to the crisis, governments should redeploy current staff, cut red tape to enable home-based work, and reorganise tasks and responsibilities instead of imposing cut-backs and lay-offs”. I understand that salary cuts are inevitable. This is happening globally and is expected in a crisis of this magnitude and uncertainty. We all need to have faith and not be too fearful or greedy. This war affects everyone and we all need to see how not only to protect ourselves and our families but our communities and our island. Government needs to protect those who have to work harder and put their lives at risk for the rest of us. In fact an insurance policy to provide for frontline workers and their families is necessary. Remember the teachers who have to put extra effort into teaching online. Those who are working less should accept that a reduction in their salary may be necessary until we open up again, which is why we all need to follow the distancing policy so we may eliminate the virus quickly. We are only as strong as our weakest link. Those who are now unemployed and receiving unemployment benefit need to be redeployed according to talent and necessity and a committee should look into this. Most of us are too young to remember the war effort in the second world war- women worked, not only knitting socks, but in defense plants and volunteering for war-related organizations, in addition to managing their households. They learned to fix their car, make munitions and aircraft in the factories, they became fire officers, train conductors and drivers, nurses, pilots, and “wrote letters to their soldier husbands that were consistently upbeat”.3 We can make masks, gowns, plant gardens and volunteer wherever needed. The COVID volunteer
effort has been tremendously helpful in China and the UK and is always a rewarding experience. Those with businesses should be asked to pay employees as close to their usual salary as possible for the next 6 weeks, until we work together again. This will save the Government now and all of us later as tax- payers.
To eliminate COVID only work that can be done with distancing must be conducted for the next 6 weeks. With innovation and an entrepreneurial spirit there is much that can be done. Businesses must demonstrate the ability to distance and be monitored. Any lapse must incur a significant fine and closure of the business for the next 6 weeks.
With respect to individuals distancing in community we must continue to educate, in a manner that wins hearts and changes behaviour. The bureau of health education, Ministry of Education, Village councils, NGO’s, churches, other community groups and volunteers are needed to get the message across that we need everyone’s help with this. We are all responsible. If there is any deviation, again we need to find the appropriate punishment for the crime- a fine, plus incarceration for a night perhaps with education and an apology ( that was an interesting strategy I saw in Trinidad), and escalating punishment for reoffenders, perhaps mandatory isolation and then community service.
Our borders need to be water -tight. Fishermen and boat owners can help the Coastguard, with fuel supplied by Government for this purpose to those who need.
The President of Taiwan said in an article in Time Magazine April 16, 2020, that their success with COVID” is no coincidence. A combination of efforts by medical professionals, government, private sector and society at large have armoured our country’s defences…Taiwan is no stranger to hardship, and our resilience stems from our willingness to unite to surmount even the toughest obstacles. This, above all else, is what I hope Taiwan can share with the world: the human capacity to overcome challenges together is limitless. Taiwan can help”4 . Let us continue to seek guidance and strength from Taiwan and other friendly nations and be willing to work with all who want to help. I wish to express my gratitude to Cuba for being so generous and to everyone who is trying to see what they can do to make a positive difference in this crisis. We all have a role to play. Believe it or not, we can come out of this having gained more than we have lost. As the President of Uganda, Kaguta Museveni said, “This is not a time to cry about bread and butter like spoilt children”. 6 weeks to freedom. Yes, we can!
1.How society can overcome COVID-19. The Economist Interview Larry Brilliant Apr 4 2020 2. New Zealand isn’t just flattening the curve. It’s squashing it. The Washington Post April 7 2020 3.The National World war 2 museum New Orleans- American women in world war 2: on the homefront and beyond. nationalww2museum.org 4. President of Taiwan: How My Country Prevented a Major Outbreak of COVID19. Time Magazine By Tsai Ing-Wen Aril 16 2020