On March 12, 2020, the first case of COVID-19 was con­firmed by the Min­istry of Health (MoH) in Trinidad and To­ba­go. Two hun­dred days lat­er, COVID-19 cas­es have soared above 4,000, and our death toll has reached an as­tound­ing 71. Our new nor­mal in Sep­tem­ber 2020 now looks like what we con­sid­ered a dystopi­an fu­ture from a Jan­u­ary 2020 per­spec­tive.

From an un­prece­dent­ed lock­down which has cost the coun­try bil­lions (and count­ing), to the new nor­mal of manda­to­ry face masks, so­cial dis­tanc­ing, and lim­its on crowds—how did we get here?

Through the num­bers: T&T’s COVID-19 jour­ney to com­mu­ni­ty spread

Be­tween March 12 to Ju­ly 20, 2020, T&T pro­gressed through “Phase One,” char­ac­ter­ized by health of­fi­cials as most­ly im­port­ed cas­es from re­turn­ing and repa­tri­at­ed na­tion­als. There were al­so a few cas­es of lo­cal spread, gen­er­al­ly pri­ma­ry con­tacts of re­turn­ing na­tion­als or health­care work­ers in­ter­act­ing with COVID-19 pos­i­tive pa­tients.

Dur­ing this pe­ri­od, T&T record­ed 137 cas­es, with two larg­er im­port­ed clus­ters. On March 17, a group of na­tion­als, who were strand­ed on the ill-fat­ed Cos­ta Favolosa cruise, were repa­tri­at­ed and placed di­rect­ly in­to quar­an­tine at Camp Ba­lan­dra. Six­ty-eight na­tion­als were part of the first group, with three in­di­vid­u­als who re­turned on their own ac­cord, to­talling 72. Of these, 52 test­ed pos­i­tive. An­oth­er clus­ter of twelve orig­i­nat­ed from a group of na­tion­als repa­tri­at­ed on the En­chant­ment of the Seas.

On Ju­ly 21, T&T’s tides be­gan to turn with case 139, mark­ing the be­gin­ning of “Phase Two.” It was the first pa­tient for which a source of in­fec­tion was not known. Two days lat­er, case 141, a mi­nor, be­came the sec­ond pa­tient with no known source of in­fec­tion and was not linked to case 139.

Cas­es of lo­cal trans­mis­sion, where the source of the dis­ease was un­known, be­gan to rapid­ly in­crease, with to­tal COVID-19 cas­es reach­ing 132 by the end of Ju­ly.

The to­tal cas­es in­creased thir­teen-fold by the end of Au­gust, from 132 cas­es to 1,759 cas­es in one month.

On Au­gust 6, T&T was of­fi­cial­ly clas­si­fied by the World Health Or­ga­ni­za­tion, per the rec­om­men­da­tion of the Min­istry of Health, as hav­ing clus­ters of cas­es. Eleven days lat­er, on Au­gust 15, the Min­istry of Health has made the re­quest, per the Chief Med­ical Of­fi­cer, to PA­HO for Trinidad and To­ba­go to be clas­si­fied as com­mu­ni­ty spread.

As of Sep­tem­ber 27, T&T has record­ed 4,312 cas­es—more than dou­bling in less than one month.

In Phase One, the ma­jor­i­ty of pos­i­tive cas­es fell be­tween ages 55 and 70. In Phase Two, the de­mo­graph­ic shift­ed marked­ly younger, with now most pos­i­tive cas­es be­tween 25 and 49.

Flat­ten­ing the

(ac­tive cas­es) curve

With a con­trolled en­try and quar­an­tine pro­to­col dur­ing Phase One, T&T suc­cess­ful­ly flat­tened our curve, with ze­ro ac­tive re­port­ed on June 8. How­ev­er, as the num­ber of cas­es rose dra­mat­i­cal­ly in Phase Two, so did our ac­tive cas­es. Yet, some ma­jor changes were im­ple­ment­ed to pre­vent the over­bur­den­ing of the par­al­lel health­care sys­tem, which con­se­quent­ly re­duced our ac­tive case­load.

Ini­tial­ly, all pa­tients who test­ed pos­i­tive for COVID-19 had to en­ter manda­to­ry state quar­an­tine, to the ire of sev­er­al, prompt­ing a few law­suits against the CMO. How­ev­er, as cas­es in­creased by the hun­dreds, when ac­tive cas­es were near­ing 1,200 on Au­gust 26, the CMO in­sti­tut­ed home quar­an­tine for cas­es that are asymp­to­matic or mild. These “com­mu­ni­ty cas­es” were un­der the su­per­vi­sion of the re­spec­tive coun­ty med­ical of­fi­cers or health.

Un­til Au­gust 26, 2020, all COVID-19 pos­i­tive pa­tients had to test neg­a­tive to be dis­charged and were re­moved from the ac­tive cas­es of the Min­istry of Health press re­leas­es. How­ev­er, ad­vances in un­der­stand­ing how COVID-19 leaves the body prompt­ed the Min­istry of Heath to move to a dis­charge based on a pa­tient’s symp­toms (or lack there­of) rather than hav­ing a neg­a­tive PCR test. On Au­gust 27, this change in dis­charge cri­te­ria, there was a 402-pa­tient spike in the num­ber of per­sons dis­charged and con­sid­ered re­cov­ered from COVID-19.

Then, on Sep­tem­ber 17, the Min­istry of Health first re­port­ed pa­tients in-home quar­an­tine that were con­sid­ered re­cov­ered, re­sult­ing in a 665-pa­tient re­moval from our ac­tive case count.

At its peak, T&T had 2,459 ac­tive cas­es on Sep­tem­ber 16, spread across var­i­ous med­ical and step-down fa­cil­i­ties, as well as home quar­an­tine. Since Sep­tem­ber 11, T&T’s ac­tive cas­es have not dropped be­low 2,000, ex­clud­ing Sep­tem­ber 17 with a brief drop to 1,900.

T&T’s COVID-19 vic­tims

To date, COVID-19 has claimed 70 lives across T&T, with two deaths record­ed in To­ba­go and six­ty-eight in Trinidad.

Ear­ly on dur­ing Phase One, there were eight COVID-19 re­lat­ed deaths, all record­ed with­in twelve days be­tween March 26 through April 6. Ac­cord­ing to the Chief Med­ical Of­fi­cer (CMO), Dr Roshan Paras­ram, all eight deaths were peo­ple over 55 and had pre-ex­ist­ing health con­di­tions.

The death toll in Phase Two has been far more sig­nif­i­cant.

T&T’s COVID-19 death toll soared in tan­dem with our case count, in­creas­ing by 62 peo­ple be­tween Au­gust 14 and Sep­tem­ber 27. Sim­i­lar to Phase One, near­ly all pa­tients who have died have been over the age of 55 with co­mor­bidi­ties. These co­mor­bidi­ties or pre-ex­ist­ing con­di­tions are typ­i­cal­ly di­a­betes, hy­per­ten­sion, and a mi­nor­i­ty of cas­es, obe­si­ty, and kid­ney dis­ease, ac­cord­ing to the Min­istry of Health.

As of Sep­tem­ber 18, when six­ty deaths were record­ed, de­mo­graph­ic da­ta from the Min­istry of Health show men ac­count­ing for 83.3 per cent the death toll, while fe­males ac­count­ed for 16.7 per cent.

This is gen­er­al­ly in line with glob­al trends where males have been dis­pro­por­tion­ate­ly af­fect­ed by COVID-19.

The shift to the new nor­mal

On March 11, the World Health Or­ga­ni­za­tion de­clared COVID-19 a glob­al pan­dem­ic. One day lat­er, the Min­istry of Health con­firmed T&T had its first COVID-19 pa­tient. Al­ready un­easy about in­ter­na­tion­al de­vel­op­ments, life in T&T was about to change dras­ti­cal­ly.

By the end of March 2020, schools were closed for the re­main­der of the school term. Bars short­ly joined with an in­def­i­nite close, and restau­rants had halt­ed in-house din­ing. Then came the bor­der clo­sures. Re­li­gious gath­er­ings, so­cial gath­er­ings, beach limes, a trip to the riv­er, and even to the cin­e­ma were no more. By March 26, the Prime Min­is­ter asked all non-es­sen­tial work­ers to stay at home, and on March 30, all non-es­sen­tial busi­ness­es were closed un­til April 30.

As a brief light at the end of the tun­nel, on May 9, Prime Min­is­ter Dr Kei­th Row­ley an­nounced the phased re­open­ing of the coun­try, fol­low­ing the first meet­ing of T&T’s eco­nom­ic re­cov­ery team.

“As we mon­i­tor, if the num­bers are just as good as now, we will take steps to ad­vance the phas­es.” Trinidad and To­ba­go made it to the end of our phased open­ing, with a sense of nor­mal­cy by the end of June with even beach­es and restau­rants briefly re­open­ing.

Then came Case 139. Now, the end of Sep­tem­ber 2020 looks re­mark­ably like the end of March. Bars, beach­es, rivers, cin­e­mas, gyms re­main closed. But you can still go to a restau­rant but not dine in. You can still go to the mall, but our new nor­mal in­cludes manda­to­ry masks, san­i­tiz­ing your hands up­on en­try, and re­main­ing six feet away from every­one else.

While the source of in­fec­tion is im­por­tant epi­demi­o­log­i­cal­ly, for the gen­er­al pop­u­la­tion, the virus is still here, and it is not go­ing any­where, any­time soon. Fol­low the reg­u­la­tions for your safe­ty—mask up, san­i­tize, and so­cial dis­tanc­ing.