rishard.khan@guardian.co.tt
Since Prime Minister Dr Keith Rowley signalled the intention on Saturday to end the State of Emergency (SoE), concerns have been expressed over the decision to do so amidst a current spike in cases.
Public health diplomat and epidemiologist with over 30 years experience, Dr Farley Cleghorn, shares a similar sentiment that the lifting of the State of Emergency may have been mistimed.
Asked during an interview with Guardian Media about concerns that the move was mistimed, Cleghorn said: “I couldn’t disagree with that.”
One of the primary bases for his evaluation is the country’s low vaccination uptake along with a parallel healthcare system that may not be able to accommodate increased cases—especially in its Intensive Care Units (ICUs).
“That is the kind of key question that a government has to ask itself when you’re saying we’re going to lift a State of Emergency- if we can tolerate more cases without overburdening the healthcare system?”
He said in the United Kingdom the decision to reopen schools was feasible because they were able to tolerate the increase in cases while keeping the death rate low.
“But what I’m seeing in Trinidad is that doesn’t necessarily play out. Our death rates are still going up which means our health services delivery for people with COVID-19 is not as effective as it can be,” he said.
Cleghorn said part of the problem is the latest trend of patients presenting too late to hospitals, which increases their chance of dying.
For almost a month, the Ministry of Health has been warning that the ICUs across the parallel healthcare system has been almost at capacity on a daily basis.
He attributed the current increase to the prominence of the more transmissible Delta variant among the population in combination with the return of secondary school students to face-to-face classes.
Cleghorn said he understood the predicament the Government is in trying to manage the pandemic.
“I understand the thinking of government which is how do we get past the economic and social effects of the pandemic while managing the medical outcomes,” he said.
Paediatrician Dr David Bratt also shared a similar view about the Prime Minister’s decision, saying: “for me, it makes no sense at all.”
Internal medicine specialist Dr Joel Teelucksingh was reserved in judging the decision to lift the State of Emergency but noted that its effectiveness is yet to be assessed.
“We would need analysis whether or not the State of Emergency and lockdowns were of any benefit for the last six months and that data is still forthcoming,” he said.
A further increase in COVID-19 cases when the State of Emergency is lifted is a real threat that even the Minister of Health, Terrence Deyalsingh, fears as he expressed as a guest on The Morning Panchayat on Akash Vani 106.5FM last week.
“I am deathly afraid of that because then the partying is going to start back and all of these things are going to start back and cases would most likely skyrocket and our health care system, the parallel health care system, maybe overwhelmed and we are dealing with the known Delta variant...what happens if tomorrow you hear about another variant which is more deadly what are we going to do?” he said then.
Despite having greater vaccine coverage than T&T, many countries around the world have re-entered into “lockdowns” due to surging cases among its unvaccinated population- most recently Austria, a country with 65 per cent of its population fully vaccinated.
Asked if it’s a situation T&T may end up in the future Cleghorn said: “As a scientist and an epidemiologist, the answer is clearly yes. We have to preserve that option.”
However, now that the decision has been made to lift the State of Emergency and bring an end to the curfew, Cleghorn said the Government needed to focus on encouraging vaccine uptake.
“If I then had to put my effort into something I would put it into really bolstering the ability to up people to get vaccinated and to get boosters. This is something you have to find new ways (to do),” he said.
He said the strategies need to target those who are vaccine resistant/unwilling and the vaccine-hesitant population. To do this he said the current approach needs to change.
“There’s a limit to the effectiveness of giving information to people, even accurate scientific information,” he said.
“When I say that the Minister of Health or the Chief Medical Officer or the Prime Minister...they’re all giving valuable information on a regular basis but that is not effective in reaching the resistant, the hesitant, the unwilling,” he noted.
He said a more grass-roots approach was needed to disseminate accurate information and encouragement directed at those who are vaccine-hesitant.
Bratt also believes this is the route the Government needed to explore.
“How do you get people to have trust? That is the question. People don’t trust the Government. People don’t trust big pharmacy. Fine. So how do we get around that?” he said.
Cleghorn suggests there is even a place in a revised plan to increase vaccine uptake for strategic vaccine mandates, which he said, “have always been part of public health management strategies.”
“What you need is a portfolio strategy. A portfolio strategy says what is the room for mandates and how would those be executed? And then what does it leave out and what would be a non-mandated strategy for them?” he said.
Cleghorn acknowledged that encouraging vaccine uptake among people is a major challenge not isolated to T&T and extends to countries around the world, including the United States.
He said it’s important the public understands that while the State of Emergency is being lifted, it does not mean the threat of COVID-19 is no longer present.
