Rishard Khan

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.