An­na-Lisa Paul

Health of­fi­cials have con­tin­ued to paint a grim pic­ture of Trinidad and To­ba­go’s par­al­lel health­care sys­tem, as they warned yes­ter­day that there were now more pa­tients than beds in the In­ten­sive Care Units (ICUs).

With on­ly one ICU bed left, the sit­u­a­tion has be­come so se­vere that it has prompt­ed the Min­istry of Health to re­open the field hos­pi­tal at the Jean Pierre Com­plex in Port-of-Spain.

Un­der­scor­ing just how dire the sit­u­a­tion had be­come dur­ing the Min­istry of Health’s vir­tu­al me­dia brief­ing, Prin­ci­pal Med­ical Of­fi­cer of In­sti­tu­tions, Dr Maryam Ab­dool-Richards, said up to 8.30 am yes­ter­day, there were 24 pa­tients at the Ac­ci­dent and Emer­gency (A&E) De­part­ments with­in the tra­di­tion­al health­care sys­tem who were await­ing trans­fers in­to the par­al­lel health­care sys­tem.

Of this num­ber, she said sev­en of them re­quired ICU care but with 51 out of 52 ICU beds oc­cu­pied, it was not known when that would hap­pen.

Ap­peal­ing to cit­i­zens to get vac­ci­nat­ed, as it would help to re­duce the sever­i­ty of the COVID-19 virus if some­one con­tract­ed it, Ab­dool-Richards said the sev­en pa­tients await­ing trans­fers had not been not ful­ly vac­ci­nat­ed.

“Our doc­tors have no­ticed that per­sons are pre­sent­ing to the A&E De­part­ment very ill, in a state that they re­quire ven­ti­la­tion and oth­er sup­port­ing treat­ment in the A&E and in some cas­es, they may be too un­sta­ble to move in the short term.”

Health Min­is­ter Ter­rence Deyals­ingh said the Jean Pierre Com­plex field hos­pi­tal was tak­en off-line when the COVID-19 num­bers be­gan to drop ear­li­er this year, but is now “go­ing back on­line.”

The field hos­pi­tal at Cou­va is oc­cu­pied.

With no ICU fa­cil­i­ties pre­vi­ous­ly avail­able at the field hos­pi­tals, Deyals­ingh said the min­istry may now have to re­vis­it this pol­i­cy.

Both Deyals­ingh and Ab­dool-Richards re­mind­ed the pub­lic that while health of­fi­cials can on­ly do so much to in­crease the phys­i­cal ca­pac­i­ty by adding more beds, re­sources are lim­it­ed.

Ab­dool-Richards stressed, “Hu­man re­sources and the avail­abil­i­ty of equip­ment and oth­er fac­tors are fi­nite. They will be ex­pend­ed in the near fu­ture if we con­tin­ue along this trend.”

She re­vealed that 98 per cent of pa­tients cur­rent­ly in the ICUs in the par­al­lel health­care sys­tem are not ful­ly vac­ci­nat­ed.

Up to yes­ter­day, there were a to­tal of 87 ven­ti­la­tors op­er­a­tional with­in the par­al­lel health­care sys­tem.

Un­vac­ci­nat­ed pa­tients re­quire ICU care

Re­in­forc­ing just how crit­i­cal the sit­u­a­tion is, Tho­racic Med­ical Di­rec­tor at the Cau­ra Hos­pi­tal, Dr Michelle Trot­man, pro­vid­ed a clin­i­cal overview of the pa­tients re­quir­ing health­care ser­vices that go be­yond the lev­el of ward care.

She said, “That pa­tient pri­mar­i­ly, is un­vac­ci­nat­ed.

“The pa­tient that we see most of­ten that re­quires not just ward care but care be­yond that, which usu­al­ly in­volves ICU or HDC care…what else is sig­nif­i­cant about that pa­tient is that it tends to be some­one over age 60 and some­body who is al­so fac­ing oth­er life health chal­lenges that we call co­mor­bidi­ties so, there­fore, those peo­ple with hy­per­ten­sion, those peo­ple with di­a­betes, those peo­ple with can­cer, those peo­ple with asth­ma…but I want to men­tion an­oth­er co­mor­bid­i­ty which of­ten does not come to light as much as the oth­ers men­tioned pre­vi­ous­ly. In med­ical terms, that’s a pa­tient’s BMI, their Body Mass In­dex, which is an in­di­ca­tion of whether your height and weight are with­in the realms that would make you at the prop­er weight, over-weight, or obese.”

She said BMI read­ings be­tween 20 to 24 meant you are con­sid­ered ac­cept­able, “so you are a good weight, you’re a good size.”

“Af­ter 24, go­ing up to about 30, you are con­sid­ered over-weight, and af­ter that you are con­sid­ered obese ac­cord­ing to cer­tain cri­te­ria.”

In the clin­i­cal set­ting, Trot­man said they were find­ing, “pa­tients that do not seem to have any co­mor­bidi­ties ac­tu­al­ly have el­e­va­tions in their BMI and that serves as a co­mor­bid­i­ty.”

Say­ing there were some who were un­aware they were suf­fer­ing from a co­mor­bid dis­ease un­til they need­ed med­ical care, she cau­tioned younger peo­ple.

“Apart from those over 60, we do see younger peo­ple, un­for­tu­nate­ly, who present them­selves for care be­yond ward care, so not be­cause you are younger, you are spared.”

Urg­ing peo­ple to pay at­ten­tion to their health and en­sure they do not wait too late be­fore seek­ing treat­ment if they fall ill, she said stays in the ICU or the High De­pen­den­cy Unit (HDU) can vary from six to 14 days, and even be­yond a month in some cas­es.

Dr Trot­man said some per­sons may be ad­mit­ted in­to the HDU be­fore be­ing es­ca­lat­ed to the ICU for treat­ment, then back down again and so on, with­out any pre­dic­tors.

In­di­cat­ing there were some pa­tients who were not even pre­sent­ing at the ward lev­el for care, Trot­man said, “What we are find­ing and see­ing, un­for­tu­nate­ly, is a trend where pa­tients are pre­sent­ing ill at the HDU and ICU, not nec­es­sar­i­ly at the ward lev­el, so it is not al­ways that pro­gres­sion we are think­ing.”

In re­new­ing the call for cit­i­zens to get vac­ci­nat­ed, Trot­man as­sured every­one would re­ceive the same lev­el of health­care re­gard­less of their vac­ci­na­tion sta­tus.

And for those be­liev­ing that be­cause they are ful­ly vac­ci­nat­ed they no longer need a mask, or could hug their friend, or par­ty more, she warned, “Vac­ci­na­tion does not take away the need for pub­lic health mea­sures.”

Deyals­ingh: Not too late to get vac­ci­nat­ed

Mean­while, Health Min­is­ter Deyals­ingh added his voice to those call­ing for greater im­mu­ni­sa­tion against COVID-19. He said vac­cine hes­i­tan­cy hot­lines had been set up to reach peo­ple want­i­ng in­for­ma­tion, clar­i­fi­ca­tion and ad­vice re­lat­ing to vac­ci­na­tions.

Re­veal­ing that this was a col­lab­o­ra­tive ef­fort be­tween the Trinidad and To­ba­go Non-Com­mu­ni­ca­ble Dis­ease Al­liance (TTNC­DA) and Pan Amer­i­can Health Or­ga­ni­za­tion (PA­HO), he said it will be manned by vol­un­teer doc­tors from Mon­day to Fri­day be­tween 1 pm to 7 pm dai­ly.

He said the deaths T&T had been get­ting since around Ju­ly were avoid­able be­cause peo­ple had ac­cess to the vac­cines. Deyals­ingh not­ed that was when the mass vac­ci­na­tion pro­gramme be­gan and for those who had not heed­ed the call to get vac­ci­nat­ed, “It is still not too late.”

The Min­is­ter added that if more peo­ple make that com­mit­ment to lis­ten to the sci­ence and act to save lives, the ICU and HDU num­bers can go down­wards in the com­ing weeks.

He said the aim is to vac­ci­nate an­oth­er 200,000 to 300,000 peo­ple, in­clud­ing chil­dren 12 years and over.

The Min­is­ter al­so urged those ill with COVID to de­sist from man­ag­ing the virus at home and not to wait un­til it was so dire that they would need ICU/HDU care.