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COVID-19: Will What-Can-Go-Wrong Go Wrong?

Lloyd Taylor
Lloyd Taylor

Part III

By restricting life to indoor activities, the government anticipates that SOE and curfew, will suppress the spread of the COVID -19 infection rates, enough to make the application of vaccines the final eventful strategy in a return to social and economic normalcy. The fulfilment of that outcome turns on an assessment of what-can-go-wrong. That is the management question for government and its medical team.   Nothing really can go wrong if one is satisfied with the government’s high confidence that inoculation with vaccine doses will put the population on the road to herd immunity.

A rise or fall in numbers of infected cases based on the policies implemented should provide some broad outlines of the trends. We flatten the curve where and when the numbers are in decline. The curve threatens to flatten us where uncontrolled resurgence prevails against the country’s best practices. We are interested in these prognoses because a flattened curve encourages government to relax public health constraints, such as curfews and the lockdown of borders and free up economic activity and economic growth. It is important to have certitude that the numbers of all ‘new cases’ includes asymptomatic cases.  But that approach seems contrary to conventional wisdom in some circles.

To discern what, if anything can go wrong, we examine hypothetical outcomes from a handful of real factors.  One relates to how data on ‘new active’ Covid-19 cases are collected, and perceived limitations in that process. Another is the fact that vaccinated persons are not immune from infection. Still another factor rests on the judgment of researchers that the reduction of antibodies over a period of 6 months creates the need for booster shots. That view suggests the corona Virus is a constant threat , and as a consequence, there may be a need for a routine allocation in national budget for Covid-19 vaccines. There is the resistance of different strains of the virus to different treatment applications; the duration, potency of vaccines and their side effects. Finally, there is always the significant probability that large numbers of the resident population may prefer not to take the vaccine for several reasons. These people can be classified as ‘vaccine reluctant, hesitant and refusal.’

 Dust-to-dawn curfews hint that terror of the  virus is unleashed at nights. Some of that implies pacotille transactions for sexual congress that no amount of contact tracing will reveal. Reported infection rates however may only slow down the spread, but does not stop its occurrence. Given the nature of the virus, infection events will be discovered on average between 7 to 14 days. So PCR tests, which only become available from the public domain when symptoms appear, will merely confirm ‘new active’ cases. Outside of the ripened gestation period of the corona virus there is no other strategy in government’s tool-kit for finding out the true state of the population’s health. That is particularly true of the security and law enforcement employees and those they apprehend. Under SOE, law enforcement owns the streets at night and is called upon to exercise police power over delinquent segments of the population. 

The fair conclusion is that the official data on ‘active cases’ at no point in time reflects the true size of the Covid-19 infected population. The data excludes asymptomatic cases and cases of those whose immune systems are strong enough to survive the infection using locally invented remedies while self-quarantining at home. To repeat, that observation derives from the fact that PCR testing is administered only during the gestation phase of the virus when a case is reported. We have no way of knowing how significant this fact is.   That the omission of these cases from the ‘active account’ has critical significance is beyond question. Undocumented though they may be asymptomatic cases are not dormant.

Trinidad and Tobago experienced a steep COVID-19 curve first especially between January and May 2021 of the last 18 months of the career of the pandemic in Trinidad and Tobago. In the last 13 months ending in December 2020 the public health resistance-regime involved six-foot social distancing, public obligation to wear masks, self isolation and testing, restrictions on carrying-capacity of passenger-vehicles, quarantine regime for returning citizens and visitors, restrictions on airline flights to Trinidad and Tobago and application for exemptions for returning citizens; hospitalisation and treatment for severe cases, regulated closures of bars and restaurants, contact tracing and public-health-emergency curfews. We note that in 2020 the anti Covid-19 regimes were relaxed for General Elections in August 2020, and were non-existent for the Carnival on February 24 and 25, 2020.  One month after Carnival the incidence of Covid -19 infections warranted a public health curfew in March 2020 and quarantining of returning residents. Reports indicate that so-called ‘zess parties’ in crowded spaces prevailed outside of public purview and subverted social distancing throughout 2020. The Venezuelan immigrant presence, aided by Washington’s foreign relations sanctions and interventions, and facilitated by our nation’s porous borders and willing and able domestic agents, must have had a so far immeasurable impact. 

The predictable effect was that numbers of infections, active cases, hospitalizations and deaths rose modestly up to July 2020 at 113 positive cases, but dramatically to 1,476 positive cases eight days before August 10, 2020 election-day. The incidence of positive cases climbed steadily to twice times in September 14, 2020 at 3, 141; to 7,320 by January 14, 2021 and to 8,000 plus between March and April 2021. Total Positive Cases accelerated between May and June 2021 to 27,533 with Active Cases moving up to 9,864, by June 9, 2021.

Part IV

An online report dated May 30th 2021 indicated that there were 637 new cases, an increase of 67.19%, plus 9 additional new deaths. May 2021 also had 381 new cases and 12 deaths that took the total numbers dead to 479. The total positive cases then numbered 23, 638, and active positive cases to 9,607. For the active cases, reports indicate that 8, 331 are in home self-isolation and 122 persons were in state controlled quarantine facilities.    Fifty two (52) persons have been discharged and there were 213 recovered community cases. It will be useful to know what treatment and patient care management helped them to recover. There were 458 cases of persons being treated at hospitals and then, 181 cases in step down facilities. Importantly, there have been 11,796 new cases and 239 deaths reported up to May 28, 2021.

On June 7th 2021, there was a virtual press conference by Health professionals Dr, Roshan Parasram,  CEO of ERHA Ronald Tsoi-a-Fatt and Dr. Christine Carrington Professor of Moleular Genetics and Virology. Professor Carrington assured the population that AstraZeneca, the British-SwIss product and Sino-Pharm, the vaccine from China, approved by the WHO, can be relied on to “prevent disease and death.”  Dr. Carrington urged people to get vaccinated. A few days before, the Ministry of Health reminded us that the second dose roll-out of AstraZeneca, would begin on Monday June 7, 2021 through to Friday July 9, 2021. 

The first dose was rolled out on April 6th 2021 or 17 months after the World Health Organization’s (WHO) officially announced that a pandemic was in existence. Trinidad and Tobago seemed to enjoy a very narrow access to vaccine supplies for most of that time.  Before the start of a new roll out of vaccines due on June 7, 2021 a total of 123,016 persons were vaccinated with the first dose and 2328 with a second dose. Of those administered doses 76, 543 were AstraZeneca doses and 46, 473 Sinopharm doses. 

According to PM Keith Rowley in a statement (June 5, 2021), his Government is forecasting a more assured relief from the pandemic by mid September 2021. Sixty to seventy percent of the population will be vaccinated by then. The new public health regime includes restrictions on freedom of movement via a State of Emergency that began on May 16, 2021, initially for 15 days, but extended to August 30, 2021 by a simple parliamentary majority.  This includes a weekend curfew from 7pm to 5am. Dependence on social distancing is just about out.

Vaccination is the main phalanx in the new counter attack against Covid -19. The thrust in the attack will be continued with Sinopharm vaccine doses which began from June 10, 2021. An additional 800,000 vaccines from Johnson and Johnson, (branded Jassen) are scheduled to be received in August 2021 or 7 weeks away.  According to the PM, Jansen will come from the African Medical Supply Platform. We can assume those doses will administer the long promised coup de grace against the enemy of Covid-19 viruses. Unconfirmed numbers of vaccines are expected from the US,  while 100,000 does from the Covax facility will complete the shock troops. There is also an anomalous report of 400 Pfizer vaccines sent by Washington as a gift to the national security services of the sovereign state of Trinidad and Tobago. Tonnerre!! In April 2021 we rolled out AstraZeneca. This vaccine was re-branded as Vaxzevria, after a troubled rollout. It also was connected to  thrombosis in the UK, Canada, Australia, some Scandinavia countries, and other EU states.

PM Rowley promised a revised border policy that includes “a controlled opening” of borders 4 to 6 weeks hence, thus by mid-July. That has since been confirmed on June 26, 2021. The border policy will be relaxed under conditions of the SOE that is due to expire one day before Independence Day on August 31st, an event that appears to be a targeted social release valve from lockdown fatigue 13 weeks away. In a self-assured-self-congratulatory fashion our PM reminds us that we would be counting 100 Covid deaths a day “ …if the Government had not intervened with measures” to slow it down. That non-competing media-narrative beds an unqualified implication that We The People are the only ones messing around. 

As correct as it is to emphasise the critical role of vaccinations in the counter attack against Covid -19, evidence suggests that in the medium to long run, an exclusive emphasis on it, as the single line of defence may be a serious error. To the extent that our public health policy admits a vaccine-only thrust, it can provoke an unintended resurgence of the pandemic, despite the 3 W rules of engagement (wash hands, wear masks and watch your distance).  While waiting on the vaccine we opened the door to rising infection rates following three events -Carnival 2020, the general election campaign of August 10, 2020, and the invitation to frolic in Tobago for 2021 Easter holiday season. This confirms the implied illusory assumption that public PCR testing taken at the virus’ gestation stage captures all existing ‘new cases’ that matter