Living with Covid-19 – A perspective

by Dr Bert Brathwaite

Covid-19 has been with us in Grenada for some 20 months. Initially, we were groping (like all other countries) as we dealt with a disease about which minimal was known and for which there were limited diagnostic and therapeutic modalities.

Today the reality is different. The PCR nasopharyngeal swab test has proven itself to be the gold standard for diagnosis. The AstraZeneca vaccine has been available since February this year and the Pfizer vaccine became available in August. Monoclonal antibodies (lab made proteins which bind to the virus and prevents its entry into the cell) which are given intravenously to out-patients are very expensive and have not been available on island to date.

It is anticipated that the Merck anti-viral drug Lagevrio (Molnupiravir), and the Pfizer drug Paxlovid, for which approval is now being sought, will provide a critical treatment modality to primary care physicians once it is confirmed that the patient has contracted Covid-19. The availability of antivirals is especially important in controlling severe outbreaks of the disease as the world eases into another phase of the illness.

Most scientists predict that like the 4 other coronaviruses that infect humans, SARS-CoV-2, the virus causing Covid-19 will never be completely eradicated but will continue to be present in populations around the world with low level of circulation in what is called an endemic state. Intermittently, there will be an upsurge in the number of cases resulting in a local epidemic.

The challenge is how do we best reach this endemic state where we coexist relatively comfortable with Covid-19. Undoubtedly, the best way that an endemic state can be achieved is for a high percentage (greater than 80%) of the eligible population to come forward promptly and be vaccinated. If our vaccination levels plateau around our present levels we will probably have future marked surges, with morbidity and mortality reminiscent of September-October 2021.

I am perplexed as to how we think about this disease. Everyone wants to be rid of it, to be able to move around as previously, to be able to get employment or if presently employed to boost their earnings. However, to date, less than a third of us have come forward to be vaccinated. Much of the responsibility as to how we coexist with Covid-19 rest squarely in our own hands and the uptake of Covid-19 vaccines.

With respect to vaccination, if it was possible to have the full drive of all medical practitioners, the marching energies of the unions, the crusade fervour of churches, the organisational skills of NGOs and civic organisations, we would be able to have 70% of the country vaccinated by February 2022. One of the more pleasing aspects of the ongoing vaccination drive is to have seen prominent political figures from opposition parties providing consistent and stellar support.

A look at what is happening in different parts of the world with respect to Covid-19 will continue to guide us in the approaches that need to be taken locally. WHO Regional Director for Europe, Dr Hans Kluge, reported last week that the current pace of transmission across the 53 countries of the WHO European region is of grave concern. Over the past 4 weeks, Europe has seen a greater than 55% increase in new Covid-19 cases. He reported that if the trajectory is maintained, half a million Covid-19 deaths would occur in Europe and central Asia by the first of February next year.

A careful and continuous watch of the case positivity rates (and other such indicators) needs to be made for all countries. For economic and practical reasons the entry protocols should allow for ease of entry from countries where there is a low prevalence of Covid-19. For countries where there is a high (or medium-high) prevalence of Covid-19 or where a traveler has had a significant intransit period in a country with high prevalence, quarantining and testing a number of days after arrival is necessary.

Such measures are necessary for countries like ours where vaccination levels are low and where the level of health care at the secondary and tertiary levels is weak. It is interesting that Dr Sonia Browne, a backbench MP in the parliament of Barbados in late October 2021 called on the Government of Barbados to review the protocols which had recently been introduced. The entry protocols into Barbados which have been recently revised, allow fully vaccinated travelers with a valid negative PCR test not to have to take a PCR test on arrival or be required to quarantine. She questioned the science in so doing and indicated that the Barbados Association of Medical Practitioners had reservations about the protocol change.

Most Caribbean countries are heavily dependent upon tourism and there is a push from the business sector to open up the borders. It is necessary to facilitate this process but clearly concurrently all actions need to be taken to shield the country from significant outbreaks. In essence, our protocol at the borders needs to be tailored to counteract threats regionally and internationally.

It would be interesting to get a comparative cost analysis of the financial implications of a significant shutdown of the country in terms of the impact on numerous operations in the retail and small business sector, the transport sector, the bars, restaurants and entertainment areas etc. Add to this the financial loss from students leaving SGU (St George’s University) and the loss of some breadwinners. One cannot quantify the emotional trauma resulting from periods of shutdown and the loss of loved ones.

The comparison would be with the loss of revenue if travellers from high-risk areas are quarantined. When this happens there will be some reduction in travellers and subsequently flights, decreased cargo uptake, decreased revenue from hotels and direct purchases from visitors.

Whichever direction Government takes the country, efficient monitoring of protocols and enforcement of regulations is absolutely necessary. We are not that disciplined a society that there will be broad compliance with protocols, unless the relevant agencies make unannounced and frequent visits to all sectors and especially those involving higher risk activities.

No discussion about living with Covid-19 is complete without examining the question of mandates. This is a very vexing one and, in my opinion, if the population truly considered the real facts about this disease should not have to be debated.

It is to be noted that in order to assist in achieving a quick pace of recovery from the effects of the virus, President Biden has had to issue new rules mandating that all federal employees be vaccinated and more recently similar rules for any private company with more than 100 workers. Mandates are present for other groups of workers. All health care workers must be vaccinated by 4 January, with no option for weekly testing, in lieu of vaccination.

In our context as we live with Covid-19, if present vaccination hesitancy is maintained, weekly testing of unvaccinated individuals in many workplaces will be necessary to keep us from having clusters and waves of Covid-19. We already have a number of communicable diseases for which children must be vaccinated to enter school and Covid-19 is as treacherous a disease, even if more so in the adult population.

Finally, we need to observe what is happening in China and ask ourselves some questions. Why is this superpower which had earliest knowledge of the disease continuing a rigid ‘zero-covid’ policy when most other countries have opened to some extent. Quarantine policies on entering China are similar to what we used at the beginning of the pandemic. Additionally, the smallest of outbreaks can lead to mass testing and tight lockdowns for tens of thousands.

Is it that China is on a wait and see policy despite the fact that it has 80% of its population vaccinated? Or is it that China views this virus in a very sinister manner and has concern about the long-term effect of this virus on the health of its people? As a consequence, it may be trying to ensure that from the outset, exposure to the virus is minimised. Whatever the reason, my take from their approach is that we need to continue to energise the vaccination programme whilst simultaneously limiting the further entry of the virus into the island.

Yes, we have to live with Covid-19 but let us do so in as an atraumatic and safe manner as possible. I have outlined some measures that in my opinion will permit this. The responsibility is on the shoulders of all.