COVID-19 and St Lucia’s worsening healthcare crisis

By Dr Alphonsus St Rose

The truth is, Saint Lucia is ill-prepared to adequately handle this COVID-19 epidemic, from real-time public information sharing and implementation to physical, human and financial resource perspective.

This is a moment of extreme national stress, distrust, anxiety, fear, and uncertainty. We are dealing with life and death situations and so well thought out decisions must be made promptly with credible evidence-based data and great analytical thought. However, disturbingly, we are faced with a potential disaster because of a disregard for urgency.

We have been faced with a healthcare crisis for some time and we could have been placed in a much better place today had our government leaders not vacillated over the last three to almost four years. I warned since two years ago that because of the status of our healthcare delivery system there is no built-in redundancy to absorb any additional stress and that we cannot disregard the urgency to fix this problem as it will only take one bad event to change our lives if not forever.

Now the COVID-19 is here upon us; we are ill-prepared, and now the best advice we can be given (by our leaders)  – is don’t panic?

Much is still to be learned about COVID-19. Its mode of engagement, disease burden and pattern will only pan out over time. However, there are already established principles in epidemiology and medicine that can effectively contain and control viral transmission and spread.

If we experience a COVID-19 outbreak we will be looking at serious issues of capacity. Inadequate hospital and ICU beds, equipment, and personnel capacity as well as isolation and quarantine spaces are real. The decision to rationalize testing to point centers as opposed to a more pragmatic community-based mass testing (most effective but a costly option) and the “when to begin social distancing” to shutting down the country are all real considerations.

All of this will carry a significant human and healthcare cost burden as well as a negative social, economic and political impact. This is one circumstance where what is happening transcends politics. Why? Because people are going to die; lives will depend on the actions we take or fail to take and how quickly we do that.

The national imperative now in protecting the citizens and homeland is for the political directorate alongside the opposition members of parliament to speak honestly to the citizens while building hope, trust, and confidence driven by the evidence-based information.

For any administration, COVID-19 is a political “Black Swan” event, especially when haunted by a deep and real sense of public distrust, anxiety, and fear.

Any refusal to simply trust and allow a tasked medical team (working with other agencies) to frame and drive the public healthcare narrative, strategy and response can and will be problematic.

And while our fears are legitimate, the contagion of ineptitude in the context of COVID-19 rewriting our socio-political and economic destiny, while remaining a real concern, must never take precedence over the immediate health, safety and welfare of the people. Business and profiteering must never override the best interest of the people during this crisis.

As such, anyone coming from an area of “high alert” ought to be treated as a suspicious case given that, asymptomatic people (carriers) and the resultant community spread are our greatest dangers/challenges to any containment/prevention strategy, especially in third world impoverished countries. Mass community testing remains a very valid consideration from a preventive, containment and identification perspective.

In Saint Lucia, we need to be real here … a travel ban ought to be in effect (a long time ago), albeit, a temporary time-specific one.

At this point, decisions are to be informed by epidemiological and clinical evidence-based critical analysis which will help fashion an appropriate preventive, containment, testing, surveillance and monitoring strategy and response, both at the community and national level.

The narrative here of necessity must be so informed rather than being politically driven. The time for decisive decisions to be made to protect the citizens and homeland is now.

The paramount consideration cannot be the political and economic blow-back but rather, the welfare and safety of the citizens first. Yes, we are caught between a rock and a hard place here, but it would be morally wrong to sacrifice the people for any industry or economic or political consideration.

This is no time for politics but time for sound leadership, and that has been sadly lacking. Saint Lucia knew of this virus since December but rather than address it and plan ahead, the leadership of the country was busy planning and preparing for horse-racing and even carnival.

Clearly, we (the people) are not a priority in this country and what is driving this attitude is that the decision-makers and the people in their coterie know they can survive the economic fall-out from this and that is shameful and deeply worrying.

The truth of the matter is that a proactive bipartisan posture has to be taken at the national and community level with clear goals, directives, and timelines. We are all in this together.

National

• The political directorate needs to identify the problem areas and lead the charge on preparing and coordinating a task force team to handle the prevention, containment and mitigation response based on evidence-based data, honesty, integrity and good faith. The narrative here must never be politically driven.
• Embark on an urgent and robust nationwide education and awareness campaign with a central point for honest, credible and factual dissemination of information.
• Prepare for and ensure support for any escalation to a state of emergency status and a kick-in of emergency laws.
• Implement effective travel ban measures with immediacy. Shut down mass crowd gatherings including schools and churches.
• Collaboration with the private sector where appropriate (enhance CSR on their part).
• All hands-on board approach.

Community

Beware of false vs factual information

• Follow protocols and guidelines established by the CMO/MOH;
• Be aware of your personal community and environmental situations and settings;
• Protecting yourselves is key. Eat well, sleep well and exercise;
• Beware of spread to yourselves and vulnerable groups.

Behavior modification

• Stop hugging;
• Stop handshaking;
• Stop casual social kissing;
• Avoid crowded areas including gyms, fetes, churches, schools, unnecessary overseas travel etc, until further notice from authorities;
• Continually wash or sanitize hands;
• Keep your hands off your face;
• Cover your cough/sneeze;
• Clean and disinfect surroundings;
• Police each other.