Paho country rep: Post-Carnival covid19 spike not officially recorded

Dr Erica Wheeler, Pan American Health Organization/World Health Organization (PAHO/WHO) TT country representative, says the country should start seeing an increase in the number of covid19 cases around this time, about two weeks after Carnival, but the more important set of numbers was that of hospitalisations.

“What may be unavoidable is an increase in cases, but hospitalisations are important to note. That is what is going to tell you how widespread it (covid19) is.

"Because remember, large numbers of people are no longer going to health centres to test. They are doing home testing, so nothing is officially recorded.”

She said the number of cases would increase because the various large gatherings throughout the Carnival season would cause the virus to continue to circulate. And TT has already had cases of the most recent omicron variant, XBB.1.5, which spread very rapidly.

She stressed that the situation would not be as bad as with the delta variant, because, while omicron was more contagious, it was less deadly. She said that was normal because all viruses had to infect their hosts to survive, and if they killed off the population, they would die as well.

In addition, she said, other than home testing with antigen tests, the increase may not be “huge” for several reasons, including the fact that parties were taking place before Carnival.

With Carnival being celebrated on February 20 and 21, TT saw a spike in cases from February 22-28. New cases were at 559, whereas the week before there were 226. Hospitalisations also increased from 39 to 53 and deaths from three to eight. Numbers for the following week, March 1-7, also jumped, with new cases increasing to 622 and hospitalisations to 75. Deaths remained at eight.

Wheeler said a factor in how high the hospitalisation numbers would get was the balance between natural and vaccine immunity, and whether those who were not immunised had underlying illnesses.

“We have a complicated picture in TT, because so many people have not come forward to be immunised – only 51.3 per cent of people have actually been fully immunised – and on top of that, we have home testing.

"The third thing is, we have co-circulating viruses. We have people coming in from North America with the influenza virus that may be slightly different, because flu viruses change every year. There’s RSV (respiratory syncytial virus) circulating in North America, that we have here, and there’s covid.

"How do you know which of those you have unless you get tested?

"And it is possible to have multiple viruses at once.”

She said with the antigen or rapid test, even if someone had covid19, if their viral load was not very high in the first few days of infection, the test may give a negative result. If still sick after a few days, they are supposed to test again but most do not, so they would not know they had covid19. Then, some people are asymptomatic. So there was more covid19 circulating than was officially recorded.

Wheeler noted that vaccinated individuals could get reinfected but usually, the rate of reinfection for immunised people was considerably lower than those with natural immunity (from a previous infection), since natural immunity did not protect against reinfection by other variants at all.

She was not aware of anyone in TT collecting data on reinfection, which would also be made difficult because of home testing. She said some organisation would have to do a study, taking a random sample of the population, to get that kind of data.

However, she said, according global data, if fully vaccinated and reinfected, a person’s chances of developing post-covid19 conditions, hospitalisation and death were very small. In fact, the hybrid of vaccine and natural immunity strengthened the immune system.

“The issue remains, people who are immunocompromised – people who are on cancer treatment, are taking medication for NCDs or have blood-clotting issues and so on – those people are very vulnerable. Older people and people with comorbidities are still vulnerable.

"So even if you get reinfected and you are vaccinated, the chances of you ending up in hospital and dying are small.”

As of March 7, among those who were fully vaccinated, the number of deaths from covid19 was 331, and there were 3,634 deaths among those who were not fully vaccinated.

Wheeler told Sunday Newsday there was a certain level of herd immunity in TT since covid19 had been around since 2020, and so many people got it at some point. But, she did not know how much, because, again, TT did not have the data.

“We can say, ‘Yes, most likely,’ because even if we’re conservative, and say in addition to those who were vaccinated, another 20 per cent of the population got covid, that would be about 70 per cent (of the population with some covid19 immunity).

“But then we got omicron, which has different variants and is more contagious, so there can be more reinfections – but we don’t have any data to prove what levels (of immunity) we’re talking about. We’re guesstimating.”

She suggested a seroprevalence study, which would determine the population level immunity against covid19 by measuring specific antibodies to covid19 in adults. With random sampling, the study could better project the most likely level of immunity of the population.

However, she said covid19 was endemic and was not going anywhere. She compared it to the flu, to which scientists had yet to find a cure. Instead, they had to keep adjusting the vaccine as the virus evolved.

“We have to learn to live with covid and be responsible.

"If you know you have covid, or even if you have the flu, stay away from people! Don’t go to work. Don’t infect other people. If you have to go out five days or something after you get it, wear your mask. Keep washing your hands and sanitising them.

"What does it take to do that? You could never, ever go wrong by doing those two things.”

She pointed out that TT had seen fewer cases of acute respiratory illnesses, flu and gastroenteritis since the implementation of the public health measures of wearing masks, washing hands, and keeping your distance, so people should not underestimate the value of public health and social measures. In fact, she believed they should be integrated more into people’s daily lives.