Fewer cases being reported but covid19 still lurking

The rolling seven-day average of new covid19 cases in TT was one as of October 28, and has been less than ten since August 20.

However, not every case is being recorded as people do home testing or none at all.

This lack of consistent monitoring is of concern to global agencies trying to keep track of new variants and effects.

Newsday asked several people if they still took covid19 precautions. Most said they continued to wash and sanitise their hands frequently, but took no other precautions.

One person said he was wearing a mask at work because his son kept getting him sick with colds from school.

“It helps me breathe easier at work because it’s really cold where I work, so when I wear it in the AC it keeps my face warm. I wash my hands and sanitise but not overly so.”

Another woman said she said she worked from home and tried to limit her interaction with the public.

“I wear masks when I go to the gas station and grocery shopping. I also go to evening classes and recently to a theatre show and I don’t see anybody else wearing masks.”

Another man said he had a mask in his car which he would wear if he heard someone coughing. He said he also sprayed his hands with rubbing alcohol often.

Pharmacies said they have seen a decline in the number of masks, hand sanitisers and home test kits being bought by customers.

At Bhagan’s Drugs in Port of Spain, the receptionist said people still came in for masks, but not test kits, and there had been a decline from the same time last year. At Longdendville Pharmacy in Longdenville, masks and hand sanitisers were still being sold, but fewer test kits.

At SRS Drugs in Arima, the pharmacist said very few masks were being sold, and at Health Corner Pharmacy in Sangre Grande, the receptionist said people would only buy masks occasionally, while home tests were bought “once in a blue moon.”

The pharmacist at Ralph’s Pharmacy, Penal said the staff still wears masks but most customers did not.

“Covid19 is still very rampant although a lot of people don’t act like it and come into the pharmacy without masks. We still sell masks and sanitiser, but not as much as when covid19 was here the first time.”

Private testing facilities have reported a decrease in the number of people coming for testing. The Renand Laboratory in St James said very few people are coming in for covid19 tests. Of these, more people opt for antigen tests than PCR tests. It said companies were no longer sending their employees for covid19 testing before they are allowed to return to work. The lab said they were still required to report positive tests to the Health Ministry.

Newsday attempted to find out if testing was available at public health facilities but was unsuccessful. At the beginning of August, the ministry lifted the requirement to wear masks at public health facilities and hospitals. Some private health facilities still require patients to mask.

Some innovations introduced into the public service during the pandemic remain, one of which is the introduction of appointment systems for people needing to access certain services.

As of November, some facilities that still require an appointment include the National Insurance Board, the Immigration/passport department, the Ministry of the Attorney General and Legal Affairs (for registering births), the Licensing Division, and getting a police certificate of character, among others.

At the Forensic Science Centre in St James, bodies are still being swabbed before autopsies are done.

New variant linked to recent spike

Data from the Ministry of Health revealed that there were 6,066 confirmed cases of covid19 between January and October 28, which was 3.1 per cent of the 192,262 total confirmed cases from March 12, 2020 to October 28.

Similarly, the 133 deaths from covid19 between January and October 28 was 3.0 per cent of the 4,419 deaths from March 12, 2020 to October 28.

Between June and October, the highest weekly number of new confirmed cases was 72 in the third week of August. There were 190 cases in August, with 115 in September, 112 in July, 70 in June, and 54 up to October 28.

The Health Ministry said the EG.5.1.1 variant of interest was possibly responsible for the spike in covid19 cases in July and August. Six deaths were recorded in August, with none in July.

Dr Aruna Ramcharitar Maharaj, who runs a private practice in Curepe close to UWI St Augustine, said in early September she had seen an increase in covid cases in her patients.

"Based on the statistics from my private practice, I would say covid19 is again on the rise."

She said some of the symptoms she had seen were severe headache, runny nose, congestion, fever, and general malaise, with only one person having loss of taste and smell so far.

“But folks are still coming in and saying’ Doc, my sinus are flaring,’ forgetting that that is the most common way covid19 presents.”

A rare symptom of covid19 is conjunctivitis, or red/pink eye. Studies say one-three per cent of people with covid19 could develop conjunctivitis.

In August, the health ministry noted an uptick in cases of conjunctivitis based on public health reports.

The Health Ministry said there are ten people in hospital with covid19 up to October 28, but they were incidental cases, meaning they were admitted for other issues, and were tested and found to be covid19 positive during the admittance process. This applied to hospitals across the parallel and hybrid healthcare systems, which includes the Couva Hospital.

The long covid clinic in Arima has been consistently operational since April 2021. The Health Ministry said from April-December 2021, there were 86 new patients and 208 revisits.

In 2022, there were 285 new patients and 450 revisits, and in 2023 up to October 28, there were 67 new patients and 303 revisits.

The ministry's corporate communications manager Shemelle Paradice, in response to questions from Newsday, said, “There has been a significant decline in the demand for the clinic. This is potentially a reflection of reduced covid19 complications as we have emerged from the pandemic. At present the subset of patients presenting are mostly due to lung (respiratory) symptoms including difficulty breathing, shortness of breath and cough. Other complaints frequently noted are non-specific chest pain and chronic fatigue.”

Scientists in India and the US reviewed six studies involving over 12 million patients demonstrated a strong connection between covid19 and elevated risks of cardiovascular and cerebrovascular thromboembolic events. The risk of these events is evident in conditions such as ischaemic heart disease, stroke, and cardiac arrhythmias. The review was published on MedRXiv, a pre-print server for health services and has not yet been peer-reviewed.

PAHO: Don't let down your guard

The Caribbean Public Health Agency (Carpha) said it continues to do genetic sequencing on samples received from its member states that tested positive for covid19.

In a statement to Newsday, Carpha said the variants most prevalent among the genomically sequenced samples have been mutations of the omicron variant, including BA.4.6, BQ.1.1, XBB.1.5, and XBB.1.16.

It said it was now integrating covid19 surveillance into routine severe acute respiratory infections/acute respiratory infections surveillance and is continuing to work with member states towards getting data on hospitalisation and deaths and long covid19.

Carpha said globally EG.5 and BA.2.86 are the most recent variants which are being seen in several countries, but at this time, neither appears to show changes in disease severity in infected persons.

It said some countries continue to maintain their covid19 surveillance separately while others have incorporated it into their routine surveillance activities. At this time, information and research on Long covid surveillance is less available as studies are still ongoing and being developed.

It said while the World Health Organization still updates its covid19 dashboard, many countries are no longer reporting through official communications and very few Caribbean countries have noted new cases on the dashboard within the last few months.

The agency noted that previously implemented precautions are no longer mandated by its member states, and encouraged the use of non-pharmaceutical interventions (such as hand washing, and social distancing) for the prevention of communicable diseases and promotes vaccination with the updated, WHO-approved covid19 vaccines.

Pan-American Health Organization (PAHO) director Dr Jarbas Barbosa said “while we have emerged from the covid19 pandemic, we cannot let our guard down. We need to take this as an opportunity to accelerate action to recuperate lost public health gains and increase resiliency in our health systems.”

He made the statement following the organisation’s 60th Directing Council from September 25-28. He said it was important for countries to increase their preparedness and response to future pandemics and public health emergencies.

PAHO said health authorities also discussed efforts to improve pandemic prevention, preparedness and response. During the session, PAHO presented a series of recommendations based on the external evaluation of the organisation’s response to the pandemic, including strengthening funding mechanisms and capitalising on new technologies.

WHO: Disturbing trends ahead of winter

“Covid19 may no longer be the acute crisis it was two years ago, but that does not mean we can ignore it.”

World Health Organisation (WHO) director general Dr Tedros Ghebreyesus made the statement in a media briefing on September 27, as he said covid19 continues to affect people around the world, causing severe illness, hospitalisations, and death.

Ghebreyesus said there continued to be disturbing trends in covid19 ahead of the winter season in the northern hemisphere.

“Among the relatively few countries that report them, most hospitalisations and ICU admissions have increased in the past 28 days, particularly in the Americas and Europe. Meanwhile, vaccination levels among the most at-risk groups remain worryingly low. Two-thirds of the world’s population has received a complete primary series, but only one-third has received an additional booster dose.”

“Data is limited, as only 43 countries, less than a quarter of WHO member states are reporting deaths to WHO, and only 20 provide information on hospitalisations.”

He said countries should continue to sustain the systems they built to respond to covid19, to ensure people can be protected, tested and treated for covid19 and other infectious threats. These systems include collaborative surveillance, community protection, safe and scalable care, access to counter-measures and co-ordination.

Asked whether the new variants were more dangerous or contagious, WHO covid19 team lead Dr Maria Van Kerkhove said it was difficult to assess the known variants and circulation of the virus because surveillance was declining. She said there was not one dominant variant in circulation.

She said the variants of interest being tracked are XBB.1.5, XBB.1.16, and EG.5, with the latter on the rise around the world, but still comprising only 30 per cent of the global sequences.

“We’re trying to look at transmissibility and immune escape, and there is some preliminary data that the current vaccines will protect against severe disease and death.

“All the variants can cause the full range of disease. We have not detected a change in severity. If you are infected with this virus, whatever variant is circulating, it can cause asymptomatic infection all the way to severe disease and death.”

She expressed concern that countries had stopped reporting covid19 deaths, hospitalisations, intensive care admissions, and gene sequences.

“What we are working on with our member States and everyone worldwide is to have good surveillance so we can track the variants, and conduct risk assessments as quickly as possible. We’ve had a decline in the number of sequences available from around the world, but we’ve also had a decline in where those sequences are coming from."

Van Kerkhove urged people to continue to use counter-measures such as improving ventilation, wearing masks, respirators and personal protective equipment, distancing, and vaccinations.

“Covid19 vaccines remain safe and effective and prevent severe disease and death, and advanced therapeutics can prevent the development of disease and prevent escalation to severe disease if infected.”