Trinidad and Tobago reached the grim statistic of 1,000 lives to the COVID-19 pandemic as of yesterday.
The country crossed the milestone after two more deaths were recorded.
COVID-19 has left no household or family untouched.
Nearly one in every 39 people in the country has been confirmed to have the deadly virus.
Also, nearly one in every 36 COVID-19 cases in the country have lost their battle with the disease.
About one in every 1,400 people across Trinidad and Tobago have lost their lives to the disease. However, while appearing higher than the world average on the surface, experts say it is not as concerning due to several variables.
The role of the Gamma (P.1) Variant
In the last COVID-19 spike, occurring between late August 2020 and October 2020, the country reported 5,266 cases with 98 deaths. During that period, roughly, for every 54 cases, the country recorded one COVID-19-related death. Based on available gene sequencing, the dominant strain circulating then was the original SARS-CoV-2 strain (the virus that causes COVID-19) that originated in Wuhan, China.
On April 19, the Gamma (P.1) SARS-CoV-2 variant, which originated in Brazil last November, was detected in a local sample within T&T’s borders. Cases were already surging at concerning numbers when this sample was sequenced. By the week of May 11, the Gamma variant had accounted for 38 per cent of some 500 samples sequenced since December 2020.
Its increasing presence in samples sequenced since April led Chief Medical Officer (CMO) Dr Roshan Parasram and Professor of Molecular Genetics and Virology at the University of the West Indies’ (UWI) Faculty of Medical Sciences, Dr Christine Carrington, to believe it was becoming the most dominant SARS-CoV-2 strain circulating in the country. It’s an outcome experts deemed as predictable, given the variant’s higher transmissibility and history.
While experts say the Gamma variant has not been deadlier, it is more infectious. Statistically, more infections result in more deaths. ALthough its true role has not been confirmed in all infections since its discovery because of sequencing capacity, from April 19 through July 20, 2021, T&T recorded 27,414 cases and 847 deaths, creating an average of one death for every 32 cases for this period.
With a current case-fatality rate of 2.75 per cent, according to pulmonologist and dean at the UWI’s Medical Sciences Faculty, Professor Terrence Seemungal, the figures were within the statistically expected range.
“When you look at it, our death rate is higher than the world average right now, but when you look at the 95 per cent confidence interval…we are within that range, so I wouldn’t say that is something to definitely worry about,” he said.
The elderly and comorbidities
COVID-19 does not discriminate – everyone is at risk for infection.
In T&T, infections have occurred in infants that are just months old to near-centenarians. Since the start of the pandemic, doctors and health officials have warned the elderly (those above age 60) and people with hypertension, diabetes and kidney disease are at high risk.
Based on 2020 estimates from the Central Statistical Office, 13.38 per cent, or 182,850 people, are above age 60 in Trinidad and Tobago.
As of April 2020, the Ministry of Health said the country had approximately 266,000 people (20.5 per cent of the population) with diabetes and 341,000 people (23.6 per cent of the population) with hypertension. Both comorbidities, according to the Technical Director of the Ministry of Health’s Epidemiology Division, Dr Avery Hinds, are the most common observed COVID-19-related classified deaths.
Dr Hinds also stated in a press conference in early June 2021 that other pre-existing conditions included asthma, ischemic heart disease (IHD) and malignancies from different types of cancer, were found in COVID-19-related deaths.
From May 1, 2021 to July 20, the country has recorded 708 COVID-19-related deaths with at least one comorbidity, 120 COVID-19-related deaths without any significant underlying health conditions, and three without any additional details, resulting in 831 deaths. Notably, 553 of these deaths were considered elderly, 259 were deemed middle-aged, 15 considered young adults and one was a teenager.
Hinds indicated in early July that Trinidad and Tobago was noting a spike in COVID-19 cases and deaths in those above age 60, with deaths spiking in those above age 75 to 80. On Saturday, Hinds clarified that the ministry noticed “an increase in numbers above people above a particular age becoming ill and that several of those did actually arise out of clusters in care homes.”
Speaking at the Prime Minister’s media conference on Saturday, the CMO and Hinds explained that the overall case-fatality rate would be affected depending on which groups become infected. According to the CMO, while the country’s case-fatality rate is at 2.75 per cent, for the over-80 age group, this rate can be as high as 20 per cent, meaning one in five people at this age succumbs to the disease.
Case of classification: Could some deaths not be COVID-19?
Former health minister Dr Fuad Khan said the “real” number of COVID-19 deaths could be lower than reported because of the ministry’s classification protocol.
He explained that once someone with COVID-19 dies, they are counted in the statistics. However, he said their passing could be unrelated to the disease.
“All the deaths that take place under COVID, none of them have an autopsy done on them… so the cause of death is not known and it’s assumed to be COVID because they are positive COVID patients,” he said.
The CMO previously said a decision was made to forgo autopsies on COVID-19 fatalities due to the risk it posed to examiners.
Khan said someone could die from a heart attack but because they test positive for COVID-19 despite being asymptomatic, they will be counted as a COVID-related fatality.
Professor Seemungal agreed.
“That’s an interesting point…dying with COVID-19 is not the same thing as dying from COVID-19, and people who die with COVID-19 may find themselves classified as a COVID-19 death, whereas they died from something else,” he said.
“I agree that that could be a contributory factor to what we see here.”
He said a similar analysis was done in Italy and they found the COVID-19 death rate was much lower than previously believed.
Hinds also used Italy as an example.
“While it’s above the global average, (it) still corresponds to places like Italy, where it’s 2.99 the last time I checked, which had a similar profile of older individuals becoming infected and then having a higher case fatality outcome just because of the risk of death in those age groups.”
Regardless of any more infectious strains or classification semantics, the proven ways to avoid becoming a part of the harrowing statistics are wearing a mask, washing your hands, watching your distance, and getting vaccinated.