Writing’s on the wall

New COVID-19 cases for April are now at the country’s highest since the second wave’s destructive peak last October.

The country is continuing to record confirmed and suspected COVID-19 deaths this month, and hospitalizations show no sign of abating.

A growing number of agencies as well as schools throughout the country are being forced to temporarily close due to COVID-19 exposures.

Princess Margaret Hospital (PMH) has been forced to scale back operations, with physicians and nurses making it clear that despite insistence to the contrary by government, capacity to handle the third wave is limited.

There is a documented surge of variant cases in the country, and though test results are pending on which variants are now in circulation, COVID-19 variants of concern are more transmissible than the original virus, and thought to be more deadly.

One need only look at the devastation in Jamaica due to the dominance of variant cases to recognize that for small island states such as ours, a surge of variants that impact the effectiveness of current vaccines ought to be responded to with as much or more urgency than previous surges of the original virus.

Though the original COVID-19 virus was determined to be a threat moreso to older people with pre-existing conditions, younger people with and without underlying illnesses in countries throughout the world are dying and developing serious illness due to COVID-19 variants.

It is a message that has not yet been sufficiently pushed by the Ministry of Health, as many younger Bahamians still believe COVID-19 is something only “old people” need worry about.

Seemingly dedicated to its political objectives above all else at this stage, the third wave could not have come at a more inopportune time for the Minnis administration, particularly since it has spent considerable effort painting itself as the reason the country was able to contain the second wave.

It does not benefit our readers to beat around the bush in making the point that what we are seeing in government’s indifference to the third wave is not about science, the oft-dismissed advice of health professionals, or guidance from regulatory agencies abroad.

It is about politics.

Were it not for Director of the National HIV/AIDS and Infectious Disease Program in the Ministry of Health Dr. Nikkiah Forbes’ declaration that the country is in a third wave – a situation neither the prime minister nor minister of health has independently admitted to – the country might still have been lulled into a false sense of security about the ongoing outbreak.

It is ironic that when the opposition called for an end to emergency rule and a transition to managing the pandemic through ordinary legislation, Minnis accused opposition members of wanting Bahamians to die.

Now that the country is in a third wave with confirmed deaths and those under investigation mounting, Minnis’ very justification for a continued state of emergency – which is to enable the government to move immediately to curb new outbreaks – is not being undertaken.

The competent authority knows, if not from his own understanding then by the advice of health professionals, that failing to implement temporary, targeted and data-driven measures to contain the third wave at this juncture threatens the economy, the tourism product and most importantly, the health and lives of Bahamians.

Though targeted measures are unpopular, cases and hospitalizations are increasing in the face of existing public health protocols that have been ignored by political parties and some in the general public, and in the face of the country’s relatively low vaccine uptake at around six percent of adults partially vaccinated to-date.

The administration’s disposition is quite clearly about clinging to a campaign narrative about the pandemic, and the unwillingness to do what is necessary to curb the third wave because doing what the country needs, is incompatible with the narrative the administration wants Bahamians to accept.

An example of this kind of indifference in the face of case surges can be found in India, where political campaigning as well as religious ceremonies are being blamed for what has now become the country’s record-breaking surge that is reportedly causing more deaths than crematoriums can keep up with.

With India’s healthcare system buckling, its Prime Minister Narendra Modi was condemned for holding a major political event this past weekend.

According to the BBC, India’s recent surge began late February, increasing sharply in March (similar to the pattern of The Bahamas’ third wave), and political parties continued campaigning despite the rise in cases, with government insisting that campaigning and rallies had no link to the surge.

Though it is not publicly known to what extent political activities have contributed to this country’s third wave, what has been disclosed is that international travel by residents and visitors – mostly from the US where COVID-19 variants are confirmed nationwide – is playing a leading role.

Most countries are not abandoning testing

While on Grand Bahama last weekend, Prime Minister Dr. Hubert Minnis sought to defend his decision to remove testing requirements for fully vaccinated international travelers, claiming that most of the world is following suit.

That assertion is false.

Most countries, including the United States and those in the Caribbean, still require that international travelers submit a negative COVID-19 test result as a condition of entry regardless of their vaccination status.

Minnis claimed the government is following US Centers for Disease Control and Prevention (CDC) guidelines with respect to its new travel policy, but insofar as the CDC’s guidance for international travelers, this assertion too, is erroneous.

The CDC requires that international air travelers to the US – whether fully vaccinated or not – submit a negative COVID-19 test for entry, or documented recovery from the virus within the past three months prior to travel.

The CDC also recommends that such travelers receive a second viral test three to five days after travel, and advises them to self monitor for symptoms, and to both isolate and get tested if symptoms develop.

Moreover, the US continues to effect COVID-19 travel bans for those who would have traveled within countries including China, the UK, the European Schengen area, Brazil and South Africa 14 days prior to attempted entry.

The UK, Brazil and South Africa are where variants of concern that have now dominated new COVID-19 infections worldwide, were first identified.

What the CDC has relaxed is its guidance for fully vaccinated people within the US, who are now free to travel within the country without testing.

The CDC’s guidance for international air travelers – with its guidance for cruise passengers expected soon – is based on existing science that indicates that vaccinated people can still both contract and transmit COVID-19.

The risk thereof is yet to be definitively quantified, though suspected to be lower.

The ministry has reported 147 COVID-19 cases with a recent history of travel abroad this year.

Of that number, 112 are on New Providence; 16 on Eleuthera; five on Grand Bahama; five on Exuma; three on the Berry Islands; and two on the islands of Abaco, Andros and Bimini and Cat Cay.

The island distribution of cases with a travel history correlates with the range of detection of variants on various islands.

Ministry data reveal that New Providence recorded the most samples with detected variants between March 13 and April 17.

Eighty percent of all samples tested the week of April 11 showed the presence of a variant of concern.

Tourism Minister Dionsio D’Aguilar, in expressing consternation about The Bahamas being among 80 percent of countries added to the US State Department’s Level 4 travel advisory list for COVID-19, argued that The Bahamas is far safer than the US based on the number of cases in both countries.

Since D’Aguilar maintains that the US’ number of COVID-19 cases makes it a less safe destination than most countries, how, then, does he justify the removal of testing protocols for fully vaccinated travelers from this plausibly high-risk destination, given that fully vaccinated travelers can still transmit COVID-19 and its variants?

The overwhelming majority of Bahamians are unvaccinated, which means safety for the Bahamian people must be judged on a different continuum at this time.

Additionally, safety is relative. An argument that posits that more should be made of the US with its millions of cases than The Bahamas with its “small” number of cases in comparison, fails the logic test.

Without stating the obvious with respect to the vast difference in population between both countries, what is most relevant in this discussion of COVID-19 surges is a country’s capacity to manage the same.

If country A has 1,000 cases with the capacity to effectively manage 5,000, and country B has 100 cases with the capacity to effectively manage 20, the crisis for country B is far more potent than it is for country A.

The Bahamas is not the US, and its pandemic response must be crafted based on its own unique circumstances and limitations.

What is at stake

Healthcare workers paid the ultimate price in the second wave, as did other frontline workers in both the public and private sector.

The more cases increase, the higher the risk of exposure for nurses, doctors and other healthcare workers, which ultimately impacts treatment for everyone in need of medical care.

Surges also increase exposure risks for the Royal Bahamas Police Force, the Royal Bahamas Defence Force, prison officers and immigration and customs officers who have high-contact jobs.

Some Bahamians who are understandably tired of the pandemic, complain that too much attention is placed on COVID-19 over longstanding chronic non-communicable diseases such as cancer or diabetes.

But what those who make this complaint might fail to appreciate is that if hospitals and clinics are overburdened due to COVID-19 cases, those who suffer from those and other chronic diseases are at greater risk of worsening outcomes due to fear of approaching healthcare facilities, or constraints on in-person care.

If government, which is the political head of the public service, continues to downplay the severity of the situation, the same can put government workers at unnecessary risk of exposure.

If COVID-19 testing on demand was free or at nominal cost, teachers and school staff who interact daily with potentially asymptomatic students could afford to get regular tests, since testing is an integral link in the chain to contain the spread of COVID-19.

The same goes for employers who could better facilitate employee screening if RT-PCR testing on demand was affordable.

Nobody wants a full-fledged lockdown, but choosing to downplay the third wave could put the country on this path, which would cause far more damage to businesses than temporary targeted containment measures that ought to have been implemented before the set in of the current surge.

Head of the Organization for Responsible Governance (ORG) and businessman Robert Myers recently said of potential new restrictions, “We can’t be a country based on safe tourism and travel if we’re not going to be responsible inside. And the only way to get the economy going again is to get this thing under control.”

It seems the prime minister may view admitting to and acting appropriately to the third wave, as an admission of failure as he continues to stump for re-election.

But when it comes to a belief that COVID-19 could have been used to catapult his administration to a second term, it is time for the prime minister to, as older generations would say, “put that baby to sleep”.

COVID-19 variants pose a greater threat than was posed in the second wave, and how political parties or personalities look in this process is irrelevant.

By continuing to resist appropriate action inclusive of suspending campaigning and conducting meaningful consultation with the country’s healthcare professionals, the Minnis administration is putting what it wants politically, ahead of what The Bahamas needs.

Governments come and they go.

But the fallout of what we stand to lose if we collectively fail to contain the third wave would be with us long after a political party in power is off the scene.

And the loss would invariably hurt most, those who are least able to manage it.

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