What Do the Numbers Say?

The following post was published by Calixte George Jr on Facebook on Wednesday January 20th 2021. It was a very well done analysis and he has given his approval to publish here as well.

Yesterday, January 19, 2021, was fairly significant thus far with respect to our COVID-19 trajectory. It has been the single highest number of new cases in a day thus far at 57. Out of a batch of 216, over 1 in 4 came back positive. Yesterday, our number of active cases (359) also surpassed the total number of recovered cases to date (354), impressing upon the extent of this outbreak. The month of January has been exceedingly bad. As of January 19, the month has seen 359 cases. January has thus seen more cases than all of last year combined, and we have 12 more days to go. Thus far, January’s caseload is now more than twice that of the previous worst month, November, in which we confirmed 179 cases. For those who thought that 2021 would wipe away our COVID woes, it clearly has been the opposite. However, what is very concerning is the rate at which things are worsening. If we were to breakdown the month by weeks, we would observe:

· Week 1 (Jan 1–7): 30 new cases

· Week 2 (Jan 8–15): 160 new cases

· Week 3 (Jan 16–21): 169 new cases with 2 more days to go in the week.

At the current trend, it is fair to project that we will exceed 200 new cases this week. The truth is, the situation is possibly worse but is limited by the extent of testing being done. For the month of January, based on the information that has been made available, we have averaged 153 tests per day. While we were told that our current testing capacity is at about 300 tests/day, it is fair to conclude there may well be other factors impacting the testing rate. Based on that, rate, we have possibly done about 2,900 tests for the month of January. As such, for every 8 tests done, 1 came back positive. However, for this week so far, 1 test in 6 has come back positive. You may also note that some of this testing also includes persons who are being retested for removal from quarantine/isolation and also persons who would have required testing for travel. Thus, projecting where we will by the end of January is dependent on whether we see any uptick in testing, or if it remains the same. In effect, our numbers will be limited by our testing. What we have seen in the last two days is in fact very worrisome. It’s not just the fact that we have gotten nearly 100 cases in 2 days. It is the positivity rate: 27%. On May 12, 2020 the World Health Organization (WHO) advised governments that before reopening, rates of positivity in testing (i.e. out of all tests conducted, how many came back positive for COVID-19) of should remain at 5% or lower for at least 14 days. I estimate our current 14-day positivity rate to be about 13%. The current trend, however, suggests that things are getting to the point where if we project forward, we could easily be at over 1,000 cases by month-end.

Some might say that this projected figure will still be less than that of Barbados. In fact, have seen quite a bit of discourse comparing the spreads ongoing in Saint Lucia, Barbados and St. Vincent & the Grenadines. St. Vincent is testing at about twice the rate of Saint Lucia, and Barbados at nearly three times the rate, when factoring the respective sizes of the population. A quick check of Worldometer will show that. We should also be very thankful that, thus far, we have not had any outbreaks in residential institutions as had been the case in Barbados where there was a massive cluster of cases in Her Majesty’s Prison Dodds. As such, an immediate measure should be to ensure extremely tight protocols and support is provided for Bordelais, our hospitals and in particular our senior citizens homes. Any breaches there could potentially have devastating consequences as we have seen elsewhere.

Of course, the debate as to the origin of the spread, while for some may seem to be one of spilt milk, is not. Identifying the source of the leak is critical step in stopping the spread. From the numbers, it is fairly obvious that we have a leaky border. During the month of December 2020, we saw 16 returning nationals testing positive for COVID-19. They all were in Government quarantine. What then of the many who were afforded home quarantine. We again dropped the ball with not having in place suitable electronic, GPS enabled geo-fencing technology to monitor persons on home quarantine. So, at a time when we had our largest influx of returning nationals, we simply were not prepared to handle them. Additionally, for the month of December, we saw 19 non-nationals testing positive. That is a significant number for a country not requiring mandatory second-testing.

In fact, if we consider the month of December, we can easily see a clear trend. In the first half of the month, we saw 19 new cases and recoveries in fact outpaced new cases. However, in the latter part of the month, the picture changed. From December 17–31, we confirmed 62 new cases. More than half of those (53%) were persons who had travelled: returning nationals in quarantine and visitors staying at hotels. We can only imagine how many more cases existed within those persons coming through our airports with up to 7-day old lab results, with no symptoms at the time of travel, who may well be asymptomatic or mildly symptomatic. With over 7,000 staff serving such hotel properties, you could well imagine the potential spread. Thus, being told of one hotel with 60 cases alone (staff and visitors) gives fair insight into what is the likely to be the main pump station for spread.

We should also note the geographic spread of COVID-19. If we exclude all imported cases, the north of the island (Castries, Gros Islet, Babonneau), with 55% of the population has 72% of all the local cases. In effect, the incidence rate in the north (45 per 10,000 people) is twice that of the South (22 per 10,000 people). Gros Islet has the highest incidence of cases of all districts, with over 50 persons per 10,000. Could there be a correlation between the concentration of large all-inclusive tourism properties and certain other commercial activities and COVID? What would help is if more data would be made available to get a better sense of the epidemiological links and the types of case clusters we are seeing. We have not generally been provided with such information, which would be very useful in how we target interventions. What we do know anecdotally is that we have seen relatively large clusters as a result of work contacts (hotels, call centres). Additionally, had we implemented the widespread use of a contact tracing app, this would have helped tremendously in being able to see how the disease is actually spreading within our local context. Where, when and how spread occurs will help in sensible actions. Thus we are engaged in a bit of guesswork in understanding human behaviour patterns. Sadly, it will take some time before things get any better.

The world, however, already seems to be taking actions on our behalf even though we appear not to be willing to take them on our own. Testing-for-travel requirements to the US, Canada and the UK has effectively forced second testing upon us despite all the weak justifications put forth by the Government not to proceed with the same. It will certainly mean that we will have to ramp up testing. The recent Level-4 Travel advisory from the CDC, placing us into a category where travel is not advised means that we may see a lessening of numbers coming in. That, coupled with flight cancellations already will slow down the leak and might give us some time relief to fix it. With a seven-day moving average for new cases now at 31 (Barbados’ now at 19), if action is not taken with haste, we will see a worsening health outcomes. We’re beyond time to flatten the curve. In the meantime, we all need to play out part: wear your mask properly in public areas, reduce face-to-face social interactions as much as possible, sanitize as much as possible, avoid touching of surfaces, self-quarantine if you’ve got symptoms, and keep healthy. Wearing your mask, however, does not mean being silent on speaking up and asking for sensible collective action. It’s part of playing our part as well!

Saint Lucian Analyzer Comments

The downgrade to Level 4 by the CDC on Tuesday January 19th was expected based on the recent data and their criteria for downgrade. Level 4 for countries with populations less than 200,000 is defined as 100 or more cases over the past 28 days. Saint Lucia is clearly significantly above that with 100 cases over each of the past seven days. The Prime Minister indicated in early December that he hopes to have Saint Lucia’s Travel Health Notice (THN) lowered to Level 1 by President Biden’s inauguration. He did succeed in having Saint Lucia’s (THN) updated, however it was in the wrong direction to Level 4. This clearly shows that the current’s administration policies are failing to handle the COVID-19 crisis.

Raising a Travel Health Notice Level

A destination’s THN level is increased when its primary criteria meet the range of a higher THN level for 14 consecutive days.

CDC may raise a destination’s THN level before 14 days if the primary criteria demonstrate a sudden or abrupt increase in COVID-19 levels for 7–14 consecutive days instead of the usual 14 days.

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