Dr Roshan Parasram, chief medical officer at the Ministry of Health, and Dr Naresh Nandram, the principal medical officer of the Epidemiology Division, were asked to defend their professional ethics today, after a suggestion that the approach of health care professionals to Covid-19 was altered for political reasons—in the build-up to the 10 August General Election.
TV6 journalist Urvashi Tiwari-Roopnarine questioned Dr Parasram’s perceived failure to recommend earlier roll-back measures for the population and suggested that Covid-19 results were shared in a way meant to create a false impression of the country’s health, in the build-up to the General Election.
Tiwari-Roopnarine suggested too that the Epidemiology Division’s graph depicting the rise of infections over the past month, contradicted information given to the public.
“On the sixth, seventh and eighth [of August], there appeared to be a lot of positive cases detected and on the ninth—the day before the election—there were four cases,” said Tiwari-Roopnarine, “and on the day after the elections there were two and then after the public gets results from 5 August.
“If the public did get results maybe they would have been able to make a proper decision on their behaviours. Would you agree that the batching of results was done at a critical time to create a false sense of security?”
Dr Nandram replied that the recent surge in cases, which he referred to as the ‘log phase’, was not unusual at all and unrelated to the recent ‘batching’ of samples at the Trinidad Public Health Lab (TPHL) that led to delayed results.
Instead, the staff there was simply overworked. Whereas the Ministry of Health created a ‘parallel health care system’ to deal with Covid-19 cases—so as to allow the hospital’s other business to proceed as close to normal as possible—nothing similar appeared to have been done at the TPHL.
At present, Dr Nandram said employees there are working seven days a week and sometimes from 5am to as late as 11pm.
“I can attest to the dedication of the Trinidad and Tobago Public Health Lab employees and their director in getting these results out as soon as possible,” said Dr Nandram. “[…] The fact of the matter is the lab was receiving sometimes in excess of 1,000 samples a day and there only handful of persons there—and they are not machines.
“[…] It is not accurate to say that the way this graph looks is a function of something that happened in a lab.”
Dr Nandram also offered an explanation for the drop in positives immediately before the General Election: it was the weekend.
“Immediately prior to the election, that was a Saturday and Sunday and maybe [the drop in cases] was because people were engaged in other activities,” he said. “Maybe it is because it is a weekend and they want to spend time with their families; but on Saturdays and Sundays—as is the normal pattern—the number of samples we were receiving at the lab is smaller.
“[That is] because people simply do not come out to health facilities [on the weekend] in the numbers that we see during the week. There is nothing sinister here; it is just a normal function of the patterns we have seen.”
Notably, Tiwari-Roopnarine did not point out that the first batched cases—and the flurry of positives that came with them—were revealed before the General Election rather than after.
After 11 confirmed cases on Thursday 6 August and 15 on Friday 7 August, the Ministry of Health first unveiled batched cases on Saturday 8 August with 50 positives that day. So the spike did not appear to be suppressed until after the election, as suggested.
There were then four confirmed cases on the morning of Sunday 9 August and two on Monday 10 August—which appeared to be in keeping with the Ministry of Health’s data regarding weekend dips. For the two mornings after the election, there were 19 and 26 positives respectively.
Dr Parasram did not specifically say if he recommended recent changes in the public health ordinance before the election, or explain the timing of it. However, he reiterated that he ‘continually’ makes recommendations to his line minister and suggested that Tiwari-Roopnarine glossed over a ‘significant’ change that he did initiate on Friday 31 July.
“There was a change in the [number of public] gatherings from 25 to 10, which was a significant public health measure,” said the CMO. “However, I don’t think people were adhering to the 10 or even 25 or [would have even bothered with] 50 at that point in time.”
Dr Parasram and Dr Nandram both urged citizens to help bring the virus back under control by following health safety guidelines, which worked before here and in other countries.
“Our doctors and nurses aren’t our front line anymore—they are our last line of defence,” said Dr Nandram. “This battle has moved into everyone’s homes. The frontline of the Covid-19 battle is the citizens of Trinidad and Tobago.
“[…] Please be responsible: wear your mask, socially distance, wash your hands.”
Tiwari-Roopnarine, during her contribution, also suggested that the Ministry of Health may have gotten its terminology wrong when it pointed to a ‘lag phase’, after the first wave of the virus, followed by a ‘log phase’.
“Log and lag would give the impression that this is a naturally occurring [evolution] of the virus,” said the journalist. “But in fact what it appears to be is a phase one, which was controlled and then breached by open borders, and then we have another phase two.
“Log and lag, when I looked it up on Google and it speaks to the growth of microbes.”
Dr Nandram stood his ground and insisted that Dr Avery Hinds, the technical director the Epidemiology Division, knew what he was doing.
“The first thing I’d like to do is thank Dr Avery Hinds, who is a medical epidemiologist with a master’s degree out of Cambridge in epidemiology, [who] created this graph for today’s media conference,” said Dr Nandram. “Urvashi, not to discount your Google search relating to microbes, but the evolution of the number cases in any outbreak follows this natural pattern: an initial lag phase and then a log phase…
“The normal pattern is always a bell curve. This is the same pattern we are seeing in Trinidad and Tobago and every other country in the world.”
During the press conference, Dr Parasram reiterated that the Ministry of Health continues to follow WHO guidelines on patient confidentiality and will not offer additional information on specific cases: such as age and occupation.
However, he did reveal that the ‘pre-existing medical conditions’ generally referred to in Covid-19 related deaths were: ‘diabetes, hypertension and chronic heart disease’.
This morning, the Ministry of Health confirmed Trinidad and Tobago’s 12th death since the onset of the pandemic, who is ‘an adult male with pre-existing conditions’.
Dr Nandram noted that the average age of patients has dropped drastically and the median for infected men now stands at 25-29.
Dr Parasram revealed that he will meet his county medical officers at 2pm today and will consider ramping up their staffing, as much as possible, to meet the sharp rise in cases. The county medical officers are responsible for contact tracing.
At present, Dr Parasram said there are 10 or 15 cases per day with varying levels of contacts. He noted one case in which a patient had over 200 contacts.
“Our county medical officers are doing yeoman service,” said Dr Parasram.
At present, the CMO shares information on positive persons to the Trinidad and Tobago Police Service (TTPS) to help with enforcement. However, the Ministry of Health will consider also flagging such persons with Caribbean Airlines and Port Authority to stop them travelling if necessary—although this will only be done if they can be assured of patient confidentiality.
The Ministry of Health confirmed 413 active Covid-19 cases today with 565 positives since the onset of the pandemic. From the 13 positives added today, nine are from Trinidad and four from Tobago. There were also an additional 33 positives confirmed last night.
The ministry is ‘awaiting laboratory forms for category purposes’ for all 46 positives, so as to determine whether there are links to current patients.
There are 100 patients at the Couva Hospital (which is the maximum number of beds at the facility) with three in the High Dependency Unit (HDU) and 49 at the Caura Hospital. There are also 53 patients at Debe, 40 at Tacarigua, 31 at Balandra and 19 in Sangre Grande.
Another 75 patients are ‘en route [or] being admitted’ to the hospital while 46 are ‘being processed for admission’. Dr Parasram explained that ‘being processed’ means the Ministry of Health is trying to contact the respective person(s).
Trinidad and Tobago vs Covid-19 (in numbers)
Local infections of Covid-19 in first wave (27 March to 26 April)
- 50 cases in 31 days.
Local infections of Covid-19 in second wave (20 July to 17 August)
- 407 cases in 27 days.
The Ministry of Health reminds members of the public to adhere to the ‘new normal’ and:
- Wear a mask over your nose and mouth when you go out in public;
- Keep your distance from others (six feet);
- Stay home if you are ill;
- Clean then sanitise surfaces, such as tabletops, door knobs and cell phones;
- Wash your hands often with soap and water or use an alcohol-based sanitiser;
- Cough into a tissue or into the crook of your elbow;
- Avoid touching your face.
Persons are urged to call Covid-19 hotline numbers: 877-WELL, 87-SWRHA or 877-3742 (Trinidad) and 800-HEAL (Tobago) if they feel unwell; or they can report a possible breach of Covid-19 regulations by calling 555, or sending messages—inclusive of photographs and videos—to the Police App or via Whats App to 482-GARY.
If the standard you have grown use to is one that is filled with dishonesty and an absence of moral or ethical consideration then you will see sinister in every act. In the case of the CMO and his staff we have seen a group that is working diligently to keep a largely unappreciative population safe. That is not to say that there haven’t been hiccups along the way (one might be the current reporting regime which seems unnecessarily complicated). But in the main I think we can be proud of the job they’ve done and the public needs to play its part in obeying the public health guidelines/measures to keep down the infection rate.