A WHO transmission classification chart (With T&T INFO).

Trinidad and Tobago has now crossed the century mark in COVID-19 deaths, with 101 fatalities recorded as of yesterday (October 21). Seven months after recording its first case, the virus has rapidly spread across the country with 5,392 people now having been infected. Globally, over 40 million cases and over 1.1 million have succumbed to the virus.

In T&T, our COVID-19 story is separated into two phases. Phase one ran from March 12 to July 19, 2020. It was marked by imported cases and minimal local spread through primary contacts of COVID-positive patients. During this phase, T&T recorded eight deaths, one in Tobago and seven in Trinidad. Remarkably, these eight deaths occurred within two weeks from March 26 through April 6.

It is no secret that COVID-19 disproportionately impacts the elderly over any other demographic cohort. During phase one, this reigned true in T&T, with the eight people succumbing to the virus above the age of 55. Whether these deceased patients had comorbidities or pre-existing conditions, or their identities, were never disclosed, although the media was able to identify a few of the victims.

T&T then went 129 days until the next death was recorded a few weeks after what Chief Medical Officer Dr Roshan Parasram dubbed phase two from July 20 onwards. This phase marked significant changes to the medical landscape across the country. T&T’s COVID-19 transmission classification quickly moved from sporadic spread to clusters of cases and ultimately, on August 14, we officially had community spread.

Since August 14, there has been a steady climb in our death toll, averaging just over one a day. With the death toll now at 101, who has been affected and died in our second phase? As of the latest demographic update from the Ministry of Health, more males have tested positive than the female population, at 52.8% males versus 47.2% females. However, when looking at the death toll, the largest proportion of deaths are males at 74.4%, while 25.3% are females.

According to a study published by the US National Institutes of Health, titled Coronavirus: Why Men are More Vulnerable to COVID-19 Than Women, men have higher morbidity to COVID-19. The study explained that the increased morbidity could be due to the higher expression of the angiotensin-converting enzyme-2 (ACE-2), a receptor for coronavirus, and sex-based differences in the immune system.

Beyond biology, the study also claimed this mortality difference may also be due to the difference in lifestyle amongst genders, as men have higher levels of smoking or drinking than women. It also noted that men tend to have a more irresponsible attitude toward COVID-19 measures than women, with lapses in handwashing, wearing face masks and staying at home.

While we have seen COVID-19 deaths in T&T from as young as 30-34, this age bracket only accounts for 11.6% of deaths to date. Ages 50 and above are mostly affected, with ages 70-79 accounting for the highest proportion of deaths, at 28.4% or approximately 27 people. The elderly continues to be the most affected population due to their pre-existing conditions or comorbidities. According to the Ministry of Health, by mid-September, 70 per cent of those who died had at least one comorbidity. In most cases, diabetes, hypertension or obesity, but in others, kidney disease, cardiac disease and cancer were also complicating factors.

This then begs the question, why did so many people have comorbidities? It turns out T&T has an unhealthy population.

According to the Chief Medical Officer Dr Roshan Parasram, 17% of the population has diabetes, 23% hypertension, 17% cancer and 9% has a cerebrovascular accident (or stroke). He also added, “There is a lot of correlation between people having hypertension and diabetes at the same time so if you have a population of a large burden of diabetes or hypertension, whatever it may be as a comorbid base. Of course, based on the infection that you get, it will be extremely difficult to isolate these people completely as a septate group.”

If you fall within this population, above the age of 50 with comorbidities, what should you do?

The CMO offered his advice, “We are asking that those persons knowing your particular situation, be extra cautious. Take the preventative measures, the public health measures in place, to avoid yourself from getting infected, and of course, if you have relatives that have these comorbid features, it augurs very well that you take extra caution to expose those individuals.”