Prime Minister’s Statement in Parliament on COVID-19 Response – Friday 04th March, 2022

STATEMENT OF DR THE HONOURABLE KEITH ROWLEY

PRIME MINISTER OF THE REPUBLIC OF TRINIDAD AND TOBAGO

TRINIDAD AND TOBAGO’S  COVID-19 STATUS/RESPONSE

 

Madame Speaker, I have been authorized by the Cabinet to make the following statement.

It was on 31 December 2019, that the World Health Organization (WHO) learned of a cluster of cases of ‘viral pneumonia of unknown cause’ in Wuhan, China. This unknown virus spread exponentially throughout Wuhan. Scientists began to take note and were making enquiries of the WHO about this novel virus that appeared to be spreading rapidly amongst the human population in Wuhan and other provinces in China.

At the time, little was known about this infectious pathogen but what became quickly discerned was that it was causing a respiratory illness and was spreading from person to person via respiratory droplet infection. It was determined that the virus had an incubation period of about 14 days.

Madame Speaker, this virus was later identified as belonging to the coronavirus family. It was subsequently officially named “severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2)”, and the disease which it caused was named ‘COVID-19’.

In January 2020, the Government began via the Ministry of Health, to sensitize the population about growing concerns surrounding this virus that was spreading at a frightening rate in China.

On January 30^th 2020, WHO declared the COVID-19 outbreak a Public Health emergency of international concern, this is WHO’s highest level of alarm.

Internationally, eyes were affixed on the events rapidly unfolding in China and nations began to prepare for the possibility of global spread.

The Government of Trinidad and Tobago was the third, in the world, to begin taking precautions and implementing entry restrictions on persons traveling from China within the previous fourteen days. This was done on January 30^th, 2020 and the decision didn’t sit well with some people who thought that we were overreacting.

On March 11^th 2020, the World Health Organization declared COVID-19 a pandemic. At the time, the virus had been detected in 114 countries, over 4000 persons had already lost their lives, and there had been more than 118,000 confirmed cases reported globally. It was the first pandemic ever caused by a coronavirus. This virus has claimed almost 5 million lives worldwide and continues to claim lives.

Madame Speaker, we also took an early decision to build out what has become known as our Parallel Health Care System to handle COVID-19 cases separately from the rest of the public health care system. In order to operate such a system the following facilities were, and are mostly still dedicated, to serving Covid infected persons:-

COVID-19 Hospitals –

• Caura Hospital
• Couva Hospital
• Arima General Hospital
• Augustus Long Hospital
• Ann’s Hospital
• Scarborough Regional Hospital
• Scarborough General Hospital
• Point Fortin New Hospital
• James Medical Complex (SJMC)
• Field Hospital, Couva
• Port-of-Spain Field Hospital (CFU)
• Point Fortin Area Hospital

COVID-19 Step-Down Facilities –

• UTT Valsayn
• Debe Step Down Facility
• Tacarigua Racquet Centre
• Ray of Hope
• Lowlands Tobago

This decision has saved lives, and fortunately to date, we have maintained our Public Healthcare system without it collapsing under the enormous strain of COVID-19 during the various surges we experienced.

It was one day after WHO declared COVID-19 a pandemic, on 12^th March 2020, that we recorded our first case; it was an imported case.

Madame Speaker, we have been responding to the COVID-19 virus in Trinidad and Tobago for over two years. The Government, and indeed the population, has had to make numerous adjustments over time, at various intervals, as we literally battled the pandemic and the effects of the virus. Our people have shown resilience as we navigated this unknown.

At all times, the Government’s response to, and management of the effects of COVID-19 has been guided by the available scientific information and analysis as well as a desire to preserve lives. We have relied on the advice of our team of expert Public Healthcare professionals, under the leadership of our Chief Medical Officer, Dr. Roshan Parasram, the guidance and learnings from WHO/PAHO and our observations and analyses of the effects of the virus on other countries and the various responses thereto.

Madame Speaker, as Prime Minister, over the past two years, on numerous occasions, I have addressed the population on our management and various responses to COVID-19. I have done so in the Parliament, via addresses to the Nation and via regular press conferences.

It was not too long ago, in December 2021, that we were actually in the midst of the largest surge of positive cases that Trinidad and Tobago has seen to date since the onset of the pandemic.

This significant surge in COVID-19 confirmed positive cases was brought on by the emergence of the Delta Variant of Concern which has demonstrated to be a formidable variant of COVID-19.  Delta proved to be more virulent, causing more severe disease manifestations. It translated into large increases in hospitalisations and deaths amongst our population. It also was characterized as being more transmissible than all of its predecessors.  It is estimated that one (1) person infected with Delta is able to transmit the virus to approximately five (5) to eight (8) other persons.

Trinidad and Tobago began to detect the Delta variant at the community level in early September 2021, and the trend of increasing hospital occupancy was confirmed from October 17^th 2021.

In Trinidad and Tobago, at the height of the surge, the highest levels of activity were experienced during the month of December. The 7-day rolling average of new cases peaked at 795 on December 9^th, 2021; while the 7-day rolling average of new deaths peaked at 27 on December 24^th, 2021. Those deaths remained largely among persons over 60 years of age with multiple comorbidities, for example, diabetes, high blood pressure, hypertension, particularly those who were unvaccinated.

The Parallel Health Care System and Accident and Emergency Departments also recorded their highest occupancies during the month of December, 2021. The highest number of patients at the Accident and Emergency Departments was recorded on December 15^th 2021 at 8:00 a.m., with 212 patients being present within the ten (10) Accident and Emergency Departments.

The highest national occupancy level (84%) was noted on 23^rd December 2021. The total number of patients in the Parallel Health Care System was 755 representing 84% of overall occupancy, with five (5) times as many patients requiring high acuity care. On the 23^rd December 2021, there were 168 patients being managed in the Accident and Emergency Departments. In total, the Public Health Hospital Sector was managing 923 patients with confirmed COVID-19. Our public health care system was stretched.

Madame Speaker, I pause here to once again, place on record, our gratitude to all of the health care workers who worked tirelessly from March 2020 to date, and in particular during the surges, to treat patients with COVID-19 who required various levels of hospitalization. We say Thank you. I thank all front line workers, and not only our health care workers, but all those who have kept Trinidad and Tobago going during this pandemic, ensuring that our essential services functioned, from electricity and water to security and food production.

Madame Speaker, peak ICU capacity, (97%), was recorded on December 18^th, 2021 with 78 out of 80 beds being occupied in the Parallel Health Care System. At the Accident and Emergency Departments, 26 out of 29 ICU beds (90%) were also occupied leaving us with five (5) beds available on that day.

Added to the presence and danger of the Delta Variant of Concern, on November 26^th 2021, the world, through the diligent work of South African scientists, became aware of a new variant which soon thereafter, became the fifth Variant of Concern known as Omicron.

In the very early days following its detection, little would have been scientifically determined regarding its disease traits, however, it was soon discovered that it was certainly more transmissible than Delta which was also the dominant strain in Trinidad and Tobago at that time.

Research also subsequently determined the Omicron variant of concern as having an increased secondary attack rate and information regarding its virulence in the early stages was not immediately known.

Given what we were experiencing with Delta, in mid-December and given the observed characteristics of Omicron, there was great fear and trepidation as to what might be in store for us as Omicron inevitably take hold. In anticipation of the arrival of Omicron to our shores, on top of the presence of Delta, we knew that this new variant posed a significant threat and we anticipated that the number of hospitalizations and commensurately the number of deaths would be likely to increase exponentially.

As we had done throughout the pandemic, we stayed in constant contact and interrogation with our Public Healthcare professionals. We were being updated on the situation facing us, including, but not limited to, the hospitalization rates, vaccination efforts and suggestions as to possible management responses.

As the days and weeks went by, new data surfaced, first from South Africa, then from the United Kingdom and other European countries where Omicron had quickly become the dominant strain, outcompeting other variants including where Delta was both in high and low circulation.  This therefore led to a consistent and significant rise in the number of confirmed COVID-19 cases in these territories.

What quickly became evident though was that the severity of disease and thus the requirement for hospitalization in the adult population, as initially feared, thankfully, did not materialize, with the highly infectious Omicron variant.  However, with Omicron, there was an increase in the number of paediatric infections which subsequently led to an increase in hospitalizations among children. This may have been attributed to the inherent vulnerability of this age group to infection coupled with the fact that vaccination within this group was comparatively low. This was so because WHO only granted Emergency Use Listing (EUL) for the Pfizer vaccine for the 12-15 age group on June 15^th 2021, and for the 5-11 year-old age group, on January 21^st 2022.

Madame Speaker, in order to prepare for the worst outcomes, Trinidad and Tobago further expanded its ICU and HDC capacities, together with making preparations for a concomitant rise in the number of paediatric hospitalizations.

By January 2022, the Omicron Variant of Concern had become the dominant strain in Trinidad and Tobago.  At a global level, the month of January 2022 also saw the highest number of new weekly confirmed COVID-19 positive cases since the onset on the pandemic.  Of note, Trinidad and Tobago had not observed a sustained increase beyond Delta in terms of the number of cases, and thankfully to date, we have seen a significant decrease in the number of hospitalizations and deaths arising out of this new variant of concern.

In fact, From December 23^rd 2021 onwards, a consistent but gradual decrease in hospital occupancy was noted. This encouraging trend caused us to hesitate and hold on any further drastic response even as we remained wary of the presence of the virus amongst the entire population.

In February 2022, the lowest occupancy levels in this current wave of COVID-19 were recorded. Over the past two (2) weeks, overall hospital occupancy has steadily decreased from the benchmark of 40% to 31% as of March 1^st 2022.

Madame Speaker, from February 1^st to 28^th 2022, a similar trend has been noted across all levels of care, and all facilities, including, the Accident and Emergency departments dedicated to the care of confirmed COVID-19 patients.

As of Tuesday, 2^nd March 2022, the following occupancy levels were recorded:

• Overall national occupancy: 31%
• ICU Occupancy: 31%
• HDU Occupancy: 32%
• Ward Level Occupancy: 31%

As at March 1^st 2022, all facilities in the Parallel Health Care System recorded occupancy levels well below the 75% (which was the benchmark for alarm).

As at 8:00 a.m. March 1^st 2022, within the Accident and Emergency Departments of our Parallel Health Care System, a total of only 15 patients were being managed, with zero (0) ICU level patients. A consistent trend of decreasing admissions to the Accident and Emergency Departments has been noted.

Besides the inherent traits of the Omicron variant, our pubic health care professional team believes that the following factors may also have contributed in some form or the other, to the welcome trends we have been observing in Trinidad and Tobago:

Population vaccination – Trinidad and Tobago began its main vaccination drive in April 2021.  By late 2021, we were seeing a slow uptake of vaccines and to date, we continue to see a very slow uptake in the number of vaccinations received on a daily basis across both islands.  Despite our best efforts to ensure the availability of and accessibility to safe and effective WHO-approved vaccines, including employing various communications strategies, our progress in the continuation of vaccinating the unvaccinated in our population has been slow.

This week we were forced to destroy over a quarter of a million doses of Pfizer vaccines which had expired.  Compare this to the days in early 2021, when the unavailable but highly desirable “gold standard” Pfizer vaccine, was regarded as the savior to take us out of the killing clutches of the deadly virus that was threatening to overwhelm us.

This is after the vaccination level has virtually stalled at 50% and as of this week, 3,642 of our citizens have lost their lives to Covid-19.

On average, the daily vaccination rate increases by 0.1% which is well below what we hoped for in the face of this continuing threat. However, we continue to make vaccines available and we continue to encourage people to get vaccinated and especially to get the booster to strengthen and prolong effective levels of immunity.

On a positive note, we are currently in the process of acquiring a new batch of paediatric Pfizer vaccines for the 5-11 age group so as to ensure that our children are well-protected once parents agree to make use of these WHO-approved vaccines.  To this end, exploration has taken place via the CARICOM Secretariat and CARPHA as well as through bilateral discussions. Madame Speaker, I signed the CARICOM agreement on Trinidad and Tobago’s behalf a few weeks ago and we look forward to the receipt of vaccines for our 5-11 year old population.

Population Immunity – Madame Speaker, Population Immunity is generated via two principal pathways:

Through vaccine-induced immunity

Through naturally-acquired immunity following infection, with or without symptoms.

Trinidad and Tobago achieved the feat of fully vaccinating 50% of our population (700,000 persons) on February 19^th 2022.  That means, 50% of our estimated 1.4 million inhabitants have either received 2 doses of a 2-dose vaccine or 1 dose of a 1-dose vaccine.

We have also seen the continued rise of infections over the last four (4) months as previously identified.  As at March 1^st 2022, we stand at a total of 128,145 confirmed cases.  It can be expected, based on our testing strategies (whereby symptomatic persons are tested predominantly aside from testing those for travel-related purposes or other special groups) that we can anticipate that a larger proportion of the population would have been infected, than confirmed.

If one were to assume for example, that for every 1 confirmed infected person, 3 other persons would also be infected but unconfirmed, we can extrapolate that approximately 30% of the population has been infected with COVID-19.

These factors taken together, in addition to the reduced severity and increased transmissibility profiles of Omicron compared to the Delta variant, may explain the continued high infection rate seen daily without the consequent rise in hospitalizations and deaths that had been previously anticipated.

Madame Speaker, that being said, the pandemic is not yet over. Our greatest threat remains the emergence of new Variants of Concern which can arise rapidly, and without warning, as has happened in many countries during this pandemic.

We must remain cautiously optimistic, whilst at the same time, being highly vigilant, and nimble, in our response. To this end, we are currently well into the stage of living with this virus, that is, we are preparing to move from the acute phase of the pandemic into the endemic phase of COVID-19.

In addition to vaccines, we now have some new therapeutics to help us fight this disease and we are expecting additional therapeutics in the near future aimed at treating mild and moderate disease.  Preparing for this endemic phase, we will be making adjustments to the Parallel Health Care System.

Madame Speaker, our Parallel Healthcare System has proven its resilience, through the many waves of the virus, and the people of Trinidad and Tobago can take comfort in the fact that it can be readily escalated, or de-escalated, based on specific needs. I can confirm that yesterday the Cabinet approved the Ministry of Health’s recommendation for the consolidation, and de-escalation, of the Parallel Healthcare System, in preparation for the transition from the acute phase to the endemic phase of COVID-19 in Trinidad and Tobago.

As we guardedly begin this process of transitioning to the endemic phase of COVID-19, we would not like to ascribe any hard timelines yet, as we have learnt that circumstances can rapidly change which may necessitate consequent adjustments.

In keeping with the general principles, and on the advice of our public health care professionals we aim to transition from population-level controls to individual-level responsibility. However, as a responsible Government, at this time we cannot afford to abandon all of our public health measures which have served us well throughout the course of the pandemic.

Madame Speaker, we are confident in the knowledge that after more than two years, the population has, for the most part, the wherewithal to navigate the vagaries of this pandemic. For some time now, we have considered and given increasing weight to the economic and social implications of how we respond to COVID-19.

We have taken more risk as the population became more vaccinated. We re-opened most of our economy. We have been cautiously getting more and more of our children back into schools.

Madame Speaker, we have been concerned about our children and their being out of the physical school environment for such a long and abnormal time. I had hoped to be able to have all of our children back in their schools at the beginning of 2022, but unfortunately the surge of cases, and increased hospitalization in December 2021 prevented that. Nevertheless, we took steps and had our older children returned to school last term and we have recently had our cohort of form 1s to 3s return to school as well as our standard 5 children from the primary school system. This has been one of the more difficult restrictions for me to endorse as I desperately wanted all of our children to return to their physical school environments at the earliest opportunity.

In short Madame Speaker, at this point in time, Trinidad and Tobago has weathered another surge of the COVID-19 storm and we are in a reasonably good position. The Government has done all that it could reasonably have been expected to do to provide our citizens with adequate health care, for those amongst us, who contracted COVID-19 and required hospitalization. We secured adequate WHO approved vaccines to vaccinate our population above the age of 12 years old and for months we have staffed and resourced mass vaccination sites to vaccinate and even provided timely booster shots for our population. We have tried every reasonable initiative to encourage those who are eligible to be vaccinated, to get vaccinated. We continue and will continue so to do.

When it’s all said and done, Madam Speaker, as a Government we are not masters but merely representatives of the people and with a hard to reach 50% vaccination level, waning virility of the dominant Omicron variant and large volumes of vaccines being dumped, the population is speaking very loudly how individuals wish to confront what’s left of the pandemic experience.

Madame Speaker, during the course of the last two years, notwithstanding numerous unsuccessful legal challenges, we have used the Public Health Ordinance to implement regulations designed to protect and preserve lives. We have had to institute a State of Emergency to respond to COVID-19, at a time when the virus began surging, and we commenced and implemented our vaccination programme all aimed at managing the spread of the virus and its negative effects on the population.

Madame Speaker, I am satisfied that the Government which I have the honour and privilege to lead, has done all that could reasonably have been expected to be done to preserve lives and balance the restoration and preservation of our economy.

We are now at another milestone moment as we decide how we respond to the virus and manage our living with the virus. It is time for us to allow for greater discretion and personal responsibility to prevail in the society.

I expect that our national watchwords ‘Discipline, Production and Tolerance’ would guide our social behaviour as we go forward living with COVID-19 and that the majority of our population will proceed with dignified restraint, and be mindful that as we begin the process of lifting the remaining restrictions we will be considerate of our brothers, and sisters, and the fact that the virus, which unfortunately continues to claim lives, is still amongst us. We have agreed now to add Responsibility to our list of watchwords. Common sense and Covid 19 demand it.

Madame Speaker, as we enter this phase of living with the virus and moving towards it becoming endemic, as it has already been declared in some hitherto ravaged populations, we have taken the following decisions going forward:-

The retention of masking– Appropriate mask-wearing is an essential public health measure which should be retained at this time especially due to the circulation of the extremely infectious Omicron variant which lends itself to aerosolization and to significantly asymptomatic and mildly symptomatic disease.

In late December 2021, the World Health Organization reemphasized its recommendation to maintain mask use in the face of Omicron.  As such, mask use will remain in force at this time in all public spaces and places where there is public interaction;

Public transport will be allowed to return to 100% of capacity. Mask wearing will continue to be required in vehicles being used for public transport, including vehicles in which persons are paying to be transported;

Families will no longer be required to be masked in their vehicles. This change will also apply to marine vessels being used by families;

 

We are removing restrictions with respect to the length of time and numerical capacity at religious places of worship. Mask wearing will continue to be required during services at religious places of worship;

 

The number of persons permitted at graveside funeral services will be unrestricted but mask wearing is mandatory for the time being.

For unvaccinated nationals returning to Trinidad and Tobago a reduction in the quarantine time would be applicable. Quarantine time will be reduced from 14 to 7 days with discharge taking place on the receipt of a negative PCR test on the 7^th day;

 

We will decrease the national quarantine time (for contacts of positive cases) from 14 to 10 days. This would allow for increased productivity and a decrease in the likelihood of staffing shortages especially amongst the essential services.  Of note, the Ministry of Health recently reduced the isolation time for positive patients from 21 days in all categories, to 10 days for persons with no symptoms and 13 days for those with moderate to severe disease.  They will be discharged in accordance with the discretion of the County Medical Officers of Health;

Public gatherings of persons in groups of no more than 25 is now to be permissible;

The recommencement of team sports and contact sports is allowed;

 

We will allow the establishments that are currently allowed to operate as safe zones for vaccinated or exempted persons, and children under the age of 12, to operate at 75% capacity;

 

Provided that we do not have dangerous changes in our COVID-19 position, we will permit all children to return to physical schooling in term three. The Ministry of Education will put out the necessary guidelines to safely manage this process;

 

As of Monday 7^th March, 2022, the public service will return to full service and ALL public servants will be expected to return to work as normal.

Additionally The Ministry of Health will be presenting a national pathway for the consolidation of the Public Health  Service  that would see the return of the Health System, and by extension Health Services, to an as-near-normal existence, as the country transitions from the acute phase to the endemic phase of COVID-19.  A structured risk-based approach will be adopted to gradually reduce the footprint of the Parallel Healthcare Systems (PHS) and regularizing the hospital system. The proposal will be implemented on a phased basis based on real-time risk assessment, starting with Pt Fortin. The Minister will give further details next week.

Madame Speaker, these initiatives move us closer to the resumption of normal life and will be implemented via the Public Health regulations (where appropriate).

We continue to navigate the pandemic and I trust that we will act responsibly as we hopefully head towards COVID-19 becoming endemic in a population that has developed good immunity levels of protection, naturally or vaccine induced.

Madam Speaker, the now known and experienced characteristics of the Omicron virus allow us to make these decisions but make no mistake about it, even as we react to an almost endemic condition it is possible that a dangerous   new variant could appear, resulting in a swift review of these decisions because we are still in a pandemic.

We look forward to being able to confidently join others who have already declared the virus endemic but we must remain cautious as we move towards such time.

Let us continue to be responsible and

May God continue to bless our Country.