There is no doubt, as Professor Clive Landis, head of the UWI COVID-19 task force has stated, that Caribbean countries have been successful in ‘flattening the curve’ for COVID-19, reducing the overall number of cases to numbers that do not overwhelm our hospital services and our undertakers. This was achieved through an attempt to identify cases early, quarantine or isolate them as needed, track down their contacts (‘contact tracing’) and attempt to limit the overall impact of the disease on the community. Complementing this is a sustained educational program designed to change people’s behavior.
An alternative approach that we see on foreign television stations every night involves attempts to locate massive amounts of hospital beds, particularly in Intensive Care Units, locate (or at least try to locate) massive amounts of personal protective equipment (PPE), and yet still there is a need for massive numbers of hospital beds and spaces (or mass graves) at the morgue. This approach does not focus on disease prevention, but instead attempts to treat full-blown COVID-19. And, in the interim, the economy collapses, not only because of the massive spending needed for medical supplies, but, as in any other disease state, an illness affects more than the person who is ‘ill’. It affects family members, friends, work colleagues, job departments, health care workers and finance officials.
In medicine, screening refers to a process of early identification of a disease (or risk factor for a disease), so that early intervention offers the opportunity to limit the impact, both medical and financial, before the full-blown disease develops.
We can then apply this “success” in dealing with COVID-19 and apply it to dealing with the non-communicable diseases, which for many years have devastated the health of our people, as well as national finances. In Barbados, for example, some two months after COVID-19 appeared on our shores, some seven persons died from this disease. In the same time period, based on the average rate of deaths from heart attacks and strokes recorded by the National Chronic Disease Registry over the last few years, at least 70 persons would have died from heart attacks or strokes – ten times the number of deaths claimed by COVID-19, in the same time period. It was the Mighty Sparrow who famously noted “ten to one is murder”.
Yet, our Ministry of Health and Wellness’ response to COVID-19 was to (temporarily) close down clinics at the hospital and the public health centers (polyclinics), discourage the patients from seeking medical attention by simply telling the patients to ‘stay home’ and make sure you have an adequate supply of medication.
The Health of the Nation study (HotN, Barbados, 2015), in which the Ministry of Health and Wellness was a study partner, found that 42 per cent of hypertensive patients on medication, and 62 per cent of diabetic patients on medication, were not achieving their chronic disease targets. It is thus unlikely that these patients, at home with their ‘ample supply’ of medications and no or limited access to their medical practitioners, will achieve good clinical outcomes. This has been the situation here, probably duplicated across the Caribbean. As well, some patients may have avoided hospital and medical treatment over fears they may catch the virus. That’s leaving them in much worse shape than they would be if they came in right away: for things as serious as heart attacks and strokes, time matters.
The enthusiasm shown by our Ministry of Health and Wellness in tackling COVID-19 “head on” is commendable. Daily press conferences reminded individuals to wash their hands, wear a mask in public, practice social distancing, and ‘stan home’ if you had no real reason to go out. A COVID-19 hotline and a high-level task force were set up, and financial resources were found to establish specific facilities to deal with COVID-19 patients, away from the already overcrowded hospital.
On the other hand, this same government ministry has not produced the Chief Medical Officer’s Annual report (which updates on the official statistics associated with national health and diseases) for eight years, established groups like the National Chronic Disease Commission and the National Physical Activity Commission that are either dysfunctional or non-functional, and the Medical Director of the island’s lone public hospital had to complain in February 2020 (in the pre-COVID era) that the beds on the medical wards had an occupancy rate of over 200 per cent. [Flattening the curve is designed to limit the number of cases of a particular condition so that the medical services can cope with the load of patients. Clearly, this is not happening with the NCDs].
The HotN report of 2015 was followed by a significant reduction in finances to the National Drug Formulary in 2018, restricting the resources available to primary care physicians to treat the NCD patients. The ‘inadequately treated’ primary care patients then end up in the hospital, or in the morgue.
The health needs of our NCD patients cannot be put on pause, hoping they will hold on till a brighter day. The health of our NCD patients must be improved by putting resources in to flatten the curve. While at this point there is no indication of how long COVID-19 will be with us, there is no doubt that the NCDs will be with us indefinitely, especially with no national efforts at prevention.
One hopes that some of the enthusiasm, the focus on screening and early intervention, and the resources devoted to COVID-19 can similarly be directed to the NCDs. After all, the international health scene reminds us that an ounce of disease prevention is worth a pound of cure.
Dr. C.V. Alert, MB, BS, DM.