Perspective

Jeopardizing our safety

Test all relevant travelers, make testing free, and put politics aside to stop this crisis

The country’s healthcare system is in crisis, and there continues to be an uncontrolled spread of COVID-19 on New Providence, with hospitalizations also high on Grand Bahama.

July is now the deadliest month of the third wave, and the country’s nurses are once again paying the ultimate price on the front line of the pandemic.

With no bed space, shortages of nurses and doctors, and public hospital services greatly reduced, the increased threat of non-COVID related deaths for babies, pregnant mothers, those with chronic diseases, and those in need of critical care, is very real.

Prime Minister and competent authority Dr. Hubert Minnis, through his Health Minister Renward Wells, announced new restrictions that were to come into effect this morning, but those restrictions do not address the gaping hole of COVID risk left wide open at the country’s borders both external and domestic.

That risk is the continuation of testing exemptions for fully vaccinated travelers.

Real world data coming out of countries with high vaccination rates, suggest that it is not as rare to contract COVID-19 once fully vaccinated as some officials in government would have us believe.

Anticipated vaccine protection against severe COVID illness and death is out of the reach of most residents, because there are insufficient vaccines available in the country to administer to those who want them.

The Bahamas very clearly has no systemic capacity to bear the risk of imported COVID variants that are evading vaccines, and resulting in exponential spread due to their high levels of transmissibility.

Even developed nations including the United States, which have a far greater degree of healthcare capacity than The Bahamas, are not bearing such a risk at their borders, whether the international traveler is a citizen or not.

And Caribbean countries that have very limited capacity, are doing the sensible thing by requiring proof of a negative COVID test prior to entry, regardless of vaccination status.

The Bahamas needs the tourist dollar, but it is not only reckless and counterproductive to assume risk in a pandemic that your country’s systems cannot manage, it is also a move that puts vulnerable Bahamians and a vulnerable economy in jeopardy.

The global reality

When questioned last week on why government is continuing to exempt fully vaccinated travelers from testing, Wells said glibly, “It has to do with the risk profile and assessment of risk.”

Our hospitals are at capacity, the majority of the population is unvaccinated, deaths are mounting, positivity rates hover anywhere between 20 and 45 percent, and the Delta variant is surging worldwide and in our principal tourism market, led by states including Florida.

Based on these grim realities, what informs Minnis’ and Wells’ apparent view that The Bahamas can manage the risk of variants being imported or taken island to island, by untested and, therefore, unmonitored travelers, whether visitor or resident?

Critical data on the reproduction rate of COVID-19 in-country, where clusters are, imported cases details, contact tracing and isolation updates, and comorbidities of those dying in the third wave were frustratingly not provided during last week’s press conference by the Ministry of Health.

Tellingly, detailed COVID data are much easier to obtain from other countries, and what that data show is that surges in highly vaccinated countries, and the level of breakthrough cases therein, make maintaining testing exemptions for vaccinated travelers in The Bahamas both foolhardy and irresponsible.

The reality is, most countries at the top of the world’s COVID vaccination ranking have experienced marked surges in COVID variant cases.

What is also a pressing reality, is it is still unknown how long vaccine-conferred immunity to COVID-19 actually lasts, further making it irresponsible to act at a policy level as though COVID vaccinations confer lifelong immunity.

Data out of Israel suggest that immunity conferred by the Pfizer vaccine, for example, wanes after about six months.

While COVID vaccines are credited with lowering the likelihood of severe illness or death in various countries, they are not the cure to stopping the spread of COVID-19 that the prime minister continues to incorrectly insist they are.

The United Kingdom, which is in the midst of a Delta variant surge, has vaccinated 68.5 percent of its population – 54.4 percent fully vaccinated and 14.1 percent partially vaccinated.

According to the latest technical briefing report by Public Health England, of the 3,692 people requiring hospitalization due to the Delta variant between February 1 and July 19, 40 percent were vaccinated, with 57 percent of that group being fully vaccinated.

According to figures provided by Our World in Data, Malta tops the world’s COVID vaccination ranking at 82.64 percent fully vaccinated, yet it recently imposed restrictions as hospitalizations spike and a variant surge continues, which is being blamed on imported cases.

Iceland, which was one of the first countries to remove border testing rules for fully vaccinated travelers, has now reinstated those testing rules as well as other restrictions, as the country – with a fully vaccinated rate of 74.3 percent – tackles a steep rise in variant cases.

Seychelles, with a fully vaccinated rate of 70.2 percent, also opted to impose restrictions to curb its worrying variant surge.

The United Arab Emirates, with a fully vaccinated rate of 68.4 percent, has reimposed restrictions to combat its surge; and Chile at 62.2 percent, locked down its capital city of Santiago last month in response to the country’s surge.

Israel was thought to have reached herd immunity, and is now grappling with a Delta variant surge.

The country has a fully vaccinated rate of 61.2 percent, and says the Pfizer vaccine it administers is only 39 percent effective against infection.

Officials said last month that as many as half of Israel’s new COVID cases were among the fully vaccinated, and in response to the surge, the government has indefinitely postponed plans to reopen the country’s borders to tourism for vaccinated travelers.

According to the The Jerusalem Post, Israel’s Health Ministry Director-General Professor Nachman Ash has urged residents not to fly abroad, stating that authorities are examining how to restrict travel, either by expanding the list of countries under the country’s travel ban or severe travel warning, or by other means.

Aljazeera reports of Indonesia that its variant surge is leading to a potential collapse of its healthcare system, with the discovery that over 300 vaccinated doctors and healthcare workers were infected with COVID-19, raising concerns about the effectiveness of China’s Sinovac jab.

Reuters reports that 75 percent of Singapore’s new COVID cases in the last four weeks were of those who are vaccinated – 44 percent fully vaccinated and 30 percent partially vaccinated, with just over 25 percent being unvaccinated.

Singapore has fully vaccinated just over half of its population.

Bahrain, at 61.2 percent fully vaccinated, has banned passenger arrivals from 16 countries in an attempt to limit the risk of imported COVID variants.

Uruguay, at 61.3 percent fully vaccinated, “lost its grip” on its COVID-19 situation in recent months, with Scientific American reporting last month that, “Uruguayan scientists say a mix of complacency fueled by the country’s early success at controlling the virus, and the challenges posed by a particularly transmissible SARS-CoV-2 variant are to blame.”

Breakthrough cases in the United States, meantime, are rising, according to media reports there.

The US Centers for Disease Control and Prevention (CDC) said on May 1, it “transitioned from monitoring all reported vaccine breakthrough cases to focus on identifying and investigating only hospitalized or fatal cases due to any cause.”

To interpret its data on breakthrough cases, the CDC says, “The number of COVID-19 vaccine breakthrough infections reported to CDC likely are an undercount of all SARS-CoV-2 infections among fully vaccinated persons. National surveillance relies on passive and voluntary reporting, and data might not be complete or representative.”

As such, the CDC reports that 5,914 COVID patients with breakthrough infections were either hospitalized or died as of July 19.

These circumstances worldwide are evidence enough to inform the competent authority that exempting vaccinated travellers from testing is not safe for The Bahamas, and has very likely contributed to what health officials believe is the local presence and spread of the Delta variant.

Make it make sense

Yes, all residents must continue to adhere to health and safety guidelines, and must push past COVID fatigue to accomplish this.

And yes, there is vaccine hesitancy in The Bahamas and worldwide.

Such hesitancy is not a new phenomenon, though understandably fueled by safety concerns and the newness of both the COVID vaccines themselves, and the mRNA technology for use in humans utilized by both Pfizer and Moderna.

It is unintelligent to continue to lay blame at the feet of unvaccinated Bahamians, when the supply of vaccines needed for the majority of the population is not available in the country.

If you invite 300,000 adults to a dinner party, but have only provided sufficient entrées for around 30,000 guests, how can you then castigate the remaining 270,000 guests for not having eaten their dinner?

Parliamentarians must remember that they ensured they got to the front of the line of the vaccine distribution so they could get their jabs before the overwhelming majority of the population could – meaning, they got jabs others could have gotten.

Just over 20,000 residents have been fully vaccinated through the government’s program thus far, and the Minnis administration seemingly rested on the laurels of what would come through the COVAX facility, though according to Wells, the government is only seeking sufficient vaccines through COVAX for up to 20 percent of the population.

Those in the private sector who have sought to supply COVID vaccines to the public have so far been blocked by government from doing so, and The Bahamas has recently had to resort to borrowing vaccines from sister countries in the region whose population and gross domestic product are a mere fraction of our own.

While Minnis and Wells insist that vaccination is the only way out of the pandemic, they are refusing to take any responsibility for the majority of the population being unable to access this “way out” in their own country, if they wanted to.

Meantime, there are some COVID restrictions that defy logic.

Given the extent of the outbreak, we fail to see how the restrictions imposed will make the immediate inroads the healthcare system requires.

What does not make sense is why indoor weddings are permitted on islands impacted by the new orders, but indoor funerals are prohibited.

Unsurprisingly, indoor dining restrictions apply to businesses except hotels, and the inequity there is obvious.

And since no data was given on COVID clusters or community spread on various islands, the general public has no way of assessing the extent to which some restrictions do not go far enough, are unnecessary, or ought to be reintroduced.

We fully appreciate the need to balance safety and the economy.

But with respect to government indifference shown to the cries of healthcare workers and hospital officials about staffing shortages and limited capacity to provide adequate patient care, we believe there is something to be said about the attitude of our government ministers who have access to insured, specialized and critical care at home or abroad at the taxpayer’s expense.

We are of the view that if our elected officials had no choice but to utilize public health, or believed they would have to wait their turn like everyone else, and thus potentially suffer bad outcomes at overburdened facilities whether public or private, they would have a much greater sense of urgency about addressing the needs of the healthcare system and its workers.

The cries of patients forced to be housed out in the elements at Princess Margaret Hospital will never be the cries of those elected to serve, and for those without the intrinsic motivation to effectively serve, we too often see an attitude of detachment in governance that puts lives in jeopardy both in and out of a pandemic.

It does not make sense to leave our borders this vulnerable to imported COVID variants.

Tourists are traveling to the Caribbean in promising numbers despite testing protocols still in effect in the region, and though the apparent view that gifting tourists with testing exemptions is a key way to attract more guests, it is a gift that The Bahamas in the midst of a health crisis, cannot afford to give.

Sacrificing health for tourism wealth should never be government’s gamble of choice, and threatens to leave The Bahamas without either of the two.

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