Andrew Manning | ‘Flattening the curve’ and stemming the community spread of COVID-19
We are now in the midst of the COVID-19 pandemic. Jamaica is in the phase of community spread. But what does this mean? Community spread is defined as the spread of a contagious disease within a community, specifically, the spread of a contagious disease to individuals in a particular geographic location who have no known contact with other infected individuals or who have not recently travelled to an area where the disease has any documented cases (Merriam Webster Dictionary). Plainly put, it means that everybody in Jamaica needs to understand and behave as if they have already contracted COVID-19.
What are the implications of community spread? It means that we are now seeing a significant increase in the numbers of cases. Sadly, we are also seeing an increase in the numbers of deaths. If we do not ‘flatten the curve’, persons will get ill at an increasingly accelerating and alarming rate.
But hold on! What does ‘flattening the curve’ mean? It simply means slowing down the spread of the virus through the community. The experts at the Ministry of Health and Wellness have stated that according to their projections, 1.5 million people in Jamaica will eventually contract the virus. These projections are based on characteristics of the virus, characteristics of the hosts (us), characteristics of the local population, and on the characteristics demonstrated by other types of respiratory viruses that we have encountered. This number is not cast in stone, but it is based on scientific calculations, albeit with some assumptions (which most scientific calculations must employ). By the time COVID-19 has passed, most Jamaicans will have contracted the virus. This is a sad fact, but it is a fact. We need to slow down the spread of the virus to keep down the numbers that contract it in any given period. And we must protect the most vulnerable among us, the elderly, and those persons with comorbidities.
Fortunately, the vast majority (over 90 per cent) will contract a mild form of the virus. Persons with a mild form can still, however, spread it. In fact, one person with the virus will typically spread it to two to three other individuals. The main problem lies with the fact that some individuals will contract a moderate or severe form of the illness, which necessitates hospital admission. About one to two per cent of persons have died of COVID-19 worldwide. If we flatten the curve, the percentage of persons dying may be less in Jamaica. How so? By slowing down the spread of COVID-19, we can slow down the rate at which persons present to the hospitals for admission. Slowing down the virus means that we will be better able to provide necessary, sometimes life-saving, medical care to those that need it. On the flip side, failure to flatten the curve will result in more lives being lost unnecessarily.
SAVING MORE LIVES
That is what flattening the curve means. It means saving more lives. It sounds simple and boring, but that is what we must do, and we must do this now. We flatten the curve by taking measures to slow the spread of the virus from person to person. By doing so, we will be able to slow down the spread through the community. The ability to flatten the curve lies with the public at large. I will say more about this later.
Back to community spread. C19 have had a moderate or severe form of the disease, which required hospital admission. If we continue to see 200-plus persons a day getting the disease, we can conservatively expect that 10 persons a day will require hospital admission (remember that this is a conservative estimate). In terms of bed capacity to deal with COVID-19, we are already close to our maximum capacity. This isommunity spread will result in more pressure on the health sector. This will result in more deaths. Our current experience in Jamaica has been that three to five per cent of persons getting COVID- currently being felt more acutely in our urban areas, but make no mistake, the COVID-19 wave and the strain on our hospitals is rapidly spreading across the island. It is no exaggeration to state that our beds may be used up within weeks.
The Government is making efforts to increase, in the short term, the bed capacity to deal with COVID-19 patients; however, there is a limit to what they can do. Properly trained staff are needed urgently to man these extra beds, and this is not easily done in the short term. Therefore, if we do not flatten the curve, persons will be brought into the hospitals, with no beds being available to care for them.
PHYSICAL AND MENTAL STRAIN
I have not mentioned the physical and mental strain on the healthcare workers, particularly those on the front line. An entire newspaper supplement would be required to express all of the physical and mental challenges facing the healthcare workers at this point in time, but members of the public need to remember that the healthcare workers have feelings, too.
We are currently facing significant challenges in acquiring personal protective equipment (PPE), for healthcare workers and other workers on the front line. Community spread exacerbates this challenge. More healthcare workers will get COVID 19 and will have to be placed in isolation. This will lead to fewer persons being available to care for our patients. These challenges will all become worse.
The authorities and front-line workers have been working extremely hard under trying circumstances to battle COVID-19. We appreciate and applaud their efforts. However, in the face of community spread, the efforts need to be stepped up. We cannot simply accept the arrival of community spread as a signal to return to business as usual. We cannot shift the narrative of COVID-19 from the identification of cases early on to looking at the number of hospital admissions as the metric to monitor. Such a move may very well result in disaster. We must still aim to identify cases early on and must fight tooth and nail, even in this phase, to slow the spread, to flatten the curve. The Medical Association of Jamaica (MAJ) has been in dialogue with the authorities and will continue to make suggestions to the Government about the fight against COVID 19. With this letter, however, I wish to address the public
The public, all of us, need to get on board with efforts to flatten the curve. COVID-19 is passing through Jamaica. It is unseen by most members of the public but is passing through none the less. The most effective tools in our fight against COVID-19 now are:
1. The proper wearing of masks when in a public space;
2. Regular washing of hands with soap and water or with suitable and safe hand sanitisers;
3. Physical distancing;
4. Avoidance of social activities that will result in the gathering of crowds - persons should stay at home unless they have to leave their yard.
EVERYONE ON BOARD
If everyone gets on board, the above measures will result in a flattening of the curve. This has been the case in other countries, and we can achieve this here. Recent reports of, and videos circulating on social media, persons breaching the directives of the authorities have been most disheartening. Even more disheartening are the reports of persons attacking the police and police vehicles as they try to enforce rules designed to protect the public. Imagine, in Jamaica land we love, during the biggest health crisis in Jamaica’s history, the police have been attacked by the same persons that the public-health measures are designed to protect. When the police are attacked in such circumstances, the healthcare workers on the front line are also being attacked indirectly.
Doctors take an oath to render medical attention to all those who need it - even those, who by their behaviour, hasten the spread of COVID-19. These persons, however, should think carefully about what they are doing. Recall the challenges that I mentioned earlier with respect to our bed capacity. As the pace of spread of COVID-19 quickens, if we do not flatten the curve, the capacity of the current healthcare system to deal with all persons needing care diminishes. This may mean that persons who need care, who turn up at the hospital, could find that there are no beds available. Persons will die because of this.
Persons who disregard the public-health directives should, therefore, bear the following in mind:
1. Every time you refuse to wear a mask properly out in public, someone may die because of that.
2. Every time you refuse to practise physical distancing, whether you are waiting in line at an ATM or entering an already crowded taxi or bus, someone may die because of that.
3. Every time you decide to host or attend a crowded event in contravention of the public-health regulations, whether this event is uptown, midtown, or downtown; whether this event is in a packed night club, for entertainment, or in a packed church for religious worship, someone may die because of that. And that person who dies may be someone close to you. Remember, he who feels it knows it.
We, the members of the public, have, at this point, the power to flatten the curve. And at this point, until the development of a safe and readily available vaccine or cure for COVID-19, flattening the curve is the best tool available to battle COVID-19.
Healthcare workers on the front,line, in both the public and private sector, are battling hard on behalf of all Jamaicans, but we cannot fight this battle without the support of the public. We are all in this together, and we must hold strain together. We need your support, and the best way to support each other, at this time, is to help to flatten the curve.
– Dr Andrew Manning is president of Medical Association of Jamaica. Send feedback to email@example.com.