[Reprinted: US News, 5-26-2020]
Shutting down tourism early, low population density and lessons of hurricanes past have helped countries in the region weather the pandemic’s harm, experts say.
In September 2017, two Category 5 hurricanes wreaked havoc on the Caribbean in the span of two weeks. Places such as Anguilla, Dominica, Puerto Rico and the U.S. Virgin Islands were badly damaged – people killed, homes demolished and power lines downed. United Nations Secretary-General António Guterres noted at the time that on the island of Barbuda, the forest was “completely decimated without one single leaf on any tree” in the aftermath of the storms.
Many Caribbean islands are still recovering more than two years after hurricanes Irma and Maria. But this “history of resilience” – as described by Neil Parsan, Trinidad and Tobago’s former ambassador to the United States and Mexico, in an interview – might have made the region particularly prepared for the crisis the world is facing today: the coronavirus pandemic.
Still, the COVID-19 outbreak is bringing a new kind of challenge, Parsan says. “Almost every single year we go through hurricanes. And COVID is a hurricane that comes every single day,” he says. “Day after day after day it hits.”
Even so, the Caribbean has not been as impacted by the coronavirus as other areas. The Dominican Republic has been by far the hardest hit nation, with more than 15,000 cases, according to Johns Hopkins University. Meanwhile, Cuba and Puerto Rico each have well over 1,000 cases. But many other islands and nations have been left relatively unscathed. Experts say a combination of shutting down inbound tourism early, low population density and the region’s history of responding to hurricanes and other disease outbreaks all contributed to the Caribbean having fewer virus hotspots than other areas of the world.
A Regional Familiarity With Sheltering in Place
Parsan says Caribbean islands’ ability to close and survey borders “very efficiently” has helped control the spread. “Many, many countries have gotten that right.”
Dr. Marcos Espinal, the director of the Department of Communicable Diseases and Health Analysis at the Pan American Health Organization, says the “decision to take action early” has played a key role in the region’s response to the pandemic, as well as the islands’ commitment to working closely with his organization.
The U.S. Virgin Islands – with a population of well over 100,000 people, spread between St. Croix, St. John, St. Thomas and Water Island – has 69 cases and six deaths caused by COVID-19, according to data from the local Department of Health. Dr. Esther Ellis, a territorial epidemiologist at the Department of Health, says that while the territory never fully closed its ports or airports, “everything has to do with closing” the islands’ hotel reservations, with regard to the relatively few number of cases. The nature of geography helps too, she says.
“We are on an island. So you can’t just drive here,” Ellis says. “A lot of states don’t have borders that they could maintain. But as soon as hotels stopped taking reservations, we had, most days, only had 30 people per day come to each district, which is incredibly low.”
Population size and spread also matters, Espinal says. While there are major cities in the Caribbean, such as Santo Domingo in the Dominican Republic and Port-au-Prince in Haiti, much of the region is “less urbanized” and, thus, it’s easier to control the spread of the disease. But cities like the ones he described, with “belts of poverty and crowdedness” in barrio neighborhoods, bear watching.
“These are areas that, if they are massively affected by COVID, it’s a recipe for disaster,” Espinal adds.
People in the Caribbean are also used to sheltering in place at some point every year, but it’s usually for weather reasons. Hurricane season annually runs from June through November. Ellis says for residents in the U.S. Virgin Islands, staying indoors, having food on hand and gas for a generator are acts they are used to.
“Having to do it for a pandemic or something that’s contagious, I think the reason’s different, but the concept is familiar. So everybody really did follow the guidance,” she says, referring to social distancing.
History of Responding to Outbreaks
The region also has a history of responding to disease outbreaks. Islands dealt with separate outbreaks of mosquito-borne diseases called Zika and chikungunya in recent years, and some parts of the region deal with cases of dengue fever to this day. Parsan says managing these types of epidemics in the past has allowed the Caribbean to “engage mechanisms” and strengthen institutions. Espinal notes that many nations in the region are signatories of the International Health Regulations treaty from 2005, which provides a “series of essential public health functions that needs to be constantly strengthened, nurtured and invested,” he says.
In the U.S. Virgin Islands, Ellis notes that because of the chikungunya and Zika outbreaks, the territory received supplemental federal funding that allowed the Department of Health to hire more staff for the epidemiological program. She says she was the only epidemiologist when she came to the territory seven years ago, but the team now has 14 staff members.
“There’s no way we would have been able to surge up as quickly as we have without all of those wonderful staff members already on board, and just switching what they’re doing to COVID,” Ellis adds.
“Some of the data manipulation that we’re doing, it’s a well-trained team because of learning how to do a lot of these things in response to our other outbreaks. So I would say it did prepare us better to respond.”
Concerns about the Caribbean region amid the pandemic do exist. The Pan American Health Organization has expressed worries over Haiti, with director Carissa F. Etienne describing at a recent press briefing the situation in the country as “a perfect storm approaching.” Etienne noted the limited capacity of Haiti’s health care system and the limited access to clean water and sanitation in the country.
Johns Hopkins University reports that Haiti has more than 1,000 cases and 30 deaths caused by the coronavirus – numbers that have been rising quickly recently but are still much smaller in comparison to its neighbor, the Dominican Republic. Espinal warns that there might be more cases than what is being reported, noting that Haiti has a testing rate of approximately 130 per 1 million people, while the Dominican Republic has a rate of about 4,400 tests per 1 million.
However, “no country in the world has the real number of cases,” he says. And there have been issues with under-testing elsewhere in the Caribbean, Parsan adds.
“It’s one thing, having the test,” he says. “But then another thing having a very convoluted protocol for administering tests. So the actual outcomes of these tests, as it reaches the public domain for scrutiny, begins to ask a lot more questions.”
Espinal does note that PAHO “cannot rule out that Haiti has less cases than others because they don’t have the same type of flights, or number of flights” as other countries in the region. But because of the political situation in the country as well as the issues described by Etienne, he says Haiti could still be an “impending disaster.”
Caution Over Early Reopenings
Ellis says the human element can sometimes be lost in the numbers. While the U.S. Virgin Islands only has six deaths caused by COVID-19 to date, three of those came from one family – a mom, dad and son. “Any death is hard because we are a close-knit community.”
Overall, however, the territory is faring well during the pandemic, Ellis adds. “It’s looking really good. Hospitals are prepared,” she says. “We know that as we start to open up that we may see additional cases, and we’re watching that data very closely.”
Both Espinal and Parsan say that as other islands and nations in the Caribbean begin the process of reopening and relaxing social distancing restrictions, it’s important to do it slowly with the looming possibility of a second wave of the outbreak.
“I do not think we should get to a point of comfort,” Parsan says. “I do not think we should be letting our guard down.”
Espinal adds that PAHO is recommending that islands do “proper analysis” and, simply, “don’t get desperate.”
“If the reopening is immediate, this is a mistake,” he says.