The University of The West Indies

Cavehill Campus

Department of Medical Sciences

Masters in Public Health

Question 1: Explain the Epidemiology of COVID-19 and Its Implications to Health and
Wellbeing in the Caribbean Using a Biosocioecological Model

GROUP A:

Tamisha Hunte: 408001738

Faithe Best: 02623119

Rebecca Cox: 400006523

Onyekachi Nkulo: 400005431

Jeffery Browne: 20051544

PBHE 6110: Epidemiology of Priority Disease

Lecturer: Dr. Clemon George

Submission Date: 30th March, 2020

INTRODUCTION

Coronaviruses are non-segmented positive stranded RNA viruses that mainly target the human
respiratory system (1,2). The new outbreak of respiratory illness caused by a novel coronavirus
termed ‘COVID-19’ or SARS-CoV-2 has emerged as a serious, unprecedented global public
health concern and has attracted interest from numerous health organizations (3). Due to the
similar hypothesized nature of COVID-19 to MERS and SARS countries have adopted
precautionary measures as a framework to halt the spread and reduce the impact of the disease
(4). For effective monitoring and containment of the pandemic, it is therefore crucial to examine
the epidemiological and clinical features of this infectious disease and its implications on the
health of Caribbean nations from a bio socio ecological perspective.

EPIDEMIOLOGY OF DISEASE

COVID 19 was first identified in Wuhan (a city in Hubei Province), China in December 2019
among a cluster of patients that presented with an unidentified form of viral pneumonia after
visiting the Huanan seafood and wet animal market. The origin of the virus was identified as
genus beta-coronavirus, placing it alongside community acquired coronaviruses such as Severe
Acute Respiratory Syndrome (SARS) and Middle East Respiratory Syndrome (MERS). Initially,
scientists attributed this virus to animal sources, suggesting zoonotic transmission. However,
person to person transmission capability through direct and indirect respiratory droplet spread
(via coughing and sneezing) has heightened public unrest and has caused reported cases to reach
pandemic proportions in some regions (5).

Through epidemiological surveillance and contact tracing, 837,021 confirmed cases of COVID-
19 and a death toll of 41,245 cases were reported on March 31st, 2020. The virus has migrated to
>202 countries, with the United States, Italy and Spain showing the highest rates thus far (6).
The spectrum of illness severity can range from mild flu-like symptoms to individuals being
severely ill (pneumonia and shortness of breath) and dying due to respiratory failure, shock or
multiorgan dysfunction. The most common symptoms of illness are dry cough, low grade fever,
fatigue and shortness of breath, as well as bilateral ground glass opacities on chest CT scan. The
clinical manifestations of COVID-19 appear after an incubation period of approximately 5.2
days. The period of onset of COVID-19 symptoms to death range from 6-41 days with a median
of 14 days (2).

Although all individuals are at risk for COVID-19, the most commonly affected groups are
patients >70 years old, immune-compromised individuals and patients with underlying
comorbidities such as diabetes, hypertension, chronic lung disease, cancer and cardiovascular
disease. Although the aforementioned signs and symptoms can occur with other viral respiratory
illnesses, the likelihood of COVID-19 is increased for individuals with high exposure risk. This
entails: if the individual had close contact (6 feet or 2 meters) with a confirmed or suspected
case, recent travel (within 14 days) to areas where there is community transmission of COVID-
19 and persons who work in health care settings. Patients with suspected COVID-19, are
required to report their symptoms to the relevant health authorities via phone and await
instructions to determine if self-isolation, mandatory quarantine or serological testing is needed
(7). A nasopharyngeal swab specimen and/ or oropharyngeal swab is usually done to test for
SARS-CoV-2. A positive test of reverse transcription polymerase chain reaction (RT-PCR)
generally confirms the diagnosis of COVID-19, although false-positive tests are possible (7). At
present, there are have also been highly effective in the control of COVID-19 infection in vitro.
(2). The onus is no specific antiviral drugs or vaccine against COVID19 infection for potential
therapy of humans. The treatment options that have so far been attempted were twice a day oral
administration of 75 mg oseltamivir, 500 mg lopinavir, 500 mg ritonavir and the intravenous
administration of 0·25 g ganciclovir for 3–14 days. Broad-spectrum antiviral drugs such as
remdesivir and chloroquine on individuals to practice diligent handwashing with antiseptic soap,
disinfect surfaces, maintain social interactions of 6ft (2 meters), use hand sanitizer which contain
at least 60% alcohol when hands are not visibly dirty, practice respiratory hygiene when
coughing and sneezing and avoid toughing the face and mucous membranes (eyes, nose and
conjunctiva) (7).

Figure 1: Epidemiological Curve Showing Total and Daily New Confirmed Cases of COVID-19
Figure 2: Epidemiological Curve Showing Total and Daily Confirmed Deaths of COVID-19.

Figure 3: Table Showing Coronavirus Case Fatality Rate by Underlying Health Condition in
China
Figure 4: Table Showing Coronavirus Case Fatalitiy Rates by Age

Note: the cases described are only for those hospitalized. All of this information needs to be
interpreted with caution – Social determinants of health???

POLITICAL AND ECONOMIC IMPLICATIONS OF COVID-19

Outbreaks of infectious diseases have always and will continue to pose threats to societies across
the world. The start of the 21st century has seen numerous pandemics and epidemics such as the
Ebola, SARS and H1NI epidemics, with the most current being that of COVID-19 (a novel
coronavirus). COVID-19 has impacted healthy systems, economies, social fabrics and political
spheres in unprecedented ways across the globe. The measures taken, decisions made and
responses to disease outbreaks are largely political in nature (8).

In light of the spread of COVID-19 around the world, governments and agencies have taken
drastic but necessary precautionary measures to contain the infection and maintain the safety of
the population. Most of these actions taken have targeted policies in an attempt to limit both the
human and economic consequences of the pandemic. These measures include travel restrictions,
bans on large gatherings, school closures and lockdown of entire nations (9). For example, in the
Cayman police are manning supermarkets and security guards are applying hand sanitizers to
customers even before their first case. St. Lucia has declared a state of emergency signed by
Governor General Emmanuel Neville despite having 3 cases thus far. Barbados, Guyana and
Trinidad have closed schools and all public gatherings with special focus on vulnerable groups
like the elderly and persons with underlying conditions (10).
Research shows with a similar pandemic Severe Acute Respiratory Syndrome (SARS) the World
Bank predicted a global economic burden from the disease is equivalent of United States 30
billion dollars (11). The Caribbean was predicted by the International Monetary Fund (IMF) to
be poised for upturn in its economic outlook for 2020 which is now an unlikely scenario (12).
Most of the Caribbean countries have entered or are exiting from an Extended Fund Facility
(EFF) with the IMF, Barbados in particular, and have little fiscal space to jump start funding
needed to support frontline healthcare workers who are change with the task of protecting their
wellbeing, taking care of the sick and slowing the spread of the virus during this pandemic(13).
Policies targeting the economics of the pandemic addressed the fiscal, monetary and macro-
financial and exchange rate and balance aspects (9).The government of Barbados employed two
of these three of these economic policy measures; fiscal actions - emergency health and capital
expenditures were identified for the management and mitigation of the spread of COVID-19,
social programs are to be introduced to assist displaced and unemployed workers including
supplemental unemployment benefits and monetary and macro-financial actions - a 6-month debt
payment moratorium as agreed by commercial banks (9). Other countries in the Caribbean region
have also adopted similar measures.
Policy decisions implemented during this time can have long term implications for countries
around the world. Policies implemented along with other measures taken have seen a drastic
decline in the global economy and consequently on the economies of countries within the
Caribbean region (14,15). In the region it is predicted that the chances of negative economic
growth are a possibility as activity in the region’s countries comes to a grinding halt (10).
Consequently, as a result borrowing costs will expose already existing financial vulnerabilities
amongst countries (14).
Additionally, as the service sector seeks to stop the spread of the virus, containment efforts and
social distancing will impact the tourism and hospitality sectors (14,15). Most of the Caribbean
economies are dependent on tourists for foreign exchange to maintain the standard of living that
its people enjoy. Therefore, over the past few weeks the covid-19 pandemic has weakened tourist
demands due to travel restriction and “the fear factor” and tourist arrivals have plummeted to an
almost halt. As a result, the associated tourist related service has been hit, workers laid off, hotel
closing, restaurant shutting, which are based on the mode of transmission of the disease which
requires “social distancing”. It has been estimated that the resulting decline in tourism activity
could result in a GPD reduction as low as 25% and as high as 75%. Costs associated with
medical services, the mobilization of health infrastructure and security could place further
financial burdens on governments who already face the issue of insufficient resources (15).

HEALTH IMPLICATIONS OF COVID-19

As of noon, 29th March 2020, the Caribbean recorded a total of 1000 cases and 12 deaths. The
Government and public health experts have encouraged citizens to continue to comply with the safety
measures in place, as they focus on the immediate needs of the pandemic. At the individual level, there
has been a rush by persons in preparation for unforeseen circumstances associated with the disease
burden of COVID-19. Panic buying among residents has led to the shortage of safety devices and
commodities such as, gloves, masks and medications. It is an indication of a level of behavioural change
in response to the pandemic. It behooves Caribbean countries with limited resources in terms of
finances and human resources, to cooperate as a community and develop strategies/policies geared
towards crushing the curve sooner than later. It has been warming to experience the private sector
donating financial assistance and technical resources where necessary to alleviate the challenges posed
by the incidence and mortality rate of COVID-19. Communities are being mobilized to assist those
vulnerable groups such as the elderly and the disable community at this time (23).

The outbreak of coronavirus has drastically affected human and social activities in our society and the
world at large. The impact of the pandemic ranges from the deaths of friends and family to the physical
effects of the disease burden, the mental trauma and fear faced by almost everyone. Unavoidable fear
of the unknown has led to feelings of panic, psychological stress and panic buying. Circulation of
misleading information about COVID-19, has amplified the effects of the disease since people are
susceptible to social media posts.

Furthermore, criminals and hackers are exploiting the situation by creating Coronavirus-themed
malicious websites, with more than 16,000 new coronavirus-related domains registered since January
2020. Hackers are selling malware and hacking tools through COVID-19 discount codes on the darknet,
many of which are aimed at accessing corporate data from home-workers’ laptops, which may not be as
secure as outside an office environment (24).

Social distancing has imposed a disproportionately high economic and social cost across the globe. The
enactment of policies such as lockdowns and quarantine, connotes a downward trend in production
activities for an unknown period. These have caused markets failure and potentially leading to
downsizing, closure of businesses and employee layoffs. Recent estimates suggest a contraction of the
level of productivity globally. For the Caribbean region, the consensus forecasts are at -3 to -4%, and it is
not until 2022 that the region is expected to bounce back to its pre-crisis output in scenarios that
envision a U-shaped crisis pattern (32). According to the Economic Commission for Latin America and
the Caribbean (ECLAC), more than 30 million people could fall into poverty margin in the absence of
proactive policies and poverty alleviation programmes to ameliorate the situation.

The pandemic has affected educational systems worldwide, leading to the widespread closures of
schools and universities. According to data released by UNESCO on 25 March, school and university
closures due to COVID-19 were implemented nationwide in 165 countries. Including localized closures,
this affects over 1.5 billion students worldwide, accounting for 87% of enrolled learners (26,27).

Social distancing, the closure of schools and childcare centres to prevent the spread of COVID- 19 have
created additional pressures on working parents, especially as traditional sources of childcare are
typically grandparents, many of whom will be in the most vulnerable groups (27).

Religious impact
The pandemic has impacted religion in various ways, including the cancellation of the worship services
of various faiths, the closure of Sunday Schools, as well as the cancellation of pilgrimages surrounding
observances and festivals.[28] Many churches, synagogues, mosques, and temples have offered worship
through livestream amidst the pandemic. Relief wings of religious organisations have distributed
disinfection supplies, powered air purifying respirators, face shields, gloves, coronavirus nucleic acid
detection reagents, ventilators, patient monitors, syringe pumps, infusion pumps, and food to affected
areas [29].

Sports impact
Most major sporting events have been cancelled or postponed [29]. All NCAA collegiate athletic
competitions for the remainder of the 2019–2020 academic year including the 2020 College World
Series and the 2020 Men's and Women's Division I basketball tournaments are all cancelled. Before
most football divisions across Europe were either cancelled or postponed on 12–13 March 2020,
matches in different countries such as Bulgaria, Denmark, France, Germany, Greece, Italy, Poland, Spain
and Switzerland were either cancelled, postponed or played behind closed doors.[30]

Transportation/Movement
In many of the world's major cities, planned travel went down by 80-90% [31]. In most countries, curfew
has been imposed to restrict movements and transportation of persons. In Barbados for example,
curfew has been imposed from 28th March to April 2020 from 8pm to 6am daily.

Conclusion
The devastating effects of COVID-19 on humans, organizations and social activities in the Caribbean and
the world at large cannot be overemphasized. However, this may lead to population growth in some
countries, as couples and families now spend more time together.

REFERENCES

1. Qiu H, Wu J, Hong L, Luo Y, Song Q, Chen D. Clinical and epidemiological features of 36

children with coronavirus disease 2019 (COVID-19) in Zhejiang, China: an observational
cohort study. Lancet Infect Dis [Internet]. 2020 Mar 25 [cited 2020 Mar 27];0(0). Available
from: https://www.thelancet.com/journals/laninf/article/PIIS1473-3099(20)30198-
5/abstract

2 Rothan HA, Byrareddy SN. The epidemiology and pathogenesis of coronavirus disease (COVID-
19 outbreak. J Autoimmun. 2020 Feb 26;102433.

3. Li H, Chen X, Huang H. The novel coronavirus outbreak: what can be learned from China in
public reporting? Glob Health Res Policy. 2020 Mar 9;5(1):9.

4. Peeri NC, Shrestha N, Rahman MS, Zaki R, Tan Z, Bibi S, et al. The SARS, MERS and novel
coronavirus (COVID-19) epidemics, the newest and biggest global health threats: what lessons have we
learned? Int J Epidemiol [Internet]. [cited 2020 Mar 25]; Available from:
https://academic.oup.com/ije/advance-article/doi/10.1093/ije/dyaa033/5748175

5. Zhu N, Zhang D, Wang W et al. A novel coronavirus from patients with pneumonia in China, 2019. N
Engl J Med 2020. - Google Search [Internet]. [cited 2020 Mar 30]. Available from:
https://www.nejm.org/doi/full/10.1056/NEJMoa2001017
6. Coronavirus Update (Live): 650,926 Cases and 30,299 Deaths from COVID-19 Virus Outbreak -
Worldometer [Internet]. [cited 2020 Mar 28]. Available from:
https://www.worldometers.info/coronavirus/

7. Coronavirus disease 2019 (COVID-19) - UpToDate [Internet]. [cited 2020 Mar 25]. Available from:
https://www.uptodate.com/contents/coronavirus-disease-2019-covid-19?source=history_widget

8. Kapiriri L, Ross A. The Politics of Disease Epidemics: a Comparative Analysis of the SARS,
Zika, and Ebola Outbreaks. Glob Soc Welf. 2020 Mar 1;7(1):33–45.

9. Policy Responses to COVID19 [Internet]. IMF. [cited 2020 Mar 30]. Available from:
https://www.imf.org/en/Topics/imf-and-covid19/Policy-Responses-to-COVID-19

10. Ecological Model [Internet]. [cited 2019 Dec 1]. Available from:
https://www.acha.org/HealthyCampus/HealthyCampus/Ecological_Model.aspx

11. Schar DL, Yamey GM, Machalaba CC, Karesh WB. A framework for stimulating economic
investments to prevent emerging diseases. Bull World Health Organ. 2018 Feb 1;96(2):138–40.

12. Marphatia AA. The adverse effects of International Monetary Fund programs on the health and
education workforce. Int J Health Serv Plan Adm Eval. 2010;40(1):165–78.

13. Arthur OS. Barbados under the International Monetary Extended Fund Facility Programme 1 - Public
Lecture. J East Caribb Stud Cave Hill. 2019 Apr;44(1):115-123,203.

14. IMFBlog. COVID-19 Pandemic and Latin America and the Caribbean: Time for Strong Policy
Actions [Internet]. IMF Blog. [cited 2020 Mar 30]. Available from:
https://blogs.imf.org/2020/03/19/covid-19-pandemic-and-latin-america-and-the-caribbean-time-for-
strong-policy-actions/

15. COVID-19: Tourism-Based Shock Scenarios for Caribbean Countries [Internet]. Caribbean
Development Trends. 2020 [cited 2020 Mar 30]. Available from: https://blogs.iadb.org/caribbean-dev-
trends/en/covid-19-tourism-based-shock-scenarios-for-caribbean-countries/.6. Holt-Lunstad J,
Robles T, Sbarra DA. Advancing Social Connection as a Public Health Priority in the United States. Am
Psychol. 2017 Sep;72(6):517–30.

16. Wickizer TM, Von Korff M, Cheadle A, Maeser J, Wagner EH, Pearson D, et al. Activating
communities for health promotion: a process evaluation method. Am J Public Health. 1993
Apr;83(4):561–7.

17. Information note on COVID-19 and noncommunicable diseases - PAHO/WHO | Pan American Health
Organization [Internet]. [cited 2020 Mar 29]. Available from:
http://www.paho.org/en/documents/information-note-covid-19-and-noncommunicable-diseases

18. Barbados-NCD-MAP-2015-2019.pdf [Internet]. [cited 2020 Mar 29]. Available from:

https://www.who.int/ncds/governance/policies/Barbados-NCD-MAP-2015-2019.pdf?ua=1
19. Gostin LO, Friedman EA, Wetter SA. Responding to COVID-19: How to Navigate a Public Health
Emergency Legally and Ethically. Hastings Center Report [Internet]. [cited 2020 Mar 29];n/a(n/a).
Available from: https://onlinelibrary.wiley.com/doi/abs/10.1002/hast.1090

20. Shortage of personal protective equipment endangering health workers worldwide [Internet]. [cited
2020 Mar 29]. Available from: https://www.who.int/news-room/detail/03-03-2020-shortage-of-
personal-protective-equipment-endangering-health-workers-worldwide

21. Singhal T. A Review of Coronavirus Disease-2019 (COVID-19). Indian J Pediatr. 2020;87(4):281–6.

22. Holt-Lunstad J, Robles T, Sbarra DA. Advancing Social Connection as a Public Health Priority in the
United States. Am Psychol. 2017 Sep;72(6):517–30.

23. John Scott. The human impact of COVID-19 – and how business can help.
https://www.weforum.org/agenda/2020/03/this-is-the-human-impact-of-covid-19-and-how-business-
can-help/.

24. Socio-economic impact of the 2019–20 coronavirus pandemic: From Wikipedia, the free
encyclopaedia.

25. https://plus.google.com/+UNESCO (4 March 2020). "COVID-19 Educational Disruption and

Response". UNESCO. Retrieved 29 March 2020.

26. Burke, Daniel (14 March 2020). "What churches, mosques and temples are doing to fight the spread
of coronavirus". CNN. Archived from the original on 14 March 2020. Retrieved 16 March 2020.

27. Parke, Caleb (13 March 2020). "Churches cancel Sunday service, move online amid coronavirus
pandemic". Fox News. Archived from the original on 15 March 2020. Retrieved 16 March 2020.

28. "Coronavirus Disease 2019 (COVID-19)". Evangelical Lutheran Church in America. 2019. Archived
from the original on 18 March 2020. Retrieved 17 March 2020.

29. "Coronavirus wipes out most of world's major sports events on an unprecedented day". BBC. 14
March 2020.

30. "The coronavirus effect: COVID-19's impact on sporting, cultural, civic events across Canada". CJOB.
Archived from the original on 12 March 2020. Retrieved 12 March 2020.

31. Team, The Visual and Data Journalism (28 March 2020). "Coronavirus: A visual guide to the
pandemic". BBC News. Archived from the original on 27 March 2020.

32. Andrés Ham. Social and economic impact of the COVID-19 and policy options in Honduras. March
2020. www.latinamerica.undp.org. |