Writing On The Wahl #032 — Question on COVID-19 to the CMO, National Epidemiologist, and Medical Director of the Respiratory Hospital.

Today, September 8th, 2021, the Ministry of Health held a press conference on COVID-19. I could not attend in person, but I could get three questions into the panel thanks to the ministries Information Officer.

Question one

How does the MOH determine a viral outbreak? Do resulting outcomes of illness factor into the declaration of an outbreak, or is it strictly the prevalence of infections? If so, how many?

Dr. Michelle Francois (National Epidemiologist)

“An outbreak is an increase in the number of cases over what is expected or what is expected. For diseases or infections that are considered “endemic,” which means they occur thought the years in a particular country, most countries would have what we consider baselines. These baselines tell us what is normal for us, so once the numbers of a specific disease, virus, or whatever have you continue to rise above that threshold or that expected number, then an outbreak is declared.”

— Dr. Michelle Francois (National Epidemiologist)

In her response, Dr. Francois used last year’s Dengue Fever outbreak as an example stating that.

“We know Dengue is something that we have seen throughout the years, and we knew what our baseline was, what to expect and when to expect it as well. When the numbers continued to rise, an outbreak was declared based on what was expected for that particular time and in our location.”

I asked the question precisely because the word outbreak is the only qualifier in the constitution that allows for the declaration of a state of emergency and the legal infringement of our rights. If I was there in person and able to ask a follow-up question, I would have asked her to be more specific to the declaration of an outbreak in COVID. Being a novel virus, we can have no baseline for how many cases we anticipate a year; therefore, how do they determine? Do they consider other similar respiratory viral infections like influenza, or do they wait to be told by the WHO and PAHO? And out of curiosity. What is the baseline for influenza in Saint Lucia, and how is the COIVD-19 situation matching up to that?

The public must consider this because we should establish better parameters than merely a declared “outbreak” before allowing our constitutionally protected freedoms to be tampered with by politicians and technocrats. I would suggest a metric that also considers the outcomes of the illness. How common are severe cases, and what are the odds of death or other consequences that are harmful to society on the whole.

Question Two

In the Ministry of Health’s tracking of vaccinations for “herd immunity,” are people who have recovered from natural infections considered in that calculation? If not, why?

Dr. Sharon Belmar-George (Chief Medical Officer)

“When we calculate herd immunity, we only use persons who have been fully vaccinated. For the vaccines that we have, they are all two doses, so it would be 14 days after receiving your second dose would make you classified as being fully vaccinated. We do not add in the persons who have been positive for COVID because the research has shown that if you have had COIVD-19, the natural immunity by six months, the levels are a lot lower than the antibodies produced from the vaccine. So for natural immunity, it’s much lower in terms of the antibodies, and the period is a lot shorter. Some people three months, some people four months, I think six months is probably the maximum. The effect of the vaccine from what they suspect because we have not had the vaccine for two years to confirm but what it looks like it will be at least two years of protection. So because of the lower effectiveness, because of the shorter period, we do not count persons who have covid as being part of herd immunity, and we do advise persons that have had COVID-19 you should still take the vaccine.”

— Dr. Sharon Belmar-George (Chief Medical Officer)

I would need to know what “research” the CMO refers to because most literature I have come across indicates the opposite. A recent study released from Israel shows individuals who have recovered from COVID are 6 to 13 times more protected than if only vaccinated. We will stick a pin in this point to be revisited later because it requires an independent blog post to thoroughly ventilate the subject of natural immunity rather than immunity derived from vaccination.

I strongly suspect that the practice of excluding and ignoring innate immunity is a directive handed down from the WHO and PAHO, not an independent determination from the CMO based on her study. But I could be wrong; It very well may be that her position is independent of the internatio0nal agencies to which she is subservient.

Question Three

Does the Ministry of Health tracks how many of the COVID-related hospitalizations are Vitamin D deficient or Obese? If so, how many?

Dr. Alisha Eugene-Ford (Medical Director of the Respiratory Hospital)

“Every patient that comes in, we take their comorbidities; if you have any medical history of anything, we take it down, and it forms part of the information that we gather. Obesity, for instance, is one of those that we have realized is popping up, and the patients that are obese are not doing well. Vitamin D deficiency is something we capture, but it may not be something that we capture as much as we would capture persons with obesity, hypertension, diabetes, heart disease or any of these things. But we are always ensuring that when we are capturing our data or when we are interviewing, interrogating, or examining patients, we take into consideration any past medical history they have. Which means we do have the information that we need. It also allows us to gauge ourselves in the hospital. If you have persons coming in with so many comorbidities, we anticipate having to work harder with these persons versus someone who might just come in with mild symptoms and not many comorbidities. This person will most likely do way better than the group that I mentioned before.”

— Dr. Alisha Eugene-Ford (Medical Director of the Respiratory Hospital)

If they were to pay more attention to capturing vitamin D deficiency, they would see clear scientific evidence supporting a mass promotional campaign to address this problem which is inextricably linked to obesity and severe illness from COVID-19. It would also be beneficial to a public health education campaign by informing people of the percentage of patients who have had a severe illness or death that present with comorbidities and help identify which at-risk communities should be priorities as far as targeted outreach.

I think this top-heavy approach on reliance on vaccinations is hazardous and short-sighted. We are allowing this crisis to go to waste in that it has allowed us to deal with some root problems in our public health. Still, we kick the can of none communicable diseases do the road because we don’t want to acknowledge we must change our lifestyle and not depend merely on miracles from modern medicine.

Hopefully, the Ministry of Health will broaden the scope of data released to the public so our debates and discussions can be based on substance speculation.

I will review the rest of the press conference and make a few posts covering notable quotes from the participants. I will dive into the question of immunity for a Blog to be posted either tomorrow or Friday.

Until then.

Be strong, stay safe, and God bless Saint Lucia.

#jvw7

Social commentary & political analysis of current affairs and the news worldwide — focusing on implications for Saint Lucia and Saint Lucians in the diaspora.