Case Study, Dominica: A Comparison With Hawaii In A Pandemic

Written with Philip Ong, reviewed and edited by Maren Purvis On March 29th, I decided to look for somewhere I could justifiably compare the effects of the pandemic to those we’ve seen on Hawai’i Island, trying to find a better match than already cited in the media. The examination included factors such as positive COVID-19 cases at the time, effective population density, climate and humidity, medical capacities, visitors being the primary vectors for infection, two primary population centers, and most importantly - it had to be another island. I came to the Commonwealth of Dominica, which saw its own legendary disaster in the last few years with Hurricane Maria in 2017, and has an history of epidemics in the 19th century, their own hot volcanic lake on the island, national parks. Geologically speaking, Dominica is one of the youngest islands in the Caribbean chain, as Hawai’i Island is the youngest livable island in Hawai’i. It seemed like a solid point of comparison to keep an eye on and track their progress with COVID-19 over time, as case loads between Hawai’i Island and Dominica were similar at the time. Today in Dominica, it has been 28 days since the last COVID-19 positive case. After a total of 16 cases of COVID-19 on their island, new cases ceased. There have been no deaths, and currently only 2 active cases remain on the small Caribbean island. The importance of the continued presence of active cases in Dominica after three weeks will become apparent in this case study’s key takeaways. The Dominican health response is being coordinated by National Epidemiologist, Dr. Shalauddin Ahmed. “Dominican citizens have adopted social distancing, good hand hygiene, and proper repository etiquette as part of the new normal for them. This has proven successful so far, and it is working. But we need to be weary about a possible second wave, the fight is far from over. We must continue these life saving behaviors.” “The COVID-19 pandemic is showing us that it is NOT about survival of the fittest, but survival of the smartest. That is to say, countries who ranked high in preparedness and health care index, have now been brought to their knees by this invisible pathogen - we do not want to become like them.” ~ Dr. Shalauddin Ahmed, Ministry of Health Covid Press Briefing, 5/1/2020 As of March 30th, Dominica’s contact tracing system was already clearly defined and implemented, testing and tracing was conducted to identify those in need of isolation. Today, contact tracing is on pause as all contacts have been cleared. The availability of testing has been a limitation that is hampering Dominica from implementing more widespread community testing, a key part of their exit strategy, as stated by Dr. Ahmed. Caribbean economies have also been badly impacted by COVID-19, especially with the collapse in tourism. The unemployment rate in Dominica has risen considerably at this point, similar to Hawai‘i’s, though statistics on Dominican unemployment have been difficult to find. Brent Barnette, Economic Growth Lead, says that 70% of businesses indicated severe impact and disruptions to their business thus far in Dominica, and likely for the remainder of 2020. The IMF donated $14M to Dominica, representing 89.4% of Dominica’s total quota. Prime Minister Skerrit plans to “kick in” income support within the month of May, though he recently rejected a proposal from the Dominica Social Security intended to assist Dominicans who have lost their jobs due to COVID-19. OK… What did Dominica do for COVID-19? - Large and early adoption of social distancing, hand washing, and masks, according to Dr. Ahmed. - Strong contact tracing program. Background on COVID-19 in Dominica: - The neighbor-islands ferry suspended operations in early March - March 22nd was the first case: A 54 year old who returned to Dominica from the UK. - Went into lock-down as of March 25th, but were slower than other nearby islands to implement restrictions. - All other Caribbean countries including the French islands of Guadeloupe and Martinique closed their borders and schools prior. - A medical brigade arrived March 26th (25 nurses, 5 doctors and 4 lab technicians) - As of April 12th; there was a high face mask adoption, with government leaders giving full speeches with protective surgical grade face masks. - State of Emergency was extended until June 30th; curfew extended until May 11th. - Antigen testing to confirm cleared cases are negative for COVID-19 prior to release from isolation. - Medical leaders desire to extend testing to all frontline workers, but there is limited testing available. - Businesses as of April 27th are now open from 6am to 4pm, a curfew remains in effect from 6pm-6am. - A ban on liquor sales was lifted April 27th, allowing for purchase only of liquor and not consumption at the point of sale. - A ban on large gatherings of more 10 persons is still in place, and physical distancing protocols are enforced. - Radio updates are a primary means of communication with the public, conducted three days a week. Radio stations out of Dominica can be found at: https://streema.com/radios/country/Dominica As of May 3rd, Dominica has conducted only 416 tests for COVID-19, with 16 positive results. Meanwhile, Hawai‘i Island is at 4,500 tests completed, with 74 positive results. Though the sample size is very small in Dominica, the hit-rate on positive antigen test results are higher than Hawai‘i, at 3.8% vs 1.6% on our island. Testing on a per-capita basis in Dominica is at 5.80 tests per 1,000 people, while Hawai‘i Island have conducted 24.6 tests per 1,000 people. While there are identifiable differences between Dominica and Hawai‘i, it’s interesting to analyze how a similar region is mitigating COVID-19 over the course of April. On one island, some measures were implemented widely early on (Contact tracing, economic stimulus, testing to determine recovery of positive cases), while on the other island these measures were implemented later, or revised more slowly, or have only recently been considered. My Two Key Takeaways For Hawai‘i: - Contact Tracing: The amount of time and care Dr. Ahmed and the Ministry of Health in Dominica takes with contact tracing cannot be understated. Details are provided on how many people were contacted, how many tests were administered, and how many were positive, with all the statistics are available for the public. The talk of contact tracing in Hawai’i is late to join the conversation at large, and in some ways our contact tracing protocols are not yet comparable to other regions successfully mitigating outbreaks for prolonged time periods. Major General Kenneth Hara’s recommendations on the expansion of contact tracing in our islands should be reconsidered by the Hawai‘i Department of Health. I question the risk analysis at the Hawai‘i Department of Health after incorporating the vectors for infection involved in resumed interstate and international travel to Hawai‘i, even with a partial resumption in tourism. - Testing Those to Be Released From Isolation: There is a reason that Dr. Ahmed and counterparts in South Korea are insisting on testing those to released from isolation: it helps ensure those cleared from COVID-19 are no longer shedding an active viral load. I would suggest that the CDC’s Symptom-Based Strategy for release on test positive cases of COVID-19 may be insufficient, and Hawai’i has “ample testing supplies and laboratory capacity“ to implement a better strategy. If a follow-up CDC Test-Based Strategy in Hawai‘i were to be performed at the end of the CDC’s Symptom-Based Strategy; 3 days since fever recedes, and 10 days from symptoms first appear, it would increase  both our public’s safety and our confidence that Hawai‘i’s available resources are being utilized as productively and efficiently as possible. Takeaways For Hawai‘i County Residents - Social distancing, hand-washing, and face-masks are proven effective. In many ways, the keys to dealing with COVID-19 are in your hands. Discover Dominica Authority participated The video on travel attached, we can find similarities where we do not expect them. Videos from Discover Dominica.