Alfred Dawes | Ja’s chances against COVID-19

On March 1, I wrote an article warning of a coming revolution, incited by someone as humble as a fruit vendor, that would be in our lifetime. Had I known that events that could lead to such a major societal disruption were already under way, I would probably have started my preparations in earnest. I speak of the spread of COVID-19 across the world, the greatest challenge to our civilisation since World War II. We are at the edge of a precipice, and how we respond to this threat as a people will determine how our country and individual lives will fare. Now is the time that we must all pull together or else we will have untold hardships for the next few years.

The impact of the virus is both on health and the economy. COVID-19 has about a 2-3 per cent death rate overall. This, however, varies from country to country. Italy and Spain, for example, have much higher death rates than Germany. The virus is more lethal in certain populations – the elderly and those with chronic diseases such as diabetes, heart disease, and hypertension. The real jump in death rates is seen when the capacity to provide Intensive Care Unit (ICU) care is exhausted. At that point, healthcare workers have to decide who they will give a chance to live and who they will watch die without the supportive care needed. Shutting down the economy by restricting movement is the only way to slow the spread of the disease, but this causes severe economic hardships to everyone, especially the most vulnerable in society.

Jamaica is in a peculiar position that can result in devastating effects on both fronts. Jamaica’s population is susceptible to the severe form of the disease, and we have severe economic and political handicaps. Transmission of the virus is easier in densely populated centres. Roughly 55 per cent of Jamaicans reside in or around major metropolitan areas. This population density is worse when we begin to factor in the thousands who live in tenement yards and crowded apartment blocks. How can we isolate persons displaying symptoms if they live in a crowded household? Transmission will be rapid once this virus hits the inner-city communities, and there is nothing we can do to stop the spread there, save moving out persons who display symptoms or test positive.

Our ageing population means that almost 14 per cent of Jamaicans are over the age of 55 years. To make matters worse, according to the latest surveys, approximately 34 per cent of the population is hypertensive and 12 per cent diabetic. These conditions can cause heart disease without showing symptoms. Our population is seriously at risk. One only has to look at Italy to see the effects of COVID-19 on a population at risk. So we are at increased risk of spread because of economic and social conditions. We are at risk of a high incidence of severe disease because we have a large section of the population at risk for severe disease and high death rates. Is our public sector ready to handle the onslaught when there is significant spread of the disease?

We Are NOT READY

No. We are not. And we will never be ready. It boils down to the numbers of healthcare workers and the ability to provide critical care for the 15 per cent of the infected patients requiring hospital care and the six per cent requiring ICU care. For years, we have underpaid our nurses, and that has led to a continuous wave of migration to countries that value their services. We are constantly experiencing a nursing shortage, and the nurses who are called on to fill the gap are young and inexperienced. Doctors are overworked, and there is general low morale among front-line workers. The human-resources component is not ready, and it will be even worse when healthcare workers start calling in sick or are placed in quarantine.

Hospital waiting rooms are overcrowded and it is difficult to isolate or treat large numbers of patients seeking treatment. When the rush comes in, you will hear of attacks on healthcare workers by frustrated patients and relatives. ICUs are already full. The increased capacity being created will not be enough because we do not have the space or the staff to create proper-functioning ICUs. With not enough ICU spaces, many will die. It would take years of strengthening and billions of dollars of investment to get the system up to speed for a test like what we are about to face.

This is not an indictment on the present hard-working team in the Ministry of Health and its health facilities. Successive administrations have kicked the can down the road when we warned about the need for healthcare reform. Now, the can is at their feet with nowhere to kick it. We who know what the facilities have been like over the years and know that this is not a fix that a few billion dollars can effect. Those who turned a blind eye to the state of the public hospitals, knowing that they could fly to Miami for treatment, will now realise that they will have to join a line for an ICU bed with us commoners and hope that the workers whose plights they ignored over the years will think they fit the criteria to get a chance at life. There is nowhere to run. Disasters are the great equalisers where money and status have less bearing on outcomes. I only cry for the perennial sufferers in these times.

EFFECTS ON BUSINESSES

The shutdown has had terrible consequences on small and large enterprises. But many have a cushion on which to fall. What of the casual worker who has to go to the shop every day to buy food to cook because they can’t afford not to? The workers laid off who have no prospects of gainful employment in the near future? Close to one hundred thousand tourism workers were sent home. They have on average three to four dependents to feed. They spend money in community shops and bars, take public transport to work, and buy lunches from cook shops. With cruise ships gone, what of the vendors? Entire towns such as Negril and Falmouth are almost solely reliant on tourism driving the supporting businesses. Farmers who supply hotels are feeling the pinch, and the entertainment industry is in shambles.

When discussions on the need for food security came up a few years ago, some poured scorn on the thought of us producing the majority of our food, albeit at higher prices than imported food. After all, there would never be any global disruptions in our supply chains. So we continued to import around 80 per cent of what we ate. We flew in tourists and flew in their food while we pontificated about the need for greater tourism linkages. We imported processed foods and fed our obesity/overweight rates to over 50 per cent of the population. Now, our ability to eat is dependent on how fast other countries recover from this crisis. We will, once again, become beggars with flags. Except this time, the field of beggars has multiplied. The direct negative impact on our food supply has been worsened by our agricultural policies designating fertile land for development and propping up the ailing sugar industry for political expediency instead of crop substitution to feed ourselves or even export the way the Dominican Republic did years ago. So now that we have thrown good money after bad money in sugar, what are we going to do when the current sugar crop ends and thousands of workers lose their seasonal employment?

With restrictions on movement, small businesses cannot earn to cover their overhead costs. They have to lay off even more staff and purchase less, worsening the downward spiral. Most small businesses cannot survive two months of this, and it may last even longer. Many will fold. Fortunes will be lost and the social disruption will be unimaginable. How will we manage the closures and high unemployment rates? What will the unemployed do? Is one of them the Fruit Man of my premonition?

SECURITY FORCES

The almost inevitability of civil disturbances would be less of a worry if the police had the resources to deal with them. But we have allowed corruption at the highest levels of the force to fester for years while we underpaid the rank-and-file members. It is no surprise that the morale of the force is low. They are underequipped and stretched thin by multiple states of emergency. If riots break out, can they effectively respond? Criminals are armed to the teeth and used to a particular luxurious lifestyle. Some have gone legit, but the links to the underworld remain. With unemployed numbers swelling, fewer foreigners to scam, and fewere businesses to extort, what will they and their guns diversify into?

We will survive this crisis, but we have to pull together as a country. If we can avoid the anarchy, it will be a wonderful opportunity to examine ourselves as a people. The deficiencies in health, agriculture, national security, the political system, and the inequalities in our society will all be magnified. Now is the time we as a people must find the inner strength to peacefully overcome this challenge and work together to emerge stronger than ever, united in a single purpose. If we can’t, then the Fruit Man will light a fuse, and our rebuilding of a greater society will be only after everything burns.

- Dr Alfred Dawes MBBS, FACS is a medical director, Windsor Wellness Centre & Carivia Medical Ltd.