Trinidad and To­ba­go has now crossed the cen­tu­ry mark in COVID-19 deaths, with 101 fa­tal­i­ties record­ed as of yes­ter­day (Oc­to­ber 21). Sev­en months af­ter record­ing its first case, the virus has rapid­ly spread across the coun­try with 5,392 peo­ple now hav­ing been in­fect­ed. Glob­al­ly, over 40 mil­lion cas­es and over 1.1 mil­lion have suc­cumbed to the virus.

In T&T, our COVID-19 sto­ry is sep­a­rat­ed in­to two phas­es. Phase one ran from March 12 to Ju­ly 19, 2020. It was marked by im­port­ed cas­es and min­i­mal lo­cal spread through pri­ma­ry con­tacts of COVID-pos­i­tive pa­tients. Dur­ing this phase, T&T record­ed eight deaths, one in To­ba­go and sev­en in Trinidad. Re­mark­ably, these eight deaths oc­curred with­in two weeks from March 26 through April 6.

It is no se­cret that COVID-19 dis­pro­por­tion­ate­ly im­pacts the el­der­ly over any oth­er de­mo­graph­ic co­hort. Dur­ing phase one, this reigned true in T&T, with the eight peo­ple suc­cumb­ing to the virus above the age of 55. Whether these de­ceased pa­tients had co­mor­bidi­ties or pre-ex­ist­ing con­di­tions, or their iden­ti­ties, were nev­er dis­closed, al­though the me­dia was able to iden­ti­fy a few of the vic­tims.

T&T then went 129 days un­til the next death was record­ed a few weeks af­ter what Chief Med­ical Of­fi­cer Dr Roshan Paras­ram dubbed phase two from Ju­ly 20 on­wards. This phase marked sig­nif­i­cant changes to the med­ical land­scape across the coun­try. T&T’s COVID-19 trans­mis­sion clas­si­fi­ca­tion quick­ly moved from spo­radic spread to clus­ters of cas­es and ul­ti­mate­ly, on Au­gust 14, we of­fi­cial­ly had com­mu­ni­ty spread.

Since Au­gust 14, there has been a steady climb in our death toll, av­er­ag­ing just over one a day. With the death toll now at 101, who has been af­fect­ed and died in our sec­ond phase? As of the lat­est de­mo­graph­ic up­date from the Min­istry of Health, more males have test­ed pos­i­tive than the fe­male pop­u­la­tion, at 52.8% males ver­sus 47.2% fe­males. How­ev­er, when look­ing at the death toll, the largest pro­por­tion of deaths are males at 74.4%, while 25.3% are fe­males.

Ac­cord­ing to a study pub­lished by the US Na­tion­al In­sti­tutes of Health, ti­tled Coro­n­avirus: Why Men are More Vul­ner­a­ble to COVID-19 Than Women, men have high­er mor­bid­i­ty to COVID-19. The study ex­plained that the in­creased mor­bid­i­ty could be due to the high­er ex­pres­sion of the an­giotensin-con­vert­ing en­zyme-2 (ACE-2), a re­cep­tor for coro­n­avirus, and sex-based dif­fer­ences in the im­mune sys­tem.

Be­yond bi­ol­o­gy, the study al­so claimed this mor­tal­i­ty dif­fer­ence may al­so be due to the dif­fer­ence in lifestyle amongst gen­ders, as men have high­er lev­els of smok­ing or drink­ing than women. It al­so not­ed that men tend to have a more ir­re­spon­si­ble at­ti­tude to­ward COVID-19 mea­sures than women, with laps­es in hand­wash­ing, wear­ing face masks and stay­ing at home.

While we have seen COVID-19 deaths in T&T from as young as 30-34, this age brack­et on­ly ac­counts for 11.6% of deaths to date. Ages 50 and above are most­ly af­fect­ed, with ages 70-79 ac­count­ing for the high­est pro­por­tion of deaths, at 28.4% or ap­prox­i­mate­ly 27 peo­ple. The el­der­ly con­tin­ues to be the most af­fect­ed pop­u­la­tion due to their pre-ex­ist­ing con­di­tions or co­mor­bidi­ties. Ac­cord­ing to the Min­istry of Health, by mid-Sep­tem­ber, 70 per cent of those who died had at least one co­mor­bid­i­ty. In most cas­es, di­a­betes, hy­per­ten­sion or obe­si­ty, but in oth­ers, kid­ney dis­ease, car­diac dis­ease and can­cer were al­so com­pli­cat­ing fac­tors.

This then begs the ques­tion, why did so many peo­ple have co­mor­bidi­ties? It turns out T&T has an un­healthy pop­u­la­tion.

Ac­cord­ing to the Chief Med­ical Of­fi­cer Dr Roshan Paras­ram, 17% of the pop­u­la­tion has di­a­betes, 23% hy­per­ten­sion, 17% can­cer and 9% has a cere­brovas­cu­lar ac­ci­dent (or stroke). He al­so added, “There is a lot of cor­re­la­tion be­tween peo­ple hav­ing hy­per­ten­sion and di­a­betes at the same time so if you have a pop­u­la­tion of a large bur­den of di­a­betes or hy­per­ten­sion, what­ev­er it may be as a co­mor­bid base. Of course, based on the in­fec­tion that you get, it will be ex­treme­ly dif­fi­cult to iso­late these peo­ple com­plete­ly as a sep­tate group.”

If you fall with­in this pop­u­la­tion, above the age of 50 with co­mor­bidi­ties, what should you do?

The CMO of­fered his ad­vice, “We are ask­ing that those per­sons know­ing your par­tic­u­lar sit­u­a­tion, be ex­tra cau­tious. Take the pre­ven­ta­tive mea­sures, the pub­lic health mea­sures in place, to avoid your­self from get­ting in­fect­ed, and of course, if you have rel­a­tives that have these co­mor­bid fea­tures, it au­gurs very well that you take ex­tra cau­tion to ex­pose those in­di­vid­u­als.”