I am writing this for the benefit of all my Belizean brothers and sisters, and also for the benefit of my medical colleagues — doctors, nurses, and other allied health professionals. Throughout our lives we are exposed to all kinds of infectious diseases, some more serious than others, that may need medical intervention, and for the most part can be resolved with complete cure. The outcome of these diseases depends on competent, accessible healthcare.
COVID-19 is a new infectious disease that has characteristics that the world is just now finding out. What we know is current knowledge, and is updated on a daily basis. So what do we know? We know it’s a type of coronavirus that causes flu-like symptoms, headaches, a dry cough, malaise, fever, and pneumonia, which can be severe and life-threatening. New information indicates that it can also be present with fever and diarrhea, and eventually, pneumonia.
Also known is that, like other viruses in this class, the incubation period is about fourteen days from the time of infection to the time of illness, and contracting the virus does not always lead to overt disease. Symptoms can be mild, or none at all. In fact, the verdict is not out on the presentation that those infected that will end up overtly ill, but it appears that in healthy people, especially younger individuals, as much as perhaps 90% will be okay. So it is not a disease like Ebola, which has a mortality rate of over 50%.
So why is COVID-19 a problem? It is a problem because of its contagion; it spreads very rapidly from person to person in close proximity; therefore, in places where there is a higher density of people, one infected person can infect hundreds.
From countries that have large populations of infected people, we now know that up to twenty percent will get sick and need medical care and hospitalization, and up to 4% will need ICU care with ventilatory support to prevent death.
And for those who are older than 68 or with underlying illnesses like diabetes, heart disease or immune suppression from cancer treatment, up to 31% will die in spite of treatment. This is the problem with this pandemic; it can produce, within a short space of time, an overwhelming burden on our health system.
An example starts with one case, which started in San Pedro; it has already produced one more case, and likely, there may be ten more from that one case, and ten from that, or more from that contact case, which in turn can produce 200 more cases, and so on and so on.
So from this point on, unless Belizeans get this point, in short, we will be in a disastrous situation. The point of this article is not to scare, but to educate. From here onward, we should behave as if though we all have the virus and stay away from people for at least a month, as best as we can.
Stay at home, with outings only for shopping for necessities. Even if we are well, remember that 90% who catch it will be well, but will cause it to spread. If you are ill, but not so ill, without breathing problems, stay at home, rest, and drink enough fluids and acetaminophen (Tylenol) for fever. And most importantly, isolate yourself from the rest of your family members. If you are ill and getting more ill, especially with shortness of breath, go to the government hospital.
Let’s look at the burden on our health system if, let’s say, 200 people have already been infected. From what we know, that amount of infected people can generate 40 ill patients that will need hospitalization, and of these, up to ten patients will need ventilation for one or more weeks.
Multiply that by ten —say two thousand infected individuals will cause 400 people to need admission and 100 to need ventilation. The KHMH will be swamped and the country will be swamped, because the resources needed to run ICU-type treatment is phenomenal, more than $1,000/day conservatively, up to $100,000 a day. Furthermore, other illnesses will not take a holiday.
So healthcare will become much less accessible for treatment of other diseases, with increasing mortality overall. I am making this point again, not to scare, but to educate on why our behavior is extremely important.
I hope the two leaders of the pandemic emergency team read this article, because the emphasis on social distancing is critical.
And to my colleagues at all the hospitals, sick people are treated in hospitals, and I expect that sick COVID patients will need hospitalization. Since highest mortality per group is amongst health professionals, I think focus and planning should be the highest priority amongst our health professionals to ensure that the protocols for infection control are of the highest quality, and to insist that the government acquire and provide to the institutions what is needed.
Bringing Cuban personnel will take away necessary resources that must be provided to our doctors and nurses and other hospital staff — protective gear and other necessary equipment. Bringing in foreign personnel at this time is misguided; we have competent physicians in this country who can be up and running from day one. What is needed is better leadership in the curative side of medicine, which we do have in Belize. I think public health is doing a good job, so far.
It is also critical that our hospitals and medical personnel be geared with the necessary supplies and equipment based on projections, so that we can increase our capacity to handle the projected increase in cases. If we are not prepared, our mortality will be extremely high, especially for our senior citizens and most vulnerable, the poor and indigent.
KHMH and the regional hospitals need to be put on emergency footing to handle the patient load. All elective admissions should be discharged or moved to institutions with capacity to treat inpatients; this is where the private institutions can relieve the load off the Government hospital so that they can handle COVID patients. All medical institutions, public and private, should be recruited into the country response.
The health response to the pandemic is critical to the timely return to economic health. The government’s response to help the workers’ buying power is absolutely necessary for economic recovery, along with loosening of financing to businesses to restore economic health and investment, and new growth.
Dr. VMD Lizarraga