The region’s main public health agency has put residents of Barbados and other Caribbean states on alert for two new highly-contagious COVID-19 variants and the reemergence of polio in the Americas.

The Caribbean Public Health Agency (CARPHA) also predicted that the BA.5 variant will cause a massive increase in COVID-19 cases across the region.

In an interview with CARPHA’s Communications Manager Carlon Kirton, following the World Health Organisation’s recent declaration of Monkeypox as a public health emergency of international concern, the agency’s Executive Director Dr Joy St John expressed grave concern about these developments. She cautioned that the situation could worsen because of vaccine hesitancy and an anti-vax campaign being waged in and outside of the region.

Dr St John said CARPHA has expanded its range of tests and increased testing for the sub-variant of the Omicron variant.

“It’s mainly BA.5, some BA.4. BA.5 is pushing everything else. But we are also seeing BE.1 and BF.1, which act just like BA.5 and spread very quickly,” she reported.

“We will continue to monitor what’s out there in the world, what’s of concern in terms of global transmission so that we would be able to keep on top of the detection tests like what we are doing for Monkeypox and the gene sequencing like what we are doing for COVID-19.”

The public health executive singled out the BA.5 sub-variant, cautioning that it is expected to be responsible for a jump in COVID-19 infections in the Caribbean.

“The need for PCR tests has reduced considerably as we have gone into this new phase of the pandemic. However, the need for gene sequencing has not. The [CARPHA] member states still want to know about gene sequencing because they need to keep on top of what is circulating and how they need to change management.

“For example, now that we have BA.5 circulating, the member states are aware they are going to get lots and lots and lots of cases. There may not be that many that are severe, and there may not be that many that go on to death, but they know there is going to be an increase in cases, so they are on the alert for that,” she said.

Meantime, the CARPHA boss cautioned that the disabling disease polio, which had been eliminated from the Americas more than 30 years ago, could resurface in the Caribbean.

The first case in this hemisphere in the last three decades was reported on July 21 in a young unvaccinated man in New York City. Health officials said he was infected by a strain related to the live oral polio vaccine, which is used in some parts of the world but has not been used in the US since 2000.

“I must confess that although polio has not been declared a public health emergency of international concern, because we are only looking at one case, it is a cause for concern for CARPHA,” Dr St John said.

“First of all, this region of the Americas eradicated polio decades ago. So, for us to see a new case, even though it is one, is of concern to me.”

She said this was particularly worrying because of an anti-vax campaign that surfaced during the COVID-19 pandemic and was affecting other immunisation efforts.

“Apart from the fact that there was an anti-vax sentiment outside of the Caribbean before COVID-19, since COVID-19 there has been an increase in anti-vaccination sentiments. Vaccine hesitancy is something that we are dealing with even for the pandemic. And so, our percentage coverage of immunisation for polio and other vaccine-preventable diseases has not been as good as it should be,” the senior public health official said.

Addressing the fallout from the anti-vax movement, she said it has dealt a devastating blow to the region’s vaccine uptake efforts.

“Vaccine hesitancy, anti-vax sentiment, and a serious campaign which is being waged through social media has definitely impacted the uptake of COVID-19 vaccines and has already started to impact the usual vaccination programmes,” Dr St John said.

“There are stories of persons who not only said they were not getting the COVID-19 vaccines, but they stopped their children from getting it and they stopped their elderly relatives, so it is very disturbing from that perspective. But once that kind of sentiment raises itself, it is going to impact on regular vaccination programmes,” she maintained.

Meantime, addressing the Monkeypox virus, the top CARPHA official noted that people are now presenting with new symptoms.

“The way in which this Monkeypox infection is showing up is different. People are speaking about really severe lesions in strange places. People are talking about the swelling of lymph nodes so that they protrude through the skin, even two inches out from where they normally would be. There are even reports of people who could not walk because their lymph nodes were so inflamed. So the way in which Monkeypox in this outbreak in non-endemic countries is exhibiting means people need to pay attention and people need to ensure they are not infected, because they are people who are infected and they are travelling,” Dr St John pointed out.

She added that while there is a vaccination for Monkeypox, it may be out of the reach of small developing countries such as Barbados, not only because the cost is prohibitive but also because it is in short supply.

(emmanueljoseph@barbadostoday.bb)

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SOURCE: AP — The World Health Organization said the expanding monkeypox outbreak in more than 70 countries is an “extraordinary” situation that now qualifies as a global emergency, a declaration Saturday that could spur further investment in treating the once-rare disease and worsen the scramble for scarce vaccines.

WHO Director-General Tedros Adhanom Ghebreyesus made the decision to issue the declaration despite a lack of consensus among members of WHO’s emergency committee. It was the first time the chief of the U.N. health agency has taken such an action.

“In short, we have an outbreak that has spread around the world rapidly through new modes of transmission about which we understand too little and which meets the criteria in the international health regulations,” Tedros said.

“I know this has not been an easy or straightforward process and that there are divergent views among the members” of the committee, he added.

Although monkeypox has been established in parts of central and west Africa for decades, it was not known to spark large outbreaks beyond the continent or to spread widely among people until May, when authorities detected dozens of epidemics in Europe, North America and elsewhere.

Declaring a global emergency means the monkeypox outbreak is an “extraordinary event” that could spill over into more countries and requires a coordinated global response. WHO previously declared emergencies for public health crises such as the COVID-19 pandemic, the 2014 West African Ebola outbreak, the Zika virus in Latin America in 2016 and the ongoing effort to eradicate polio.

The emergency declaration mostly serves as a plea to draw more global resources and attention to an outbreak. Past announcements had mixed impact, given that the U.N. health agency is largely powerless in getting countries to act.

Last month, WHO’s expert committee said the worldwide monkeypox outbreak did not yet amount to an international emergency, but the panel convened this week to reevaluate the situation.

According to the U.S. Centers for Disease Control and Prevention, more than 16,000 cases of monkeypox have been reported in 74 countries since about May. To date, monkeypox deaths have only been reported in Africa, where a more dangerous version of the virus is spreading, mainly in Nigeria and Congo.

In Africa, monkeypox mainly spreads to people from infected wild animals like rodents, in limited outbreaks that typically have not crossed borders. In Europe, North America and elsewhere, however, monkeypox is spreading among people with no links to animals or recent travel to Africa.

WHO’s top monkeypox expert, Dr. Rosamund Lewis, said this week that 99% of all the monkeypox cases beyond Africa were in men and that of those, 98% involved men who have sex with men. Experts suspect the monkeypox outbreaks in Europe and North America were spread via sex at two raves in Belgium and Spain.

Michael Head, a senior research fellow in global health at Southampton University, said it was surprising WHO hadn’t already declared monkeypox a global emergency, explaining that the conditions were arguably met weeks ago.

Some experts have questioned whether such a declaration would help, arguing the disease isn’t severe enough to warrant the attention and that rich countries battling monkeypox already have the funds to do so; most people recover without needing medical attention, although the lesions may be painful.

“I think it would be better to be proactive and overreact to the problem instead of waiting to react when it’s too late,” Head said. He added that WHO’s emergency declaration could help donors like the World Bank make funds available to stop the outbreaks both in the West and in Africa, where animals are the likely natural reservoir of monkeypox.

In the U.S., some experts have speculated whether monkeypox might be on the verge of becoming an entrenched sexually transmitted disease in the country, like gonorrhea, herpes and HIV.

“The bottom line is we’ve seen a shift in the epidemiology of monkeypox where there’s now widespread, unexpected transmission,” said Dr. Albert Ko, a professor of public health and epidemiology at Yale University. “There are some genetic mutations in the virus that suggest why that may be happening, but we do need a globally-coordinated response to get it under control,” he said.

Ko called for testing to be immediately scaled up rapidly, saying that similar to the early days of COVID-19, that there were significant gaps in surveillance.

“The cases we are seeing are just the tip of the iceberg,” he said. “The window has probably closed for us to quickly stop the outbreaks in Europe and the U.S., but it’s not too late to stop monkeypox from causing huge damage to poorer countries without the resources to handle it.”

In the U.S., some experts have speculated that monkeypox might become entrenched there as the newest sexually transmitted disease, with officials estimating that 1.5 million men are at high risk of being infected.

Dr. Placide Mbala, a virologist who directs the global health department at Congo’s Institute of National Biomedical Research, said he hoped any global efforts to stop monkeypox would be equitable. Although countries including Britain, Canada, Germany and the U.S. have ordered millions of vaccine doses, none have gone to Africa.

“The solution needs to be global,” Mbala said, adding that any vaccines sent to Africa would be used to target those at highest risk, like hunters in rural areas.

“Vaccination in the West might help stop the outbreak there, but there will still be cases in Africa,” he said. “Unless the problem is solved here, the risk to the rest of the world will remain.”

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The Director of Medical Services at the Queen Elizabeth Hospital (QEH) has parted ways with the institution while calling for a review of the operating structures that have been in place since the healthcare facility opened almost 58 years ago.

Dr Clyde Cave, who has been associated with the QEH for more than four decades, said on Wednesday that the country’s lone public hospital needs more resources.

“I think, first of all, [there needs to be] recognition that the institution is underresourced and structures which were put in place when we moved in in the 1960s need to be reconsidered and re-resourced.

“And when I say re-resourced, it’s not just finance – although that is part of it too – it’s human resource development. The quality of the doctors encompasses the human and professional side and not just the technical side,” Dr Cave, who declined to renew his contract, told Barbados TODAY as he responded to a question about what improvements he would like to see at the QEH which opened its doors in November 1964.

“I would [also] like to see the caring and bedside manner get a little bit more prominence than it seems to have taken on in recent times,” he further suggested.   

Dr Cave, a consultant paediatrician and neonatologist, explained why he decided to leave the hospital at this time.

“My mandatory retirement was coming up in January and having gotten through the bulk of COVID, it was time for long-range planning and somebody else to take on the responsibility. I figured now would be a good transition for them and certainly a well-deserved rest for me. The contract ended, so I just didn’t renew or extend for the six months to January. I am out of here,” said Dr Cave, who started at the QEH as a medical student in 1978.

The specialist also reflected on his tenure at the hospital, particularly during the height of the COVID-19 pandemic.

“The last two years I wasn’t working as a paediatrician, I was in administration. We all know there were extraordinary times and challenges with COVID across the world. The QEH was no exception, and when called on to help in any way, you respond. I think during that time we were able to stabilise the ship. QEH was the one who responded nationally through our isolation centre and so on. A lot of other countries failed,” he contended.

“Given the situation and our available resources, we did a very good job,” the senior medical practitioner declared.

He pointed out that while the hospital looks to recover from the insults of the COVID-19 pandemic and faces a new viral threat of Monkeypox, there is planning for what comes next.

Looking back at the highlights of his career at the QEH, Dr Cave identified his management of the Neonatal Intensive Care Unit (NICU) as one.

“From the time I took over the NICU, we have seen a dramatic drop in the death rates. And I think that was due to services we implemented when we opened the NICU,” he said.

Dr Cave said that although he has left the QEH, he will continue to teach paediatrics at the University of the West Indies (UWI), Cave Hill Campus, train nurses in paediatrics and human resource development through the Shaw Centre for Paediatric Excellence which he heads, and remain with the World Paediatric Project to share his expertise with other Caribbean neighbours.

He said many children in other parts of the region do not enjoy full health care benefits and with international assistance, they are brought to Barbados and given the necessary care.

“It’s a slowing down, but not a stopping. I will still be running my office,” Dr Cave told Barbados TODAY.

Dr Chaynie Williams is now Acting Director of Medical Services.

(emmanueljoseph@barbadostoday.bb)

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The Caribbean Public Health Agency (CARPHA) has advised against imposing restrictions on people arriving from any country as it closely monitors the spread of the Monkeypox virus.

At the weekend, Barbados confirmed its first case of the virus which has been reported in 63 countries.

Minister of Health and Wellness Ian Gooding-Edghill said a Barbadian man in his 30s who recently flew into the island tested positive for the virus after he presented to the Sir Winston Scott Polyclinic.

Two other Caribbean countries, The Bahamas and Jamaica, have also confirmed cases of the virus.

“CARPHA is monitoring the spread of the monkeypox virus – looking at prevention and control. We have also commenced testing for the Monkeypox virus. At this time, CARPHA does not recommend restrictions on entry of persons from any country,” Executive Director of the Trinidad-based regional health agency Dr Joy St John said on Monday.

“Working alongside our member states, we will support activities and educate the public to protect the health of all within their borders.”

Dr St John urged member states to continue to remain on high alert for the importation of viral or other infections and monitor in-country syndromic surveillance systems for increases in fever and rash illnesses.

“We know that diseases do not recognise borders, and international travel makes us aware that no borders are secure from the threat of diseases, especially infectious ones. At this time, member states are in various stages of easing of restrictions for COVID-19 which severely impacted the region,” the CARPHA boss said.

Dr St John assured that the agency will continue to coordinate public health policy and work closely with member states and other public health partners to respond to public health issues.

“As part of our regional public health management, we provide assistance to member states through the development of tools for investigation and epidemiological monitoring, and personnel are prepared to respond in country to assist in the investigation and control of outbreak, should the need arise,” she said. (BT/PR)

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