The relatively higher death rate for Covid-19 in Trinidad and Tobago is noted with some concern.

As stated earlier, there are several factors that can explain this. This is particularly a susceptible population possibly due to a high prevalence of diabetes and hypertension (and its complications) in an older age group. Couple that with vaccine reluctance and late hospital presentation, and you can see the near-perfect storm.

Treating patients sick with Covid during the second wave of infection in the UK had not only been a daunting task, but gave me much better insight into this elusive new disease that at times clearly did not follow. the standard rules.

For example, luckily the patients you expected to die did not, but unfortunately vice versa.

I can fully appreciate the dedication and selfless work that overworked medical, nursing and auxiliary staff do to provide the best possible care to their patients, which simply cannot be underestimated.

It is safe to say that the quality of care (based largely on a better understanding of the disease) is improving in many countries. I would like to recall some routine practices now implemented in intensive care and high dependency units and used to give rise to a better survival rate for these patients:

1. Use of blood inflammatory markers such as IL6 (a potent association with lung inflammation in Covid) and C-reactive protein to predict which patients should receive early ventilation.

2. Management of patients ventilated in the prone position (lying on their stomach), which may aid oxygenation and postural drainage of the lungs, but which requires adequate staff to help carefully return these very ill patients.

3. Early tracheostomy (after two weeks) has been shown to lead to a slightly better prognosis and is necessary in people requiring medium and long-term ventilation.

4. The use of strong anti-inflammatory drugs such as IL6 blockers plus the addition of Remdesivir with Dexamethasone and blood thinners.

5. The management of multiple organ failure which requires great intensivist skill and attention to detail.

6. A warning note that pulse oximeters (the small device at the fingertip used to monitor oxygen levels in the blood) in people with dark skin can underestimate the oxygen level.

7. The realization that some of these patients benefit from longer term ventilation, but of course, it’s always a balancing act between pressure for ventilatory support and its availability.

I can’t end without a comment that the chief medical officer wants to share his precious time monitoring the Covid crisis and wants to help sell rum. The spirit is mind boggling.

Dr Azad Esack

former consultant neurologist

Eric Williams Medical Sciences Complex

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