Six months have passed since the first two cases of Covid-19 were announced in the Virgin Islands on March 25, and government decisions to control the virus have been met with near-constant debate as movement restrictions have devastated businesses and left thousands of residents unemployed.
The number of confirmed Covid-19 cases climbed slowly to eight in spring, then plateaued for 75 days before surging to 71 in the past two months. But through it all, one constant has remained: uncertainty.
“It’s like a duck paddling where we’re moving continually,” BVI Health Services Authority CEO Dr. Ronald Georges told the Beacon. “I think a lot of challenges we’ve had to come up with solutions.”
Today, however, Dr. Georges believes the territory has a strong understanding of its position.
“Whereas many countries are only seeing the tip of the iceberg, I think we’re seeing most of the iceberg,” he said.
In spite of the recent surge in cases, strict public health measures here have helped control the VI outbreak as the global number of confirmed cases has exceeded 33 million — roughly 0.4 percent of the world’s population — across 213 countries and territories.
But for many residents — including some who lost jobs because of the economic shutdown — the recently announced tourism reopening on Dec. 1 can’t come soon enough, and more information is needed urgently, said Keiyia George, executive director of the BVI Chamber of Commerce and Hotel Association.
“Businesses are still asking for the plans, because those that are making reservations are asking what the protocols are,” she said. “That’s where they are right now, where they can’t answer that. That makes it hard for those who want to visit to keep hope or confidence in the Virgin Islands.”
Start of the outbreak
It was in November when patient zero contracted a new strain of a severe acute respiratory syndrome coronavirus, SARS-CoV-2, scientists believe. The highly infectious disease was first identified in December in Wuhan, China, and it quickly spread.
In the VI, Dr. Georges recalled, preparations began early.
“I think it was January or February that we started hearing about the Wuhan virus,” he said. “Once the first set of cases came out of China, we got very interested and concerned. Along those times, there were some meetings in government as well, long before it came out in the public.”
In those early weeks, he said, officials expected that a Covid-19 outbreak in the VI would be much worse than what has actually played out since then, and their “planning assumptions were for more severe outcomes health-wise.”
On Jan. 24, the government released a statement informing residents that officials at the Ministry of Health and Social Development “have begun collaborating with local, regional, and international health agencies as a precautionary measure against the coronavirus.”
At that time, there were 846 confirmed cases and 25 deaths across seven countries including China, Japan, Thailand, Korea, Macao, Taiwan and the US, while the United Kingdom, Australia, Russia, and Saudi Arabia were testing suspected cases. As a result, China placed three cities under lockdown.
By Jan. 28, the number of global cases had increased to 2,798 including 80 deaths, and Health and Social Development Minister Carvin Malone announced the activation of the Quarantine Authority, which includes consultation with more than a dozen government agencies.
In addition, Mr. Malone said communication with air and seaport authorities from other island nations also ramped up to “determine if adequate protocols are being practised … so as to avoid the occurrence of transmission or delivery to our shores.”
On Jan. 30, the World Health Organization declared coronavirus a public health emergency, which is defined as “an extraordinary event which is determined … a public health risk to other states through the international spread of disease and to potentially require a coordinated international response.”
VI officials released a statement the next day, informing residents that the Ministry of Health and Social Development was working with the Caribbean Public Health Agency, the Pan American Health Organisation, and Public Health England to determine the “best local response in the safety of the territory.”
Meanwhile, residents were urged to continue practising proper hygiene, including keeping objects and surfaces clean and sanitised.
Travel restrictions
On Feb. 2, the VI issued a travel advisory for high-risk areas including China, South Korea, Italy, and Iran. The advisory asked that all non-essential travel be limited, and that people who develop any symptoms after visiting the affected areas seek medical attention.
For most of the month, travel in and out of the territory remained largely unrestricted. Cruise ships continued to operate as usual, as did airports.
On Feb. 14, officials reassured the public that a cruise ship clearance protocol was being practised that required each ship to submit a Maritime Declaration of Health, a Ship Sanitation Control Certificate, a passenger and crew list, and other relevant documents 12 to 24 hours prior to docking in the territory.
The Florida-Caribbean Cruise Association said the industry was conducting pre-boarding health screenings of all passengers, increasing surveillance of flu-like symptoms, increasing sanitation measures, and conducting temperature scans of all crewmembers.
On Feb. 26, the cruise ship Costa Favolosa, which is operated by the Italy-based Costa Cruises, was turned away from the VI after officials received reports of sick passengers who tested positive for Influenza A virus. Testing capability for Covid-19 wasn’t available on the ship.
Four days later, the first known case of coronavirus was confirmed in the Caribbean when a tourist from Italy tested positive after being transferred to an isolation room in a military hospital in the Dominican Republic, according to Reuters.
But the Costa Favolosa was allowed to dock again in the territory on March 11, the same day that the WHO declared coronavirus a pandemic. Three days later, two of the ship’s passengers tested positive for Covid-19 in Martinique. On the same day, March 14, the territory closed all cruise ports.
Meanwhile, news trickled out about Covid-19 cases among passengers from two other ships that had visited Road Town in late February and early March: Costa Magica and Braemar.
Cruise lines have since suspended operations to mitigate the spread of the virus, though Royal Caribbean and others have announced plans to resume operations starting Nov. 1.
Response measures
In the VI, the first line of defence officials addressed was the borders. Border personnel were informed and trained about preventive and control measures as early as mid-February. Meetings with ferry operators, freight companies, yachting companies, and taxi drivers also took place at the end of February and throughout March.
Ferry operators were asked to increase their sanitisation and to inform officials of any sick passengers prior to entering the territory.
As the WHO declared a pandemic, the territory began to shut down on March 11, starting with the airports on Anegada and Virgin Gorda. In the following days, ports and schools were closed, and visitors were restricted from elderly homes and prisons.
On March 25, the first two confirmed cases in the VI were announced by Premier Andrew Fahie, Governor Gus Jaspert, and Mr. Malone, along with a 24-hour lockdown for six days starting March 27.
At the time, 27 people were tested and 107 people who recently travelled were placed in self-quarantine for 14 days. Globally, the virus had reached 372,757 confirmed cases.
Supply concerns
Though the strict response measures helped keep new cases from entering through the borders when the virus first hit, a major underlying issue was ominous: a lack of supplies.
“At that time, personal protective equipment was a very big concern, and disruption to supply chains,” Dr. Georges said. “We started making requests for funding and reaching out to supply chains. It was a concern then because prices are sky-rocketing and we were hearing about consumption and blockades.”
The territory still faces such issues, Dr. Georges said, but the fear of not having enough supplies like personal protective equipment, masks and gloves is no longer the most pressing concern.
Other parts of the world faced similar issues. Dr. Lakshman Swamy, a pulmonologist as Boston Medical Center, said the uncertainty of materials needed to fight the outbreak coupled with a limited understanding of how the virus spreads led to extreme measures.
“We were really ignorant in the spring,” he said. “We had to go to extremes because we didn’t understand how the virus might be spreading.”
More cases
In the VI, a third case was confirmed on March 30, and the 24-hour lockdown was extended through most of April, with residents allowed out on two occasions to access essential goods and services.
Government tried to control the resulting shopping craze by allowing residents to shop by surname alphabetically on certain days, but crowds overwhelmed many grocery stores and other businesses.
Around the time the second curfew period ended on April 18, another two cases were announced, including the first Covid-19 death, and the 24-hour curfew was extended again. Government tried again to control the shopping craze by allowing residents from certain districts to access essential services on certain days.
Other adjustments were necessary during this period as well. A house-to-house waste collection programme began on April 3, a government food-delivery programme began after April 18, and grocery stores were allowed to deliver toward the end of the month.
This week Dr. Heskith Vanterpool, owner of Bougainvillea Clinic and Eureka Medical Centre, agreed that the initial lockdown was a strict measure, but said it was “as it should be.”
“The experts advised us that this was necessary,” he said. “It felt quite restrictive, but we know we were being restricted for the overall health of the community. I think not only has the government done an excellent job, but the people of the territory have been very cooperative in general.”
‘Soft reopening’
It wasn’t until April 27 that the government allowed a “soft” internal re-opening for essential businesses with curfew hours in place between 1 p.m. and 6 a.m. for two weeks. Though another case was confirmed during this time, curfew hours were shortened between 7 p.m. and 6 a.m. beginning May 10. Four days later, an eighth case was confirmed.
However, between May 14 and Aug. 1, for a period of 75 days, no new cases were confirmed in the territory.
During this time, the health sector continued its ongoing work to beef up its capabilities for testing and treatment.
Mr. Malone announced $12 million allocated from government funds to go into the health sector in the fight against Covid-19. This money funded projects including the construction of an isolation ward, retrofitting of government offices, equipment, and ventilators.
Where at first all testing samples had to be sent to CARPHA for confirmation, the territory built its own laboratory, enabling tests to be completed locally.
No mass testing yet
So far, 4,841 people havebeen tested in the territory, andthe VI has around 4,000 moretest kits from a range of suppliers including Public Health England, Dr. Georges said. A request for 20,000 test kits hasn’t been fulfilled yet, headded, and mass testing is still out of reach.
“Supply chains continue tobe an issue, as demands for different things increase,” Dr.Georges explained. “We’ve hadsome price gouging. We’ve also had issues with availability. We had a situation where a couple major suppliers in the US had coronavirus in their businesses,so they were out of commission for two weeks. Looking for other accredited suppliers also became a challenge.”
Some specialised hospital equipment can’t be maintained without authorised service agents who have to be flown into the territory, Dr. Georges added.
“Maintaining those things and getting techs from overseas has been very challenging,” headded. “The other issue, as you know, we had some construction happening at the hospital. Again with all the lockdowns and curfews, it’s been challenging to keep those projects going in a timely manner.”
Reopening
By the end of May, authorities decided to open the borders to nationals andpermanent residents startingon June 2.
Strict protocols were put inplace. Those abroad had toapply to get in, and they weretemperature screened upon arrival and tested after 14 days of quarantine. Government-funded quarantine became available on June 15 and at least $1 million was allotted towards hotels and villas for accommodations.
Restrictions on businesses also continued to ease during this time, as more businesses were allowed to operate with safety measures in place. Curfew hours also shortened during June and July.
Reports of a Jost Van Dyke resident testing positive after travelling to St. Vincent and the Grenadines sparked a 24-hour lockdown of the island on July 21, and eventually 335 people were tested as a result. With all the results returning negative, the lockdown was revoked four days later.
Despite another confirmed case on Aug. 1, curfew lifted entirely on Aug. 14. Then the situation dramatically changed.
Within one week, 12 new cases were detected, and another curfew order effectively shut down most businesses as the territory battled with its highest number of active cases since the pandemic started.
“We probably relaxed our guard a little bit too much,” Dr. Vanterpool said. “Maybe we weren’t guarding the borders between the USVI and here as vigilant as we should have.”
Contact tracing teams detected 45 cases in less than a month, but the last announcement of new cases was on Sept. 18. As of Tuesday, there were three known active cases and 67 recoveries, government said.
Tourists welcome
In the midst of the surge, government began allowing expatriates back into the territory starting on Sept. 1, and on Sept. 21 officials announced that tourists would be welcome starting on Dec. 1.
However, a comprehensive plan for the tourism re-opening hasn’t been announced.
“We don’t know what the government is thinking,” Dr. Vanterpool said. “It seems to me that [the re-opening plan] is a fairly closely kept secret.”
Dr. Vanterpool recommended mass testing for all people who come in, and suggested monitoring tourists for seven days.
“It’s a difficult situation and I don’t know what the correct answer is,” he said. “Our tourism is primarily water-based and most tourists are not mixing with the local population too much except when they come in and go out.”
If the VI can find a safe way to work with the tourists, he said, it would benefit the territory greatly.
“We are gradually opening up and we are doing it as slowly, but fairly, safely, thus far,” he said.