Posted March 23, 2020
Government dithers, people act
The situation in Antigua and Barbuda is marked by palpable uncertainty and tension ever since the first confirmed case was announced two weeks ago, and the Antiguan government announced on Friday, March 13 that schools and some other institutions would close. I went to the island’s main supermarket on that afternoon, and have NEVER seen it so crowded and chaotic, not even when Hurricanes Irma and Maria approached. Fistfights broke out over shopping carts and the shelves were emptied of essential items. Friends who went that weekend said the crowds continued, although by the time I went on March 21, the situation seemed to have normalized.
The perspective for the island is rather bleak. The health authorities report 6 quarantines to date (as of 3/18) and one confirmed case. However, I suspect the number of actual infections is much higher. For one thing cruise ships continue to dock at Antiguan ports and airlines to land, bringing tourists from all over the western world, although the government blocked an Italian liner and has halted flights and ships from other countries with major outbreaks. My son and brother and his wife came to visit in early March. My sister-in-law wanted to visit the local tourist shopping area (against my recommendation), which was still frequented by an international host of tourists, although not as crowded as it has been.
It is also possible that the authorities are concealing information. I was shocked to learn last fall that the government had forbidden ministry of health personnel from disclosing a serious Dengue outbreak for fear of scaring off tourists. Moreover, the government announced last week that people who suspect they may be ill should not go to the clinics or hospital, but should call a special hotline, instead. A nurse friend noted that this would lower viral transmission in clinics and hospitals (and, presumably, allow triage of patients to pare down inpatient costs and avoid overload of the facilities’ limited capacity), but it also clearly allows the authorities to control access to information.
For another thing, the health infrastructure is deficient and ill-prepared to deal with this looming disaster, largely due to the politicians’ proclivity to line their pockets with public funds. The most salient problem with respect to C-19 is the lack of testing. Information on the number of tests done is unavailable. The island has sampling kits but no RNA analysis kits, and so must send samples out to Trinidad.
It is telling that a Pan American Health Organization technical commission provided training in coronavirus laboratory testing to eight Caribbean countries in early February. Antigua and Barbuda was not included. The criterion for the training was that the country already had labs set up to do influenza screening. One would think that a densely populated country with a huge influx of tourists would have such a facility.
And the Antiguan Chief Medical Officer finally provided criteria for testing, “in a bid to quell rising confusion and hysteria.” According to the officer, “persons [can be] a suspected case if they have cough, fever, shortness of breath and a travel history.” Only a “suspected case” can be considered for testing. Such a narrow definition would exclude community transmission. It would also exclude weighing in risk factors for mortality, such as cardiovascular disease, diabetes, certain cancers, and, now, digestive symptoms.
There is one major hospital, some community clinics — both under-equipped and understaffed, with poorly paid and badly overworked nurses — and a few expensive private clinics. The country has a “Medical Benefits” program that workers pay into which provides partial coverage for certain conditions. But, for many illnesses, there is no coverage. And given the conditions at the local public hospital and the costs of a private clinic, many people forego medical treatment. The major industry, the tourism industry, pays hotel staff miserable wages and fires them if they take off sick, paid or not.
The country spends about 3.8% of its GDP (2014) on public health, about average for Caribbean nations. It has 38 hospital beds per 10,000 population (2014), which would mean about 380 beds (optimistically — there are 185 at the major local hospital), far fewer than it will need for the potential number of C-19 cases. Under such conditions, assuming coverage, the Medical Benefits scheme would collapse. Many people do not have running water, homelessness is on the rise, and in many places open gutters carry sewage by the sides of roads in towns.
Although the health indices for the island are not horrible for the global south, nor are they great. WHO figures indicate a doubling of diabetes rates since 1980 and high prevalence rates of diabetes (males 10.0%, females 13.6%) and obesity (males 22.8%, females 39.0%), not surprising, since the popular diet consists largely of imported processed and fast foods. Diabetes is a risk factor for coronavirus mortality. The island is small (108 sq miles) and densely populated (about 100,000), a culture medium for C-19.
The threat posed to Antiguans and Barbudans by this pandemic goes way beyond the coronavirus itself. Under the guidance of the local comprador bourgeoisie, Antigua and Barbuda came out of a plantation economy, based on sugar and cotton, only to fall into another one, based on tourism. Thus, the nation is not only subject to the whims and dictates of the tourism industry — including such casino economy byproducts as human trafficking, a risk factor for C-19, in its own right — but is thoroughly dependent on the U.S. for its food supply.
During the course of post-independence “development,” the local oligarchs disdainfully eschewed local agricultural development as “slaves’ work,” in favor of the more lucrative tourism. Antiguans have expressed the concern that when the U.S. decides to completely close its borders, the island will starve, despite the Antiguan and Barbudan government’s belated and superficial current effort to promote home gardening.
It’s also important to note the government’s ongoing effort to impose disaster capitalism on the Barbudan people, eliminating by fiat their treaty right to own the land of their small island in common, and to privatize the land in favor of tourism developers. Under the cover of the C-19 crisis, the government of Prime Minister Gaston Browne has just backed accused billionaire fraudster Peter Virdee’s efforts to claim 987 acres of prime real estate at the expense of dozens of residents, issuing an order for them to vacate their land. This, at a time when even U.S. municipalities are halting evictions and foreclosures.
The government’s response to the pandemic threatens to put a match to the powder-keg and constitutes barely-concealed blackmail. On Monday, according to the Antigua Observer, Prime Minister Browne announced that the country would not close the ports to visitors from the UK and U.S., because, “If we stop flights from outside the UK and the U.S., I would believe that practically all the hotels would have to close. It would mean sending home all the hotel workers; government’s revenue would reduce significantly; we would not be able to manage our payroll and other obligations.”
Thus, Browne — who has his hands up to the neck in the till of tourism and real estate — seeks to avoid taking necessary measures to contain the virus in a pathetic attempt to protect investments and the island’s erroneous development path. And it is pathetic, because the sad fact is that the number of tourists is in decline, as fewer westerners risk travel. Some hotels have already closed down, while others have cut hours and laid off workers.
According to the news report in the Antigua Observer, “while noting that ‘unfortunately,’ there would be more imported cases, Browne suggested that the practical thing to do, at this point, was to manage the risk.”
By “managing the risk,” Browne referred to various social isolation measures, such as recommending limited travel, especially for those over 80, “strengthening capabilities at all ports of entry for these particular visitors, as well as returning nationals,” purchasing testing kits and 20 ventilators, and importing a Cuban drug “which is expected to boost the immune system.” There was no mention of paid sick leave, extending free health coverage for testing and sickness during the pandemic, or assuring that those under quarantine or released from work have access to food, childcare, eldercare, and other necessities.
On the other hand, where the government has made little and belated effort to prepare the island for C-19, the Antiguan people may well be stirring to action (the Barbudans have been stirred to action since Hurricane Irma in 2017). One local climate activist explained,
REAL NEWS — Today. St John’s [the nation’s capital] is like a Ghost Town. Parts of English Harbour [a historic site, port for yachts and center of tourism] continue like a river in Egypt — yet C-19 disturbia is is palpable in both. Realization is setting in that reactive instead of pro active is not the way, it’s taking too long … but getting there. Thankfully restaurants and yachts and tours are starting to close and self sterilize and quarantine without mandatory. Seems government is behind the curve, no panic, keep calm, but “when you clean house you clean all.” Leadership is transferring daily from status quo to the people which is encouraging and makes us safer. Common sense prevails.
Great synergies with the messages of Climate Change. Disaster resistant systems, scalable models. Solar or wind energy, water wells or cisterns, food security, harmony with the land, sea and environment.
Barbuda is the way.
Mike Friedman is a biologist with experience in public health education and epidemiology who has been teaching in an undergraduate program of the American University of Antigua School of Medicine for the past five years.