COVID-19 and the Comorbidities of Spatial Inequality and Colonial Legacy: Two Caribbean Cases - Jamaica and Trinidad and Tobago

From an historical perspective public space has been subjected to the control of the state. It has been used as a means to control those that are considered as needing to be kept in the proper place and, therefore, to maintain social order. However, public space is often used by those who are marginalized in the society who have limited private space for a variety of functions including making a livelihood, private living necessities, and recreation to name a few. With the rise of the COVID-19 pandemic the use of public space was severely restricted in an attempt to curb the pandemic. However, these restrictions on public space have revealed the ways in which spatial inequality is exacerbated in the Caribbean. This chapter addresses the ways in which emergency space management measures adopted by the state to address COVID-19 affect the use of space amongst the poor and marginalized. Using a thematic analysis of newspaper articles from two main daily periodicals in Trinidad and Tobago and Jamaica, the chapter assesses the ways in which restrictions on public space creates spatial inequality. The chapter shows that the COVID-19 policies that have been enacted in Trinidad and Tobago and Jamaica have resulted in a clear disproportionate burden on the poor and marginalized in these countries. It shows that the use of spatial, particularly public space is multi-dimensional in how it is used and control by different stakeholders. The chapter argues that this is not accidental, but rather part of a larger systemic process that is grounded in the history of coloniality. © The Author(s), under exclusive license to Springer Nature Switzerland AG 2022.

Education experiences of primary school children with no or limited ICT during the COVID-19 pandemic in Trinidad and Tobago

The article investigates the education experiences of primary school students with no or limited information and communication technology during the pandemic in Trinidad and Tobago. Data were collected from sixteen students and a parent or guardian via face-to-face interviews and analysed using constant comparison analysis. To ensure equal and quality education in Trinidad and Tobago, revisions to the public assistance grant, a laptop distribution programme, a sustainable psychosocial outreach programme, and strategies to reduce variation in teaching quality among schools are recommended.

An integrated approach: The use of both methylprednisolone and dexamethasone in the management of COVID-19 acute respiratory distress syndrome (ARDS) in Trinidad and Tobago

Case report Background: With the continued rise of COVID-19 hospitalizations due to variants, breakthrough infections and vaccine hesitancy, current treatment regimens must be evaluated. Corticosteroids (CS) have been shown to decrease mortality in patients who require oxygen, especially those on invasive mechanical ventilation [Pinzo et al. 2021]. Steroids also lower intubation rates and transfer to intensive care units [Ahmad et al. 2021]. Methylprednisolone (MP) and dexamethasone (DEX) have been used for the treatment of COVID-19 patients with varied data on outcomes. Having obtained the patient's consent, the case below aims to highlight the use of both MP and DEX in the management of COVID-19 ARDS. Case: A 61-year- old male with a history of prostate cancer in remission presented with fever for 2 weeks and cough and dyspnoea for 2 days. He denied any gastrointestinal or neurological symptoms. He was unvaccinated to COVID-19 and reported recent exposure. On examination his oxygen saturation was 89% on room air and on auscultation, decreased air entry and crepitations were noted bilaterally. COVID-19 infection was confirmed by a positive nasopharyngeal swab. Lab investigations revealed an elevated C-Reactive Protein (CRP) of 26 mg/L, with a normal leukocyte count and renal function. Chest radiograph showed scattered consolidations bilaterally. A diagnosis of ARDS was made and non-invasive ventilation via dual oxygen therapy was initiated. He was later admitted to the High Dependency Unit (HDU) for continuous positive airway pressure ventilation. A tapering dose of MP was administered starting with a loading dose of 1g intravenously (IV) followed by 250 mg IV daily for 3 days and then 1 mg/kg twice daily until discharged from the HDU. MP was then switched to DEX 8mg IV daily and continued until supplemental oxygen was no longer needed. Serial blood draws noted a gradual decline in the CRP value. He was subsequently discharged and followed up in an outpatient setting. Conclusion(s): Current guidelines recommend fixed dosing regimens of CS in COVID-19 ARDS. This case demonstrates the effectiveness of using tapered MP followed by DEX in the management of COVID-19 ARDS. As such CS should not be a fixed dose regimen but rather tailored to the patient's requirements with dose adjustments guided by supplemental oxygen demand and CRP values. Further research is required on CS potency and dosing in COVID-19 associated pulmonary disease.

Trinidad and Tobago and money laundering control: a country committed to strengthening the link

PurposeIn 2008, the author wrote on the Concept of "Money Laundering Control: The Missing Link in Trinidad and Tobago. Now, approximately two years after that seminal assessment, the author has re-assessed the domestic anti-money laundering (AML) framework, with particular reference to the controls in place to address money laundering (ML) and the confiscation of the proceeds of crime. This paper aims to assess the efficiency and effectiveness of the newly implemented regime and considers whether it meets international standards.Design/methodology/approachThis analysis embraces a pluralist approach. Within this assessment, a case study method is used with contextual qualitative analysis. Empirical data is analyzed and causal connections are linked to the analysis.FindingsThis research highlights catalytic change and creativity in addressing deficiencies within the AML architecture in Trinidad and Tobago. Upon analysis, it is pellucid that a radically altered criminal justice landscape has emerged and a more aggressive and targeted approach to address ML and the confiscation of the proceeds of crime is apparent. The result is a shift in paradigm with tangible outcomes to suggest that the strategies have borne fruit and that the twin island Republic is indeed committed to strengthening the link.Research limitations/implicationsFindings are limited to Trinidad and Tobago and to the period ended April 2020.Originality/valueAs a country with a medium to high ML risk, the possible negative socio-economic effects of ML cannot be underscored. Disruption of ML and the confiscation of the proceeds of crime are, therefore, imperative. This paper considers the progress made in addressing these pertinent issues and assists in assessing the effects of the reformation efforts undertaken by Trinidad and Tobago.

Correlates and Predictors of COVID-19 Vaccine Hesitancy Among Persons Living With HIV in Trinidad and Tobago.

BACKGROUND: Persons living with HIV may be at risk of more severe forms of COVID-19 infection and minimizing health risks largely depends on their acceptance of the COVID-19 vaccinations. OBJECTIVE: This study examined the correlates and predictors of COVID-19 vaccine hesitancy among persons living with HIV in Trinidad and Tobago. METHODS: A cross-sectional survey using a structured interview was conducted. Data were compiled on patient socio-demographics, diagnosed chronic diseases, psychological factors, and decisions to take the COVID-19 vaccine. Pearson χ2 tests examined the associations between study variables and COVID-19 vaccine hesitancy, and multivariable logistic regression analyses examined its predictors. RESULTS: In this study, 84% were virally suppressed, i.e., HIV viral load <1000 copies/ml. COVID-19 vaccine hesitancy was found to be 39%. Univariate analysis showed that higher vaccine hesitancy was significantly associated with females (OR 2.02, 95% CI 1.23-3.33) and patients of mixed ethnicity (OR 1.84, 95% CI 1.07-3.15). In our multivariable analysis, psychological factors namely, confidence in the COVID-19 vaccine (OR 0.16, 95% CI 0.05-0.47), the perceived benefits of the vaccine (OR 0.54, 95% CI 0.37-0.79), and cues to action (OR 0.68, 95% CI 0.47-0.97) were observed as predictors of COVID-19 vaccine hesitancy. CONCLUSION: Psychological factors such as confidence in the COVID-19 vaccine, perceived benefits of the vaccine, and cues to action were possible predictors of COVID-19 vaccine hesitancy. This study underscored the continued need for strategies to increase confidence and knowledge about the benefits of taking the COVID-19 vaccine among persons living with HIV.

Antimicrobial Consumption from 2017 to 2021 in East Trinidad and Tobago: A Study in the English-Speaking Caribbean.

An antimicrobial consumption (AMC) study was performed in Trinidad and Tobago at the Eastern Regional Health Authority (ERHA). A retrospective, cross-sectional survey was conducted from 1 November 2021 to 30 March 2022. Dosage and package types of amoxicillin, azithromycin, co-amoxiclav, cefuroxime, ciprofloxacin, levofloxacin, moxifloxacin, nitrofurantoin and co-trimoxazole were investigated. Consumption was measured using the World Health Organization's Antimicrobial Resistance and Consumption Surveillance System methodology version 1.0, as defined daily doses (DDD) per 1000 population per day (DID). They were also analyzed using the 'Access', 'Watch' and 'Reserve' classifications. In the ERHA, AMC ranged from 6.9 DID to 4.6 DID. With regards to intravenous formulations, the 'Watch' group displayed increased consumption, from 0.160 DID in 2017 to 0.238 DID in 2019, followed by a subsequent drop in consumption with the onset of the COVID-19 pandemic. Oral co-amoxiclav, oral cefuroxime, oral azithromycin and oral co-trimoxazole were the most highly consumed antibiotics. The hospital started off as the higher consumer of antibiotics, but this changed to the community. The consumption of 'Watch' group antibiotics increased from 2017 to 2021, with a drop in consumption of 'Access' antibiotics and at the onset of COVID-19. Consumption of oral azithromycin was higher in 2021 than 2020.

Establishing the Paediatric Neurology Service in a Resource-Limited Country'Trinidad and Tobago

Objective: To discuss the challenges in establishing the paediatric neurology service locally in a resource-limited setting and how we overcame these limitations. Methods/Challenges: (1) Discussion of the service prior to 2020;(2) Training of paediatricians and the local medical board drafted pathway for subspecialty registration;(3) The difficulties in securing posts within the health system (as well as the discrepancies amongst different regions within Trinidad and Tobago);(4) Discussion of a tiered referral system;(5) Limitations in services (including investigations and treatment options);(6) The effects of COVID-19 on a new sub-specialty service. Results/Discussion Points: Prior to 2020, there was no established paediatric neurology service. Changes in local medical board paediatric training from 2020 and the impacts on sub-specialty pathway registration. Discussion on the need for a national service provision due to the discrepancies amongst RHA trained consultants. The development of paediatric epilepsy surgery service within the Caribbean. This would influence the tiered referral system both locally and regionally. The routes for accessing investigations that are not available within the public healthcare setting, including genetic testing. Pathways for accessing treatment on a case-by-case basis. The impact of COVID-19 on service provision'negative and positive aspects. Conclusion(s): With the established local training pathway for paediatrics, as well as opportunities to extend our subspecialty knowledge base in developed countries e.g. UK, Canada, we can improve the services provided. Despite being an independent nation, we are grateful to our Commonwealth leaders for continuing to guide our professional tutelage.

A Bibliometric Analysis of COVID-19 Scientific Literature From the English-Speaking Caribbean.

The COVID-19 pandemic has led to a global crisis and has affected the Caribbean islands, leading to significant health and socioeconomic consequences in this region. Efforts to mitigate the burden of this disease have led to an accelerated amount of research in the English-speaking Caribbean (ESC). This bibliometric analysis aimed to evaluate the COVID-19-related scientific literature from the ESC nations. A total of 175 articles were included and analyzed from an initial PubMed search (n = 638) for COVID-19-related scientific literature from the ESC nations published between January 1, 2020, and June 30, 2022. Microsoft Excel 2016 (Microsoft Corporation, Redmond, Washington) and the VOSviewer (version 1.6.18) were used to characterize countries, authorship, journals, affiliations, and keywords of the COVID-19-related articles. Trinidad and Tobago (38%), Jamaica (22%), Barbados (20%), and Grenada (15%) contributed to the greatest number of publications. The University of the West Indies (UWI) campuses in Trinidad and Tobago, Jamaica and Barbados, and St. George's University in Grenada were the most prolific institutions. Srikanth Umakanthan from the UWI was the most prolific author. Cureus, SN Comprehensive Clinical Medicine, and Frontiers in Public Health were the first three most productive journals; 59% of the 175 articles had either the first or last author affiliated with an institution in the ESC, and 19% of the articles were country-focused: Trinidad and Tobago (16/175), Jamaica (9/175), Barbados (5/175), and Antigua and Barbuda (2/175). Among the top themes of research, 27% were outbreak response and rearrangements, epidemiological studies (23%), clinical management (23%), and medical education (13%). Over the last two years, an interest stimulated by the pandemic has expanded the research in ESC countries. However, gaps in the knowledge exist, especially in the epidemiology of COVID-19 complications in the sub-populations of chronic non-communicable diseases, post-COVID syndrome, and the long-COVID syndrome in the region. Hence, there is enormous scope for more research across the region.

The Trinidad and Tobago Covid-19 Domestic Violence Victimization and Perpetration Study.

Purpose: While there is available scholarship in the Global North on DV victimization and perpetration during the COVID-19 pandemic, there is a dearth of similar scholarship in the Global South. With this in mind, the Trinidad and Tobago COVID-19 Domestic Violence Victimization and Perpetration study was conducted in an attempt to fill that void. Method: An online questionnaire containing a qualitative component was used to gather data aimed at determining whether DV victimization and perpetration had increased during the COVID-19 pandemic as well as possible contributory factors. Participants were 602 married or cohabiting adult citizens in Trinidad and Tobago. Results: The results indicated that overall there was an increase in DV perpetration (13%) as well as an increase in DV victimization (16%) among the sampled population. The results also indicated that males (17%) and females (13%) in the sample engaged in increased levels of DV perpetration, while males (25%) and females (12%) were victims of increased DV victimization. Six themes emanated from the qualitative component of the study, namely: isolation/Covid-19 restrictions, lack of assistance for victims, male fear of reporting DV, work as a safe space, mental health effects and job loss. Conclusion: The findings revealed increased DV perpetration and victimization among the study's participants. These findings have implications for policymakers in Trinidad and Tobago.

Laboratory predictors for COVID-19 Intensive Care Unit admissions in Trinidad and Tobago.

Understanding symptoms associated with COVID-19 cases requiring intensive care unit(ICU) attention is important in management of the life-threatening cases of the disease. This study aimed to determine laboratory indicators of ICU admission for COVID-19 patients. For this retrospective chart review study, data from 116 patients(ICU, n = 18, Non-ICU, n = 98) with confirmed SARS-CoV-2, managed at two hospitals in Trinidad and Tobago, from March 12th to April 12th 2020, were analyzed. The median age of non-ICU patients was 59.0(IQR = 23.5) years; ICU patients had a median age of 62.5(IR = 17.5). From univariate analysis, laboratory indicators significantly associated with ICU admission included WBC(P = 0.037), lymphocyte(P = 0.016), LDH(P = 0.002), AST(P = 0.005) and CRP(P = 0.0001). However, multivariate analysis including WBC, neutrophil, lymphocyte, PLT, AST, LDH, ALT and CRP indicated that only AST was associated with high odds of ICU admission(OR 0.002, 95% CI 0.000-0.004, P = 0.017). Statistically significant AUC were obtained for neutrophil(AUC = 0.704, P = 0.007), CRP (AUC = 0.81, p = 0.00) and LDH(AUC = 0.766, P = 0.00) and AST (AUC = 0.729, P = 0.003). The findings indicate that neutrophils, AST and LDH's ROC curves are good tests, CRP curve is a very good test, but lymphocyte curve is a poor test, in determining COVID-19 patients for ICU admission. Neutrophil, AST, LDH and CRP are suitable predictors of COVID-19 patients that should receive intensive unit care. The study provides significant insights into laboratory parameters that can be used to predict COVID-19 severity and important considerations for healthcare providers in making evidence-based decisions regarding COVID-19 patient management, especially in the context of limited ICU facilities. This study was not funded.

The Impact of COVID-19 on the Functioning of a Neurosurgical Service at a Tertiary Institute in a Low-Resource Setting.

Objective During the COVID-19 pandemic, certain precautionary measures were implemented to limit its effect, including the cancellation of clinics and elective surgical lists. To determine the impact, if any, of the pandemic on the running of a neurosurgical service, an audit was performed on the volume of referrals, admissions and type of surgeries performed at a tertiary institute in a low-resource setting. Methods An audit of the neurosurgical department's database was performed on the number of referrals, admissions, surgical procedures, and types of procedures done at the San Fernando General Hospital. This was divided into two 15-month periods, pre-pandemic (January 1, 2019 to March 31, 2020) and intra-pandemic (April 1, 2020 - June 30, 2021). Results During the pre-pandemic period (January 1, 2019 - March 31, 2020), 2,597 patients were referred to the service and 309 major procedures were performed. Two thousand and forty-two patients were referred during the intra-pandemic (April 4, 2020 - June 30, 2021) period, with 354 surgeries performed. More external ventricular drains (29 vs 50), craniotomies for trauma (73 vs 98), anterior cervical fusion (42 vs 47), lumbar fusions (9 vs 12), ventriculo-peritoneal shunts (16 vs 19) and aneurysm clipping (10 vs 13) were done during the intra-pandemic period. Conclusion Although elective surgical procedures and clinics were reduced, the number of patients seen and total procedures performed did not vary significantly. The neurosurgical pathology encountered remained constant during the pandemic. This shows the importance of maintaining a fully functional neurosurgical service, as we continue to adapt to the COVID-19 pandemic.

Issues challenging food security goals in the era of disruptive change and opportunities to revisit extension education strategies. (Special Issue: Journal of international agricultural and extension education.)

This study examined the challenges to the achievement of food security goals and the role of Extension Advisory Services (EAS) at a time when the world is faced with the double burden of an immediate pandemic in the midst of ongoing climate change events. EAS have always played vital roles in past emergencies around the world and are being challenged to respond timely and appropriately in these times. The purpose of this paper was to (i) describe the impacts of disruptive changes on food systems across the world, (ii) present key agricultural education and extension responses to such changes and (iii) make recommendations to strengthen EAS responses. There was a focus on Covid-19 and climate change as disruptive changes. An internet-mediated approach to source information and a review of published literature were used to gather information. Results detailed the several impacts of Covid-19 and climate change in seven regions of the world, the impacts of both disruptive events on the four pillars of food security, and some global responses in the areas of agricultural education and extension to meet present challenges. Recommendations included the strengthening and deepening of collaboration of all extension service providers at country level to ensure coordinated responses, building stronger community resilience and extension research directed to assist the reengineering of extension organizations in terms of structure, leadership and management.

Knowledge, attitude, and practice toward COVID-19 in Trinidad and Tobago

Background: Severe Acute Respiratory Syndrome Coronavirus 2 (COVID-19) has affected over 250 million people globally and resulted in over 5 million deaths since it was first reported in November 2019.

Knowledge, Attitudes and Practices (KAP) regarding the Novel Coronavirus Disease (COVID-19) Post-lockdown in Trinidad and Tobago.

The Novel Coronavirus Disease (COVID-19) was declared a pandemic by the World Health Organization (WHO) in March 2020. Trinidad and Tobago reported its first infection on March 12th 2020. This study assessed knowledge, attitudes and practices toward COVID-19 among Trinidadians during the post-lockdown period. A validated questionnaire was used to conduct a cross-sectional survey from May 25th to June 6th 2020.Most respondents (512, 96.6%) knew that COVID-19 is highly infectious. Many (523, 98.7%) identified vulnerable groups as persons 65 years and older and those with preexisting co-morbidities (480, 90.6%). Respondents identified COVID-19 symptoms as fever (498, 94.0%), dry cough (495, 93.4%), myalgia (403, 76.0%) and sore throat (441, 83.2%). Most 504 (95.1%) acknowledged that COVID-19 threatened the country's economy. Dominant practices included regular hand washing (97.2%) and social distancing (512, 96.6%).Health authorities should continue public education efforts to increase knowledge and the adoption of recommended practices.

COVID-19 and its effects upon orthopaedic surgery: The Trinidad and Tobago experience.

The World Health Organisation (WHO) declared coronavirus disease 2019 (COVID-19) a pandemic on March 11, 2020. COVID-19 is not the first infectious disease to affect Trinidad and Tobago. The country has faced outbreaks of both Chikungunya and Zika virus in 2014 and 2016 respectively. The viral pandemic is predicted to have a significant impact upon all countries, but the healthcare services in a developing country are especially vulnerable. The Government of Trinidad and Tobago swiftly established a parallel healthcare system to isolate and treat suspected and confirmed cases of COVID-19. Strick 'lockdown' orders, office closures, social distancing and face mask usage recommendation were implemented following advice from the WHO. This approach has seen Trinidad and Tobago emerge from the second wave of infections, with the most recent Oxford COVID-19 Government Response Tracker report indicating a favourable risk of openness index for the country. The effects of the pandemic on the orthopaedic services in the public and private healthcare systems show significant differences. Constrained by shortages in personal protective equipment and inadequate testing facilities, the public system moved into emergency mode prioritizing the care of urgent and critical cases. Private healthcare driven more by economic considerations, quickly instituted widespread safety measures to ensure that the clinics remained open and elective surgery was not interrupted. Orthopaedic teaching at The University of the West Indies was quickly migrated to an online platform to facilitate both medical students and residents. The Caribbean Association of Orthopedic Surgeons through its frequent virtual meetings provided a forum for continuing education and social interaction amongst colleagues. The pandemic has disrupted our daily routines leading to unparalleled changes to our lives and livelihoods. Many of these changes will remain long after the pandemic is over, permanently transforming the practice of orthopaedics.