Beating an epidemic with speed
Trinidad & Tobago is a small country led by a volcanologist that recently managed to wrestle their active COVID-19 cases down to one. The secret to their success is widely available to everyone on Earth.
No matter how small or under-resourced you are, if you act early and act fast, that gives you massive leverage over a pandemic.
The basic epidemiological playbook is not complicated or new. Test/trace/isolate has been the mantra for hundreds of years, with the only major advance being PCR testing rather than just eyeballing the sick. If you catch and quarantine any epidemic early enough, you can get it down.
That’s what Trinidad and Tobago did.
The key insight here is when they did it. Unlike ‘developed’ countries that waited until there were thousands of cases, Trinidad and Tobago reacted fast. This gave them — a small, under-resourced nation — a massive amount of leverage.
They got the same WHO advice as everybody, including America. They just listened to it. When the local WHO body offered reagents and knowledge, they took it. And so they were ready.
On 10 February the Caribbean Public Health Agency (CARPHA) in Trinidad and Tobago informed that its laboratory is ready to respond to the new coronavirus. (Pan American Health Organization / WHO)
Note that Trinidad and Tobago (and the region) was ready well before the American CDC. As you can see, a test in time is worth nine million.
Trinidad & Tobago still hasn’t tested much per capita (about 2,000 people out of 1.36 million), but they did it early. This gave them leverage. They were able to take a little and make a big impact.
That’s the power of when.
Regardless, Trinidad and Tobago still had to go into lockdown. Mass-testing countries like Korea and Taiwan could stay open, but most of us don’t have that luxury. We have to lockdown. All we can choose is when. The longer we wait, the more expensive it is. The longer we debate and complain, the worse it gets.
Trinidad and Tobago started shutting down one day after the first confirmed case. That’s leverage again. A stitch in time.
On March 12th, Trinidad and Tobago announced its first case of COVID-19, a returnee from Switzerland. He had returned on March 9th and gone into self-isolation, but they didn’t know what else was out there.
This is the important part.
Other countries wasted time dithering, running computer models, debating how much they cared about old people. Trinidad and Tobago didn’t do that.
The next day — March 13th — cruise season was suspended and people were advised to socially distance. Gradually, lockdown had begun. With a week schools were closed. Within 10 days all ports of entry were shut.
By acting early, Trinidad and Tobago saved lives (and money). The west got to these policies eventually, but by then it was too late. They had no chance of suppression and were merely fighting for their lives. Their criminally stupid governments missed the massive power of when. That’s something they need to learn from humble places like Trinidad and Tobago. It’s a lesson to us all.
On March 23rd, Prime Minister Dr. Keith Rowley (a geochemist by training) announced expanded testing and aggressive economic support, including over $2,000 USD in direct cash assistance over three months (including rent and food). Note that announced is the keyword here, I don’t know how widely or effectively it’s been disbursed.
This was still the right policy at the right time — early. Western countries have debated supporting their citizens, but the longer they wait the more expensive it gets. Their bailouts now cost trillions, and don’t even work.
By acting early, Trinidad and Tobago didn't just save lives, they saved significant amounts of money.
On March 26th, Trinidad and Tobago went into lockdown with just 66 confirmed cases. Think about that. When the UK went into lockdown on the very same day, they had 60 cases every five minutes.
Again, Trinidad and Tobago’s secret weapon was just sitting there on the wall, visible to all. Time. They went into lockdown at the right time, which enabled them to chase complete suppression.
And it worked.
Trinidad and Tobago’s confirmed cases peaked at 116. They were able to effectively do contact tracing on this number and it didn’t strain their medical system. As of today, active cases are down to one. The number of tragic deaths (8) would suggest some unconfirmed, so they must remain vigilant and keep testing, but it’s still an achievement.
None of this was luck. It wasn’t because they’re an island, or because it’s hot. They had 40 infected people get off a boat on March 21st. If they weren’t on high alert they would have gotten hammered. But thankfully, they were.
Trinidad and Tobago’s secret weapon isn’t that secret. It’s probably sitting on your wrist. They just acted in time.
As of today (May 14th), Trinidad and Tobago’s active cases are down to one. As I’ve said before, true leadership is getting to zero. Not a few, not excuses. Zero. They’re almost there.
Days 60 - a long time
This, however, was just the first innings. The first wave. COVID-19 is relentless. Just one missed case can trigger another outbreak, and another lockdown, and more pain.
Therefore — even though Trinidad and Tobago is nearly clear — they’re still in lockdown, and they’re only releasing very slowly. Again, this is pretty standard epidemiological advice. Be careful.
Western countries are exiting lockdown ruinously early because people want haircuts, or miss the pub. This is dumb. Trinidad and Tobago is only talking about opening up malls and beaches months from now, because they’re smart.
On May 9th, PM Dr. Rowley announced a six-phase reopening plan, which stretches on forever, and isn’t based on political dates. The last phases don’t have dates at all, because the virus eats dates for iftar.
Dr Rowley said the adjustments will take place on a phased basis. Each phase will be determined by the results from the COVID-19 Community testing and monitoring done by the Ministry of Health. (PM’s Office)
They’re letting testing and science determine their reopening, not politics and impatience. This is textbook epidemiology, which is just listening to the epidemiologists. It’s also good politics, because you're less likely to have a relapse and lose all your gains.
None of this is rocket science. They’re just executing well.
The Key Lesson: When
This is why we can learn a lot from Trinidad and Tobago. Because they didn’t do anything crazy, unusual, or new. They just took the standard playbook and executed it quickly. Given that spacetime is pretty constant across the universe, this is something any of us could do.
Indeed, many countries did. The western media is so flooded with western failure that we miss this. Hell, I’ve missed it, but there are a lot of success stories out there. I’ll try to cover more neglected global leaders in future articles — but for now, I’ll leave you with one lesson.
Move fast. Like the fearsome Windies cricket teams of the 70s and 80s, Trinidad and Tobago didn’t bowl anything fancy at COVID-19, they just bowled fast, and that has made all the difference.
Why am I, a random Sri Lankan, talking about Trinidad and Tobago? Well, their citizens recently gave me a good scolding.
I wrote a piece talking about how white people were ignoring Asian leadership, and they pointed out that I was ignoring the Caribbean, and Africa, and everywhere else. I did some reading, and they were right.
So based on that, I edited that post and have written this. Note that T&T is not an ideal state or anything, their opposition has a lot of complaints. I’m sure they can do better, but I’m not getting into that here. I’m just noting that they’re not dead.
I must also note that a few people mailed to say that even months in they’re stranded abroad and waiting for repatriation. They are stuck and I quote “Every day hanging on the TT government’s daily media announcement like soap opera junkies waiting on the next episode.” As with the Sri Lankans stuck abroad, I hope everything is done to bring them home soon.
Finally, I’m not trying to exclude other West Indian or Caribbean nations. This is just what I fit within this word count. And this is just one region. I’m working on adding more underdog stories over time. Please feel free to blow up my inbox (firstname.lastname@example.org) but don’t yell.
Stay healthy, and good luck.