Health officials are scrambling to stay ahead of the novel coronavirus in the territory, but like their counterparts throughout the United States, they are facing a serious risk that the pandemic will outpace the limited resources available to combat it.
National attempts to slow the spread with “social distancing” are especially important in the Virgin Islands where demographics – and underlying health conditions – make the fight more challenging.
Although in the past week there have been signs that young adults are more at risk than first believed, the most vulnerable are still seen as the elderly and those who have underlying health conditions, and the Virgin Islands has more than its fair share of both categories.
Numerous reports point to an aging population in the territory over the last few years. The Community Needs Assessment, compiled by a University of the Virgin Islands team of researchers and issued a year ago, included information that 39 percent of the population is over 50. In testimony to the Legislature last October, Human Services Assistant Commissioner Michal Rhymer-Browne said data extrapolated from the 2010 census indicates at least 18 percent are over age 65, and the actual percentage is probably higher.
Nationally, six in 10 people have at least one underlying health condition; four in 10 have two or more conditions. Virgin Islanders have significantly higher rates for some of the more common chronic diseases.
The national average for diabetes is 10.5 percent according to the American Diabetes Association. In a Source interview last year, the V.I. Director of Chronic Diseases Kathleen Arnold Lewis put the V.I. rate at between 12 percent and 14 percent. The national rate for asthma is 7.7 percent; the V.I. rate is 10.9 percent. The HIV/AIDS national average infection rate is 320 per 100,000; in the territory it is 618.
Given that COVID-19 affects lung function, it seems logical that it would be a particular threat to asthma sufferers, but Lewis said Friday it’s too early to know if that’s the case. It’s not known whether some chronic diseases are more likely than others to enhance the dangerous effects of the coronavirus.
“It’s hard to say because it’s so new,” she said.
Lewis also said not all chronic illnesses affect a person’s immune system in the same way. And she stressed that if a condition is well managed, it will not necessarily weaken the immune system.
Another factor likely to work against the territory is its high poverty rate, leaving many individuals with very limited resources to face the pandemic. Nationally 14 percent of the population falls below the federal poverty line. In the Virgin Islands, that number is 22 percent. The Community Needs Assessment estimated 30 percent of V.I. residents are without health insurance.
Add to those stresses the territory’s distance from supply lines for medical equipment and medicines and a health care system that is still coping with damages from the 2017 hurricanes.
By the weekend, the Health Department had not replied to questions submitted Thursday concerning the actual status of health care facilities in the territory, such as the numbers of hospital beds, ventilators and other intensive care equipment or the amount of medical personnel.
But as residents are well aware, the health system overall has been struggling. Personnel shortages were so severe that in early 2017 the Virgin Islands was designated a Geographic High Needs Professional Shortage Area by the U.S. Health Resources and Services. After two severe hurricanes hit the territory in September of that year, there was a mass exodus of residents, including an untold number of medical professionals.
It is unclear how many of those professionals have returned or how many of their vacated positions have been refilled.
Meanwhile, restoration of health facilities destroyed by the hurricanes is still ongoing, especially on St. Croix.
According to testimony at budget hearings last summer, the Gov. Juan F. Luis Hospital on St. Croix had 46 in-patient beds and the Schneider Regional Medical Center on St. Thomas had “80 percent” of its 169 beds, or approximately 135 beds. That’s a total of 181 beds. If and when both hospitals are at full capacity, the total number of hospital beds would be 249 – which is still woefully under the number that could be needed.
Current estimates are that in a regional outbreak, 15 percent to 20 percent of those who develop COVID-19 will need hospital intervention. In the case of the Virgin Islands, which has a population a little under 100,000, that means that if just 10 percent of residents are sick at one time, 1,500 of them would be vying for the 249 beds.
Health officials have not commented publicly yet on the practicality of using some hotel facilities to supplement hospital facilities.
But the numbers illustrate why Health officials are urging residents to avoid even small gatherings and stay home as much as possible to try to limit exposure and slow the spread.
Prevention Measures at Health Facilities
Private and public health care facilities are walking an ever-moving line between providing medical care for immediate needs and avoiding increasing the near-future need.
Call the number for Frederiksted Health Care Inc. which operates clinics on St. Croix, and you will be greeted with a recording instructing you not to come in if all you need is a prescription refill.
“We’re trying to actively keep people out of the facilities,” said clinic director Masserae Sprauve-Webster.
FHC and its counterpart on its sister island, the St. Thomas East End Medical Center Inc., are the territory’s two Federally Qualified Health Centers, meaning they are approved to provide treatment for federally sponsored programs. Combined, they serve a regular clientele of about 10,000 people.
Both Sprauve-Webster and Moleto A. Smith Jr., executive director of STEEMC, said they have been implementing precautions for months.
“We follow the guidance of CDC [Centers for Disease Control and Prevention]” Smith said.
All patients coming to the East End clinic are screened outside the facility, which is located in Tutu Park Mall, before they are allowed inside. Once they have answered a few questions and been checked for fever, they are given a card that allows them access to the clinic where they must present both the card and identification.
Smith said waiting rooms are set up in line with CDC recommendations of spacing. That recommendation was six feet apart but was recently lengthened to 10 feet.
“All of our staff have gone through training” on the new protocols, he said.
Sprauve-Webster said the Frederiksted clinic has been handing cases as much as possible over the phone and has been screening those who come into the clinic. Starting this week, it will use wands to take patient’s temperatures and it will institute telemedicine for consultations.
Asked whether clinic staff have sufficient protective gear, Sprauve-Webster said, “A month ago, I would have told you ‘yes’ – even two weeks ago.” But now, she said, “Vendors are rationing orders.” So, while the clinic may ask, say, for six boxes of gloves or face masks, it may receive only two.
Similar measures to limit exposure are in place at hospitals.
Late last week, SRMC issued a release updating its protocols. The hospital has postponed elective, outpatient and non-emergent services. The public is no longer allowed use of non-medical areas inside the hospital such as meeting rooms, the cafeteria and gift shop.
Visiting hours are now limited to between 9 a.m. and 7 p.m., with no more than one visitor per patient and no visitors under age 18.
Everyone must enter through the front lobby where they will be screened for COVID-19.
SRMC’s services at the Myrah Keating Smith Clinic on St. John have been suspended, with few exceptions for existing patients with standing orders. Patients are advised to call 340-776-8311 ext. 6606 with questions.
Public response to restrictions seems to be positive.
“The community and the patients have been very receptive,” Smith said. That’s important, because “this is not something to take lightly.”