The Caribbean has reopened and COVID-19 is spreading

Jacqueline Charles Miami Herald (TNS)
After reopening to international travelers on July 1 amid the COVID-19 pandemic, the Bahamas announced it was temporarily closing to U.S. travelers as of July 22. Days later it reversed the decision but said visitors have to quarantine for 14 days.

After being hit with an "Avoid non-essential travel" warning by the U.S. Centers for Disease Control and Prevention because of the coronavirus, the eastern Caribbean island of St. Lucia recently got some good news: it was moved to the "No Health Warning" list.

"The key here is confidence," St. Lucia Prime Minister Allen Chastanet told the Miami Herald. "Confidence of my nationals; confidence of the persons who work with us and then confidence of the persons who are coming down here on vacation. That's where you have to start: How do we gain that confidence?"

St. Lucia, which has suffered more than $220 million in revenue losses after temporarily shutting down its airspace to visitors on March 23 before reopening in June, stands as the exception rather than the norm in a vast sea of increasing COVID-19 infections sweeping the Caribbean.

Three months after the tourism-dependent region began reopening borders to sun-seeking foreign visitors, a growing number of Caribbean islands are seeing drastic spikes in coronavirus infections and transmission of the disease into new communities.

The Dominican Republic, which leads the region with 106,136 cases and 2,022 deaths, the Bahamas and Jamaica continue to report large daily increases in COVID-19 cases since fully reopening, while less populated territories such as French Guiana, Aruba and the Turks and Caicos Islands are leading the list of confirmed COVID-19 cases per capita.

Even the U.S. territories of Puerto Rico and the U.S. Virgin Islands haven't been immune.

On Friday, the Puerto Rico Department of Health reported that the island had 39,684 total probable and confirmed cases and 599 deaths. Data from the nationally sponsored tracking system showed that from Aug. 1-21, there were 120 coronavirus clusters in the territory with nearly 60 percent of them due to family gatherings that included birthday parties and wakes.

Only 3 percent of all the outbreaks were related to travelers.

Manuel Santiago, an epidemiologist who has worked for the western municipalities of Cabo Rojo and Hormigueros to contain and manage the virus, said cases have gone up in the past week. He expects more increases, he said, following Gov. Wanda Vazquez's recent executive order, which entered into effect on Sept. 12, and reopens more sectors of the economy.

There is even more: In the last two weeks, deaths in Puerto Rico have increased by 111 percent, according to The New York Times COVID-19 tracker. Santiago attributes the spike to long-term patients who were infected in July and early August when cases were at an all-time high, following an opening that was later reversed.

The climbing numbers in the Caribbean come as the Americas region, which includes the United States, Mexico and Canada, recently marked nearly 15 million cases and more than a half million deaths, according to the Pan American Health Organization.

"When people travel between countries, so does the virus," said Dr. Carissa Etienne, the director of PAHO, who continues to voice concerns about countries' failure to control the spread of the virus after reopening. "We are seeing this in the Caribbean, where several countries that had virtually no cases experienced spikes as tourism resumed. This does not come as a surprise but offers an important lesson."

A native of the eastern Caribbean nation of Dominica, which has registered 24 cases and no deaths, Etienne said PAHO is seeing many places within and outside the region applying travel measures with limited impact.

Emphasizing the risk of nonessential travel, Etienne continued to reiterate the World Health Organization's position on pre-departure testing: "Relying on laboratory tests for travelers is expensive, hard to implement and of limited impact in controlling the international spread of the virus."

But with most countries struggling to contain the spread, an increasing number of Caribbean leaders, led by Chastanet, are advocating not only for pre-departure testing but arguing that it should be mandatory for all travelers to help bolster efforts to contain the spread of COVID-19.

"If we didn't have to coexist with COVID, we would just stay on lockdown," said Chastanet. "You can protect a country as much as you want from a health perspective, but given the nature of an island, and our dependence on international trade, you couldn't stay on lockdown forever and we still don't have the financial resources to do so."

Although the alarming spikes have coincided with the reopening of borders, some Caribbean leaders insist visitors are not to be blamed for the increases. The culprits, they say, are locals who are flouting the rules to wear masks and avoid large gatherings.

Acknowledging that Caribbean nations are "highly dependent on the travel and tourism sector," Ralph Gonsalves, the prime minister of St. Vincent and the Grenadines and head of the Caribbean Community regional bloc known as CARICOM, announced Tuesday a safe "Travel Bubble" for countries within the region.

The bubble, he said, would apply to travelers from Caribbean islands with no cases and considered low-risk based on the number of positive cases per 100,000 people in the population within a 14-day period. So far, the countries in the bubble are Antigua and Barbuda, Barbados, Dominica, Grenada, Montserrat, St. Kitts and Nevis, Saint Lucia and St. Vincent and the Grenadines.

Outside of the Travel Bubble, there really are no standardized travel measures in the Caribbean, with different countries adopting different health protocols and testing requirements for visitors and returning nationals.

In some cases measures have been changed and implemented on the fly:

– After fully reopening in July, for example, the Bahamas banned commercial travel from the United States, then reversed itself three days later only to announce a 14-day quarantine for all arrivals into the country amid tightened restrictions and spiking cases that effectively shut down tourism.

The government has targeted Oct. 15 as the date for the country's hotel and beaches to be fully operational, but last week the Bahamas was still posting daily double-digit infection increases in its population of 300,000 residents, which has now seen 3,089 confirmed COVID-19 cases and 69 deaths.

– Recently, after the virus spread to a fifth island in the chain despite a new round of curfews, the Turks and Caicos health ministry announced a 15-day extension of its nightly curfew, domestic travel restrictions and social limitations.

"A policy has also been established that penalizes any person who does not adhere to safety regulations," said Pamela Ewing, director of tourism for the Turks and Caicos Islands Tourist Board. "Entry requirements to the Turks and Caicos Islands remain unchanged as TCI Assured, a comprehensive quality assurance pre-travel program and portal, is already in place. We feel confident new and existing protocols allow us to safely keep borders open while containing COVID-19 within the Turks and Caicos Islands' communities."

– Jamaica, which appeared to have had one of the best reopening plans on paper when it reopened on June 15, also revised its COVID-19 travel protocol several times and now has 4,571 confirmed cases. There are also 22,972 people in home quarantine compared to 13 in government facilities, according to the Ministry of Health and Wellness' website.

"The Jamaicans return home and disregard the protocols while the tourists stay within the Resilience Corridor," Tourism Minister Edmund Bartlett said, referring to the plan, similar to St. Lucia's, that keeps visitors confined to a specific area to better track outbreaks.

Jamaica has also "created an insurance and logistics plan to cover all visitors' health and repatriation to the U.S. destination," he said, "so the visitor will pay for the testing treatment and possible repatriation if seriously ill."

According to Ministry of Health and Wellness, 467 of Jamaica's cases are imported, while 2,900 remain under investigation. Jamaica, which never fully shut down its economy, has also struggled with spread from workplace clusters.

– In Trinidad and Tobago, an increase in cases, along with lack of compliance by those on home quarantine, have led to the Police Service getting involved. The service announced on Thursday that it will start monitoring COVID-19 positive patients to try to curb the spread of the virus, now recorded at 1,905 active cases out of 3,434 total infections.

"It has come to the attention of the TTPS that persons who have tested positive for the virus and placed in home quarantine have been breaking the Public Health Ordinance Regulations," the police said in a release. "There are also reports that some of these patients have been entertaining family and friends at their homes, although they were advised to stay in isolation."

The health authorities said that there are more than 2,100 patients who have been placed in home isolation in the twin-island republic.

But if travelers are not the culprits on some islands, they are nevertheless being tightly monitored on others.

– Effective Thursday, U.S. travelers from Florida and several other "high-risk" states will face tighter testing requirements when traveling to Aruba, where the government on Sept. 17 reported an additional 54 new cases and one death, for a total of 3,328 confirmed cases and 22 deaths in a population of 106,766.

Under the more stringent requirements, high-risk tourists will no longer be allowed to test for COVID-19 upon arrival in Aruba, but will need to come with the result of a COVID-19 molecular polymerase chain reaction (PCR) test that has been taken within 72 hours of their departing flight. In addition, visitors will need to take a second test upon arrival and remain in quarantine until results are in.

– Visitors to the U.S. Virgin Islands will also have to present a negative COVID test if they wish to avoid having to quarantine. In August, the territory's governor announced a one-month pause on leisure travel after cases _ now at more than 1,200 in a population of more than 106,900 _ spiked across the territory two months after it reopened to visitors.

The mandate, which went into effect on Aug. 19 and expired on Saturday, prohibited hotels, Airbnbs and other short-term rentals from accepting any new reservations for 30 days.

"Coexisting with COVID is an important concept to understand because there is no perfect solution. There is no failsafe solution," said Chastanet, who has been taking the lead within the Caribbean community on travel amid the global pandemic and has found support for pre-departure testing in U.S. Virgin Islands Gov. Albert Bryan Jr. "You need to not lament on changes; you have to change. If circumstances change you must change with them."

From July 9 to Sept. 14, visitor arrivals in Saint Lucia totaled 7,258, dropping 92 percent. During the same period last year, it totaled 87,353.

"We took a lot of flak from people saying, 'but you're allowing the tourists to stay in a hotel.' But it was no different than a quarantine. It was just a quarantine vacation," he said. "What we know for the most part is the tourists were adhering to the calls to be pre-tested and going through the proper processes. The problems that we had was our nationals who were returning."

In the case of mountainous St. Lucia, which is home to volcanic beaches and more than 181,800 residents, Chastanet credits the success thus far to a seven-day pretesting requirement for all visitors, and a compulsory 14-day quarantine in a government facility for returning nationals.

"That idea we had where we did not let persons go into home quarantining was a big, big deal," Chastanet said, adding that the cost has been about $1 million a month. "And yes, it cost me money. But I can actually show, 'Here is what it cost me and here is the benefit.'"

Chastanet said a hodgepodge of ineffective measures, ranging from no requirements for a negative COVID-19 to home quarantine measures have also contributed to the spread.

The home quarantine model, he said, was initially used by St. Lucia, Antigua and Barbuda and Jamaica in early June, and turned out to be "a disaster."

"Like in America, there was a massive backlog in doing the testing because (countries) couldn't cope with the numbers, so persons were going home on quarantine," Chastanet told the Miami Herald. "We in St. Lucia realized very quickly that we could not rely on people's integrity, sadly, to home quarantine."

The other credit, he said, goes to the pre-testing requirement.

With the exception of one positive case from someone who returned to St. Lucia using a rapid test, St. Lucia has had no cases of tourists spreading the virus, Chastanet said. The country has registered 27 cases with no deaths.

Pre-testing, he said, should be mandated by all of the airlines, which should work with private-sector companies to set up testing facilities at the airports.

"There was no scenario that we ran that testing people on arrival worked, and it doesn't' take a genius to figure that out," said Chastanet, a former tourism minister. "If you have people who are flying on the plane and only one people or two people test positive, then it contaminates the whole plane."

Equally problematic, he said, is having to call up a tourist at their hotel and say, "I just want to tell you that the guy who was sitting next to you had COVID, so we're going to have to put you in quarantine."

"That's a PR nightmare, and from a customer-service perspective, really a horrible position to put all of us in," Chastanet said. "We knew from the get-go that pre-testing was a requirement."

The dilemma facing the Caribbean's cash-strapped tourism economies is clear, Chastanet said:

"How do we now, with COVID, re-instill the public's confidence for them to want to travel, getting on a plane in which there is no business model in which a plane can operate two-thirds full and financially make it work?" he said. "The same way I go to get my bags wrapped or there is the magazine shop, there should be a kiosk where I go to get my test and it electronically then submits it to the country.

"The responsibility of the airlines collectively should be ... to say, protecting the safety of everybody on our flights, "We think people should be tested before they come on the plane.'"

Chastanet concedes that neither the airlines nor the International Air Transport Association, the trade organization for airlines, has been responsive to a requirement to test for COVID-19 before travel.

In June, after tourists in Antigua balked at the idea of being forced to quarantine after being told they tested positive, IATA spokesman Markus Ruediger told the Herald that airlines have recommended that testing be done before departure to avoid such problems.