Different problems, different solutions in COVID-19 response in the Caribbean part of the Kingdom

In the Caribbean part of the Kingdom of the Netherlands, the local authorities are working hard to combat the coronavirus outbreak. RIVMNational Institute for Public Health and the Environment provides support in the form of knowledge and advice, testing equipment, and whatever else is needed.

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The small-scale context of the islands makes it difficult to organise the control of infectious diseases. Expertise is often scarce, since it is difficult to bring highly educated professionals to the islands and keep them here. There are no academic hospitals there, of course; that is not cost-effective since fewer people live there. The expertise that is available is more than sufficient. The laboratories and public health services have the same high standards as here; only the scale is different.

Hans van den Kerkhof coordinates and advises on infectious disease control in the Caribbean part of the Kingdom, operating from the National Coordination Centre for Communicable Disease Control (LCI) at RIVMNational Institute for Public Health and the Environment . Obviously, the emphasis in this period is on controlling COVID-19.

Requirements from the WHO

The World Health Organization (WHO) has established a framework for handling “public health emergencies of international concern”, including situations involving infectious diseases. All WHO countries must comply with this overarching legal framework, known as the International Health Regulations (IHR). These regulations set out requirements for such aspects as tracing, epidemiology and how the public health response is structured. The Centre for Infectious Disease Control at RIVMNational Institute for Public Health and the Environment supports the Caribbean part of the Kingdom in meeting all those requirements. “Where things are tight, we try to provide support,” as Van den Kerkhof describes it.

We sent equipment to Saba and St Eustatius, so the small islands can run tests too

 

 

Familiar faces

This is not the first time that Hans van den Kerkhof and his colleagues are offering support in the Caribbean Netherlands. “We’ve been coming there for a while now. We also offered help and advice for chikungunya fever, zika fever and the preparations for ebola. Also, we meet once a year on one of the islands to discuss all the issues during a conference with local colleagues. Our cooperation stands or falls based on personal contact and familiarity with the local circumstances in the region. That is why we are assigned to the same project for a longer period of time. Dorothee Rosskamp, Marieta Braks, Johan Reimerink and I are familiar faces there.”

 

Photo: local colleagues and RIVM staff on the island of Sint Maarten. Clearly, the photo was taken before the COVID-19 pandemic.

 

Testing equipment

“We help out if new diseases or problems arise. With zika, for example, an RIVM laboratory set up the tests. And now, with COVID-19, we provided support in setting up tests, and we made sure that molecular testing equipment was sent. We sent equipment to Saba and St Eustatius, so the small islands can run tests too. Otherwise the samples would first have to be transported to another island by plane to be tested there, with all the added expense and delay that involves.”

COVID-19 introduced through tourists

When the novel coronavirus first emerged, the goal was clear: keeping the virus away from the islands, Van den Kerkhof explains. That was reasonably easy, precisely because they are islands. A strict lockdown was implemented. However, many people on the islands earn their living from tourism, so a lockdown could not be maintained indefinitely. The economy runs on tourism. The islands’ food supply also depends on imports. “Numbers were low during the summer, but the islands still opened up to tourists,” Van den Kerkhof says. “We knew: when they open up, the virus will be introduced. And that was the case; the number of infections increased from August on. There was a very sharp increase on Aruba at first, but it did subside later due to intensive control measures. Infection numbers on Curaçao are also rising significantly. There is a lot of pressure from the local population to let tourists come. For many immigrants who work as cleaners or taxi drivers, for example, no work means no food. The region is reasonably prosperous, but many middle-class entrepreneurs are now also running into serious problems. Many people are now dependent on food aid.”

We advise colleagues there on the best way to define the rules for tourists

Focusing on control

Since COVID-19 can no longer be kept away from the islands, local authorities are focusing fully on control, with support from RIVM. Expert recommendations are often based on slightly different considerations in the Caribbean part of the Kingdom, especially since the economy there has been hit much harder than here. Hans van den Kerkhof: “We advise colleagues there on the best way to define the rules for tourists. We also organise OMT consultations, with a different OMT composition than in the Netherlands. We work with local expertise. In the OMT, we provide advice on the methodology of the laboratory tests, among other things. Other topics include epidemiology and travel advisories.”

It is a busy time for Van den Kerkhof and his colleagues. “It is difficult to take any time off. Due to the five-hour time difference with the islands, we often make our phone calls in late afternoon or evening. We are in contact every day; it never stops. But we are dedicated to infectious disease control, here and on the islands in the Caribbean part of the Kingdom.”

The Caribbean part of the Kingdom

As of 1 January 2020, the islands in the Caribbean part of the Kingdom had approximately 380,000 inhabitants. The Caribbean islands in the Kingdom of the Netherlands are the countries of Curaçao, Aruba and Sint Maarten (the CAS islands) and the special municipalities of Bonaire, Sint Eustatius and Saba, also known as the BES islands.

The COVID-19 updates for the Caribbean part of the Kingdom are provided on the RIVM website (in Dutch).

More COVID-19 information (in English).