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Model suggests lockdown is controlling outbreak

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Active measures: Kim Wilson, the health minister, listens to a question at a press conference held by the Government last week on the fight against the novel coronavirus (Photograph by Blaire Simmons)

Covid-19 deaths might already have reached at least 25 without a government-imposed lockdown, a worst-case disease spread model has suggested.

Figures released by the Government showed that without precautions, the island could have seen more than 120 hospital admissions and about 50 people who needed critical care up to April 23.

But the Modelling Estimates for Bermuda and Potential impact of Non-Pharmaceutical Interventions report showed that, in reality, 19 people had been admitted to hospital by that date and four had needed critical care.

The news came as David Burt, the Premier, tweeted last night that a “phased reopening plan” had been agreed at yesterday’s Cabinet meeting and details would be announced today.

But he added there was “no plan to fully reopen all government offices or schools on Monday”.

Mr Burt confirmed the island’s sixth death related to Covid-19 on Sunday.

Kim Wilson, the Minister of Health, explained last week: “The worst-case scenario is what Bermuda could experience with no interventions or public health measures.

“Bermuda has already put many such interventions in place ranging from social-distancing to the shelter in place that we are currently in.”

A ministry spokeswoman warned against treating numbers in the document as predictions and added that the modelling would be used to help “refine” interventions.

She said on Monday: “Every day the world is learning more about this new virus and how it acts. With that new information, the world adopts new guidance to try and further protect.

“Bermuda implemented health interventions early on to address this virus that appears to be droplet-borne. It may be too early to directly link actions we have taken in Bermuda.

“However, some of the most effective interventions we have seen around the world are the recommendations of social-distancing of six feet, correctly wearing masks and correctly washing hands to ensure it is not transferred to others.

“In addition, there have been the more aggressive interventions for our vulnerable populations such as halting visitors to long-term care homes, closing schools and day cares, stopping public transport, the travel ban and quarantining.”

The spokeswoman said: “We will be constantly monitoring our numbers against the modelling to adjust the interventions if we see numbers change.”

The spokeswoman added that the public should expect mask-wearing and social distancing to continue until more was known about the coronavirus. She said: “If numbers change and increase we may see an escalation in more extreme public health measures.”

The modelling statistics, which were released last week, showed that the highest number of hospital admissions in a day was four, recorded on April 3.

The worst-case scenario suggested an upward trend in daily hospital admissions that reached about 12 by April 23. Mr Burt told a press conference on Monday the hospital faced a limit of five Covid-19 admissions a day before it started to become “overrun”.

The modelling report explained that a “reproductive number” — the average number of people infected by a single case — of 2.4 was recommended to generate a worst-case scenario outcome.

It said that the goal was to reduce that figure to near, or just below, one. The model was based on an Imperial College London paper with guidance for Overseas Territories from Public Health England and used Bermudian population statistics and mortality rates.

However, Patricia Gordon-Pamplin, the shadow health minister, said she feared there was a “missed opportunity” to make it even more relevant to the island.

She added that the collection of information on whether or not positive cases were symptomatic would be useful. Ms Gordon-Pamplin said she had asked Ms Wilson if that information was collected and was told that “the model assumes a certain asymptomatic or symptomatic element”.

She added: “My contention is that, if you know what your population is doing locally, whether your positive tests were people who were symptomatic and people who were asymptomatic, it would give us a better indicator of where spread and the contagion is coming from and how it’s being passed on.”

Ms Gordon-Pamplin said: “What we are going from is really a UK model, where our demographics are completely different.”

A health ministry spokeswoman said last night: “Those with positive case results will be provided a questionnaire to collect further information.”

Considerations identified by PHE for Bermuda included a “slightly older population and “poorer outcomes in persons with Afro-Caribbean heritage.”

But the health ministry spokeswoman said that Afro-Caribbean heritage was not built into the Bermudianised modelling and that PHE reported age remained the most important factor for infected people.

Ms Gordon-Pamplin said: “As a predominantly African-descent population in Bermuda, we certainly need to be mindful that this seems to be hitting some other jurisdictions with our demographic a little harder.”

Ms Wilson explained last week that the modelling included the assumption that there was no immunity to the virus in the island’s population.

She added: “To avoid a rebound in transmission, effective interventions will need to be maintained, at least intermittently, for up to 18 months or more, depending on how immunity develops in the population, either herd immunity or through vaccination.”

PHE added that tougher social-distancing, or “lockdown”, was “an appropriate measure to control strong epidemics”, but that took up to ten days to have any noticeable effect and a further ten days to show peak effect.

The report added: “Optimum length of time for implementation of such measures is unlikely to be less than four to six weeks in most cases.”

It showed a “better case” scenario — based on a reproductive number of 1.4 — could result in a total of 1,030 people admitted to hospital, with 359 in critical care and 263 deaths.

The peak identified in the scenario was September 6 to 15.

But Ms Wilson said: “Our aim is to do even better than this.”

Holding steady: cumulative critical car hospitalisations modelling to April 23, 2020 (Graphic courtesy of the Bermuda Government)
Holding steady: the cumulative confirmed infections, with worst case, better case and actual number of cases in Bermuda (Graphic provided by the Bermuda Government)
Holding steady: the cumulative hospitalisations projections, with worst case, better case and actual number of cases in Bermuda (Graphic provided by the Bermuda Government)