Haiti seemed to have escaped the worst of COVID-19. Now a virus surge is sparking alarm.

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After months of low reported COVID-19 cases in Haiti, doctors in the Caribbean nation are reporting a worrying rise in infections and hospital bed occupancy after health authorities confirmed the presence of at least two highly contagious variants.

“There is indeed a certain panic because the cases are increasing,” said Dr. Lauré Adrien, the director general of Haiti’s Health Ministry, urging citizens to double down on precautionary measures like mask wearing, which has significantly dropped.

The uptick is particularly concerning because Haiti has not yet received a single COVID-19 vaccine dose. Some hospitals had shuttered their virus wards because of low demand. Now they are scrambling to get back up and operating and finding shortages of basic supplies like medicinal oxygen. The increase is also putting pressure on the supply of medicinal oxygen. Gang violence forced the temporary closure of one oxygen plant this week.

The medical director of the St. Luke Foundation for Haiti, which runs one of the few operational COVID-19 treatment centers in Port-au-Prince, said his hospital has seen a 100% increase in the number of virus patients since January, after registering no more than a dozen patients late last year.

“Now we’re averaging 20 positive at a time and the same amount of COVID-19 suspicious patients awaiting COVID-19 testing results but clinically ill enough to require hospitalization,” said Dr. Marc Edson Augustin, noting that St. Luke Hospital is overwhelmed from the constant influx of the past 10 days.

Haiti’s Health Ministry said Friday it has identified infections with two variants of concern - those first identified in the United Kingdom and in Brazil. The P.1 variant originally detected in the Amazonian city of Manaus is being partly blamed for the current surge in cases across Latin America and Caribbean. Health officials had been on alert for virus mutations since variants were identified in neighboring countries, including the Dominican Republic, which shares a land border with Haiti.

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Augustin said after recently increase the number of COVID-19 beds from 24 to 50, St. Luke Hospital is now considering expanding to 100 beds and bending under the weight of oxygen demands. Things became especially urgent Wednesday when a fresh spate of violence in the Cité Soleil neighborhood of the capital forced the closure of an oxygen plant, preventing dozens of canisters from reaching the hospital.

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Richard Frechette, the foundation’s founder who is also a doctor and a priest, said each COVID-19 patient at St. Luke requires about four tanks of oxygen a day at a cost of about $12 a tank. The hospital, he said, was not only facing an increased demand for oxygen but also in need of mattresses, sheets, personal protective equipment, Clorox and other materials.

Dr. Carissa Etienne, the head of the Pan American Health Organization, the Americas branch of the World Health Organization, has said a typical COVID-19 patient can require up to 300,000 liters of oxygen during a 20-day hospital stay. Patients in critical care often need double that.

The rise in hospitalizations across Latin America and the Caribbean, she told journalists Wednesday, was triggering “an unprecedented oxygen supply challenge throughout the Americas.”

The same day that Etienne was providing an update on the situation in the Americas, Haiti’s health ministry, which had shuttered a large temporary COVID-19 treatment center and returned the facility to its owner, decided to activate a new COVID-19 unit, this one in the Delmas 2 neighborhood.

Dr. Jean “Bill” William Pape, the former co-chair of Haiti’s national commission for COVID-19 response, said even his own clinics face challenges. The Haitian Group for the Study of Kaposi’s Sarcoma and Opportunistic Infection, known by the acronym GHESKIO, facility doesn’t have an oxygen problem. It has offered to generate oxygen for St. Luke, which shuttered its COVID-19 unit last year amid low demand and is “in bad shape because our COVID-19 support dried out completely,” Pape said

The detection of the variants, Pape said, is happening around the same time that the country—a year ago—reached a peak in cases and today “most people have lost their protective antibodies.”

“The immunity of the population is very low,” he said.

While impossible to know exactly the percentage of Haitians who have been infected, Pape said they have data showing that immunity, if measured by the presence of COVID-19 antibodies, does not last long. Most people lose their antibodies after six months, he said.

The University Hospital of Mirebalais, located about two hours away from the capital in central Haiti, said its COVID-19 unit has remained open since last March and they are accepting patients.

In an official note, the health ministry Thursday asked local media to assist in making the population aware of the increase in suspected and confirmed coronavirus cases, and emphasizing the need to wear face masks and practice social distancing. Since May 1, Haiti has registered 189 new cases and eight deaths. In total, the country has 13,353 confirmed cases and 271 deaths as of May 11, the ministry said.

Though the numbers are widely believed to be an undercount because of limited testing and Haitians’ reluctance to get tested or treated for COVID-19, by all accounts the country had been spared from the dire scenes taking place in much of Latin America and the Caribbean.

“Until we have enough vaccines to protect everyone, our health systems and the patients that rely on them remain in danger,” said Etienne.

Etienne said nearly 80% of intensive care units in the region are filled with COVID-19 patients, and the numbers are even more dire in some places.

“Based on how COVID is spreading, we estimate we’ll need 20,000 doctors and more than 30,000 nurses to manage the ICU needs of just half of countries in Latin America and the Caribbean,” she said. “Our health workers are also facing mounting challenges as the lifesaving supplies they rely on —like oxygen —are running dangerously low.”

In a workshop with regional journalists about variants, Jairo Méndez-Rico, PAHO’s regional adviser for viral and emerging diseases, said that while variants remain under study, the key to stemming them is maintaining social distancing measures. The more countries relax control measures, such as mask wearing and hand washing, and return to large gatherings, the more they allow the virus to transmit, he warned.

“That’s why we insist...we have to maintain strict measures until we really reach what is known as herd immunity, the very high vaccination levels in our countries,” Méndez-Rico said.

Haiti, however, has shown little discipline in maintaining or enforcing public health measures. Most people continue to shun wearing face masks and life has returned to what it was pre-pandemic ,with crowded public markets and buses, large anti-government protests, and the reopening of nightclubs. The government even sponsored carnival earlier this year, leading the Bahamas to issue a Feb. 13 ban on travelers from Haiti.

Earlier this week, the Bahamas extended its months-long ban, citing “uncertainties” regarding the Haitian government’s management of the pandemic and its delay in securing vaccines.

Adrien said Haiti continues to work on its vaccination plan and will soon send a note to Gavi, the Geneva-based public-private vaccine alliance that is helping low and middle-income countries get access to vaccines through the COVAX Facility, which is also supported by the World Health Organization.

Haiti is among 10 countries in Latin America and the Caribbean that have been allotted COVID-19 vaccines at no cost for 20% of its population. As part of its first shipment, the country is slated to receive 756,000 doses of the AstraZeneca vaccine, but the government’s delay in completing the necessary steps in a timely fashion has delayed shipment.

Haiti, Adrien said, wants to vaccinate but is late in rolling out a campaign because it had requested another vaccine instead of the AstraZeneca shots amid health concerns about clotting.

He acknowledged that the 756,000 doses, which were slated to arrive at the end of this month, could end up being furthered delayed. Haiti’s batch was supposed to come from the Serum Institute of India, but due to mounting COVID-19 cases in India, the Indian government has halted exports of the AstraZeneca vaccine.

“There is a good chance that this delivery, even without our request, would be delayed,” Adrien said. “We cannot give you a [date] on when we will receive the vaccine, it depends on available stock and the managers of the COVAX mechanism.”

The Pan American Health Organization has said there are four variants of concern and six of interests that are closely being monitored in the region. Though it has said there is no evidence to suggest that variants affect patients differently, some experts think the U.K. variant may be associated with an increased risk of death compared to others, but acknowledge that more studies are needed.

Early data, however, suggests that the variants cause the virus to spread more easily, heightening the threat to underfunded health systems. The new variants, along with the accelerated spread, PAHO has warned, could turn 2021 into a far worse year than 2020 for countries struggling to control the global pandemic.

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