STATEMENT BY ACTING CHIEF MEDICAL OFFICER

DR. RONALD GEORGES

COVID-19 UPDATE

December 28^th, 2021

Good Day residents of the Virgin Islands, a happy holiday season to all. 

Today, the Ministry of Health and Social Development is informing the public of the continued rise in cases in the current outbreak of the Delta variant of COVID-19 in the Territory. 

As of the 28^th of December 2021, there are 256 reported cases of COVID 19 in the Territory with the majority 218 on Tortola.

As previously mentioned all samples previously sent to CARPHA for typing were positive for the Delta variant and samples continue to be sent for typing on a regular basis. 

In the Virgin Islands, clusters of cases have been identified among businesses, related to social gatherings, events, nightspots and other areas where persons congregate. 

In this holiday season and during this period of increased transmission, as we prepare to engage in the many family and social gatherings and enjoy the holiday season with our friends and families, let us remember that COVID-19 is still present amongst us, and we are to intentionally take the necessary precautions for our health and safety.

You can access PCR testing at the Dr. D Orlando Smith Hospital Tent by registering at https://althea.bvi.care and by calling the Medical Hotline at 852-7650 if you have any symptoms of COVID-19. 

Alternatively, private medical establishments also provide PCR testing, and rapid antigen type tests, and many persons have access to home self-test kits.  The PCR test remains the Gold Standard for diagnosis. 

As a reminder, the Omicron variant continues to replace Delta as the dominant strain, and it is now present in 89 countries worldwide.  Omicron has not yet been identified in the Virgin Islands. We continue to send samples for typing regularly to ensure our awareness of the variants in the Territory.

The symptoms of COVID include, fever or chills, cough, shortness of breath or difficulty breathing, fatigue, muscle or body aches, headache, new loss of taste or smell, sore throat, congestion or runny nose, nausea or vomiting, and diarrhea.  If you or anyone you know have these symptoms you or they should immediately isolate and seek to be tested either by rapid test or PCR test.

Should you test positive for COVID-19 your period of isolation under a Quarantine Order will be for 10 days and your symptoms must also have resolved for at least 24 hours before you end isolation.  After this period, you are no longer infectious but may still test positive for COVID by PCR test for a period of up to 90 days.  Re-testing for clearance is therefore neither recommended nor necessary.  You will therefore instead receive a clinical recovery letter from the Ministry of Health indicating that you have completed the required period of isolation. 

Isolation under a Quarantine Order means that after you are confirmed to be positive for COVID you should stay at home and always wear a mask when in the presence of others for a minimum period of 10 days.  At the time of completion of your isolation your rapid antigen test should be negative but your PCR test can remain positive for up to 90 days. 

The Centers for Disease Control and Prevention (CDC) recently on December 27^th 2021 in response to the high prevalence of the Omicron variant in the US reduced isolation periods to 5 days once symptoms have resolved based on new evidence showing that these persons are no longer infectious. 

Research has shown that persons are infectious 1-2 days prior to onset of symptoms and 2-3 days after onset of symptoms. 

The new CDC recommendation is that for the remaining 5 days persons should always wear a well-fitted mask when around others.  We will be reviewing these updated guidelines in the next few days and giving updated guidance as required.

All household or travel companion contacts of cases in the Virgin Islands should at this time be quarantined and be tested at least 10 days after their last exposure or 7 days if they are not quarantining with the case in the same location. 

In the Virgin Islands, we are currently requiring persons with unprotected contact of confirmed cases to self-isolate and wear a well-fitted mask when around others for a period of 14 days. 

Persons should be tested between 7 to 10 days after exposure.  If at any time during the 14-day period they develop symptoms, they should immediately self-isolate and if they test negative, they can end their self-isolation or if they test positive begin a period of 10 days of isolation as described above.

The CDC also recently on December 27^th 2021 in response to the prevalence of the Omicron variant in the US also changed the quarantine period for persons exposed to cases of COVID.  They recommend that persons who are unvaccinated or those that are more than 6 months from their second dose or first dose of a one-dose regime and have yet not been boosted should quarantine for 5 days followed by 5 days of strict mask wearing. 

The CDC also recommends that those who have had a booster dose should simply wear a well fitted mask when around others for 10 days.  Their guidance is that all persons should seek to be tested at Day 5 after exposure and if symptoms occur should immediately isolate until a negative test confirms that symptoms are not due to COVID or if they become positive isolate as a case.  We will review this latest CDC guidance and update as required in due course. 

While the main tools of our control and suppression measures in the past have been curfews, business restrictions and lockdowns, Government policy has moved away from these drastic measures as vaccination rates have increased to just over 60 percent.  We will be reviewing and advising the Government on any necessary changes to our policies. 

The current vaccines offer very good protection against severe disease, hospitalisation and death associated with Delta infection and residents should therefore avail themselves of opportunities to be either vaccinated or receive their booster dose.  Current evidence from the United Kingdom and South Africa demonstrate that two doses of vaccine are about 35 percent effective while adding a booster dose increases effectiveness against infection with Omicron up to 75 percent.  Vaccination uniformly and significantly reduces the risks of severe disease, hospitalisation and death from COVID infection.

As I mentioned earlier, the findings of the UK COV-Boost survey were that the mRNA vaccines give the best overall increase in neutralising antibodies and immunity as a booster vaccine after a primary course of COVID vaccination.  Pfizer vaccine, an mRNA vaccine was then chosen as the easier vaccine to supply to the Territories.  There are no safety concerns with having a Pfizer vaccine after a full series of AstraZeneca.

Moving into the new year Pfizer will be the vaccine mostly available in the Territory based on UK availability, supply ability and evidence of efficacy.  Persons who have completed their primary vaccination with either a 2-dose regimen like AstaZeneca, Pfizer, Moderna, or Sinovac or a one-dose regimen (Johnson and Johnson) can receive a Booster of Pfizer vaccine 3 months after completion of their last dose.  A booster dose simply provides a recent stimulus to the immune system to boost the levels of neutralizing antibodies and cellular immunity to COVID. 

Persons who are severely immune compromised, e.g. those on chemotherapy, or on high doses of steroid, or on other immune suppressive therapy may be eligible for a third dose which can be Pfizer as well as a Booster dose three months after, to ensure that they sustain sufficient immune protection.

Pfizer vaccine roll-out is currently being handled by the BVI Health Services Authority and will recommence on Wednesday 29^th December using the published schedule for priority groups of:

1. elderly over 60 years
2. frontline and health workers
3. those who are immune compromised
4. children from 12 to 18 years of age
5. those with chronic diseases. 

Vaccines are being given on a first come first serve basis without appointments.  Persons are asked to go to the vaccine administration location with a form of government issued identification and their vaccine card or proof of vaccination to be registered on site for vaccinations.

From the 4^th of January it is expected that all population groups will be eligible to receive a Pfizer vaccine.  The UK Medicines and Healthcare products Regulatory Agency (formerly known as PHE) has approved the use of pediatric doses of Pfizer for children from the ages of 5 to 11 years of age and arrangements are being made to make Pfizer vaccine available in the smaller pediatric dosing to this age group.  As of January 4^th Pfizer vaccination will be opened up to all residents.

Given the increased COVID activity in the Territory all residents are asked to continue to be vigilant and abide by the established public health measures and:

1. Limit your exposure to persons outside of your household
2. Adhere to the public health protocols
   
   1. Do wear your mask at all times when within 6 feet of persons
   2. Wash your hands regularly or use hand sanitizers
   3. Maintain a distance of at least 6 feet from persons outside your household
3. If you are sick isolate and get tested as soon as possible as described above
4. If you are positive stay away from others for at least 10 full days and abide by the terms of your quarantine order
5. If you have been exposed self-isolate and follow the testing advice above
6. If your condition worsens do seek medical attention early.
7. Get vaccinated with either your first or second dose and if three months has passed since  your last dose and are eligible get your booster, please go and get it.

I would like to take the opportunity to commend the public for the role they have played so far in limiting the impact of Coronavirus on the Territory.  I ask for their continued participation and support in continuing to limit the impact of the virus in the Territory and wish all a happy holiday season and New Year when it comes.