Terms of Reference for Committee

Committee appointed to Investigate the Factors contributing to Clinical Outcomes of COVID-19 Patients in Trinidad and Tobago

Committee Members:

1. Professor Terrence Seemungal, PhD, FRCP, FACP - Dean Faculty of Medical Sciences, University of the West Indies (UWISTA)
2. Professor Emerita Phyllis Pitt-Miller, MD, FRCA - Consultant Anesthetist and Intensive Care Specialist, Former Dean Faculty of Medical Sciences, University of the West Indies (UWISTA)
3. Dr. Anton Cumberbatch, MD, MPH - Public Health Specialist and Former Chief Medical Officer, Ministry of Health (MOH)
4. Dr. Vidya Dean, DM (UWI), DA (UK), FFDRCS (I), FRCA (L) - Consultant Anesthetist and Intensive Care Specialist
5. Professor Donald Simeon, PhD - Director, Caribbean Centre for Health Systems Research and Development, Professor of Biostatistics and Public Health Research, Faculty of Medical Sciences, University of the West Indies (UWISTA)

Background:

As of January 11, 2022, Trinidad and Tobago has recorded 3,102 deaths out of 97,897 positive cases. The Case Fatality Rate (CFR) in Trinidad and Tobago has varied over the course of the pandemic ranging between 6.2% (130 cases, 8 deaths) in the first wave April 2020 to a low of 1.0% on 27th August 2021. A case fatality rate of 0.032 or 3.2% has been recorded as at that date. This indicates that for every 100 persons infected with the COVID-19 virus, three (3) persons succumbed as a result of the disease. Out of the 3,102 deaths, 175 (5.6%) of those fatalities were fully vaccinated while 2,927 (94.4%) were not fully vaccinated or unvaccinated. These deaths would have occurred in both hospitals and at home. The records suggest that approximately 94% of deaths occur in hospital in the system with the remaining 6% occurring at home. Total deaths of those fully vaccinated as at January 12, 2020 was 177 (5.7%).

Scope:

1. To identify the profile of the patients who died from COVID-19 by:

a. Number and types of comorbidities including obesity
b. Ethnicity
c. Age
d. Gender

2. To review the definition of ‘COVID-19 Death’ used by the Ministry of Health for consistency with WHO guidelines and standard practice; and comment on the different methodologies for calculating case fatality rate (CFR) and make recommendation for the appropriate methodology for Trinidad and Tobago.

3. Examine the Admission, Discharge and Transfer (ADT) policy and procedure to determine the impact, if any, on clinical outcome.

4. Determine if the treatment and management protocols adopted by the Hospitals are consistent within WHO guidelines and international best practice, with access to adequate:

a. Levels of Staffing appropriate in a mass response to a global pandemic;
b. Essential Medicines;
c. Laboratory and Diagnostic Imaging Services;
d. PPE; Oxygen; other.

5. Review the standards of care of COVID-19 patients, based on acuity, for uniformity and consistency within and across hospitals in the Regional Health Authorities (RHA).

6. Identify any other factors that may affect clinical outcomes including, but not limited to:

a. suboptimal home treatment, for e.g., utilizing non-WHO approved therapeutics;
b. delayed presentation to health facilities;
c. efficiency of the transfer system in transporting patients from home to hospital and inter-hospitals in the RHA health network.

Duration:

 One (1) week January 17- 24, 2022

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