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Serge JC Pierre-Louis, MD, MPH

Joel Augustin, MD


The COVID 19 epidemic presents challenges that are both universal and unique to countries with limited resources. Countries must often choose to emphasize preventive or curative measures. Haiti has severe limitations in both arenas. With about 124 level 1 ICU beds and 30 mechanical ventilators, the health system will quickly be overwhelmed. The absence of a robust public health infrastructure makes screening and testing, case ascertainment and identification of contacts, quarantine and surveillance all problematic. Finally the level of poverty, poor sanitation, poor nutrition, inadequate water supply, high population density, cultural biases and lack of coordination between regional hospitals add to the complexity of the fight against the epidemic. Some of the recent decisions of the Haitian government are important steps in the right direction. However, while listening to international guidelines, Haiti must develop its own strategy to prevent excessive transmission of the virus. Here are a few suggestions that may help contain the epidemic, some being evidence-based while others are mainly intuitive.

Immediate Measures

1. Close international airports and international borders, until proper screening and rapid testing can be put in place

2. Limit mass transportation between major cities, allowing only food deliveries and health travels

3. An overnight curfew may help decrease social interactions, although a ban on restaurants and night-clubs at night may have the same effect; people should be allowed to attend to their medical needs

4. Identify in each city which hospitals should receive COVID 19 cases, prepare a few rooms for that purpose with adequate protective equipment for health personel and basic supplies

5. Handwashing should be tailored to the resources of each city; where running water exists, proceed with handwashing with soap for about 15-20 seconds (the time to sing the first 4 lines of “Haiti Cherie” once); where there is only standing water in a large container, such as at entrance of public buildings, ask someone else with clean hands to poor the water over your hands using a smaller container; use hand sanitizers or solution with 70% alcohol, when available

6. Wear a surgical mask if you are coughing or sneezing (or around people doing so), if you think you have a cold, if around people with suspected or confirmed COVID 19; where no mask is available, place a handkerchief on your face to cover your nose and mouth, wash the handkerchief when you get home

7. Cough and sneeze into your elbow, never directly in front of you; you may abort a sneeze in public by pressing hard or rubbing one side of your nose; clean your nostril thoroughly while taking your morning shower, that will decrease your need to sneeze during the day; do not spit in the streets

8. Avoid shaking hands and embracing other people; avoid elbow bumps as well, as most people are sneezing into their elbow; a head bow (and a smile) should suffice

9. Keep at least one meter from other people when in public, wear a handkerchief on your face

10. Stay home as much as you can; send one person out at a time to fetch water, food, medicines; if you don’t have a home, stay as much as possible close to people you know

Medium to long-term measures

1. Coordinate with larger hospitals the role they should each play in combating the epidemic; use donations from international community to prepare specialized rooms with basic equipment and supplies, as well as proper protective equipment for health workers

2. Avoid using chloroquine to treat COVID 19, until the evidence becomes strong enough; the widespread use of such drug may create unwise resistance to the drug when needed to treat malaria

3. Strengthen capacity of public health infrastructure to conduct testing and surveillance, using international donations

4. Educate police and public about epidemics in general and COVID 19 in particular

5. Coordinate with Dominican Republic and CARICOM surveillance and management of local epidemics

6. Incorporate Haitian Diaspora into efforts at preventing epidemics and other natural disasters

7. Increase Haiti’s health budget to minimum required by international standards, i.e. about 15% of annual total budget (instead of current 4.5%)

8. Create level 1-3 ICUs and adequate isolation rooms in each department to manage trauma patients, disaster victims and future epidemics such as cholera and COVID 19

Final thoughts

The current epidemic may have dire consequences, given Haiti’s institutional weaknesses. It can also be an opportunity for Haiti to lay down adequate public health infrastructures and become a model of self-sufficiency and efficiency, when dealing with future epidemics.

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