EHO Knows: Virus of the Caribbean w/Dr. Stephanie Fletcher-Lartey

Today’s episode of Eho Knows feels like a James Bond episode. So, it’s going to be starting on the back streets of Sydney and we’re we’re going to go international and we’re going to be going around the world and then we’re going to be bouncing back to to Australia and then we’re back over internationally. This is the jet set eho nose and the mcguffin in this James Bond is co and so what we’re doing is having a look at how one person through a multiple of jobs had such a fascinating insight into not only the spread of co but how totally different countries were responding and we’re not talking about the US or the UK because everyone knows what happened there, but we’re having a look at how some of the the smaller nations around the world struggled and dealt with co as well as getting the magical insight into some of what was happening here in Australia. So, this one’s truly international. James Bond saved the world episode of eho knows and to take us through it, Dr. Stephanie Fletcher Latte. Thank you very much for coming along.

It’s great to be here, Shane. Thanks for having me.

And so to to get this epic journey started in 30 seconds, summarize your entire life leading up to the end of 2019.

Thank you. So I initially trained as an environmental health officer in Jamaica in 1997 and I worked in Jamaica up to 2014. Then I came to Australia to do my PhD and has been working more in the capacity of an epidemiologist post phd and been you know advisor consultant in emergency preparedness and response.

Okay. So so there’s the backdrop that’s the opening the intro and now what we’re going to do is pick up the story December 2019 whereabouts were you? So yeah, I was working as a senior bioparness epidemiologist in Sydney in one of our in Liverpool area to be exact and that was my primary role. And so then suddenly 2020 life changes for you before you know the rest of the world. You make another big change. So it’s now January 2020 and you do what? So yeah, so I was in Liverpool and I actually came to this place where I felt like I needed a change. I was looking for something big to use up all my bio preparedness and emergency response skills and I landed this big role as an advisor to the Caribbean public health agency and just arrived in Trinidad and Tobago in January the very first week and and that’s where I was at the beginning of January just settling in in my brand new role as the head of the communicable disease and emergency department at in the Caribbean. Okay, so you’re in the Caribbean, got this brand new job. What did you think this job was going to be?

Oh, I thought it was going to be amazing. You know, I was really looking forward to some opportunities to, you know, use some of my technical skills in research evaluation and of course, you know, the routine disease surveillance stuff as an advisor. And of course, I was really hoping to have a few outbreaks here and there that I would get to show off some of my skills that I gained in Australia. And you know, I was hoping that something exciting would happen. I get to travel a little bit to some of the the countries in the region. And you know, I was pretty excited about the role actually.

And so you go, “Oh, okay. Actually, we can joke about, you know, hey, bring it on. Give me a little bit of a um a disease outbreak. And then a couple weeks into the job, we know that around the world there was those those first whiffs of, hey, there’s something happening in China. So, how did it slowly enter your world? 

Yeah. 2 weeks after arriving in Trinidad and Tobago, where I was based, I got a request from the head of the organization that, you know, there’s this brand new virus that seems to be causing some panic in Asia. can you write a brief so that we can be prepared? And I was like, never heard of it. Started reaching out to some of my colleagues back here in Australia to see, you know, if I could really make sense of what was happening and they were just as clueless as I was. So anyway, you know, as as we all did, rummaged around, found whatever little information was there and pieced it together based on previous knowledge of similar conditions and, you know, more like a hypothetical scenario of what we could potentially expect, which was pretty much nothing. We prepared as best as we could, but you know, the rest of it is is history now in terms of how that played out. But I was basically just as you know raw as everybody else preparing for this unknown virus and what it would mean for the rest of the world.

So in terms of the Caribbean, what’s the geography like like you know and and what’s the the politics of the governments and the structures? What were you working with?

Yes. So, so the organization I was working with is the regionalwide public health agency which actually reports to the governments of the region quite similar to how we have here in the Pacific you know for example SPC you know South Pacific the health agency here and this organization had 27 member states essentially that were looking to us for public health leadership and my role was basically to prepare the organization to be able to provide information to these member states in a timely manner. The the Caribbean is quite diverse, maybe not as large in size as the Pacific, but very similar in location, very tropical, quite disasterprone in terms of cyclones and so on. But small island developing states quite similar to the Pacific maybe has a little bit more advantage in terms of human resources for health and expertise very close in proximity to the USA. So that proximity as well is is something to be taken into consideration but that’s kind of like the lay of the land in terms of where I was located at the stage. very close-knited group as well in terms of governance and leadership mainly democracies and um you know similar kind of governance systems predominantly English speakaking a few French and Dutch territories in in the region. 

So we’re talking about multiple governments but they’re working together. You’re talking about a country that’s like in the shadow of the US. So there’s there’s money coming in but it’s not a rich nation. So in one sense it’s it’s absolutely amazing having someone in your role and having an organization like that. So they’re partially ahead but then no one in the world expected um co and and the way it rolled out. So here we are you in position and you are preparing reports and I assume that it’s like the rest of the world. It went from page four news to page one news to what the hell just happened. So what was the what the hell just experience February, March? How did it roll out? For us at that time in the Caribbean, we had a slight bit of advantage because of the distance we were from the epicenter of the start of the pandemic, which was a great blessing for me as well because it means that I had a bit of lead time, which I still believe was the the blessing that the Caribbean received. you know, not blowing my own trumpet, having somebody with my expertise there on the ground before it all happened was a great great blessing for us. So, also having just maybe recently come out of the Ebola pandemic as well with that kind of headset on the Caribbean had just finished all their Ebola planning again. So they had a bit of a framework and they had a pandemic response policy in place in most of in quite a few of the countries and there there was a bit of a a foundation to build on. So with that in mind coming in and understanding that what we’re hearing has a likelihood of getting bigger and spreading that was a great advantage for me. So remember that when I initially left I was looking for something big. So,

so co is your fault. You’re there going, I want something big.

That’s right. 

So, this was my, “Oh, I want something big being handed to me on a golden platter.” So, my mindset was already prepared to deal with something big way too early if you ask me. You know, I needed some time to actually get to know the organization. But it was like hit the ground running, begin to roll out all the knowledge, the expertise. But that little bit of lead time that we got, it was about maybe seven weeks or so that we got before things got really really messy around us in the North America gave us enough time to be able to put all the policies and procedures in place and you know the governmental system as I mentioned before is a very welloiled machine in that region. So they were on the front foot speaking to each other, seeking our advice and and and we were just really not just a health response but it was a really a whole of society response and in these small island developing states they really do that a lot better than some of the big countries. They actually talk to their other partners in the other sectors and that’s a was a very welloiled machine already happening in that region. So, so that was a really amazing experience for me to be able to tap into that. And if you remember, I am from the region, so I know the region extremely well.

Yes. Yeah. I’m just going to say that you just lost most of our Australian and American listeners when you said they communicate with each other. They go, “Sorry, I don’t understand that. Can you please explain that concept?” You know, they actually work together. Um and so so you put these procedures in place. How long did it take before you went into lockdown where people couldn’t be traveling and and mingling anymore where you know commerce basically shut down and everything?

So that happened in at different times in different locations cuz I’m talking about we have 27 different member states here. in the location where I was, Trinidad and Tobago was the first country that closed down and they are one of the more higher income countries in the region. So they had the resources to be able to do that. The vast majority of countries in the region are very highly tourism dependent. So lockdown was really a last resort for many of these countries. It was we will remain open as long as possible to protect our population. So Trinidad closed early February. Most of the other countries started closing after the pandemic was called because they were so much more highly reliant on tourism and also the fact that it was a big this was a big tourism season. You know, it was the North American winter season, which means all the tourists head for the sun, sand, and sea in the Caribbean. So many countries hesitated for as long as it was possible to close their borders. And so they did that in a more phased basis. Trinidad and Tobago on the other hand, you know, they went into it because they had, you know, internal resources that were not as dependent on foreign foreign influence from, you know, tourism coming in. 

So, it’s the double-edged sword that you need like these these are people who are surviving daytoday on the tourist dollar. Uh, so you’re talking small businesses and if the tourists stop then effectively they’re not feeding their family anymore. But at the same time, the tourists are the bloody plagued ones who they’re going to be bringing the problem in. And so, yeah, you can shut that, but then you’re not going to be uh, you know, feeding your family. So, I Yeah, that decision to close down must have been really, really hard. And so, you then do the the shutdown. What are the consequences for these small locations that rely on on tourism? What happened then? Well, as you could well imagine, a lot of them had major major implosion in their economy. This then resulted in a higher dependence on foreign support from bigger highincome countries, which in the Caribbean, they’re probably not as dependent on foreign income as much as maybe our Pacific Islanders in terms of, you know, the day-to-day running of like health systems. But one of the beautiful things about the Caribbean is they have a very strong tourism health program that has been in existence for many years. That system was fully well in effect where they have you know regular you know collaboration with for example cruise shipping. It’s a very strong system in the Caribbean that came into play during the pandemic and in that planning phase where it wasn’t just the government says no, it’s how do we work with all these players in the tourism industry, in the cruise shipping industry to make the transition as smooth as possible. I mean it it worked really well for a little while, but there were, as you could well imagine, this was so new and the scale was so big that, you know, we we had to calibrate a lot of things to make sure that it could work. And then there came a point in time when they just said, look, you know, we do our best to protect our people, but we got to live. So many countries started to open back their borders quite early. So great place to just slow down. What do you mean by that? Like what was happening in the lockdown that then said, you know, we can’t sustain lockdown.

Yeah. So in some of the smaller countries for example, you know, they stopped people coming in for a little while, but they recognized that that it was going to be absolutely impossible to maintain their economy without having a stream of income from those external tourists coming in. So what they did was they recognized that, you know, people were out of jobs. That was one of the biggest thing. people couldn’t feed their families because their their employers weren’t earning income to pay them. So many countries ended up trying to do some kind of relief, but our our economies are not really structured that way. You know, we don’t have a center link in these countries. Yeah.

So, here in Australia, we had JobKeeper and um or Job whatever the other one was. So, so the government was pouring money in to try and keep people employed.

And so the irony is we’ve got teenagers who are buying laptops because they’re suddenly so much wealthier than before.

Here you’re the businesses weren’t being subsidized. They weren’t paying their ex employees. You were largely now starting to rely on international donations, but they weren’t necessarily getting through. So you’ve now got families that have no income. So how bad did it actually get? Well, some some countries it it got bad, but then the governments decided, look, there’s going to be a measured risk taken. So, I think many countries decided that they were going to put in as many mitigation type policies and risk reduction type strategies and have some kind of phased reintroduction of tourists coming in. Some of the things that happened were stuff like people get tested first. So they had a lot of those test before you fly policies and then the quarantine was was probably a introduced a little bit later but people didn’t want to go on holidays and be in quarantine. One of the other strategies they used were was that you know if you enter and you test positive there’s a certain um zone that you had to remain in. So that was maybe towards the closer towards the end of of the first year of the pandemic where you could travel but if on arrival you ended up testing positive there’s a quarantine zone you cannot leave this property or you know all the people here have COVID anyway so so nobody’s going anywhere or something like that you know we we are all positive and we’re enjoying the sun sea and sand anyway they’re not sick requiring hospitalization and so on. So, a lot of it was just taking some of those policies that we’re well used to with surveillance and disease risk controls and tailoring them for the the need while allowing people to be able to come in and have the the the currency flowing again in the system. So were you keeping track of numbers like you know so here in Australia every single day it was you know number of COVID cases in Australia you know 1,024 or whatever and we were literally just tracking them day by day going oh and we were aiming for for zero. That was never the case. You weren’t aiming for zero. Were you doing that daily we’ve got you know 20,000 cases of COVID or whatever. Yeah. What was the messaging going out into the um the public? 

We did and with my background as an epidemiologist, I was the one writing those reports not just for our organization, but remember there were 27 countries that were sending data to us and we were compiling that and sending that back out. So yes, we were tracking the numbers and where I was based was also the regional reference lab. So before individual countries had capacity to test everything came to us. So we had all the numbers from day one and we were tracking that until capacity was built in some of these smaller locations to be able to do like PCRs and we didn’t embrace for example the antigen testing until way down when you know when I think the rest of the world was started to do that but we were tracking numbers and we we were writing these reports. I remember when we produced our 100th surveillance report. We actually had a 100th celebration, a special edition of our 100th COVID 19 surveillance report and we had a special designer. It it that’s how you know it was so big.

So So you’ve got an autographed copy out there now worth it its weight in gold. How many editions did they make it to? Did they 

you It was after your time you left, but 

I don’t remember to be honest. I think I got to probably about maybe episode 300 or something before I left cuz we were doing initially we were doing maybe once a week and then by by March when the pandemic was declared we were doing twice. So Tuesdays and Thursdays we were sending out a report and for I think the rest of the six months we were doing like two reports per week and then towards the end I think that became just so unsustainable because it took a lot of time. So I think eventually we returned to once a week. So by the time I left we were probably up to about episode 200 and something or close to 300. But a lot of the systems that were set up continued until after I left.

Yes. Okay. So, you’ve got the first year you are waiting for something and you get more than you ever hoped for. But it’s just really really interesting that you’re in an environment where the goal was never ever to have total suppression. It was the focus was you have to get on with life. And so you go for total shutdown. You reopen. You work out how to get things moving. And so things are now looking relatively rosy. Yeah, there is a global pandemic going on. But then you decide to make another move. And so here we go. James Bond time back on a plane and you head for Sydney, Australia. And as our episode draws to a close, we hear the happy music start and we watch a shot of a plane taking off into a sunny sky. All is good. And then the music turns sinister as it cuts to an empty streets of Sydney and then fades to black. Catch us next week to hear about what is going on in the chambers of power in Australia. And now, please leave a comment on what you have learned in hindsight.