COVID-19 mortality in six Caribbean countries during Four Waves of the COVID-19 Pandemic
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Background
Mortality associated with COVID-19 in the Caribbean during specific waves and exposure to different variants has not well described, especially for the six most populous English-speaking countries (Bahamas, Barbados, Guyana, Jamaica, Trinidad and Tobago, and St. Lucia), compared to the United Kingdom (UK).
Methods
The first four waves of the pandemic, cases and deaths were estimated from epidemiologic curves on Johns Hopkins University Coronavirus Resource Center for the countries of interest from 10-Mar-20 to 12-Aug-22. Crude mortality rates (CMR), case fatality ratios (CFR) and standardized mortality ratios (SMR) were calculated using England as the standard population.
Findings
The six countries reported 550,657 cases and 10,259 COVID-19 deaths. First wave Caribbean CFRs (1-3%) were significantly lower than the UK (20%). Thereafter (1-Apr-21 to 31-May-22) Caribbean SMRs exceeded 1 (range: 1.37-6.35) while UK CFRs declined to 2.3% (2 nd wave) and 0.2% (3 rd wave). Caribbean CFRs were highest with circulation of the Delta variant in the 2 nd and 3 rd waves. Barbados had the lowest SMR (0.65). COVID-19 vaccine roll-out (since Feb-Mar 2021) first targeted high-risk groups (elderly, health workers, co-morbidities). No Caribbean country achieved the global full vaccination target (70%) by the 4 th wave, range: 21% (Jamaica) to 54% (Barbados), compared to 86% for the UK.
Interpretation
Early in the COVID-19 pandemic, Caribbean CFRs were lower than the UK, probably due to more intensive non-pharmaceutical interventions. Limited vaccine coverage negatively impacted mortality in later waves, which was highest when the Delta variant was prevalent, declining with the later Omicron variant.
