– COVID-19 cases in younger persons, men significant, says outgoing CMO
– points to existence of underlying, undetected health issues

By Vishani Ragobeer

POSITIVE COVID-19 cases recorded consistently in young people between the ages of 20 to 39, and in men, are a cause for concern as it points to underlying and largely undetected health issues in Guyana’s population, according to senior health professionals.

It was none other than outgoing Chief Medical Officer (CMO), Dr. Shamdeo Persaud, in an exclusive interview with the Guyana Chronicle, who shared his observation of the concerning number of positive cases of the novel coronavirus, COVID-19, recorded in these two groups- younger folks and men.

The CMO related that the number of cases being recorded in men were the first demographic which “jumped out” at him, as he reviewed the data of the COVID-19 cases in Guyana months ago. Subsequently, he soon became concerned about the positive cases, and few deaths, recorded in the younger demographic.

The outbreak of the novel coronavirus, COVID-19, reportedly originated in Wuhan, China, late last year. Since then, it has since spread across the globe. The World Health Organisation (WHO) stated that common signs of infection include respiratory symptoms, fever, coughs, shortness of breath and breathing difficulties. In Guyana, the first case was recorded on March 11.

Since that first case was recorded, positive cases have been consistently, more so over the past few months as the installation of a new Government allowed for more concerted focus on managing the spread and ramification of the virus. But, Dr. Shamdeo bemoaned that the focus has always been on the numbers — the number of cases, deaths and recoveries. A closer examination provides more insight and, well, cause for concern.

“The observation that the 20 to 39 age group has been affected in Guyana in a way that brings us extra concern is absolutely correct because across the world that is not usually the high-risk age group,” Head of Medical Services at the Georgetown Public Hospital Corporation (GPHC), Dr Mahendra Carpen, told the Guyana Chronicle.

Both Dr. Carpen and Dr. Persaud stressed that this points to the prevalence of underlying and perhaps even largely undetected health issues. These include non-communicable diseases (NCDs) such as diabetes, heart diseases and cancers, which, according to the Pan-American Health Organisation (PAHO) accounted for about 70 per cent of deaths in Guyana.

“I think the coronavirus has actually shown us that there is an underlying level of changes even in those early age groups with NCD preconditions that exist and maybe are not being picked up in a timely manner,” the CMO related. Explaining this, he said that persons may be in their 20s and are already pre-diabetic or may have hypertension but they would not go for a checkup until they are in their 40s or 50s.

The WHO and the Centre for Disease Control and Prevention both indicated that older folks and later, older folks with pre-existing, underlying health conditions were more vulnerable to contracting COVID-19 and becoming severely ill. Younger folks, who were more likely to be asymptomatic (infected with the virus, but not showing any symptoms), were cautioned that they might be “carriers”- spreading the disease to other, older folks.

PRIMARY HEALTHCARE

Yet, here in Guyana, there is a concerning number of COVID-19 prevalence in younger folks. This, according to Dr. Carpen, signals the deficiencies in Guyana’s primary healthcare system. Through adequate primary healthcare, individuals would be able to get regular health checkups and early screening, thus rendering them more likely to detect these conditions much earlier. In Guyana, and throughout much of the Caribbean, there is a more ‘treatment-focused’ approach to health care

Last year, Dr. Carpen highlighted that 30 per cent of patients who go to the GPHC for emergency health care- due to a heart attack, for example- only then realise that they are also diabetic. Regular health checkups could have revealed this earlier, and perhaps even prevented those emergencies. Now, with COVID-19, younger persons may be increasingly vulnerable to the virus, but the dearth of regular checkups and screenings inhibits their cognisance.

Zeroing-in on diabetes to illustrate Dr. Carpen’s sentiments further, the International Diabetes Federation (IDF) 2018 report estimates that around 18, 921 persons, in Guyana, are unaware they are diabetic. The report also stated that of Guyana’s 505, 722 adult population, some 53, 496 persons are diabetic, representing a national prevalence rate of 10.6 per cent.

The GPHC doctor posited that Guyana may eventually have to adopt a chronic disease screening regime where persons are required to have constant medical checks. Through this screening, he said that information on an individual’s height, weight, physical activity, family history, social habits (such as alcohol consumption and smoking, which contribute to the development of NCDs) and dietary intake should be taken. Then, more “objective testing” for the NCDs or other conditions which impact overall long-term, survival and quality of life should be done.

Joan (not real name) is a 64-year-old woman. She sells cold drinks from a cooler on the pavement of the busy shopping centre of Regent Street. In April, on her birthday, she was taken to the Bess Hospital because she had contracted COVID-19. Joan also has a heart condition, which combined with her age, makes her more vulnerable to this novel virus.

Aside from her visit to the hospital a few years ago which led to the discovery of her heart condition, regular screening and medical checkups is not a norm for her. And in April, a few weeks after she found out she had the coronavirus, her 40-year-old daughter and 18-year-old granddaughter were also infected. The trio received institutional care at the West Demerara Hospital before being transferred to the Diamond Diagnostic Centre.

Joan’s daughter and granddaughter were not aware of any underlying conditions that they had, and much like Joan, regular medical checkups and screenings were not commonly done.

Dr. Carpen also reasoned that there may be a sense of “false security” among the younger population, because the vulnerability of older folks has been well-ventilated. Adding to this, Dr. Persaud explained that this group may feel the strongest, and would probably be taking less precautions than the average person, again, because they believe they are less vulnerable. This, he said, places them at a higher risk.

“But the sad part of that is that even though the young population may survive, they are potential carriers that can transmit the disease from themselves to more vulnerable members of their circle, like their parents, their grandparents, co-workers who are older, friends and people who have underlying conditions and may not fare so well,” Dr. Carpen said, too.

MEDICAL HISTORY IMPORTANT

It is for this reason that both doctors emphasised also that all persons should be cognisant of their medical history. The WHO states that there is increasing evidence to show that there is a genetic role in major NCDs.

Dr. Carpen explained that many chronic diseases have a genetic correlation which means that they can be passed down from grandparents to parents to children. These chronic diseases, he said, include diabetes, hypertension and bad cholesterol. And if someone in one’s family may have had a premature stroke or cardiac arrest, it places an increased risk on the other family members.

But let’s also consider the men too. It is now exactly seven months since Guyana recorded its first COVID-19 case. Since then, it has been reported that the positive cases are being recorded in more men than women.

A few months ago, Director of Primary Healthcare Services Dr. Ertenisa Hamilton, noted that males accounted for 53 per cent of the COVID-19 cases. Subsequently, Dr. Persaud noted that in the over 50 group males and females are almost equally affected, but in the 30 to 49 age group (also the largest age group tested), men were four times more likely to have been infected with the coronavirus.

Though the country is provided with daily COVID-19 updates on the number of tests done, the amount of new positive cases recorded from those tests, and the number of deaths (if any), the data disseminated through the daily dashboard does not indicate the sex distribution of the cases. However, the Guyana Chronicle combed through the reported COVID-19 deaths and found that more men have died either due to the coronavirus or due to complications exacerbated by the coronavirus.

One official, who wished to remain unnamed, noted that the health authorities are now trying to determine what causes the greater prevalence of COVID-19 cases in men. Currently, the authorities, this official said, are considering whether men are more ignorant of their medical history; have reservations about the measures used to safeguard against COVID-19 (such as wearing a masks); are less likely to report COVID-19 symptoms or, whether the underlying diseases are the largest contributing factor.

“Compared to women, most countries with available data report that men with COVID-19 have greater disease severity and higher mortality,” an article published in a September edition of the American Journal of Men’s Health stated.

This article also related that lab and animal data indicate that men respond differently to the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection (this is what causes COVID-19). This, therefore, presents another possible explanation for the observation that COVID-19 is more prevalent in men than women.

“Coronavirus does not respect your age, it does not respect your ethnicity, your gender. Everyone is vulnerable,” Dr. Carpen stressed.

While the more long term health effects of the coronavirus are yet to be seen, given that the virus is less than one year old, Dr. Persaud advised that persons continue to follow all precautions outlined. These include practising good hand hygiene, wearing a mask and staying physically distant.