The blog this week is based on a report  by  Ms. Peggy DaSilva, Chair of the Caribbean Regional Nursing Body (RNB).  It is a follow up in reference to her comment  made in the April 9 Blog,  Celebrating 2020 World Health Day - Supporting Nurses and Midwives - in a time of Crisis. In a  report covering a range of issues, Ms. DaSilva has sourced data and responses from nursing bodies in the 15 CARICOM Member States and 5 Associate Members.  It is evident that the RNB is a vibrant regional enterprise that represents a critical force on the frontline of the fight against COVID 19.  GOFAD joins in the well-deserved commendations for the dedicated efforts of our nurses. The CARICOM COVID-19 Dashboard tracker, places in context the spread of novel coronavirus throughout the region.   The tracker on April 30 shows that there are 1177 confirmed cases, 62 deaths and 337 recoveries.  Jamaica has the highest rates including 396 confirmed cases, 8 deaths and 29 recoveries. 
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The CARICOM region has been plagued by a number of challenges that have serious negative effects on the functioning and sustainability of health systems in general, nursing, in particular. These are not limited to migration trends that have shown a significant brain drain related to the experienced and qualified nurses.  They also have implications for the quality of leadership among the nursing profession in the region.  The  World Health Organization (WHO) State of the World’s Nursing 2020 Report has underscored the  critical  role of nurses  towards the achievement  of universal health coverage.  Nurses have always been and will continue to be central to the health systems in spite of new and emerging technologies and other modalities in the management of client systems.  The  growth of new and emerging infections, exacerbated by the Chronic Non-Communicable Diseases (NCDs) as we have seen in the case of COVID 19,  has intensified the prevention, care and essential services demanded of nurses.
 
WHO declared 2020 as the International Year of the Nurse and Midwife with a call for governments to invest more in Nursing.  The advent of the COVID-19 pandemic has brought to the fore the critical importance of the need for such investment.  The global economic challenges affecting countries, especially small and middle to low income ones like ours in the Caribbean, are projected by the CDB and IMF, as well as our local experts to have a serious and debilitating impact on the economy and workforce.  The epidemiological data and trend analysis associated with the current pandemic predict a potential second and third wave. In these circumstances, the economic and human resource impact will be especially challenging for CARICOM member states, especially if the need for additional resources required for effective management of those who are critically ill becomes more pronounced.
 
The immediate challenges faced by the nursing profession in the Caribbean have persisted over a long period of time.  COVID 19 has however brought them into sharp focus.  Based on a sample of responses from a cross section of CARICOM States the following have emerged:
 

• As women continue to give birth during this period of crisis,  the dearth of midwives is evident. This is so especially at the secondary care level. It  is a result  of  a pull for midwives between hospital and community services, with midwives mostly opting for the socially easier option of primary health care, where the grade is higher, and the possibility of working nights and unsociable hours is less.
• In some countries,  the absence  of stipulated procedures for the registration of foreign nursing is  a major setback in the event  of emergencies and/or natural or manmade disasters.
• Absence or limited capacity of nursing schools to provide online theory and practical teaching/learning will have to be seriously addressed.
• Unavailability of qualified and competent staff as well as resources to facilitate online assessments.
•  Insufficient scholarship opportunities for advanced nursing education, training  and  job security.  
• Fear expressed and demonstrated by some health care workers including nurses of overexposure to COVID-19.
• Inadequate  remuneration packages including  variation in salaries between the public and private sectors.
• In the current period, many  countries have reported:

 

• high levels of absenteeism amongst nursing personnel.      
• fear of nurses in contracting and bringing home the disease to relatives.  
• requests by nurses for special accommodation  instead of going home to their
• families.
• inability  of nurses to make use of allotted shopping days due to work schedules and long lines of people waiting to access supermarkets.
•  Inadequate Personal protective equipment (PPE) and  supplies.

 
There are other dislocations confronting nurses that need to be urgently addressed. These include:
 

•  Lock down of the country and mandatory curfews instituted by the Governments that are contributing to the need for  some nurses having to make additional child care arrangements.
• Limited or absence of psychosocial support for nursing personnel to address multiple issues including personal and professional issues associated with functioning effectively under the intensity of  the stressful environment.
• Stigma and discrimination against nursing personnel caring for patients with COVID 19.
• Inflexible regulations requiring that replacing and expanding  of the  nursing pool can only be made where there are vacancies.
• Inadequate training programs  to expedite increasing the nursing pool to respond to health emergencies.
• Insufficient  testing kits.

 
The Regional Nursing Body has developed a Strategic Plan for Nursing and Midwifery (2020-2024).  It was finalized and presented to the Council of Human and Social Development (COHSOD) in September 2019.  Many issues contained in that plan require urgent implementation.  Among them is the need to increase the number of nursing graduates, ensuring that they find jobs, are adequately remunerated and retained in the health system.  Specifically mentioned in the Plan are the needs for:

• Evaluating and revamping the  Regional Examination for Nurse Registration (RENR)  managed by the Caribbean Examination Council (CXC).
•  Standardizing the  Clinical Assessment Tool for final year nursing students  based on recommendations made by RNB.
• Regulating and standardizing  the employment  and deployment of Assistive Nursing Personnel (ANP).
•  Addressing the perennial problem of migration of trained nurses from the Caribbean.

 
Conclusion
 
While COVID-19 has placed a strain on the healthcare system as more resources are funneled toward caring for coronavirus patients, nurses and other health professionals still need to pay attention to the essential services.  Maybe, the Caribbean might wish to consider paying  homage to our nurses and others on the frontline by dedicating a time and day when the entire region would collectively  pause, toot their horns, wave , applaud, and symbolize in whatever way,  the importance we ascribe to  these valiant soldiers  on the battle field to save lives and livelihoods of us all.  This gesture would at least bring the countries on the  Region -- physical distancing together --   in line with engendering a spirit of "CARICOM as a Community for All".  
 
 
Eddie Greene and Peggy DaSilva

Among the takeaways in the global fight against the coronavirus  is the need to come together to tackle thorny problems. We have learnt the benefits of  sharing  medical equipment and research, staff and scientific expertise, and data. We have also learned the necessity of setting  aside our sense of entitlement, our pride, our egos, and hoarding our resources, for the greater good of others.  This realization comes when we feel that our  well-being depends upon  being well too.  One of the most interesting aspects of the way the world has been dealing with the novel coronavirus pandemic is for the most part, the pivot that policymakers who have previously been anti-science tacked  back to respecting science around the pandemic. This is the stark  reality  in an appeal by Dr. Rick Wright ,  Coronavirus Virus Vaccine Research Chief at the US Health and Human Service (HHS),  who has allegedly been  removed from his post  for objecting to making the available the drug hydroxycholroquine ----  over the counter due to its unproven value in protecting COVID -19 patents — “ I am speaking out because to combat this deadly virus, science — not politics or cronyism — has to lead the way,” he said.
 
Science trumps Politics
 
Most compelling and relevant is  the  view by Paul Arthur Berkman   “As a common and apolitical language, in Scientific American in 2018 that “ science brings allies and adversaries together with technology and innovation to address cross-border challenges.” Those  borders may can be political, state, cultural, religious, gender, ethnic , or international borders.  Pandemics like COVID -19 obliterate them all.  The evidence is clear.  Viruses know no state or country boundaries, nor abide by any regulations,.  The ubiquity of global travel coupled with the fact that one can unknowingly have the virus and be asymptomatic, thereby spreading it to innocent bystanders, family members and friends, adds to its frustrating illusiveness.  That’s why science needs to come to the rescue to stop it too, with accurate, verifiable, safe and scalable testing for the virus, the disease, its antibodies and to determine immunity to it, as well as a safe, effective and scalable vaccine.  None of which we have yet.  What resonates is that Science matters, but Science takes time.
 
The same need to adhere to scientific evidence applies to approaches to climate Science. The same principles also apply to ensure that climate action is not put in eclipse.  How to strengthen resilience? Why a whole of Government approach is necessary  to cut emissions and stimulate behavioral changes? What are the elements of a recovery climate plan? How to prioritize protection of biodiversity, promote renewable energy, and afforestation, and prevent soil degradation.   
 
 
 
 
Positive movements since the inaugural World Earth Day 1970
 
The onset of the deadly COVID-19 pandemic from the novel coronavirus has made more people value science.  Flattening the curve has given proof to the fact that when lives are on the line, and as people understand that their daily decisions are connected to the lives of others, people everywhere will act in accordance with the scientific findings. Knowledge of the scientific information will provide the basis for communicating  effectively and combating disinformation. When World  Earth day was inaugurated in 1970, the configuration of the world economy,  diplomacy and international relations were vastly different from they are today. John Kerry, former US Secretary of State,  who along with Al Gore, former Vice President was  among the pioneers of the 1970 Earth Day movement provided a poignant reflection.  According to him, the advocates  knew that the solutions on climate were  actually good for our economy.  But they  didn’t have confirmed proof.  Today, looking  back at the scare tactics and false information by the big polluters were  in 1970,  science has proven them wrong. His  vivid portrait :
 
 
            “That’s the story of climate change. Progress has been halted by finger-pointing, denial, replacing real science with junk science, misinformation, and flat-out lies, elevating political hacks instead of scientists and experts, refusal to work with allies and even adversaries, and leaving states and cities   to fend for themselves.  Sound familiar? It’s no coincidence that the same president who called COVID- 19 a “Democratic hoax” referred to climate change as a “hoax from China.”  Kerry said in an interview with Our Daily Planet. (April 21, 2020) 
 
But there’s a story of hope in the climate crisis that is the opposite of what is required  to stop the spread of COVID-19.  Basically there is need to shut down much of the economy to stop this disease. On climate, it is  not a choice between economic recovery and climate action.  The science is explicit: solving the climate crisis is the engine of our economic future.  We end up healthier and create more jobs.  As the  pandemic upends our world, it reminds us of what really matters is the health and safety of our families and our loved ones, our communities and countries.  Climate science teaches us to  connect the dots between our health and the health of our planet, and explains how burning fossil fuels and climate change threaten them both.
 
At the same time, an expected drop in greenhouse gas emissions linked to the global economic crisis caused by the COVID-19 pandemic has attracted some optimistic prospects.  According to Gerhard Adrian,  World Meteorological Organization (WMO) Secretary-General in reference to a 5.5 to 5.7 per cent fall in levels of carbon dioxide due to the pandemic,  this trend is only “short-term good news".  It is predicted that once the global economy begins to recover from the new coronavirus, emissions will return to normal. “There might even be a boost in emissions because some of the industries have been stopped”, he cautioned. 
 
Conclusions
 
The last 50 years have seen the physical signs of climate change - and their impacts – gathering speed at a dangerous rate.  Consequently,  The UN Report on Climate Change (September 2019) has warned that unless the world can mitigate climate change, persistent health problems, especially hunger and inability to feed the growing population of the world, and there would be also more massive impact on economics. The report shows that since the first Earth Day in 1970, carbon dioxide levels have gone up 26 per cent, and the world’s average temperature has increased by 0.86 degrees Celsius (33.5 Fahrenheit). The planet is also 1.1C (nearly 34F) warmer than the pre-industrial era and this trend is expected to continue.  In addition the last five years were the hottest on record. This warming has been uneven, with Europe seeing the highest change in the last decade (of around +0.5C, or 32.9F) and South America and the Caribbean experiencing the least change.  Other key indicators showed an acceleration of climate change in the past five year including ocean heat and acidification, rising sea level (up 112 millimeters since 1970), glacier melt and Arctic and Antarctic sea ice shedding ice loss five times higher in last five years, compared to the 1970s. 
 
Under these circumstances,  the future choices revolve around two options.  One is a path of global solidarity like we experienced in 2015 with the embrace of the UN 2030 Sustainable Development Goals and the Paris agreement  signed by 192-198 countries . The other is to devolve into division, hate and nationalistic authoritarianism.  GOFAD is optimistic in its belief that the enormous pain and suffering of responding to COVID-19 will actually increase the chances for Climate Action.
 
Eddie Greene

This blog is being written  before the full  report  of a specially convened meeting  of CARICOM Heads of Government  on  April 15 to discuss the Regional response  to COVID 19,  is available. A CARICOM Secretariat press release (March  16)  highlights some of the major  proposals that revolve around a common public health policy, food security, inter-regional transportation, threats to security, building a robust digital architecture to facilitate commerce and assist in the fight against the virus.
 
The Blog is inspired by the view of  CARICOM Chair and convener of the special meeting, Barbados Prime Minister,  Mia Mottley.  It is  that "the community is being confronted with  a virtual reality  beyond the physical boundaries of its sovereign states". Her implicit  conceptualization of the solution brings into sharp focus  the prospects of the Region's  collectively planning to overcome the threat of COVID 19 to lives and livelihoods in the  Caribbean. She sees this as  a trigger for  sharpening   the reality of functional cooperation and acting as a spur to  an accelerated quest  toward   a genuine single market and economy.  The Special CARICOM conference coincided with a session of the IMF-World Bank Spring Meetings (March 15)  on  actions to save lives globally and protect livelihoods with targeted fiscal measures. Both conferences  conducted  virtually,  provide an indication of the new normal for governance and decision  making.
 
In her address to the opening press conference of the IMF-World Bank meeting,  Kristalina Georgieva, IMF Managing Director reinforced the extraordinary uncertainty about the depth and duration of this crisis.  Referring to the World Economic Outlook,  she said that it is already clear that global growth will turn sharply negative in 2020, leading to the worst economic fallout since the Great Depression.  In the previous quarter, January-March,    per capita income growth was expected in over 160 of IMF  member countries in 2020. “Today, that number has been turned on its head: we now project that over 170 countries will experience negative per capita income growth this year. The bleak outlook applies to advanced and developing economies alike. This crisis knows no boundaries. Everybody hurts.” 
 
This is no doubt,  the virtual reality to which PM Mottley refers.  It is a realization that the health crisis will hit vulnerable people hardest and  the economic crisis will have severest impact on vulnerable countries. And this means that CARICOM countries will be exposed to massive external pressure, dangerously exposed to the ongoing demand and supply shocks, drastic tightening in financial conditions and the reduction in remittances. Some may face  unsustainable debt burdens.
 
It is the widely accepted view  that the response to the coronavirus will be  fully resolved only when enough people are immune to the disease to blunt transmission, either from a vaccine or direct exposure.  Until then, it is evident that  governments that want to restart their economies must have public-health systems that are strong enough to detect and respond to cases.  A template by the World Health Organization (WHO) based on empirical observation illustrates  the disease progression by phases and responses.
 
 https://www.mckinsey.com/~/media/McKinsey/Business%20Functions/Risk/Our%20Insights/COVID%2019%20Implications%20for%20business/COVID%2019%20April%2013/SVGZ-covid-413-Ex1-revised2.ashx
 
Listening to International Experts without neglecting regional expertise
 
Taking a different angle, the Brookings Institute  (March 2, 2020)  reveals the  many channels through which an infectious disease outbreak influences the economy. Direct and indirect economic costs of illness are often the subject of the health economic studies on the burden of disease. The conventional approach uses information on deaths (mortality) and illness that prevents work (morbidity) to estimate the loss of future income due to death and disability. Losses of time and income by those infected  and direct expenditure on medical care and supporting services are added to obtain the estimate of the economic costs associated with the disease. However, this conventional approach underestimates the true economic costs of infectious diseases like COVID 19 and before, SARS. and HIV. These are all of epidemic proportions which are highly transmissible and for which there is no vaccine.
 
In the Caribbean, a study by UWI (Trinidad and Tobago) Health Economics Unit in 2000  led by Prof Karl Theodore,  sensitized CARICOM Heads of Government to the exceptional costs of  HIV as a percentage of GDP that jolted the region into action. This included  the establishment  of  the Pan Caribbean Partnership against HIV (PANCAP) on February 14, 2001.
 
The seminal Report of the  CARICOM  Commission on Health and Development  2005 , Chaired  by Sir George Alleyne did the same for our understanding the macroeconomic implications of the Non Communicable Diseases (NCDs).  It triggered the Port of Spain Declaration  (2007),   "Unite to Fight the NCDs" and a worldwide movement  on the wellness revolution through advocacy at the levels of the Commonwealth Heads of Government and the United Nations General Assembly. Both HIV and NCDs reflect the principles of Test, Treat and Defeat  a response actually coined by Professor Clive Landis one of the current researchers  on the UWI COVID 19 Task Force. An emerging  slogan in this contemporary fight is: Test, Trace and Treat. 
 
The experience from the response to  previous disease outbreaks includes success through collective action.  The Caribbean region was the first in the Americas to eliminate poliomyelitis and the first to eliminate indigenous measles and rubella. This among others,  must have provided useful  lessons about mitigating and containing the coronavirus.  It is heartening to note that CARICOM Heads from what we have so far learned,  have placed emphasis on:
 

• strengthening mechanisms for joint procurement of pharmaceuticals and  personal protective equipment and  sourcing medical personnel.
•  if required, the deployment of healthcare workers on a regional basis.
•  ensuring food security through a regional production and supply of food products.
•  recognizing the importance of introducing digital means  to trace and contain the virus.   
•  expanding on the approaches to regional problems already being taken by institutions such as the Caribbean Public Health Agency (CARPHA) head quartered in Trinidad and Tobago,  the Caribbean Disaster Emergency Management Agency (CDEMA) in Barbados  and the Caribbean  Competition  Commission (CCC) in Suriname. 

 
Equally important is the recommendation for a collective approach to the international institutions for addressing the financial challenges, placing emphasis on vulnerability  over GDP.  The allocation  of  an initial  package of  US$140 million  by the Caribbean Development Bank  which follows this principle is invaluable.  It is intended to provide  assistance to its borrowing member states coping with COVID-19.  According to CDB President,  Dr. Warren Smith, "this assistance is directed mainly towards the most vulnerable within our societies and giving the highest priority to strengthening social safety nets”.
 
Good practices and innovations within the region — Jamaica an Outlier  
 
Most Caribbean countries  have been responding with varying formulae  to mitigate the economic fallout from the coronavirus.  However, the most comprehensive that we have come across is the Jamaica government’s  J$25-billion fiscal stimulus package announced by the Minister of Finance to cushion the impact on businesses, creative industries, workers and the vulnerable groups including the elderly.  Heralded both nationally and internationally is Jamaica's  robust  health programme for prevention and mitigation; its  sharing information and  public awareness; strict enforcement of physical distance and protection for frontline workers; and making provision for quarantine  facilities.
 
Innovations are also to be highlighted. University of Technology (UTech) student in Jamaica,  Rayvon Stewart has produced  XERMOSOL , an ultraviolet technology  which field and laboratory tests have found to be  efficient in killing about 99.9 per cent of deadly  pathogens found on doorknobs, thereby reducing the spread of bacteria.  This invention may prove to be as a possible key weapon in the fight against COVID-19. It is also worth noting the gumption of two Jamaica  young inventors. With the assistance of UWI Engineering faculty and UWI Hospital in Jamaica,  they have used their creative talents  to build ventilators and develop 3D face shields  https://www.youtube.com/watch?v=q9Au4TY8yG4
 
On Easter Sunday night, Jamaica again demonstrated to the world its creative talents.  Undaunted by the challenges, and supported by the Government in partnership with the Private Sector, its producers master minded and its artists delivered a spectacular virtual mega concert.  It was dubbed “Jamaica together we stand” and connected Diasporans in Europe, North America and throughout the Caribbean  raising over US$10 million to support frontline workers in Jamaica.
 
Conclusion
 
It is increasingly clear that this new decade will be defined by an unprecedented new reality. We are enveloped by a new normal.  It is most likely to usher forms of engagements  that  diverge from those which previously shaped our lives.  Hopefully the contours of the regional discourse on COVID -19 convened by Prime Minister Mottley, will inspire CARICOM Leaders and citizens  to let virtual reality trump national sovereignty. 

​Eddie Greene

2020 World Health Day on April 7 passed with a whimper, dwarfed  as it were,  by the continuing focus  globally on the war against COVID-19. Its theme, supporting nurses and midwives is incorporated in the worldwide recognition given to health  care workers and others on the frontline of the fight. The annual day,  inaugurated  in 1950,  aims at raising awareness of important health issues, including mental health, maternal and child care, NCDs, food safety, climate change and most recently,  in 2018 and 2019, “universal health coverage everyone everywhere”.
 
This year’s World Health Day should jolt us more than ever in  celebrating the work of nurses and midwives among other health workers.  We are reminded of the critical role they play in keeping the world healthy. Nurses and other health workers are at the forefront of COVID-19 response - providing high quality, respectful treatment and care, leading community dialogue to address fears and questions and, in some instances,  collecting data for clinical studies. Quite simply, without nurses, there would be no response. Over these seventy years of celebrating World Health Day there has been no greater disruption to the health  systems and no greater challenge to health workers globally.
 
All over the world, nurses are foremost among health workers fighting day and night not only to keep us safe from coronavirus,  but also to provide the essential services we need to keep healthy in other ways. In his statement to mark this significant day,  WHO Director General,  Dr. Tedros  Adhanom Ghebreyesus recognizes the vital role played by nurses  and midwives. “These are the people who devote their lives to caring for mothers and children; giving lifesaving immunizations and health advice; looking after older people and generally meeting everyday essential health needs”.  Indeed, they are often, the first and only point of care in their communities.  And, more so, in these devastating times of death during social distance, they act as surrogate family to many,  giving comfort and support to those who would otherwise expire in utter loneliness.  At the same time, shortages of the most basic protective equipment leave doctors, nurses and other frontline workers dangerously vulnerable as they care for COVID-19 patients.
 
State of the World’s Nursing Report 2020
 
It is fitting  that in commemoration of World Health Day, WHO launched the first ever report, The State of the World’s Nursing 2020.  It provides  an in-depth look at the largest component of the health workforce. It reflects a global picture of the nursing workforce and supports evidence-based planning to optimize their contributions  to improve health and wellbeing for all. The report sets the agenda for data collection, policy dialogue, research and advocacy, and investment in the health workforce for generations to come.
 
Although the number of nurses globally increased by 4.7 million between 2013 and 2018, the world is facing a global shortfall of 5.9 million nurses, especially in Africa, South East Asia, the Eastern Mediterranean and some parts of Latin America. The report predicts that the current shortage of some 5.9 million nurses will increase, as 1 in 6 nurses worldwide is projected to retire within the next 10 years.
 
The State of the world’s nursing 2020 report provides the latest, most up-to-date evidence on and policy options for the global nursing workforce. It also presents a compelling case for considerable – yet feasible – investment in nursing education, jobs, and leadership. A similar report on the Midwifery workforce is to  be launched in 2021.
 
Bridging the nursing gap in the Americas
 
The Report documents that the Region of the Americas is home to 30% of the world’s nurses, or some 8.4 million people, of whom 87% are female. On average, the Region has 83.4 nurses per 10,000 population, more than twice the global average of 36.9 per 10,000. The figure, however, masks extreme disparities in the availability of nurses in different countries. Fully 87% of all nurses in the Americas are concentrated in just three countries: Brazil, Canada, and the United States, which account for 57% of the Region’s total population. That translates into a density of 80 nurses per 10,000 population in those three countries but contrasts starkly with the less than 10 nurses per 10,000 population in Haiti, Bolivia, and the Dominican Republic.
 
In the Americas, some 30% of the nursing workforce is aged 55 or older, with nearly a quarter of nurses expected to retire over the next 10 years. While there are currently 1.2 young nurses available to replace each retiree, that replacement rate will be insufficient to keep pace with population growth. This is happening at a time when there continues to be a hemorrhaging of the nursing pool in the Caribbean due to migration and the proposals from CARICOM for managed migration have not yield beneficial results.
 
The Americas Region also has major disparities in the distribution of nurses within countries. In the 35 PAHO Member States that have reported data on distribution, only 36% of nurses are located in rural areas, even though 50% of the population resides there.  The availability of nursing personnel is also complicated by the fact that a number of countries, especially in the Caribbean, are net exporters of nurses.
 
 
Commenting on the status of the situation in the Americas, Dr. Carissa Etienne, PAHO Director said in a press briefing on World Health Day that through April 6, 384,435 confirmed cases of COVID-19  were reported in the Americas, and 11,270 people have lost their lives. “In just seven days, we witnessed cases and deaths more than double in our region.  The pandemic is accelerating rapidly, and I urge governments to prepare and respond at the same speed,” she said.
 
Cuba's  Health Brigade must be Celebrated
 
COVID-19 has placed a strain on the healthcare system in various Caribbean countries as more resources are funneled toward caring for coronavirus patients.  The mammoth effort by Cuba in sending aid in the form of doctors and nurses to Italy and other hard-hit territories cannot go unnoticed.  Cuba has been exporting doctors and nurses throughout the Caribbean as COVID-19 cases began to pop up in the region and governments reached out for help. As of  2020 World Health Day,  Cuban health professionals are being or have already been deployed to:  St Kitts and Nevis  (30); Barbados (101); Antigua and Barbuda (29); St Vincent and the Grenadines (16); Jamaica (140); St Lucia (120); Dominica (34); and Belize (58).
 
To bridge the nursing gap by 2030, the WHO  report says countries will need to increase the number of nursing graduates by an average of 8% every year and ensure they can find jobs and be retained by health systems. This will require investments to expand educational and training opportunities, increase nurses’ remuneration and improve their working conditions to ensure better retention. Funding these measures would cost roughly US$10 per capita (overall population) per year, the report says.
 
Addressing Health Disparities
 
COVID -19 has demonstrated the worst-case scenario involved in the spread of an epidemic into the developing-world where huge  numbers of people live, where health care facilities are poor and where millions lack the money to afford whatever care is available. There are also larger emerging-market countries that will take a huge economic hit as a result of lost tourism,  and basic commercial and agricultural activity.  But there are more specific and immediate areas to be addressed.
 
Speaking yesterday (March 8) to Ms. Peggy DaSilva, Coordinator of the CARICOM Regional Nursing Body from her base in St Vincent and the Grenadines, reinforced  some concerns of that regional organization about the special plight of the differently abled that was brought to the attention CARICOM Heads of Government. Among them,  the  need for sign language accompanying health briefings to ensure this demographic has  greater access to public  education; statutory mandates for construction of  ramps to facilitate access to public and other buildings;   and  special support to care givers and care giving institutions.   At the same time a release from UNAIDS (March 7) draws  attention to the particular hardships  facing sex workers globally, and calls on countries to ensure the respect, protection and fulfilment of sex workers’ human rights.  The case of prisoners  in  cramped cells has led to a rapid spiraling of the coronavirus in those institutions, in most cases without adequate plans for effective  preventive and remedial action. In the USA, the Chicago jail for example has the highest concentration of deaths.
 
While all levels of society are being affected by COVID-19, the impact of this pandemic is particularly hurting schools and places of worship, and disproportionately impacting the underrepresented communities, the sick, the elderly and the lower income groups. In the USA,  statistics reveal the enormity of the disparity afflicting the black and brown communities, with Black Americans at  overwhelmingly higher risks of infection and deaths.  As a result, it is  vitally important that organizations delivering critical social services and meeting community needs remain viable, particularly during this economically challenging time. Consideration may be given to including places of worship as recipients of support in the category of small businesses. 
 
During this weekend’s celebrations of Easter,  Christians may wish to reflect on the fact that Jesus’ crucifixion and  resurrection were  indeed instigated by  the betrayal of ‘Judas’. The Washington DC National Cathedral  Lenten Medication by The Rev. Canon Leonard Hamlin (March 8) is a fitting preview of life beyond COVID -19.  "Today, what does betrayal to His teachings look like when we see the hoarding and cleaning of shelves, communities disproportionately affected because of economic, environmental, political and racial factors? When we are able to reach a point of looking back, will anything be different because of what we have been through? Will the change be limited to our habits or will change truly be in our hearts? I am praying that the change begins with me and together, we will see a different world on the other side of this moment”
 
For believers as well as non-believers, this sacred pledge is a truly respectful tribute to those, the focus of our celebration of World Health Day. 
 
 
Eddie Greene

The devastating trends of COVID 19 continue.   Judging from the experiences in Italy, Spain, and in USA, especially in New York, California, Louisiana and the increasing impact on over 190 countries the world over, the war against this invisible enemy is deadly not delusional. The new reality as expressed in a recent tracking  report shows the expected exponential rate of spread, excessive demands on  health systems and the stress on health practitioners suffering from lack of personal protective equipment (PPE), helmets and ventilators. The  projected number of deaths from COVID-19 in the USA is estimated to be approximately  93,500  by August.  This is frightening. It  is a reflection of the gravity  of the situation likely to afflict other countries. http:covid19.healthdata.org/.
 
To stem the social and economic effects of this devastation, there are examples that there is  need for policies and programmes to mitigate the effects on workers  losing  their jobs, renters and homeowners being evicted, bankruptcies of companies, avoided,  and business and trade networks, preserved.  These are all prerequisites for mitigation to ensure that recovery will occur sooner and more smoothly. The enormity of the challenge  is visible in many of the developed countries. Yet an IMF Report illustrates how the challenge is even greater for low-income and emerging economies that face capital flight and will require grants and financing from the global community . Antonio Gutérres, UN Secretary General advocates a Global Humanitarian Fund.
 
 
“May your choices reflect your hopes, not your fears.” (Nelson Mandela)
 
Nelson Mandela's aspirations are reflected in the sustainable solutions to cope with this situation  gleaned from lessons learned.  China, South Korea and Singapore that have flattened and bent the curve downward provide templates charting the difficulties they faced, the measures that proved most successful in mitigating the human and business impacts of the virus, and how their operational emphasis shifted throughout the stages of  the  epidemic based on "hopes" rather than "fears". 
 

• Extraordinary containment measures limiting the movement of millions, coupled with rapid medical responses, appear to have proved effective in preventing new infections. There is however awareness that  social distancing is a privilege that many in poorer countries and communities within countries don’t have.

 

• Acting fast to provide protective gear and sanitizer, additional insurance, and other health-related benefits emerged as the most effective strategic response, as this is  crucial for prevention, increasing safety and maintaining morale.

 

• Digital communication with employees, and general citizens both of safety measures and operational changes, and messages of support generally and to customers, became vital in keeping strategic responses on track. Compare this with many countries where these methods are assumed to be an invasion of human rights.   And in others, where internet penetration is either hampered by inadequate bandwidth  or access  limited or non-existent, exacerbating  the gap between the ‘information rich’ and the ‘information poor’.  Regulators and policymakers must make changing this, a priority.

 

• Completely resetting  thinking, concentrating on protecting the safety of partners, families  and customers. It is important to make sure that citizens feel supported by governments they trust, and workers feel supported by management. A combination of managerial courage, teamwork, and strong resilience is required.

 
 
SDGs: Reducing  Inequalities and Increasing Inclusiveness
 
The 2030 Sustainable Development Goals (SDGs) provide a useful set of markers linking health and economic factors.  Implicit in these lessons are the inequalities that are being compounded. Unlike other economic downturns, the fall of output in this crisis is not driven by demand. It is an unavoidable consequence of measures to limit the spread of the disease. The role of economic policy is hence not to stimulate aggregate demand, at least not right away. The main objectives according to the IMF include:
 

• Guaranteeing the functioning of essential sectors by boasting testing and treatment, strengthening  health systems,  securing food production and distribution, and maintaining  essential infrastructure, and utilities.
• Providing  enough resources for people hit by the crisis specifically expanding  unemployment benefits and extending  cash transfers are needed to reach the self-employed and those without jobs.
• Preventing  excessive economic disruption through    programs of loans and guarantees  (with the risks ultimately borne by taxpayers).

 
SDGs: Shared Responsibility and Global Solidarity
 
While we were in the midst of this blog, The UN Secretary General issued a UN report, Shared Responsibility, Global Solidarity: Responding to the Socio-Economic Impacts of COVID-19.  It has led to an appropriate diversion in its amplification of his previous call for a global humanitarian response. Its message is made more forceful by empirically demonstrating the impact of COVID on the 17 sustainable development goals. https://www.kff.org/ce6c676/
Among the  examples of increased  inequalities  are: 
 

• Loss of income leading vulnerable segments of the society and families to fall below the poverty line.
• Disruption of food products and distribution could be disrupted.  
• Devastating effects on health outcomes.
• Remote learning for schools, less accessible  for some.
• Increased violence against women.
• Populations in the slums facing higher risks of exposure due to population density.
• Reduced commitment to climate action but less environmental footprints due to less production and transportation.
• Aggravate the backlash against globalization but highlighting the importance of international cooperation on public health conditions.

 
Dare and care. 
 
This important refrain  emerged out of the lessons from China. South  Korea and Singapore.  
Dare to take quick decisions by a crisis management team properly informed, trusted  and empowered to preserve social cohesion, business continuity, and enforcement of sanctions.  
Care,  demonstrated by the management  team, always putting people first in terms of health and financial security with emphasis on those first responders on  the frontline of testing and treatment,  the back office to guarantee service continuity and the marginalized to reduce inequalities. A statement in the UN report aptly captures the present reality.
 
"COVID-19 is menacing the whole of humanity and all humanity must fight back . An effective response needs to be multidimensional, coordinated, swift and decisive. It needs to be a result of strong political leadership and buy-in of the population. It needs to foster public trust; be focused on human values; and supported by solid institutions, technical skills and financial resources.  Everyone needs to play their part. No individual country can do it alone"