The Barbados Association of Medical Practitioners (BAMP) recognizes the negative impact that the COVID-19 pandemic has had on the cultural industries, national festivals, tourism product, economy and psyche of Barbadians . As an association of medical doctors, we are compelled to advocate for the importance of maintaining the physical and mental health of the population, which has implications for national productivity and the economy, both in the short and long-term.

In calculating any risks that we take as a country, we must never forget our limited human resources, particularly in the healthcare sectors, as well as our unique vulnerabilities as an island with an extremely high NCD burden and an elderly population. Our concerns and recommendations concerning the latest announced directives include the following:

1) Vaccination Definition and Reporting
The OMICRON subvariants ( BA1, BA2, BA 2.12.1 , BA4 and BA5) have all shown varying degrees of immune escape. Immunity developed through vaccination or prior natural infection wanes with time, and vaccination provides the best protection after booster doses are given. As of May 21,2022, 56.2% of the susceptible Barbadian population has completed the first series of vaccination and the percentage of those who have received first and second boosters remains unreported.

Important questions arise from the definition of who is protected against severe COVID-19 at this time. Is it those who have had the correct number of approved vaccines at any time during the pandemic? Or is it those who are up to date and have had evidence of having vaccines and boosters at the appropriate intervals? Scientific evidence suggests that with the Omicron subvariant, it is the latter 1.

We recommend strongly that:
(i) urgent consideration be given to re-examining the definition of who is considered ‘fully vaccinated’
(ii) every avenue be explored to increase vaccine uptake, particularly among the most vulnerable as well as among healthcare and frontline workers.
(iii) appropriate data should be collected, stratified and analyzed with respect to growth in vaccination rates and booster uptake among subgroups of the population (such as the over 60’s, persons with comorbidities, school children etc.), and this data should be reported.

2) Variant Surveillance and Testing
We were told in April of this year that genomic testing suggests that the majority of recent infections in Barbados are due to Omicron BA2 subvariant . Some time ago we were told that such genomic testing would soon become available in Barbados and that surveillance for variants would be ongoing and frequent. We suggest that normalization of disease surveillance and genomic surveillance through increased testing in-country and strategic testing at our borders, will result in appropriate and dynamic response to increases in cases and timely detection of new variants.

3) Changes In Protocols re: Mass Gatherings
The most recent Emergency Management (COVID-19) Order (No. 18) introduced the idea that a rapid antigen test is now valid for 48 hrs among those providers and patrons of an event at which ‘members of the public may be entertained for payment of money directly or indirectly’. We point out that these same directives still require that unvaccinated staff and patrons attending party cruises or those who operate nightclubs produce a negative rapid antigen testing valid for up to 24 hours before the event. We are not privy to the scientific evidence that has supported the extended validity of a rapid antigen test solely for persons hosting and attending entertainment events for payment of money, as outlined in Section 8.

Given that our mass gathering events and festivals will not be limited to persons who are appropriately vaccinated, we therefore strongly recommend that all providers and patrons attending a mass gathering event, festival, party cruise or nightclub, show evidence of a recent rapid antigen test taken no more than 24 hrs prior to attending.

The most recent literature also strongly supports saliva testing as a quick, effective, less intrusive and appropriate means of COVID-19 surveillance 2,3 .We recommend that immediate consideration should be given to saliva testing and to the resources required for surveillance of mass-gathering.

4) Other Changes in Protocols
It was announced on May 21, 2022 that Barbadians will soon no longer be required to wear masks when gathering outdoors, but may do so optionally. The mask requirements for indoor activities and schools, we were told, remain unchanged. BAMP maintains that wearing masks is one of the most important and effective public health interventions in reducing disease transmission. In many countries with higher population vaccination rates than Barbados, when mask requirements were removed there was an uptick in both cases and deaths, even with the Omicron subvariant.

We recommend therefore, that except in instances where all persons attending an outdoor mass gathering have had a negative rapid test taken within 24 hrs, mask requirements for the general population should remain unchanged.

Entry requirements
We have noted the decision to remove any testing requirements for ‘fully vaccinated’ persons entering the country. If our definition of fully vaccinated remains the same , by removing any testing requirements for these persons, we will have removed any opportunity to detect infection among the majority of persons entering the country and to conduct surveillance for new variants at the borders.

BAMP cannot, therefore, support the decision to remove all testing requirements for the ‘fully vaccinated’ entering through our borders, as defined at this time. We recommend urgent reconsideration of this proposed measure.

Dr. Lynda Williams
President and Co-Chair BAMP COVID-19 Task Force