 Hello and welcome to another special interview where we're discussing the COVID-19 Prevention and Control Act. We did have the first part of our conversation with the Attorney General recently and we'll be speaking now with the Chief Medical Officer Dr. Charm Belma George where we'll be delving more on the health aspect of this act and what it really means for us in terms of protecting us from COVID-19. Dr. George, thank you so much for coming in and for having this important conversation. Before we get into COVID-19, I know that right now for St. Lucian's the dengue fever definitely has caught the attention of the public with the recent related death and we are over 500 cases with dengue. But the ministry has been very proactive because even through our own medium here at the GIS, we've been speaking about the outbreak of dengue. Can you give us some insight as to what is the severity we're facing with dengue at this time? Well, as most people know, dengue fever is endemic to St. Lucian. That is, it's one of the diseases that we get usually in low levels. But usually with the rainy season between June and November, we get increases in dengue fever traditionally here. From earlier in the year, we've been monitoring the outbreaks of dengue fever in the region. For example, from Martinique has been having outbreaks and we have been looking at our mosquito indices around the island. Over the last month, we began to note increases in mosquito indices and also increases in cases when we did declare a dengue fever outbreak. So within a very short period of time, we've just seen the numbers increasing. And when we get a number of over 500, that is those that are confirmed, we know that's just the pick of the iceberg because a lot of persons don't come in to get care. What we also note that we have the serotypes 2 and 3 circulating and traditionally we've had the other serotypes as well. So it puts us in a situation where persons who may have had dengue fever before are now at high risk for some of the complications of dengue fever. So it is extremely important that, first of all, the public health measures are enforced, which we have been doing, the surveillance on the ground, the fogging, the community activities, the health education as well, and the management and care to ensure that all of our healthcare workers are monitoring for complications of dengue fever. But we really want to urge the public that each and every one of us in our households, we need to ensure that we monitor around our home because the Ediz-Egypti mosquito, which is the vector that spreads dengue fever, it's a household, it's domestic. So it tends to breathe in clear clean water in and around your house, in any flower pots, in any containers around house. So it's extremely important that we break the cycle of the mosquito. So each and every one within, first of all, our households, we do the necessary cleanups around to look for areas where mosquitoes can be breathing in buckets of water, where a lot of persons because of not having a regular water supply may decide to store water. So we need to look around to see where, if you have a lot of mosquitoes at your house, you need to search for the breeding grounds of the mosquitoes, first of all, after you've done that around your house. On a community level, we need to look to see what are the issues that need to be addressed to reduce the collection of water in and around the home. I also want to indicate that we've noticed that in the ages below 14 years, we've seen most of the cases are in young adults as well. So the public needs to be aware that the regular signs and symptoms as most people, I think almost everybody knows somebody who has had dengue fever, the high fever, the retroorbital pain, that is a pain at the back of the head, the joint pains, the feeling of weakness. But you have to also monitor for signs of bleeding because your blood platelets tend to go low and these are responsible for clotting. And that is where you can get some of the complications that can lead to death in relation to dengue fever. So as much as we're managing COVID, but we're managing a lot of other things at the same time. And it is extremely important because we've had our first death. So we have to ensure that we manage and we're very vigilant in terms of the public knowing what the signs of complications are. If you're getting worse, you're getting vomiting, you're feeling very weak, you need to go to your nearest healthcare facility to get tested, to get checked as well to ensure that the dehydration and everything else, you don't lead to a complication. So you mustn't stay home. Other underlying conditions that would perhaps make one more susceptible to the severity of dengue? Yes. As with people with chronic conditions, the extreme age groups are very young and they're very old as well, tend to be more. And if you have any other severe, like a heart condition, this can also put you at greater risk for getting a complication. And one of the things is that if you've had dengue once or twice before and you're now getting a different, because remember we have four serotypes, you're now getting a new serotype, you're even more susceptible to bleeding out with dengue fever. So this is serious. The public, we need to all play our part at the level of our household and community to try to reduce the mosquito indices within within our homes. The public is concerned that they're not seeing the fogging. So the Department of Environmental Health has said, yes, we can fog, but it's not necessarily the most effective. Right. You see, we've been fogging and our strategy, we've been looking at the places with the highest mosquito indices. And for this year, I have to indicate that usually the progress of the cases happened within a very short period of time. And as much as we have some areas that are more highly affected, it is island wide. Every single day we have a number of communities in dengue fever. So it is difficult for us to fog everywhere at the same time. The Environmental Health Department, they have a schedule which we have been sharing so that communities are aware when they're coming in. But this is just one measure. The fogging kills the adults. However, if you kill the adults and you still have the other stages, the larvae, you have them breeding in your buckets at home, it means the adults die, new ones come up and the cycle continues. So as much as we are trying to reduce the numbers with the fogging of the adults, we have to ensure we cut the cycle with the breeding grounds for those mosquitoes. And that would be the most effective way to reduce the mosquito population and as a consequence reduce the dengue fever numbers that we're seeing now. And so it's a question for all of us to play our part. All of us have to play our part. Okay, let's get to the substantive matter at hand with COVID-19. You know, the state of emergency that came to an end and so the COVID-19 Prevention and Control Act is now here. We've heard that the state of emergency perhaps would have been too much of a draconian measure to keep up with. The Quarantine Act and the Public Health Act have been told, woefully inadequate to be able to provide your office with the sort of powers and provisions needed to do what you need to do with COVID-19. As succinct as possible, tell us why are you comfortable with having this COVID-19 Act as opposed to all the other forms? COVID-19 prevented it presented a very unique situation for us in terms of our public health response. As much as this is a respiratory illness, but the measures that need them to come into place to manage it were different to anything that we have implemented before within our time. When the outbreak started and we started seeing cases and especially given that it is a new disease, all of the ministries of health around the world, everyone was monitoring, trying to get information on a disease which is new. A lot of the information that we need to manage was not available at the time because we were looking at how that disease was manifesting in other countries. A lot of the measures we put in place in the early days were to prevent the entry of COVID-19. When we got our first case in March, it was March 13th and as the cases started to increase within the month of March, a number of very strict measures had to come into place within a very short period of time. Hence the decision on March 23 to implement that state of emergency. Now the state of emergency gave the power for a very wide overarching activities and restrictions to be put in place in an effort to reduce any possibility to contain COVID-19 within that period. And from that period up to September 30th, it allowed us to put measures in place to reduce community spread, to reduce the impact that COVID-19 could have had on us during that period. Since then, we've had cases, we've been able to put those measures in place in a very effective way to reduce the possibility of deaths in our community. However, as the number of months have passed, we've learned, we've seen what a lot of the other countries, we've looked to see what are the most effective measures, we've adapted them to our own public health situation here in St. Lucia. And as has been predicted, COVID-19 is going to be here for a while. So it became necessary to get a specific piece of legislation to allow us to regulate, to contain and to manage COVID-19 in a more effective way. The Public Health Act and the Quarantine Act, which are the main health acts that we use on their review, they would not have been adequate to be able to cover a lot of the measures that have to be put in place to manage. The Public Health Act, it was from 1975 and revised in December of 2001. As you would imagine, it's a very outdated act. COVID-19 is not even in there as a, as a notifiable disease under there. And the measures that we use effectively to manage COVID-19, a lot of them were out of the public health realm. For example, the zoning, restricting movement of persons, the licor, suspension of a liquor license, a lot of those don't fall under the Public Health Act. The ports of entry. So there are Customs Act, there are acts under a lot of the other ministries, which feed into those measures that we needed to be able to do. So this COVID-19 Prevention and Control Act, it actually allows you to regulate and contain in a more specific way, putting pieces of legislation that would have ordinarily belonged on the different acts. If not, you'd have to now put amendments over a wide range of acts to be able to get everything that you need. So what we had to do was to look at, we reviewed, which we were familiar with, both the Public Health Act and the Quarantine Act, and looked at all of the gaps, which would not allow us, give us the legislative backing to be able to implement. We've had to do things that we don't normally do under the Public Health Act. It's mainly food establishments, offensive trade, nuances, apartments and guesthouse swimming pools, bakeries, human remains. But in terms of putting protocols for a hardware store, a lot of the new things that we had to put in place, physical distancing, use of more, a lot of those don't fall under there. And given the wide range of things that need them to be implemented, it would have been very difficult to even try and just amend it to make it work. And the time it would take to do that. So putting all of those measures, looking at the gaps in the Public Health Act and putting it into one act was the most effective way to be able to manage COVID-19 effectively. We're here in the two year period. Yes. For us here in St. Dushan, I don't think that we're able to relate because COVID-19 is not sort of this prevalent threat here. So for us, we're not able to compute why this two years because we will tell you, well, we have no COVID. Yes. I think we've been fortunate in St. Dushan not to experience what the rest of the world experience with COVID-19. We look at the number of persons who have to be placed in ICU, even in the developed world with healthcare capacity, way surpassing our, our possibilities here in St. Dushan, even on a regional basis, when we look at our, our sister countries, we have been fortunate not to have to deal with the huge outbreak of COVID-19 which would stretch our, our healthcare system. And I think this has led to a level of complacency and persons not understanding the level of risk which still exists. When we started off in the first few months of managing COVID-19, the numbers were a lot lower. At present, in October, most countries are now going through their second wave. We've cut with cases increasing in, in the US, in Canada, in the UK, and closer to home, a lot of our caracal and OECS countries, we have Jamaica, the Bahamas, Trinidad and Tobago, and even closer, Martinique Guadeloupe, we have some of our other islands now going through community spread. So some of the islands that managed earlier, managed well earlier are now seeing active outbreaks with deaths as well, and increasing, increasing numbers within the community. So both Dr. Tedros of WHO, Dr. Carissa Etienne from PAHO, Dr. Joyce and John from CARFA, and even through our analysis locally, given what we expect to manage, we are a susceptible population. We expect to be seeing cases and managing waves for an extended period of time. So this bill, it gives us the capacity to be able to manage. And if you notice a lot of what is here, we're not, it's not presently enforced because here right now, Senutra is practically open with few exceptions. I mean crews, yachting, we're not fully within mass crowd. There are few activities that are still restricted because they're a very high risk. But we practically, we're practically down to normal operations, managing with, with protocols. So it, what it does, it gives us the capacity given that the rest of the world is still in very high risk. It now gives us the capacity to be able to manage within a short period of time if we were to develop community spread at any point. And we've done a review of our system, and we have seen that our vulnerabilities are very close by. We look at, our borders are now open. We look at the level of risk in our tourism destinations. It's high. A case can come in at any point through the numbers. And between October and December, our risk is even more in, is even higher as our arrivals will be increased during that period. It's also a period where because of the temperatures, et cetera, it's, it's the flu season. So we expect to see increases in respiratory tract infections at that point as well. Apart from that, specific to St. Lucia, our poorest borders, we continue to get illegal entry coming from our high risk neighbors, Martinica and Guadalupe coming in. Those are persons who are coming from areas of active disease coming into communities. We also look at the fact that we, we get breaches to home quarantine. We continue to get breaches to persons coming in from high risk. Presently, children, persons who, with medical conditions, there are certain persons who, one of us used to do surgery because of their condition, we give home quarantine and there are certain groups we allow it. It just takes one breach of home quarantine and so far 80 over 83% of our cases were returning nationals. Could you imagine if those persons were out in the community and went into the banks went and especially since we noticed a level of complacency with the protocols, we, we know that there's a reduced use of face masks within the community. So it just takes one of those persons to break the protocol, get on a field bus where no one has a mask. This is a bus with 14, 15 persons on it. Those persons go home. That's communities spread for us here. And each person with their family with their community. So we've looked at all of the risks and all of the different possibilities where we can get cases introduced into St. Lucia. And the risk is high at any point we are at a good place now, but at any point we can get introduction of cases. And with the introduction of cases, it would mean now we would need to step back a bit. And as much as our plan and the setup of the public health system is to allow us to to manage cases effectively because we've set up the network of clinics, we've set up the respiratory hospital, we have measures in place where we we can manage a threshold of cases safely. But it is something we have to look at very closely as we see how the cases increase quickly in countries where it becomes infiltrated, especially if there's a level of complacency with the protocols. So given the level of risk, we need to be our surveillance has to be high and we need to be prepared that if at any point we develop cases increases, increasing, we can put the necessary measures in place in a very short period of time to allow an effective response. Let's look at go into the act itself. In section 10, we speak about the approval of testing and we know that testing is key. Yes. The the act speaks to the designation of a laboratory. Yes. We, the Central Medical and Dental Association is a bit concerned that the act was perhaps specifying only one lab would be accredited to perform tests. Can you explain to us how testing and the designation of laboratories would work? Okay, testing is an extremely important component of the response for COVID-19. And initially in our response, we relied on the Caribbean Public Health Agency to test and to give us those results and there was a bit of a delay. So one of the one of the components that thanks to the leadership of the the lab, the Azure long lab that they were able to put in place is accurate, efficient and sustainable testing locally so that we can get results within 24 hours. Given that we are dealing with a disease such as COVID and the capacity for spread, the capacity for complications in the initial phase where we're still trying to manage and contain COVID-19. It is extremely important that whichever lab that is allowed or given permission to test, the level of the standard of the lab, the accuracy of the lab and also it's important the type of tests in terms of specificity and sensitivity of the test. So for us here, given that the goal standard for testing for COVID-19 is the PCR testing, we have to ensure that whichever lab is testing, whichever test that is being used is done on accurately to give us a result. We can't have persons who are negative testing positive because it would mean we would not put you into care. We would not put you into a respiratory hospital where you can now get it because you're in an environment where there may be other persons and vice versa. We can't have someone who's positive getting a negative result and being sent home to their family. So in this phase, it is extremely important that wherever and whoever is doing the test is extremely accurate. There's a level of accountability there. There's a standardization of the reporting mechanism as well. And also important is the appropriate management of the cases when diagnosed. So at this point, we have kept the testing within the national level, also treatment and care. We've kept it at a national level to ensure that the same protocols for treatment and care are given. Notwithstanding, we anticipate within the next few months that WHO will approve rapid tests that are accurate enough. And given that, we expect based on the analysis that COVID-19 will be here for at least another two years. Once this comes into play and we get labs that are of the standard with testing that is accurate enough for us, it will be necessary to have a number of different labs also testing because it will increase the capacity of the country to be able to test. So this is one of the things that we are looking at. Other labs that can test give us accurate results. However, the reporting mechanism and that is why within our public health legislation, it's important that COVID-19 become a reportable disease, especially now. We will need to know who has it. Those persons would need to be referred into our respiratory hospital because as much as possible, we'd want to reduce community spread. We wouldn't want different persons managing COVID differently and end up with increased cases within the country. We need to have that uniformed approach to it. Now on your advice, the Minister for Health can prohibit the assembly of two or more persons in a public space. Physical distancing also being imposed. I think we have gotten accustomed to those two protocols. But there remain the public concern that the measures are perhaps infringing on the rights of citizens. Can you give us a likely scenario that would trigger a decision from your office, especially in restricting the assembly of individuals to be able out in a public space that sounds a bit drastic? COVID-19 has presented us with so many unique situations and for us, the priority and the focus. And I think with this bill, we've lost focus on what we're trying to do. We have to remember what the bill is there for. It's to regulate and to contain an infectious disease which has the capacity to claim lives, lives of our most vulnerable within St. Lucia. The measures to contain and to prevent is to reduce the transmission of COVID-19. It's a respiratory disease where you have too many people gathered. There's that possibility of transfer of this virus from one person to the next. So having people congregate, having too many people in any one space, as much as possible. If we are to get community spread, if we are to get increasing cases, those are some of the measures that we would need to put. And as much as it is inconvenient because we, from as a healthcare system, we noted the increase in mental health issues during and after the curfew and the lockdown and asking people to stay home. We are social beings. It's difficult to tell us we can't go see some of the family members that are very close to us. So apart from the possibility there are certain rights that we have to look at what we're trying to do. We're trying to manage and monitor an infectious disease. We're trying to contain and prevent. Our priority here is health and safety. So the inconvenience of a lot of those protocols and it's inconvenient to all of us and we are aware. But the priority is protecting health and safety on first. And as much as it was hard in the beginning of the year, I think we have a lot to be thankful for that our relatives, our vulnerable groups are here with us. So we have to, yes we have to balance it out, but we have to look at what the measures are for. At this point where we have 28 cases and thankfully for one of our protocols, this was somebody who was already in government quarantine. So in terms of transmission it was low, in terms of getting new cases. We didn't expect many cases coming out of this one because all of the protocols will will followed as planned. So it reduces the the impact and yes they are inconveniences. Quarantine is not easy for anyone and we're aware of that. But if it will reduce you spreading it to your family going home, we need to look at it that way. In section 19 with the response plan and the recommendation coming out from certain quarters is that maybe you should just allow, give a template so that someone can follow. Because as it is businesses, individuals, they are being asked to devise their own plan and present it for approval. How do you know that they are along the right path? Perhaps it's time consuming to go back and to amend and yes well the plans that existed before the bill would still stand. When we closed after the shutdown, I think that was in in April, our opening was in a in a phased manner looking at the most essential services first and we and we looked at the essential services and the level of risk of opening. So with each sector opening there were protocols that this sector has to follow and the protocols are specific to the type of service that's been offered. They submitted their protocols, we reviewed, we also did reviews within the the business place for example. Now within each protocol it's broken up into the the infection prevention control, the disinfection and cleaning, the physical distancing, there are a number of sections of each protocol that is given to the service because we have a wide range of services it is difficult to have one generic template. There are certain basic things that each service needs but the services are so different. Now each each protocol it speaks to what each service needs to have in the plan to make it easy for them to prepare the plan and submit to us. So yes some parts are generic but there are lots for example a supermarket would be very different to a bank to say the rainforest hide away or park. So because of this great difference it's difficult to have just one generic template that everyone fills out and it's dependent on where you located, the size of your of your business, the type of customers that you that you get, what you sell, how you sell it. So it would be difficult to have just one template that everyone follows. But the ministry is working along with anyone who needs that guidance. Yes the environmental health officers have been extremely busy working with the different entities to put and if there's something missing to make the recommendations to ensure that it's put in place to facilitate a speedy reopening. So the places that have already been opened through those plans and protocols they don't need to change. They've already been given the authorization and the act actually speaks to that that those persons are already covered. Yeah they've already covered, they've already been given their permission for opening. Let's talk about the medical information. In section 57, why is it necessary to collect, to use and even share the health information with a third party whether it be in country or out country? I think this is an extremely important part of the COVID-19 prevention and control bill and as you're speaking of health information I think it's important that we highlight some areas within there that specifically protects the public and their information. It says about the collection of health information and under section 50 it makes it clear that where the ministry collects health information directly from a person, the ministry at the time of collecting the health information and ensure that the person is informed in a language that he or she understands the fact that the information is collected, the purpose of it being collected, the recipients of the information and who the name and address of the ministry collecting that information. There's a lot of other information as to why it's collected also consent for processing of health information is also important. Subject to section 2, the ministry shall not process health information unless they obtain the expressed consent of the person. So you sharing your information under the act and it goes on to explain apart from consent, the accuracy, the use of the information and all of this is to protect person's information. Whatever information that we collect under COVID-19 as we do for other diseases it's it's collected by healthcare professionals towards health and safety of the individual. Now in terms of the sharing of health information given the nature of COVID-19 as we are managing the global this global pandemic it becomes necessary especially with the movement of persons to share information with consent of the person. I'll give you one scenario which we've dealt with and we've dealt with a lot of others for example someone who may have come through St. Lucia and goes to another island or country and they're diagnosed with COVID-19 the CMO of that country would then call me and let me know this is a situation and we've we've had to deal with quite a few of those situations where someone may have come through our airport or come through the island. We had a national who went to another island and they tested positive so a call from that CMO would now inform me so that we can do the necessary contact tracing we can increase our surveillance we can test it's all to contain and to prevent the impact of of COVID-19 so the the information is sharing that way in a discrete way to allow us to do the necessary to to contain so a lot of the times we may share data in terms of numbers but not persons but we don't give even in in our updates we don't give people's names we give general information we don't give places we don't give the store we won't give the name of the hotel as much as possible we we try to protect the the privacy of people we try to protect the privacy of business places as much as is possible but there are certain instances where um to protect health and safety to allow containment of the disease it becomes necessary to share um health information with another country to allow them to do the necessary to contain COVID-19 we seen the introduction of monitoring devices uh we have the bio sticker and there's also a wrist watch and explain to us how the these devices work yeah it became necessary when we look at um like i said we are now look moving on moving on into living with COVID-19 as we move to the latter part of the year we note that our government quarantine will have less space available to us so home quarantine will become increased and also with our planned opening for the alternative accommodation that is the smaller villas and the smaller guest houses it became necessary for us to get a more efficient way to be able to monitor um breaches to quarantine or breaches to persons breaking the the protocol for the accommodation um sector and given the the human resource that is necessary to allow that would be exhaustive you can't be everywhere in a community monitoring where the persons enter or leave um we looked at those technologies to assist us in giving us timely information to reduce any possibility of impact and this became relevant like i said earlier at least 83 percent of our cases were returning nationals and the number of breaches over the last couple few weeks we've had over 24 breaches to home quarantine just imagine if those were positive cases we got persons going into banks we got persons going into supermarkets we had someone who was selling in a community all those breaches if those persons were positive well we would definitely have had a level of community spread by now so the the the watch for example it allows us to be able to track and it's it's specific to the parameter of wherever the person lives if you live in a smaller place then the parameter will be a lot more restrictive as compared to if you live in a bigger estate so what it would do it would allow us to know if that it would send us an alert if that person passes a certain distance from where they at it does not take video it does not take conversations it just gives us the indication that you have passed a certain point the the button it allows us to monitor persons vital signs remotely so your temperature your pulse your respiratory rate and certain signs and symptoms of COVID-19 we'll be able to pick this up remotely I also need to indicate that this is information that we are already collecting when we monitor persons within home quarantine and all of this information is collected by healthcare professionals we have we collect a lot more information routinely on persons so it's not any information that is more than what we routinely collect and it is only going to be collected during that 14-day period while you are either in quarantine or within an alternative accommodation sector so is it free no it's not free of charge you would need to pay for the watch and for the and for the bio button the bio sticker but the cost of having this within the 14 days would work out a lot cheaper than if you were to pay for example for for quarantine and when you look at the the level of human resource that we would need to be able to to monitor the number of persons in home quarantine this would be a more accurate measure for us if someone spikes a temperature or develops a cough we would now have an objective measure to be able to pick that up as soon as it happens to ensure that that person is taken into care and tested instead of us waiting for a visit or waiting for them to indicate that so to provide us with a more objective measure and the monitoring takes place by healthcare professionals remotely by healthcare professionals and so they will be receiving the signals the alerts right they would be we be receiving it and then if need be then we can alert the Royal San Ushua police force they have been working closely with us especially on the breaches to home quarantine because anyone who breaches home quarantine is immediately taken to our government quarantine site while we are in quarantine so we have been saying for quite some time that the cost of quarantine would be passed on to individuals that the government would no longer be able to bear that full cost we are here in the public you won't cry it is a bit exorbitant in the minds of many can you explain the fee structure to us and how would these fees arrive at the fee structure is based on the hotels course for persons coming in for quarantine those will be paid directly to the hotel it's not a fee going to the government it is a fee going directly to the hotel for the stay there it includes the stay it includes the meals it includes care it includes everything on there so this is a fee you pay to the hotel for the quarantine period where government comes in is be our healthcare professionals at the hotel doing the monitoring of the health aspects the vital signs we provide healthcare persons who are there because we get persons with chronic conditions and we also do the testing so the the actual quarantine facility will now be in the hands of the hotel the hotel will be the one these are the fees to cover the hotel stay and the meals our part will be the healthcare monitoring while persons are there for the period of time and the there is now the provision for individuals to spend seven days in quarantine at the facility and then seven days home how do we know that this is a safe measure because we know that someone can develop covid well into a 14 day period yes um that is why it is extremely important that people understand that quarantine is 14 days the safe period is the full 14 days based on limitations in in quarantine capacity and also to reduce the cost what we do at seven days within um state quarantine we tested the 70 now the seventh day it provides some coverage but it's not a hundred percent risk-free about 70 to 80 percent of persons who've been exposed to covid-19 would develop covid-19 signs and symptoms and be picked up by the 70 so usually by the seventh day we do the tests and we usually get the result by the eighth ninth day if you're negative what we advise is that you spend up to the 14th day in home quarantine so you're not free to roam you're not free to go out it means you would have to have the conditions for home quarantine that is a room and a bathroom and you should be staying in your home because you're still a threat we still have at least 30 percent of persons who can develop covid-19 in the in the last period of of the quarantine time so even if you you released from the the state quarantine it is still important that you stay in up to day 14 so we are taking a level of risk by allowing persons into their home for the tail period but it's a lower risk looking at the cost and looking at the possibility of developing covid-19 now would these individuals be required to get the biostack or the wrist watch yes for the for the final seven days at home to ensure that they're staying in as much as possible for your ministry you see this as being quite a task because whereas you have the act which gives you all of these powers and provisions to do what needs to be done in terms of the public cooperation public understanding the public patience yes I think generally for a lot of the protocols we have received the cooperation of the public and if we were to just stay from a policy level and put laws and put protocols as we've seen in some other countries where the adherence and compliance led to community outbreak because people just didn't listen I think for St. Lucia it's different generally our population people have taken covid-19 seriously they've had head and they've done what needed to be done to protect our more vulnerable people however we still have especially at the level of the community groups who are resistant to those and unfortunately they present a risk to the rest of us who may be complying developing the illness so hence the reason why we needed to have the legislative backing there and also on an enforcement part given the crime and all other things that the Royal St. Lucia Police Force has to do it's not realistic to expect the police to be in all of the communities monitoring persons on home quarantine monitoring stores our environmental health officers are stretched thin we can't have them in all establishments ensuring that the number of persons who come in the persons wearing a mask physical distancing is almost impossible to allow that level of enforcement from any entity so keeping those measures it's really and we've noted when we do our reviews within the community there are some groups that just don't adhere they just don't adhere and hence the need for for some level of of fine or imprisonment or something to try to encourage people to stay there are people who would just be difficult either way but for St. Lucia you can see that if we are to stick to what we've been doing and improve on that right we can be relatively safe with COVID-19 we can be we've demonstrated that the protocols work and the protocols work effectively the case we had a positive case come into one of our hotels and because of the adherence to the protocols our hotel workers were safe the other guests were safe our communities remain safe we have so the protocols are actually produced so that if there's a positive case coming in and you adhere transmission would be next to nothing if a positive case were to come into the supermarket and they adhere to the protocols there should be no transmission to to the staff there to other people using the supermarket our reality is we have to learn to live with COVID we have to learn to manage we can't close up every time we get cases cases will come we have to be aware of the risk of cases coming and we have to be prepared to manage them effectively and continue living we can't keep we can't keep ourselves close we can't keep there are new set of complications developed from that so at this stage and as it's predicted by our other public health agencies this will be an inconvenience for another couple of years but we need to look at the some of the positives because we have had gains coming out of COVID-19 and the development of our hotel system the the development of our lab system because apart from COVID-19 testing the PCR capacity we can now test and stereotype for example dengue leptospirosis there's a whole new set of viral illnesses and we can now diagnose locally which before that capacity we were not able to do it so even within the system it has provided certain opportunities it has strengthened our system in many other ways as well all right thank you so much chief medical officer there Dr. Shahan Belmar George speaking with us looking at the COVID-19 Prevention and Control Act I want to say thank you so much for watching this special production by the National Television Network Government Information Service I am Lisa Joseph saying goodbye