An important component in the fight against COVID-19 is monitoring and tracking the local transmission rate. Doing so allows swift and appropriate action to manage and reduce outbreaks in the community. It’s the responsibility of the Cayman Island’s Ministry of Health and Wellness to track this data.
Here is how community transmission is defined, monitored, and reported as well as the indicators being used to measure transmission.
What is the key indicator for determining community transmission?
To determine the community transmission level in the islands, the Ministry of Health and Wellness uses hospitalisation rates as its key indicator. During active community transmission, data is centred on the percentage of beds occupied by, or available for COVID-19 patients, while routine health services continue. This means that elective surgery for knee arthroscopies or taking a surgical specimen of a lump or having a telescope investigation can all continue at the same time as people are admitted with COVID-19 disease.
The Ministry monitors the number of COVID-19 admissions in all three major hospitals in Grand Cayman, namely the Cayman Islands Health Services Authority (HSA), Health City Cayman Islands (HCCI) and CTMH Doctors Hospital (DH). COVID-19 patients in Cayman Brac and Little Cayman who require hospitalisation are transported to Grand Cayman for care.
The Ministry also checks for patterns in the transmission rate and the overall impact on the country’s entire healthcare system. This helps dictate what actions need to be taken to combat any increases in COVID-19 infections or localised outbreaks.
The World Health Organization (WHO) recommends that key indicators are assessed bi-weekly. This two-week average minimises random fluctuations and false alarms, and in the Cayman Islands the week runs from Sunday to Saturday.
The different community transmission levels
There are four different community transmission levels which are:
- Level 1 (CT1): Low
- Level 2 (CT2): Moderate
- Level 3 (CT3): High
- Level 4 (CT4): Very High
Every level’s definition has been approved by the Ministry’s Chief Medical Officer and the bi-weekly results are reported to the public for awareness and transparency. The indictors for these levels are as follows and apply to each of the three hospitals in Grand Cayman.
Community Transmission Level 1 (CT1): Low
At this stage, there are low levels of locally acquired COVID-19 cases. Cases have been widely dispersed in the last 14 days with no link to specific clusters. Most importantly, there is a low risk of infection for the public.
The low-level transmission rate shows low hospitalisation rates with the majority of cases being mild or asymptomatic. Most infected patients don’t need to be admitted to a hospital and can recover through home care.
Key indicators:
- Less than 5% utilisation of COVID-19 beds.
- Routine health services are unaffected.
- No to little impact on healthcare staff availability.
Response action needed: Limit hospitalisation and slow down transmission.
Total of 55 COVID-19 hospital beds available:
- HSA - 28
- HCCI - 25
- DH - 2
Community Transmission Level 2 (CT2): Moderate
For CT2, there is a moderate level of locally acquired cases in the last 14 days. The hospitalisation rate is also moderate at 65% or less of the capacity set aside to care for COVID-19 patients whilst still continuing elective care, and there is a moderate infection risk to the public.
For patients requiring hospitalisation, some will need ventilation and will occupy Critical Care Unit (CCU) beds. The mortality rate is also at a relatively low rate.
Key indicators:
- 5% - 65% utilisation of COVID-19 beds.
- Routine healthcare services are unaffected.
- Healthcare staff absence below 15%.
Response action needed: Reduce the number of patients with severe symptoms requiring intensive care.
Total of 55 COVID-19 hospital beds available:
- HSA - 28
- HCCI - 25
- DH - 2
Community Transmission Level 3 (CT3): High
CT3 sees the healthcare system being challenged. To address the problem, the government may open field hospitals to help manage patients with milder symptoms. There is widespread local transmission detected and a serious infection threat to the general population.
CT3 also may have an increased mortality rate with healthcare staff being affected in large numbers. With this, some regular healthcare services will be discontinued, and the focus will be on COVID-19 patients.
Key indicators:
- More than 65% utilisation of COVID-19 beds.
- Routine health services are affected, but emergency services continue.
- Healthcare staff absence at 15% - 40% due to illness.
Response action needed: Reduce the mortality rate.
Total of 147 COVID-19 hospital beds available:
The number of COVID-19 beds has increased to accommodate the increased infection rate with elective healthcare discontinued. 23 beds will have ventilators.
- HSA - 40
- HCCI - 35
- DH - 2
- Field Hospital - 70
Community Transmission Level 4 (CT4): Very High
CT4 is the worst-case scenario. There is widespread infection with high local transmission. The general population is at high risk of infection. As a result, the healthcare system is under severe pressure with COVID-19 and CCU beds heavily occupied. The field hospital may be nearing full capacity as well and additional low risk patients may be treated at district clinics.
To prevent the system’s collapse, any clinical sites and operating theatre spaces will be considered for emergency use. Asymptomatic staff may be required to work or volunteers to be brought in.
Key indicators:
- Extensive utilisation of COVID-19 beds.
- All elective health services are discontinued.
- Healthcare staff absence at 40% or more due to illness.
Response action needed: Prevent the healthcare system’s collapse, for example by considering more widespread population level suppression methods (like closing schools and reducing movement generally).
Total of 316 COVID-19 hospital beds available:
The number of COVID-19 beds will have increased again to accommodate the high infection rate. 36 beds will have ventilators.
- HSA - 68
- HCCI - 120
- DH - 20
- Field Hospital - 80
- District clinics - 28
These indicators in each of these levels are reviewed every two weeks by the Chief Medical Officer and will be communicated to the public, the aim of which is to protect and quickly react to COVID-19 in the community and protect the Cayman community and the economy.
