A day after Haitian health officials declared that COVID-19 infections had peaked without sparking the alarmingly death toll some models predicted, regional health experts with the Pan American Health Organization continued to voice concerns that the pandemic could lead to a health crisis in Haiti.
Dr. Carissa Etienne, the director of PAHO, said the "spike" in COVID-19 infections that Haiti has been seeing over the past several weeks remains a serous concern along with the increasing flow of Haitian returnees crossing the country's land border with the Dominican Republic despite restrictions.
"A much broader coalition to address a potential health crisis in this country is needed," Etienne said Tuesday during PAHO's weekly press update on how the virus is evolving in the Americas region.
Since the start of the outbreak, 47,000 Haitians have returned home from the neighboring Dominican Republic, according to the United Nations International Office for Migration. While some are crossing the 224-mile border using the four official entry points, where quarantine facilities have been set up and health workers are checking temperatures, many are crossing at unofficial points and bringing back the disease undetected.
As of Tuesday, the Dominican Republic had registered 23,868 cases of COVID-19 and 615 deaths. Haiti, which shares the island of Hispaniola with its Spanish-speaking neighbor, has 4,441 confirmed cases and 76 deaths. Both nations have roughly the same population of 11 million inhabitants, but the Dominican Republic has tested far more of its citizens than Haiti.
That gap in testing and the different evolution of the pandemic in each country continue to raise concerns among some health experts about whether Haiti, without increased testing, can say with certainty how COVID-19 transmissions are unfolding within its impoverished borders.
On Monday, the director of Haiti's National Laboratory, Patrick Dely, told journalists that based on the 9,000-plus tests the country has conducted, a few trends have emerged _ and the reality is far different than the modeling. To begin, the coronavirus, which has killed thousands in Brazil and Ecuador, has not been as deadly in Haiti. Secondly, while Haiti was expected to hit its peak at the end of June, he is seeing "a downward tendency in the numbers we are registering."
"That's why we estimate, based on the information we have ... we have a peak that began the 22nd week," Dely said, referring to the end of May.
He also said "the virus, which has caused so much damage in other countries, is not behaving the same way here. The question now is why. That is what we are researching."
Dely acknowledged that some of the conclusions could change if testing, which is limited and centralized in the capital of Port-au-Prince, were to increase.
But for those questioning the country's 1.7% fatality rate, Dely said if more Haitians were dying from COVID-19 than the system had captured, "we would have seen this ... in the country, in the community."
Looking at the latest figures for Haiti, Florida International University's Carlos Espinal said that while Haiti went down from 1,300 new cases during the 23rd week of the epidemic to 368 cases by week 25, the critical question remains: How many tests is it conducting?
"Week 25 starts today until June 21," said Espinal, the director of the Global Health Consortium at the Robert Stempel College of Public Health at FIU. "We need to see sustainable reduction of new cases during several epidemiological weeks; one is not enough."
Etienne, the PAHO director, did not address Haiti's cautious optimism. She instead focused on how border communities and uncontrolled migration continue to present huge risks for Haiti and other countries in the Americas as they try to contain the disease.
"The increase of transmission in this area is cause for serious concern, and immediate action," Etienne said. "To contain the spread of COVID-19 and to protect migrants and other vulnerable populations on the border, countries must work together to strengthen the health response within their territories and across frontiers."
Haiti confirmed its first COVID-19 infections March 19. The Dominican Republic, currently the epicenter of the outbreak in the Caribbean, did so about three weeks earlier on March 1. As the disease has spread in the Dominican Republic and the country went on lockdown, Haitians fled, both out of fear and lack of employment.
With the Dominican Republic preparing to relax some of its measures, including reopening its airport ahead of its scheduled July 5 presidential elections, some are waiting to see what will happen.
"We want to see what will happen when the DR gets better and Haiti is still probably in the high phase of COVID. Are we going to see people crossing back into the Dominican Republic and stay there to find a job? Are we going to see more deportations? Because for sure the Dominican Republic is not going to accept Haitians going back," said Giuseppe Loprete, the International Office for Migration's chief of mission in Haiti. "The different phase of the two countries, for us, is the thing we want to monitor very closely."
The International Office for Migration has been especially concerned about the movement along the border, which Giuseppe said has been increasing in some regions of the countries. At the onset, IOM pushed for isolation centers in towns like Ouanaminthe, just outside of Cap-Haitien in the north, and Belladere in the Central Plateau where the medical charity Zanmi Lasante was doing rapid testing to help screen for the virus among returning migrants.
Between June 1 and June 13, Zanmi Lasante, which is the Haitian counterpart to Boston-based Partners In Health, has screened 768 returning Haitian migrants. Dr. Ralph Turnier said the numbers crossing at Belladere have diminished in recent days, but it doesn't mean they aren't crossing elsewhere. There are various unofficial entry points along the porous frontier, he noted, adding that it has become increasingly difficult to hold people for observation.
Etienne said PAHO is working with several U.N. agencies to do increase surveillance along the Haiti/Dominican Republic border where returning migrants are provided with information on preventing COVID-19 and screened. It has also distributed 85,008 personal protection equipment items to essential workers, including members of the Haitian Coast Guard in Cap-Haitien, and trained 1,163 front line workers in COVID-19 management.
At the Ouanaminthe border, the surveillance plan consists of 60 field teams, made up of rapid-response teams and community health workers, 15 supervisors, two data analysts and a two-member call center.
So far, more than 13,500 migrants crossing that border back into Haiti from Dajabon in the Dominican Republic have been screened, Etienne said. Of the number, 64 were suspected cases and of those, 49 were admitted to a quarantine center.
Calling for governments of bordering countries to work together to contain COVID-19, Etienne said, "We at PAHO remain vigilant of the evolving situation at that particular border and we are working urgently with Haitian health authorities and others partners."
