Fighting COVID-19 in the U.S. Virgin Islands
By Leah de Wilde
In March, I returned to my home on St. Croix in the U.S. Virgin Islands (VI) around the same time that COVID-19 was declared a global pandemic, ready to rejoin my team at the local Department of Health (DOH) as a full-time contractor to help in any capacity that the territorial epidemiologist needed filled. I started with the VIDOH epidemiology division in 2016 as a surveillance officer during the Zika outbreak. It was an entry level position and my first foot in the door working in public health. I fell in love with the field and working an outbreak because there was always a new task and a learning experience every day.
For those who don’t know, the U.S. Virgin Islands is a territory 90 miles southeast of Puerto Rico comprised of four islands with a little over 100,000 inhabitants. The year-round temperature hovers around 85 degrees and the beaches are some of the most beautiful in the world.
Alongside our isolated beauty and a small population, the islands’ leaders and inhabitants are rightfully anxious about our healthcare system’s capacity to handle what could potentially be a large surge of ill COVID-19 patients in our two small hospitals.
To date, the territory has fared extremely well in comparison to other parts of the world. Our number of confirmed positives is 72 cases, and we have had six deaths attributable to COVID-19. The low case count can be partially attributed to low population density and the proactive decision to shut down all hotels, AirBNBs and vacation rentals early. Ports and airports were never shut down, but once there was nowhere to stay, only about 30 people were flying into each district (St. Croix and St. Thomas/St. John/Water Island) per day.
I work on the dedicated epidemiology team that fields COVID-19 hotline calls, coordinates testing and does investigations, better known as the COVID-19 Surveillance Branch. We are a small division of about 15 employees, and we all wear many hats. One hat I wear is assisting in coordinating our drive-through testing site. The local Department of Health is safely and efficiently able to test all symptomatic individuals as well as all positive cases’ contacts, maintaining a positivity rate that is below or equal to 10 percent, which is a benchmark for sufficient testing. With low infection rates and sufficient testing, this tells us that the territory has done extremely well with social distancing measures, quarantining of sick individuals and quarantining of visitors flying into the territory.
Working the drive-through testing site has been a rewarding exercise of logistics training and adapting to an ever-changing environment, which are the aspects I really enjoy about it. Each day we deploy a team of two or three depending on how many people are scheduled to get tested that day. I am trained to perform nasopharyngeal and oropharyngeal swabs, so most days I don a powered air-purifying respirator (PAPR), lab coat, base gloves and “dirty” gloves that are changed between tested suspect cases. It definitely gets hot standing outside in full PPE for an hour and I’m always glad to doff, disinfect and take a break in the heavily airconditioned emergency operations van.
This month, the Virgin Islands’ reopening plan allows for leisure travel to begin again. We at DOH will continue very close surveillance and continue testing all symptomatic individuals as well as rigorous contact tracing in the case of new positives. As for my own personal timeline, there is lots to consider in a very short period about my next move. Year two of my master’s degree on campus is calling my name, but on the other hand, so is my island home.
Leah de Wilde is a Master of Public Health student at the George Washington University Milken Institute School of Public Health.
