SINCE the inception of the current pandemic, COVID-19-related misinformation has delayed containment of the pandemic especially in low resource nations.

This has been exacerbated by the relative ease of dissemination of unfounded and misleading theories through social media and other web-based communication outlets. It has perpetuated beliefs that led to interference with public health interventions resulting in vaccine avoidance or hesitancy, non-compliance with social distancing recommendations, mask mandate refusal, and utilisation of medications with insignificant scientific data and unproven efficacy, ultimately contributing to increased morbidity and mortality.

Several studies addressing misinformation in health care consistently show that false and misleading claims negatively influence people’s attitudes towards vaccines.

A recent paper specifically looking at COVID vaccine presented findings from a global survey of 18,400 individuals from 40 countries and showed a strong association between perceived believability of COVID-19 misinformation and vaccination hesitancy. The study showed that only half of the online users exposed to rumours might have seen corresponding fact-checked information refuting the rumours. Moreover, depending on the country, between six per cent and 37 per cent of individuals considered these rumours believable.

A key finding of this research is that poorer regions were more susceptible to encountering and believing COVID-19 misinformation; countries with lower gross domestic product (GDP) per capita showed a substantially higher prevalence of misinformation.

Undoubtedly, misinformation is partly responsible for the relatively low vaccination rates in many countries which has slowed down the efforts to halt the pandemic. As at the end of October, about 13 billion doses of coronavirus vaccines have been administered around the world. While nearly 70 per cent of the world population has received at least one dose of a COVID-19 vaccine, when you look at low-income countries which include many countries in the Caribbean, Latin America, and Africa, only 23 per cent of people have received at least one dose of a COVID vaccine. More booster doses have been administered in high income countries than total doses in low-income countries.

In the English-speaking Caribbean, Latam and Africa, the story is mixed. In Trinidad and Tobago, for example, only about 50 per cent got at least one dose of the vaccine or are fully vaccinated with only about 12 booster doses for 100 residents. In Belize and Guyana, about 60 per cent of the population received at least one vaccine dose or are fully vaccinated while only about 10 doses of booster vaccines are available per 100 citizens. In Jamaica and Nigeria, less than 30 per cent of the population got at least one dose and less than 25 per cent are fully vaccinated. In both countries, there are only about two booster doses for each 100 residents. About eight countries in the Caribbean have vaccination rates less than 50 per cent. Haiti and Burundi both have less than five per cent of the population fully vaccinated and virtually no booster doses for the population.

Cuba is a remarkable Caribbean vaccination success story with nearly 400 vaccine doses per 100 people with an impressive 95 per cent of citizens receiving at least one dose and almost 90 per cent of the population fully vaccinated. About 75 doses of booster doses are available in Cuba per 100 citizens. Peru and Ecuador are also successful examples in the Latin American region with about 90 per cent of the population receiving at least one dose and about 85 per cent fully vaccinated. In Ecuador, about 90 per cent received at least one dose and about 80 per cent fully vaccinated. In Africa, Mauritius and Rwanda are breakout stories with Mauritius having about 90 per cent of the population receiving at least one dose of the vaccine and another 90 per cent being fully vaccinated while in Rwanda, 72 per cent receiving at least one dose and 70 per cent being fully vaccinated.

Despite enormous public spending and engagement, the US has just about 80 per cent receiving one dose of coronavirus vaccine and 67.5 per cent being fully vaccinated. The poor vaccination rates in many poorer countries and the relatively unimpressive vaccination rates in the USA can at least be partly attributed to misinformation.

COVID and cardiovascular risk

There is very little reliable data specific to Jamaica or the Caribbean as a region. However, as has been widely reported in the literature, novel coronavirus pandemic has significantly impacted cardiovascular health care globally. Patients with pre-existing cardiovascular disease are at higher risk of morbidity and mortality. The COVID-19 pandemic has directly caused significant excess mortality on a global scale. There is emerging evidence that cardiovascular (CV) mortality has increased during the pandemic, independent of COVID infection. This has been attributed to several factors, including patients avoiding health-care environments to avoid exposure to SARS-CoV2, redeployment of specialist health-care staff to support COVID-19 services, and reduced availability of routine investigations and procedures

Patients with pre-existing comorbidities are thought to be at an increased risk of infection with SARS-CoV2 virus and tend to have worse clinical outcomes. Specifically, patients with cardiovascular disease, diabetes and hypertension are thought to have a high complication rate with mortality rate of 10.5 per cent reported in cardiac patients and mortality rates of 7.3 per cent and 6.0 per cent for diabetes and hypertension patients, respectively. COVID-19 is believed to have contributed to 15 million new cases of heart disease worldwide.

A study published in Nature Medicine (Feb 2022) by a group from Washington University looked at data on more than 150,000 patients with COVID-19 and showed that people who have had COVID-19 are at increased risk of developing cardiovascular complications within the first month to a year after infection. Such complications include arrhythmias, myocarditis, myocardial infarction or ACS, heart failure, stroke, or death. Overall, they found that those infected with the virus were 55 per cent more likely than those without COVID-19 to suffer a major adverse cardiovascular event, which includes heart attack, stroke, and death. An earlier study by a Swedish group found strong evidence that heart attacks and strokes risk rise sharply in the weeks following a COVID-19 diagnosis. The findings were published on August 14, 2021, in The Lancet, and included about 87,000 people with a median age of 48. In that study, the week after a COVID-19 diagnosis, the risk of a first myocardial infarction increased by three to eight times. The risk of a first ischemic stroke multiplied by three to six times. In the following weeks, both risks decreased steadily, but stayed elevated for at least a month

Impact of COVID on access to cardiovascular care

Regarding access and availability of cardiovascular services, significant disruptions to access were noted globally and in the Caribbean region. At the Heart Institute of the Caribbean (HIC) and Heart Hospital, we were part of the INCAPS COVID Investigators Group that looked at the International Impact of COVID-19 on the Diagnosis of Heart Disease. Our research study which was published in in the Journal of the American College of Cardiology (JACC) in January 2021 sought to assess COVID-19’s impact on global cardiovascular diagnostic procedural volumes and safety practice. The study looked at data from nearly 1000 facilities in 108 countries and found that cardiovascular diagnostic services declined by 40-78 per cent depending on the procedure. In multi-variable regression analysis, significantly greater reduction in services occurred for centres in countries with lower gross domestic product. Location in a low-income and lower–middle-income country was associated with an additional 22% reduction in cardiac procedures and services. The decline in elective procedures and services was thought to be mainly because individuals chose to defer elective cases out of fear of exposure, economic impact from the pandemic and government mandated lock downs that made it difficult for individuals to attend to elective needs.

The panel noted that as the world learns to live with COVID and brace for other potential future pandemics, it is imperative that we learn these lessons from COVID and put measures in place to mitigate the outcomes and be better prepared function within the context of the new normal.

Dr Ernest Madu, MD, FACC and Dr Paul Edwards, MD, FACC are consultant cardiologists for Heart Institute of the Caribbean (HIC) and HIC Heart Hospital. HIC is the regional centre of excellence for cardiovascular care in the English-speaking Caribbean and has pioneered a transformation in the way cardiovascular care is delivered in the region. HIC Heart Hospital is registered by the Ministry of Health and Wellness and is the only heart hospital in Jamaica. Correspondence to info@caribbeanheart.com or call 876-906-2107