Cayman the world’s hotspot for COVID infections

The Cayman Islands is currently the world’s hotspot for new COVID-19 cases. For the past week, the New York Times has featured Cayman at the top of the list for daily average cases per 100,000 people.

Cayman’s daily average rate of 147 new COVID cases means it leads the world when that figure is adjusted for Cayman’s population size.

The number of people testing positive jumped almost fivefold in the past 14 days, the data shows. This increase is also the fastest in the world when countries with only a handful of cases are excluded.

Comparing such data globally must come with the caveat that not all countries are testing equally. Some countries may barely test at all or fail to properly collate or publish the data.

But Cayman’s first true COVID wave is building rapidly.

In the past five weeks, active cases have skyrocketed from 70 on 1 Oct to 1,600 on 5 Nov.

During that period the positivity rate – the share of COVID-19 tests that come back positive – also soared from an average of 1.8% for the week ending 8 Oct to 11.7% last week.

A high positivity rate can sometimes indicate that there is insufficient testing. This is not the case in Cayman. Since 1 Oct on average 1.18% of population was PCR tested every single day. That figure does not include self-administered lateral flow tests.

The number of local active cases relative to the population is equally high. In Cayman, a total of 2.25% of the population are known to be infected with the coronavirus.

In the US that rate is 2.76% and in the UK 2.29% of the population are testing positive for COVID-19, based on data from the website worldometers.info which aggregates information from individual government sources.

Globally, Cayman is among the top 15 countries in this category, but the situation is significantly worse in the French-speaking Caribbean. In Guadeloupe, St. Barth or Martinique, more than 11% of the population are considered active COVID cases.

The rapid increase in cases in Cayman largely reflects how contagious the Delta variant of the virus is once it takes hold in the community. But it says little about the severity of the cases. This depends to some extent on the age groups affected and the level of vaccination or natural immunity in the community.

While Cayman’s population has not developed any natural immunity, due to the absence of cases for most of the past 18 months, the local vaccination rate is very high.

The New York Times data shows that Cayman has the fifth-highest vaccination rate in the world, trailing only Gibraltar, the United Arab Emirates, Portugal and Malta.

The rate of 83% for Cayman uses previously reported, rather than adjusted, population figures for the islands.

Based on a population estimate of 71,106, the Cayman Islands government puts the local vaccination rate at 80% for the first dose and 77% for fully vaccinated people.

Bermuda suffered similar outbreak

Bermuda saw a similar surge in COVID cases earlier this year and found itself at the top of the New York Times list in mid-September.

The number of active cases in Bermuda, which has a population of 62,000, peaked at 1,612 on 25 Sept. It took five weeks for that number to drop below 100 again. On Sunday 7 Nov, Bermuda reported 59 active cases.

Since the beginning of the year, Bermuda suffered two larger outbreaks of COVID-19. More than 300 people were hospitalised as a result and 96 people died, 71 of those in the past two months. Six people remain in hospital.

Figures for Bermuda highlight both the importance of COVID-19 vaccination and the vulnerability of older age groups as well as people with underlying health conditions and  those who are immunocompromised.

The average age of those who died following a COVID-19 infection in Bermuda was 72. More than 40% were 80 or older.

The number of unvaccinated in Bermuda who were hospitalised this year for COVID-19 was more than eight times higher than for vaccinated patients. The number of deaths among the unvaccinated was five-and-a-half times higher.

According to Bermuda’s Chief Medical Officer Ayoola Oyinloye breakthrough infections among the vaccinated that resulted in death affected older people with severe underlying health conditions.

Bermuda has a vaccination rate of 69% but it was still lower two months ago.

Data reported by the Health Services Authority for the final week of October indicates that although there are four times more people who are vaccinated than unvaccinated in Cayman, 61% of new positive tests are among the unvaccinated.

So far the number of hospitalisations is relatively low. There are 12 COVID-19 patients hospitalised in the Cayman Islands, all in stable condition.

Chief Medical Officer Dr. John Lee indicated last week that most of these cases would not be in hospital in other countries but “out of an abundance of caution” had been admitted for observation.

While the situation in Cayman is not yet comparable to Bermuda, it can be expected that hospitalisations are going to rise, given the high and growing total of active cases.

There is also a delay of between three and 10 days between the onset of COVID-19 symptoms and hospitalisations. This means that a rise in cases typically precedes an increase in hospitalisations by several days.

Adjusted for population size, the number of COVID-19 patients in hospital is already slightly higher than in the UK and the US.