Updated on May 13 at 12:30 p.m.
The number of confirmed coronavirus cases in Haiti has doubled over the past week, according to the Haitian Ministry of Health.
As of May 13, there were 219 cases, up from 108 a week earlier. Cases are now being reported from all 10 departments, the local version of states, although the bulk of confirmed infections are in and around the capital Port-au-Prince.
That bump in cases comes in the wake of a Pan American Health Organization warning of an impending humanitarian crisis in Haiti because of the pandemic. Haiti shares the island of Hispaniola with the Dominican Republic, which is experiencing one of the worst outbreaks in the hemisphere. With the Dominican Republic under lockdown, thousands of laid off migrant workers have headed home to Haiti, and presumably some of them are carrying the virus with them.
"There is real danger of a large-scale outbreak followed by a humanitarian crisis in Haiti," said Carissa Etienne, the head of PAHO, in a briefing with reporters. She said Haiti's health care system is ill-equipped to deal with an outbreak of a highly infectious, potentially fatal respiratory disease. And the measures used elsewhere to stem the spread of COVID-19 are impractical or impossible in Haiti.
"It is extremely difficult to institute proper social distancing in Haiti," she said — especially in the densely packed neighborhoods of Port-au-Prince.
"Most Haitians do not have access to potable water and sanitation, and many live in crowded households where quarantine and isolation are challenging," she noted. "In addition, there is the real risk that growing food insecurity will result in famine. Civil unrest, a difficult political situation and precarious security may further complicate the situation."
Elections scheduled for last year fell apart because of political gridlock, the terms of most of the legislators expired and President Jovenel Moise has been ruling the country by decree ever since.
"I'm extremely worried for a number of reasons," Dr. Jean "Bill" Pape says about the coronavirus situation in Haiti. Pape did pioneering work on HIV and AIDS in Haiti in the 1980s. He's now co-chair of a national commission trying to address COVID-19. And his list of worries is long.
"First, we have a divided country, politically. We need to fight this virus. We need to be united, and with a divided country, that division is a big issue," he says. "Secondly, there is the security issue. As you know, a lot of poor people live in the slums. Slums are controlled by gangs. And how can we reach the poor people there if access is not readily available?"
Pape also worries about the economic impacts of the coronavirus crisis. Haitians rely heavily on money sent home from relatives working abroad. As the global economy has stalled, remittances to the island have dropped sharply.
As of Friday, Haiti had only reported 129 coronavirus cases, but Pape says the actual number is likely far higher — even with very limited access to testing, and the pace of newly diagnosed infections is increasing.
Elsewhere, most people with COVID-19 have mild symptoms, which Pape thinks could make tracking it in Haiti even more difficult. "We are only screening people who are symptomatic for the virus," he says. "Haitians are very tough. They will not go to a health center if they have mild symptoms."
After the first official coronavirus case was detected on March 19, the government closed schools and banned church services. Tap-taps, the ubiquitous vans that serve as public transportation, were supposed to reduce the number of passengers they carry. But Sandra Lamarque, the head of mission for Doctors Without Borders in Haiti, says she sees many that still appear packed. And most other commercial activities in the country are continuing.
"It is very, very busy as usual. Markets are crowded," she says. "Really it looks like business as usual."
Doctors Without Borders is setting up isolation wards for COVID-19 patients and helping to run information campaigns on the disease. Still, Lamarque says confronting this virus in Haiti is going to be difficult.
"Just getting enough personal protection equipment for health staff in Haiti and getting oxygen for every single severe patient of COVID- 19 in the country will be challenging," she says.
Only two laboratories in the country are able to test for the virus. One of them is at Dr. Pape's organization GHESKIO. The other is at the Ministry of Health.
Pape says there are other clinics nationwide that have machines capable of testing for the virus, but Haiti can't get the specific cartridge necessary to adapt these GeneXpert diagnostic machines to screen for SARS-CoV-2.
"We don't have access to those tests," he says. "They cannot export them. They are only kept in the U.S." Some of the kits have been exported, but other countries including South Africa have complained that the U.S. is hampering the sale of this particular test abroad.
To meet the need for personal protective equipment, Haitian factories have started producing it themselves. And Pape has been trying to fly in other medical supplies from China.
"It's been a nightmare, a total nightmare," he says of trying to import supplies and equipment. Most commercial flights in to Haiti have been canceled. "We cannot have a direct flight from China because we don't have diplomatic relations with China. Secondly, supplies are very, very expensive. And then if you're getting it by plane, the cost of [chartering] a cargo plane is $1.2 [million] to $1.5 million. I could not believe it."
He says he checked into shipping the gear via FedEx, and it was even more expensive.
"Haiti always benefited from the support from its friends," he says, but "the United Nations is no longer united. The nations are fighting one another [for supplies]."
"I've lived through the AIDS epidemic, TB, cholera, malaria, Zika, Chikungunya," the 73-year-old says. "Yet this is the most difficult. Yes, this is the most difficult epidemic we've had to deal with."
MARY LOUISE KELLY, HOST:
Haiti is not prepared for the coronavirus to hit. Top officials from the Pan American Health Organization are warning Haitians to get ready for a large-scale eruption of COVID-19, but closed borders and a global scramble for medical equipment are making it difficult for the impoverished country to get the resources it needs to address the virus. NPR's Jason Beaubien reports.
JASON BEAUBIEN, BYLINE: As a physician in Haiti, Dr. Jean Pape has seen a lot in his 73 years.
JEAN PAPE: I've lived through the AIDS epidemic, TB, cholera, malaria, Zika, chikungunya.
BEAUBIEN: But trying to gear up to confront the coronavirus pandemic, he says, is different.
PAPE: This is the most difficult epidemic we had to deal with. It's been a nightmare.
BEAUBIEN: Pape is sort of Haiti's equivalent of an Anthony Fauci. Not only did he make his name toiling in the trenches in the early days of HIV, Pape is now the co-chair of the national committee on COVID-19. He says Haiti's problem is right now, it's facing this crisis at exactly the same time as the rest of the world, and they can't compete in bidding wars against France or California for supplies from China.
PAPE: Supplies are very, very expensive. And then if you're getting it by plane, the cost of a cargo plane is 1.2- to $1.5 million. I could not believe it.
BEAUBIEN: And international aid agencies which Haiti has traditionally leaned on for logistics and supplies have scaled back their operations and pulled out staff.
PAPE: Haiti always benefited from the support from their friends. And I said that the United Nation (ph) is no longer united. The nations are fighting one another.
BEAUBIEN: So Haiti is pretty much going it alone and relying on what they have on hand. The country has just two labs capable of testing for the virus. And they've only confirmed a couple hundred cases, but Pape thinks there's probably a lot more out there. That's mainly because there's a major outbreak in the neighboring Dominican Republic, and the lockdown in the D.R. is forcing Haitian workers to return home.
PAPE: We have about - over 1,000 people who are crossing every day. They've been crossing for the past four weeks because they lost their job in the D.R. So they are coming back to Haiti, and they will be bringing the virus to us.
BEAUBIEN: To a place with poor sanitation, a weak health care system and where social distancing is unrealistic. Carissa Etienne is the head of the Pan American Health Organization.
CARISSA ETIENNE: The living conditions in Haiti, like overcrowding, makes physical distancing very difficult. It's unpossible (ph), almost, to quarantine at home.
BEAUBIEN: Back in March, Haiti issued a lockdown order. It shut schools and churches. But with so many Haitians relying on daily earnings to survive, street markets and small shops remain open.
SANDRA LAMARQUE: It's very, very busy, as usual. Markets are crowded. Public transports are also crowded.
BEAUBIEN: That's Sandra Lamarque, the head of mission for Doctors Without Borders in Port-au-Prince. Doctors Without Borders is helping to set up isolation wards for COVID-19 and assisting with information campaigns about the disease. Dr. Jean Pape says that particularly after watching what happened in ICUs in New York and Italy, Haiti is not going to try to maintain severely ill patients on ventilators or other complicated medical equipment.
PAPE: I am concentrating on what we can do, and what we can do is make sure we can provide oxygen to everybody who needs it.
BEAUBIEN: He says the goal is to get protective gear for health workers and provide basic supportive care to most patients.
Jason Beaubien, NPR News. Transcript provided by NPR, Copyright NPR.