COVID-19 mortality in six Caribbean countries during Four Waves of the COVID-19 Pandemic

Background: Mortality associated with COVID-19 in the Caribbean during specific waves and exposure to different variants has not well described, especially for the six most populous English-speaking countries (Bahamas, Barbados, Guyana, Jamaica, Trinidad and Tobago, and St. Lucia), compared to the United Kingdom (UK). Methods: The first four waves of the pandemic, cases and deaths were estimated from epidemiologic curves on Johns Hopkins University Coronavirus Resource Center for the countries of interest from 10-Mar-20 to 12-Aug-22. Crude mortality rates (CMR), case fatality ratios (CFR) and standardized mortality ratios (SMR) were calculated using England as the standard population. Findings: The six countries reported 550,657 cases and 10,259 COVID-19 deaths. First wave Caribbean CFRs (1-3%) were significantly lower than the UK (20%). Thereafter (1-Apr-21 to 31-May-22) Caribbean SMRs exceeded 1 (range: 1.37-6.35) while UK CFRs declined to 2.3% (2nd wave) and 0.2% (3rd wave). Caribbean CFRs were highest with circulation of the Delta variant in the 2nd and 3rd waves. Barbados had the lowest SMR (0.65). COVID-19 vaccine roll-out (since Feb-Mar 2021) first targeted high-risk groups (elderly, health workers, co-morbidities). No Caribbean country achieved the global full vaccination target (70%) by the 4th wave, range: 21% (Jamaica) to 54% (Barbados), compared to 86% for the UK. Interpretation: Early in the COVID-19 pandemic, Caribbean CFRs were lower than the UK, probably due to more intensive non-pharmaceutical interventions. Limited vaccine coverage negatively impacted mortality in later waves, which was highest when the Delta variant was prevalent, declining with the later Omicron variant.