On October 24, the Prime Minister eased lockdown restrictions, inter alia gyms to be reopened at 50 per cent capacity; beaches and pools from 6 a.m. to 6 p.m.; churches/places of worship to restart services but not to exceed one hour; civil servants to return to their office full-time; bars and restaurants to remain closed re sit-down operations.
According to the Health Ministry, the ensuing three weeks ending November 14 showed gratifying improvements in several monitored categories: active cases fell from 1,380 to 592; when a cluster which came to light at the Maximum Security Prison in Golden Grove in the first two weeks of November is omitted, newly confirmed cases which had averaged 32/day for the week ending October 24 fell to 27, 22 and 24 for the three weeks that followed; and average weekly inpatient case loads decreased from 76 to 61, 49 and 34 for the identical period under review.
Deaths/week attributed to the virus fell from nine for the week ending October 24 to three, three and zero.
However, the ministry’s chief epidemiologist continued to express weariness with the slow downward movement of the statistical data, which he termed as “plateauing”. His concern is well placed, given the pronouncement by the Finance Minister that success with the radical initiatives outlined in his national budget rested squarely on the country’s ability to eliminate the Covid-19 bug.
Elimination is defined as “reduction to zero of the incidence of a specified disease in a defined geographical area as a result of deliberative efforts; continued measures to prevent re-establishment of transmission are required”. This means bringing active cases down to zero, or near zero, in a geographical location, and continued vigilance via testing.
It is my opinion that plateauing will persist and T&T will not attain the desired goal of zero active cases in the absence of radical changes in the country’s test, trace and isolate (TT&I) programme.
Testing for Covid-19 is the initial step for identifying and isolating infected individuals to reduce spread. Equally important is contact tracing to identify exposed persons, i.e, those who may have had direct or primary contact with the index case, as well as secondary and possibly tertiary contacts, ie, those who may have had contact with the primary contact.
The T&T Dashboard reveals little action re contact tracing: the positivity rates are simply too high.
Positivity rates answer the question: what percentage of tests conducted are positive for Covid-19? For the week following easing of restraints the number of tests performed was 901 or 128/day; Nov 1-7: 842 or 120/day; and Nov 8-14: 776 or 111/day.
Since, as stated above for this period, newly confirmed cases averaged 27, 22 and 24 per day, the calculated positivity rates for this period are 21, 18 and 22 per cent—a virtual quadrupling of the internationally accepted benchmark of five per cent.
According to the Johns Hopkins University experts on global health and infectious disease, such persistently elevated positivity rates suggest that a community may be testing the sickest patients and possibly missing the milder or asymptomatic patients—a dangerous development.
Multiple global studies have shown for any outbreak, 20 per cent to 45 per cent of infected persons may be asymptomatic and thus escape isolation, and more critically become super-spreaders in an unsuspecting population.
The ministry at this point in time should have completed training of persons and deployment of rapid antigen test kits (RATs). In terms of fighting the pandemic, the RAT should now be the frontline tool in controlling and ultimately eliminating the wily virus.
According to the CDC, persons should be tested “if they have been in close contact, such as within six feet of a person with documented SARS-Cov-2 infection for at least 15 minutes, even if they do not have symptoms”.
Exposure begins 24 to hours before symptoms become manifest. Test results are available in 15 minutes, i.e, before persons tested are allowed to leave the facility—a fact that makes contact tracing and isolating more efficient and effective, and minimises the leakage of asymptomatic but contagious persons into the community.
Any question about sensitivity of the Standard Q and Standard F test kits (purchased by the ministry through WHO), can be resolved by simply repeating the test in five to seven days on those who tests negative but are clinically suspect of harbouring the virus; needless to say, such persons should be isolated until re-tested.
These RATs are available in the open market at around US$5/test and are a worthwhile investment, given the height of the stakes involved.