This week the World Health Organisation in a startling policy reversal, issued a warning to policymakers the world over that restrictive measures such as lockdowns should not be used as primary tools to tackle Covid-19 outbreaks. According to WHO envoy Dr David Nabarro, such measures are only justified to buy time to re-organise, regroup and rebalance resources, and bolster other measures such as testing and contact tracing in the effort to safely reopen the economy and avoid future lockdowns.
These admonitions and recommendations on the way forward are timely and relevant to T&T’s current Covid-19 situation. The gravity of the situation is underscored by the fact that for diabetes and hypertension T&T has some of the higher prevalence rates in the western hemisphere. T&T’s Covid-19 death rate per 100,000 population presently stands at 6.8. Comparative figure for Jamaica is 4.9, Barbados: 2.4, Venezuela: 2.2, Haiti: 2.0, and Singapore: 0.4. Singapore’s, the up-to-date record is 57,884 confirmed cases but only 28 deaths. Occult virus in the T&T chronic disease environment is a deadly cocktail.
There is little leeway to address the reduced clinic attendance for viral disease as cited by Chief Medical Officer Dr Roshan Parasram other than employers enforcing stay home orders for employees with symptomatic illness. Health personnel, however, have to adopt a hard-nosed attitude when faced with patients whose symptoms suggest Covid-19 infection but refuse testing. Home or State quarantine should be enforced according to the clinical presentation, with follow-up by the County Medical Officer of Health and his/her team which members would include law enforcement personnel. Clinic personnel should be explicit, especially with patients assigned to home quarantine, that consistent with adopted protocols, quarantine would last for 14-21 days; and that period could be shortened if they agreed to be tested, and successive tests are negative.
Aggressive TT&I must also be applied to all households/work places connected to all deceased persons whom the immediate cause of death is determined by the medical doctor to be Covid-19. It matters not whether it is an elderly male/female with co-morbidities, a younger person with pre-existing conditions, a person not known to be unwell or whether the ultimate demise occurred in the ICU, HDU, a step-down facility, in the ER or at home, state or home quarantine will be enforced on all individuals connected to the household/work place of the deceased person. Person-to-person is the mode of transmission and some contagious person(s) transmitted the bug to the decedent. The objective of the aggressive TT&I is to uncover the index case or cluster, and curtail further spread..
Lastly, the public health need is for a quick, reliable, efficient and cheap method of identifying individuals who are not only infected with Covid-19 but also contagious; infected persons would be identified whether symptomatic or asymptomatic. Rapid antigen tests fit this billing and the FDA (US) has granted emergency use approval to many manufacturers.
Minister Deyalsingh has recognised these rapid tests as “game changers’. As in other countries where rapid antigen tests are available, it (rapid screen tests) should become the primary screening test for Covid-19 in T&T. With the festive season coming up fast, persons can be tested and advised in ten to 15 minutes whether they can enter an event venue. Similarly at ports of entry persons can be advised of their status on site, and if and how they will be allowed entry into the country.
Overhaul of our test, trace and isolate programme will not only save lives but enable success with the initiatives outlined in the national budget.