When ‘not now’ really means ‘no’

DR FAITH B.YISRAEL

DrFaith@ImaniConsulting.Org

I have made a concerted effort to limit my weekly articles to topics related to health and wellness. In fact, I frequently refuse to write about specific issues, because they may be interpreted as being “political.” This week though, I am forced to break my rule, because the health and wellness of Tobago and Tobagonians depends on several key people making different policy, and therefore different political decisions pertaining to the testing and treatment of covid19 in Tobago. In this article, I will focus on testing.

WHAT IS COVID19

As outlined in a previous article, coronaviruses (CoV) are a large family of viruses that cause illness ranging from a very mild cold to more severe diseases. The novel coronavirus (nCoV) is a new strain that had not been previously identified in humans. On 11th February 2020, nCoV was officially renamed severe acute respiratory syndrome coronavirus 2 or SARS-CoV-2 by the World Health Organization (WHO). SARS-CoV-2 is genetically related to the coronavirus responsible for the SARS outbreak of 2003, although the two are not identical. On 11th February 2020 the disease associated with being infected with SARS-CoV-2 was also officially named corona virus disease 2019 (covid19).

TESTING FOR COVID19 IN TOBAGO

The Tobago House of Assembly should have ensured that we were testing for covid19 in Tobago from the get-go. All over the world, countries are recognising that one critical component in this war against covid19 is determine very quickly, who has it (and keeping those people away from others – also known as isolation). Various countries have used different models to test, and those who have expanded their testing to cast the widest net as possible, are the countries that have been successfully keeping their covid19 numbers at bay. Germany for example, did not limit who can test, where they can test and how often. Both the public and private sectors were allowed to create the various testing kits, and citizens were allowed to use which ever method they chose. Iceland went beyond the WHO testing suggestions, and started testing random people, a process known as “surveillance testing.” Iceland discovered, that up to 50 per cent of the people who have covid19 are asymptomatic (they showed no signs of being sick).

Trinidad and Tobago, on the other hand, has used the most restrictive testing criteria, because we have been ONLY using the Caribbean Public Health Agency (CARPHA) laboratory, and CARPHA is using the WHO case definitions to determine who should be tested. This means that for a very long time in Trinidad and Tobago, the ONLY people who could get tested were people with symptoms AND either a travel history or contact with someone who CARPHA tested and confirmed had covid19. This means that someone who has travelled and contracted covid19, but has not developed symptoms, would not be tested (even though we now know that they can transmit the virus). It also means that someone with symptoms, would not get tested, if they didn’t travel or didn’t come into contact with a confirmed case.

This is dangerous for Tobago because we had a significant number of people who came back into the country within the last three to four weeks, who have not been in quarantine, who may be infected, and therefore may be infecting others on the island unknowingly. In other words, Tobago may currently have “community spread”, but our limited testing capacity means that we would never identify the true number of people who have covid19.

On April 2 the Chief Medical Officer (CMO), Dr Roshan Parasram, indicated that Tobago was offered a machine and the necessary resources to allow us to test for covid19 here. Instead of jumping at that offer then, we indicated that we did not have the necessary infrastructure RIGHT NOW. After much complaining and advocating by the people of Tobago, we were finally told on April 9th that during the week of April 13 three laboratory technicians would be sent to Trinidad to be trained, and when the Ministry of Health gets another batch of Polymerase Chain Reaction (PCR) machines in one to two weeks, we would get one of those. This means that Tobago MAY start testing at the end of April, if not later. This is unacceptable.

This is unacceptable because we currently have a situation where we continue to send samples to Trinidad to be tested, and Trinidad decides which samples they will test. When asked for a breakdown of what percentage of Tobago samples are being rejected, our Tobago counterparts could not give an answer. In addition to this fact, we were also told on April 9 that instead of the original wait time of 24 to 48 hours between samples being sent and results being received, we are now waiting over a week to receive results. Also unacceptable.

WHY WE NEED TO STAND ON OUR OWN

If Tobago, via the Tobago House of Assembly, really had the autonomy that we have been clamouring for, we would have been able to have our own testing in Tobago from the beginning. If Trinidad was limiting the process, we would have been able to go out into the open market and get machines (and the necessary resources) from Germany or the United States or any other country offering those systems. If Tobago really had autonomy we would have been able to decide who gets tested right here, and not limit it to who Trinidad says can get tested. We would have been able to do surveillance testing where we:

1. Test everyone who shows up with flu-like symptoms, because we honestly don’t know where some of our cases have contracted the virus, and

2. Randomly test one in every 100 or 200 people on the island to get a better picture of our actual rates here, and to determine if we have asymptomatic positive cases. This means paying to test between 300 to 600 people – a price worth paying, since early diagnosis helps us all in the long run. CARPHA stated that each test costs about US$250. Which means that each test costs TT$1,750, and 600 tests would cost TT$1,050,000. The 2019 budget for Tobago jazz Festival was $12 million.

The rest of the world is showing us that a delayed response is a recipe for disaster. We are experiencing the progression of this disease several weeks after other countries, and as a result, we have the benefit of learning from those countries. We can’t continue to say “NOT NOW”, because we do not have the luxury of time. We will quickly recognise that our “NOT NOWS” really mean “NO”, because by the time they materialise, it may very well be too late.

Dr. Faith B.Yisrael (formerly Faith Brebnor) is a health educator, social scientist, public health specialist and politician.

Email address: DrFaith@ImaniConsulting.Org

Phone number: 494-8827

Facebook page: @ImaniConsultingAndFoundationTobago

References

Plans for covid19 testing facility in Tobago: http://www.looptt.com/content/plans-covid19-testing-facility-tobago

Mass testing, empty ICUs: Germany scores early against virus: https://www.timesofisrael.com/mass-testing-empty-icus-germany-scores-early-against-virus/

Germany to run Europe’s first large-scale antibody test programme: https://www.ft.com/content/fe211ec7-0ed4-4d36-9d83-14b639efb3ad

Iceland lab's testing suggests 50 per cent of coronavirus cases have no symptoms: https://edition.cnn.com/2020/04/01/europe/iceland-testing-coronavirus-intl/index.html