Overhaul of covid testing overdue

THE EDITOR: As 2022 unfurls, there is much cause for concern on TT’s covid19 pandemic front. With new records set for cases and deaths in December – 20,538 cases and 711 deaths – recent history offers little hope that the Government’s most recent proposal to stop the bleeding will be successful in the short term.

Semantics aside, the Government’s “no vaccine, no pay” policy for all workers on the public payroll, promoted by Health Minister Terrence Deyalsingh as an essential tool since his ministry simply could not continue “to report 30 deaths per day,” will likely fail in pursuit of such goal if the experience of First World powers is any indication.

Dr Amesh Adalja of John Hopkins University in the US, in the course of an interview with MSNBC on October 5 last, noted “there’s been a lot of spread of infection and a lot of disruption to people’s lives because we lack proper testing.”

The thrust of an October 6, 2021, New York Times newsletter was to lay out the difficulty citizens of the US were experiencing in locating rapid tests; a stark contrast to residents of Britain, France, Germany and other places where such tests were widely credited in reducing the virus’s spread. It is common knowledge that the outcomes of the recent delta surge, ie, hospitalisations and deaths, were worse in the US than in Europe, even though Europe’s vaccination rate was only modestly higher.

Dr Jennifer Nuzzo and Emily Pond, epidemiologists at the Johns Hopkins Coronavirus Resource Center, had earlier in the year noted: “Even with vaccines, the coronavirus won’t subside if we don’t keep tabs on it.” President Biden has since belatedly heeded this warning; US$2 billion for rapid testing was included in the American Rescue Plan Act.

In TT, the value of testing – rapid and otherwise – remains grossly under-appreciated, to say the least; it is a chronic problem set to get worse. The country has now lurched from the ancestral SARS-Cov-2 (July/September 2020) to the gamma variant (April/August 2021) and is presently in the midst of a transition from delta to the omicron variant, each surge characterised by geometric increases in transmissibility, and thus an unrestrained rise in new cases.

The Ministry of Health, meanwhile, has persisted with its strategy of reporting results of PCR testing two-five days later, an incongruous gaffe, since for many the days of maximum infectivity were already bypassed, making isolation and quarantining at that point of little utility. When such faux pas is coupled with perennial under-testing – mainly those showing up at testing venues for whatever reasons (presence of symptoms, known exposure, and impending travel) being tested – opportunities to diagnose and isolate the mildly symptomatic and asymptomatic people are being irrevocably lost.

Bottom line, the number of new cases could be geometrically higher and that translates into thousands of infectious people circulating among a public exerting maximum effort at adhering to the public health regulations, including older people compromised by comorbidities staying at home to protect themselves.

How high is the number of new cases being missed as a result of this testing imbroglio? Estonia, a country not unfamiliar to the TT Government and of similar-size population (1.327 million), has to date recorded 243,296 positive cases from 2,538,216 tests, and 1,939 deaths. For TT, the statistics to date: 92,658 positives from 512,168 tests, and 2,914 deaths. Nearby Barbados and Guyana also sport statistics with similar diversions from TT’s.

Testing will remain essential to diagnose and isolate cases, and to screen for asymptomatic infections. Such information will better inform the authorities on what actions are needed to break the chain of transmission and, most important, protect those people at higher risk. Rapid overhaul in this arena is long overdue; it can no longer be avoided.

To close on a bright note: as is occurring elsewhere, the omicron variant is set to become widespread in the TT community. The saving grace is that so far it appears to be of much lower virulence than the variants that preceded it. That factor coupled with the likelihood that the TT population is probably closer to herd immunity than is apparent, not from vaccination but from undiscovered infection, gives hope that we will get by without the premised increase in serious illness and deaths.

KENWYN NICHOLLS

retired international public

health epidemiologist