The recently confirmed cases of Covid-19 on the island are a cause for serious concern as it highlights many weaknesses with the entry protocols at our ports of entry. The problems must be fixed as soon as possible to prevent community or even epidemic spread throughout the tri island state.
Failure to do so will cause untold death and suffering among citizens of this country. I believe there can be a successful gradual reopening of the economy if Government finds the right trade-offs that make most economic and social sense.
Based on the island’s heavy reliance on tourism and international trade, critical to any successful reopening of the economy is the strength of entry protocols as the first line of defence at the air and seaports. Government must strive to achieve a balance between the need to restart tourism and trade and protect the population from the dreaded coronavirus.
However, closer scrutiny of the recently adopted entry protocols suggest too much emphasis on personal responsibility and the absence of a system of monitoring and surveillance of persons in quarantine. The protocols appear to have tipped the balance to tourism and getting tourists to our shores over public health safety of the population.
Allowing persons to enter the country on the basis of a negative PCR test and go into self-quarantine at a private residence is dangerous because between two to thirty percent of persons who present a negative PCR test can actually be positive.
In the absence of an effective monitoring system for places of quarantine, persons can leave the premises and mingle with the general population or have others join them at the place of quarantine while they await being tested by the Ministry of Health.
If the person in self-quarantine is positive for coronavirus this is an opportunity for it to spread once again.
Similarly, if persons are sent to quarantine with the expectation that they be tested within four to five days and after the time has passed no health official came to do the test that is also an opportunity for the virus to start spreading again.
They would know they are positive for the virus after the test is conducted by health authorities and results are available. Having interacted with persons prior to the test the damage would be done if the results are positive. This situation presents an opportunity for the virus to spread once more.
Similarly, if persons are sent to self-quarantine on arrival at the airport with the expectation they will be tested within four to five days and no one came to conduct the test leaving the person in a quandary. That person would eventually leave the quarantine setting and join the wider community without having knowledge of their status.
Should the person be actually positive for the virus then that is another opportunity for the virus to spread.
These persons would eventually leave the quarantine setting and join the wider community without having knowledge of their status.
Tourists, from high risk countries, who have confirmed bookings at one of the major hotels or villas, on entry at the airport, would present a negative PCR test and be allowed to go to their hotel or villa with the agreement they have an option to be tested on the fourth day if the result is negative they will be allowed into the community, however if they choose not to take the test they are to remain at the hotel for the duration of their stay.
Should the tourist test positive after the fourth day workers who interacted with that person would be at risk for infection. If the tourist opted not to take the test on the fourth day and continues to vacation in place at the hotel, workers would still be at risk since up to thirty three percent of travellers who present a negative PCR result on entry to the island would actually be positive and will be contagious even if they are asymptomatic not exhibiting any symptoms.
A yachtie and his family enter the territorial waters of the island and slips into one of the coves undetected by our coast guard, later travel by dinghy to purchase supplies at one of the supermarkets.
The yachtie having interacted with workers and locals at the supermarket, if that person is positive for the virus, he can spread the virus as well. Even if the yachtie goes to one of the areas designated to quarantine yachts and is not tested after four days however leaves his boat goes to a restaurant, supermarket, vegetable market or gas station to purchase fuel that person or persons can spread the virus if they are infected and are asymptomatic.
These situations describe earlier, highlight how gaps in the entry protocols and limited capacity to carry out testing and monitoring functions can lead to opportunities for the virus to spread in the tri island state.
It should be noted that the Association of Medical Practitioners in neighbouring Barbados citing available scientific evidence including the possibility of false negative testing raised serious concerns with similar protocols adopted by health authorities in that island.
The association concluded that the protocols would fail to detect up to thirty three percent of travellers who contract Covid-19 between the initial test and arrival on the island. The association raised further concerns with physical and human capacity to test and monitor the increasing numbers of travelers from medium and high risk.
The concerns raised by the Barbados Medical Association are similar to the emerging situation in Grenada.
The recent cases of two persons with negative PCR test on arrival at the airport however tested positive five days after and the breaches of quarantine by individuals is a testimony to the concerns raised by the medical association.
The concerns raised by the umbrella body of medical practitioners in Barbados are relevant to Grenada since the entry protocols are similar for both islands.
Moreover, in the last three weeks both countries have had to deal with cases of persons presenting negative PCR test on arrival at the airport then testing positive five days later. There needs to be an urgent review of the entry protocols to prevent community spread.
The protocols as currently designed appear to have tipped the balance to getting tourists and other visitors to our shores over public health safety. This is dangerous in a pandemic. We all know the economy can’t remain shut down for an extended period of time, the damage will be irreparable.
Likewise, opening up too soon and too fast in an unbalance manner can create similar lasting damage to the economy. The challenge for government is to strike the right balance with the trade-offs that make most economic and social sense.
Why risk community spread with protocols that are skewed towards attracting travellers to the island? Why, fully, open up bars and entertainment venues while schools are forced to operate in a limited manner?
Many governments have gotten it wrong when making tradeoffs during this pandemic. They tilt towards the extreme ends of the spectrum like Sweden who promoted personal freedoms and allowed the economy to remain open while Israel and New Zealand shut down to protect lives.
Sweden saw an explosion in infections and deaths per capita, Israel and New Zealand experienced deep economic decline as a result. However, countries like Taiwan, Germany and South Korea focused on the right tradeoffs and got it right. South Korea shut down bars and churches while Germany restricted abattoirs and bars to contain outbreaks.
South Korea and Taiwan used laser targeted testing and tracing to identify hotspots and super spreader venues. They then implement a system of effective quarantine to isolate, treat and stop the spread of the virus.
Government must strike a balance between getting tourism restarted and protecting citizens from the virus. Government must identify the tradeoffs that makes most sense, wearing masks and fully opening up schools including St. George’s University (SGU) should be a priority over opening up bars and entertainment venues.
Three persons to a row on public buses to allow for more ventilation and free flow of air making it difficult for the virus to spread should be reconsidered over trying to satisfy indiscipline bus drivers when hundreds of workers in other sectors are out of a job and others having to take pay cuts and make other sacrifices.
Putting persons in quarantine who may be unknowingly harbouring the virus or came in contact with a confirmed case is a sure way of preventing spread.
Having a smaller number of well-run and secure government sanctioned quarantine facilities should be given priority over having a larger number of properties, most of which don’t have systems in place to secure and monitor persons in quarantine.
Time is running out for government to get it right as the tourist winter season approaches and the second wave of the virus peak in source market countries including United States and United Kingdom.
The entry protocols must be tweaked to consider the dilemma of false negative testing. A system of rapid and PCR testing must be set up to test all workers in the major hotels, villas and government sanctioned quarantine properties on the island.
Health officials and the police should undertake systematic monitoring of quarantine facilities. Government can’t rely on ‘personal responsibility’ any longer and must take punitive action to improve public health regulations, including wearing mask and physical distancing when in public.
Compared to St. Vincent with over forty five beds dedicated to treating Covid patients, St. Lucia eighty eight beds, Barbados two hundred beds, Jamaica over five hundred, and Trinidad and Tobago one thousand beds, Grenada only has fourteen beds in its parallel health system dedicated to treat Covid-19.
The island can’t afford community much less epidemic spread. Thousands will die and untold suffering will be unleashed throughout the island. The responsibility is on government to strike the right balance and make the tradeoffs that make the most sense economically and socially to avoid a catastrophe.