It is just a matter of time for the coronavirus to start spreading again in Grenada, if Government do not move quickly and decisively to strengthen weakness in public health protocols and step up enforcement.
According to the recently updated Grenada Entry Protocol, residents from islands within the Caricom travel bubble do not require a PCR test to enter the island. Persons from low risk countries require a negative PCR test taken within seven days of travel. Travellers to the island from all other countries require a negative PCR test taken no more than seven days before travel.
A minimum of four days reservation at approved accommodation for observation and quarantine.
Visitors on day four have the option to take a PCR test to be allowed into the community or remain at the hotel for the duration of their visit. Returning residents on day four in quarantine have to get a negative PCR test result to be allowed to go home.
On paper the protocol looks good however when one considers the science there are many weaknesses that must be addressed to prevent re-importation of the virus into Grenada.
According to Dr. Anthony Fauci, head of the National Institute of Allergy and Infectious Disease in the United States, although the situation varies with each individual the time from first exposure to appearance of symptoms takes four to five days, during that time the virus starts to replicate for a couple days in the upper respiratory track.
However, two days before the onset of symptoms an infected person can become contagious and spread the disease to others. It normally takes ten days from onset of symptoms for a person to stop shedding virus or still be contagious.
Doctor Robert Schmerling, writing in Harvard Health Publishing said it is tough to pin down the accuracy of the PCR test with a reported rate of false negative ranging from a low of two percent to a high of thirty seven percent.
Doctor Matthew Binnicker, director of Clinical Virology at Mayo Clinic in Rochester, Minnesota wrote, the timing of when the sample is collected, the type of the sample collected and the quality of the sample can influence the accuracy of the Covid-19 results.
Binnicker went on to write, the virus is thought to be present at the highest levels approximately five days, on average, after being exposed or around the time the person develops symptoms. If a high quality nasopharyngeal swab is collected within twenty four hours of symptoms onset is tested by an approved PCR method and the result is negative the likelihood of the person having Covid-19 is low.
However, if a less preferred sample such as throat swab is collected after three to five days of symptoms and tested by PCR a negative result would be less reliable to rule out Covid-19. That being said the PCR test is not one hundred percent accurate.
Closer review of the recently adopted Grenada Entry Protocol for low risk and all other countries, the findings by doctors Robert Schmerling and Matthew Binnicker, and available scientific data on the possibility of false negative testing, between two and thirty seven percent of travelers who present a negative PCR test result on entry to the country will actually be positive.
In addition, approximately thirteen percent of travelers who obtained a negative PCR test result within the stipulated seven days before travel, to the tri-island state, will get infected between the time the test was taken and arrival on the island.
This is a significant number of infected persons who can slip through the cracks and cause the virus to spread again in Grenada. A case in point is a recent cluster spread in neighbouring Barbados where a person who entered the country on the basis of a negative PCR test was found to be positive five days later after the second test was done. The housekeeper to the person became infected who then spread the virus to six family members including a fifteen year old school girl.
Contact tracing is ongoing to determine if more persons were infected and the school, Ellerslie Secondary School, where the fifteen year old attend is closed for two weeks.
Based on the science well over thirty percent of travelers who present a negative PCR test result on arrival at the MBIA could actually be positive for Covid-19 and likely to be contagious. This means that local workers at the various types of accommodation including hotels, villas, resorts and guest houses are at risk and could be infected as the housekeeper in Barbados.
This is frightening since once infected the workers will carry the virus back in their homes and communities where they live. What is the Government doing to protect these hundreds of hotel workers? Is this not playing ‘Russian roulette’ with poor hotel workers lives?
According to reports from persons who came into the island since the reopening, the situation at the Maurice Bishop International Airport is one of chaos and disorganisation. This is precipitated by insufficient personnel to efficiently carry out health screening and other administrative functions required by the entry protocols.
Several persons complained about having to fill out forms that were already completed online prior to travel while others paid for a particular hotel to quarantine, however was sent to another facility of lesser quality.
As the number of travellers increases in the coming months more personnel will be required to undertake health screening and other administrative functions at the airport, and to test and monitor travelers in quarantine at hotels, other forms of accommodation and, in self-quarantine at home or at an approved facility.
This leads to another concern, who will bear the cost of testing the persons in quarantine? Will government have to do so or the traveler has to pay for the second PCR test? Would the quarantined traveler have to privately arrange with the testing facility for the second test to be done or would health officials conduct the test? Who will monitor the traveler/visitor when in quarantine? Finally, what happens if a traveler refuses to do the second test on completion of the five days in quarantine?
These are questions health authorities must, urgently, answer and inform the nation. Of equally grave concern is the continued dismissive attitude towards the virus displayed by large sections of the population. Huge number of persons can be seen not wearing mask in public, on public buses, and business places.
People are still not physical distancing when in business or other places where they congregate. School children are forced to use public buses where they are pressed shoulder to shoulder again with other passengers not wearing mask. Even some bus drivers and conductors are either not wearing or doing so improperly.
Every weekend entertainment venues are filled to capacity with no social and physical distancing or mask being worn. There is a serious lack of adherence to public health regulations and enforcement of protocols by the authorities. This is frightening in light of concerns raised with the entry protocols at the airport.
It is only a matter of time for the virus to jump up and start to transmit again in Grenada and when it does it will surely be community spread if government does not act now to correct the weakness in entry protocols and step up enforcement of public health regulations on the island.
Health authorities need to consider extending the period of quarantine from five to fourteen days for travelers in the “all other countries” category and administer the first PCR test after two days in quarantine and a second one seven days after. Should the two tests be negative the visitor will be allowed to leave the property and mingle in the general population.
Therefore, all tourists traveling to the island for less than fourteen days must vacation in place at the hotel, resort, villa or guest house and not be allowed to enter the general population. The cost of the two test must be covered by the visitor and not government.
All workers at government approved accommodation facilities should be rapid test twice a week paid for by their employer. Travelers and repatriated nationals staying beyond fourteen days will be allowed to leave quarantine once they have a negative PCR at the end of the period. The negative PCR test taken within seven days of travel to the island must remain. If a visitor/traveler refuse to take the test during quarantine they must remain in quarantine for the duration of the stay.
The Ministry of Health must immediately institute a system of testing for hotel workers paid for by their employers. Workers should be given rapid antigent testing twice weekly and a PCR test every fortnight.
Transmission of the virus from traveler to hotel worker while in quarantine can be a conduit to spread the disease into the community that will result in dangerous community spread.
Government must consider going back to the three persons in a row on public buses and strictly enforce the mask and physical distancing mandate. All citizens cannot be expected to demonstrate personal responsibility. Public health officials and the police should be empowered to aggressively enforce regulations and protocols.
Coronavirus will wage an unrelenting war on the population if given an opportunity. Therefore, government must mobilise all available resources to defend the country. Our cultural ambassadors should be engaged to prepare jingles educating citizens on the dangers of the virus and highlighting importance of wearing mask, sanitising hands regularly, and social distancing in protecting against the plague.
Political parties, religious groups, sporting organisations and all of civil society must be called upon to help combat widespread indifference to the scourge called Covid-19.
Government must adopt a zero tolerance approach to breaches in regulations. Non-compliant bus operators should be penalised, restaurants and entertainment venues shut down until proper measures are put in place to adhere to public health protocols.
When the virus reaches community spread and hospitalisation and deaths start to occur the same persons advocating for loosening of restrictions and commending the Government on the new protocols will be the first to blame and cry shame on the Government.
History will treat the leader harshly if he fails to take action to protect the population from this dreaded virus.