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The buck stops with both of them

Recently I found myself between sleep and wake in a daze and thought I was in a dream with the main characters being Brer Anansi and Brer Rabbit. One voice which I thought was Brer Anansi purported to tell a story how the villagers would not forgive him, Anansi, if someone dies from the virus under his watch.

The other voice was that of Brer Rabbit who told a story about not wanting to play a potentially dangerous game referred to as Russian roulette with other young villagers. However I became bewildered on realising the utterances in my dream may have been that of officials speaking on coronavirus.

After hearing the voice of who I thought was Brer Anansi relating the story of villagers not going to forgive him if one of them died on his watch, I immediately referred to the World Health Organisation (WHO) six criteria for reopening.

The first criteria is disease transmission is low and under control. The second one, the health system is able to test, isolate, trace and treat every case. The third is that hot spots risk are minimised in vulnerable places. The fourth one, work places, schools and other essential places have established sufficient preventative measures. The fifth criteria is the risk of imported cases can be managed. Finally, the sixth criteria is communities are fully educated, engaged and empowered to live under the new normal.

In summarising the six criteria for reopening Director General of WHO, Tedros Ghebreyesus said countries should ask themselves three questions. The first – is the epidemic under control? Secondly, is the health system able to cope with a resurgence of cases that may arise after reopening? The third question, is the public health surveillance system able to detect and manage the cases and their contacts in the event of an outbreak?

Analysing the situation in Grenada, the epidemic spread of the virus appear to be under control, however the situation of asymptomatic carriers are largely unknown since health authorities have not undertaken a concerted effort of random testing in the general population.

The focus for testing continues to be persons entering the country, contacts of confirmed cases and frontline workers. This in spite of the mantra for reopening, internationally, is test, test, test to determine the level of silent spreaders within the population.

Recently, when the three Trinidadians who lived in Grenada turned up positive in Trinidad, health authorities hinted at the possibility of asymptomatic spreaders among the population. However, to date no effort was made to undertake random testing.

Notwithstanding, the authorities can give a positive response to the first question. However, it will be difficult to do so for the second and third questions the Director General suggests countries should ask themselves.

Brer Anansi or the voice I thought was his must be very concerned that someone or hundreds of persons die on his watch because he is head of the Village Council that took the decision to allow entry into the village before making sure all the criteria as stated by WHO are met.

As head of the Village Council, Brer Anansi, it should be noted, failed to consider the recent outbreaks and upward trends in infections in European Union countries and the buck must stop with him should the virus jump up and start to spread again.

Currently, experts are debating whether the outbreaks are a second wave and some countries have begun to place travel restrictions on their neighbours such as the British and Germans restrictions on travel to Spain. This has also led British Prime Minister Boris Johnson to put the brakes on his country’s reopening.

Yet our authorities have not seen it fit to delay the opening of borders to medium risk countries mainly from the European Union for a week or two to observe if this upsurge in infections are indeed the expected second wave in Europe. We must not forget that the virus moves as people moves and our first cases came from Europe.

As an island heavily dependent on tourism the virus will spread through imported cases and asymptomatic carriers, therefore it is imperative that the guidelines outlined by WHO be implemented before full reopening of our borders.

Policy making during the time of Covid should be nimble enough to quickly respond to changes in countries infection rates that we are expecting visitors from. Europe is our second largest source market for overnight visitors.

Brer Anansi, as the village elder, is correct he would not be forgiven by the villagers if deaths occur on his watch. On that note Brer Rabbit, a subordinate of Brer Anansi said he would not play Russian roulette with villagers’ lives. Yet he has not delivered for his chief Brer Anansi to allow him to say yes to the second and third questions that countries have to ask themselves before full reopening.

Three neighbouring village islands, the Bahamas, Barbados and Trinidad and Tobago are experiencing significant spikes in infections after reopening their borders. The Bahamas government in response moved quickly to introduce a total lockdown and a mandatory fourteen day quarantine for all visitors to the country irrespective of country of origin.

Brer Anansi should follow closely the emerging situation in Europe and our three neighbouring village islands and respond immediately to protect the lives of villagers or else he would not be forgiven.

In fact the village of Barbados has now joined Bahamas in updating its health protocols for entry into the island. Will Grenada follow the lead of its two neighbours or wait until there is another imported case.

At present our health system can’t handle an outbreak that requires large number of hospitalisations because there are only fourteen beds to treat Covid-19 patients. Since April there have been calls for authorities to increase the number of hospital beds by renovation of an additional existing building, to date nothing has been done.

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Barbados renovated an abandoned building into a two hundred beds facility at Harrison Point, St. Lucy in quick time. While Trinidad and Tobago has over nine hundred beds available in three hospitals, Couva Children’s Hospital, Caura Chest Hospital, Arima health facility and Augustus Long Hospital to treat Covid-19 patients. Both countries authorities have acted swiftly to contain this current outbreak.

There has been repeated calls from different quarters to strengthen the health care infrastructure in the tri island state to be able to shift to effectively detect and isolate confirm cases in proper facilities. Apart from establishment of testing capability at two labs no serious effort is being made in expanding isolation and treatment facilities.

Although health authorities have had some success in detecting imported cases at our international airport the measures in place are still wanting. The use of the very unreliable rapid test must be discontinued and replaced by PCR test.

Passengers from medium risk countries although having a negative PCR result to travel must pay in advance for a mandatory PCR test to be done on arrival and be quarantined until the test result becomes available.

Recently, there have been too many sights of Caucasian people moving around the island not wearing mask, drinking and partying like those on Wall Street last weekend, the popular street food liming place. We know Brer Rabbit like to think of himself as Caucasian, however, he must have the courage to enforce the wearing of masks to these people as well.

With the current poor state of our health system Grenada would not be able to handle nor cope with a resurgence of cases or worst yet a significant outbreak at this time.

Regarding the third question, whether the public health system is able to detect, manage cases and their contacts and identify hotspots, at present the disease surveillance system is not sufficiently resourced. How many epidemiologists and disease detectives are there to police this dreaded virus?

Do we have an effective management health information system, manned with trained staff, to adequately manage the spectrum of information required for planning and decision-making during an epidemic spread?

In spite of the posturing and constant use of sound bites, Brer Rabbit did not listen to Mike Ryan of WHO, who said the best way to ensure Covid-19 cases are on a downward trajectory is to put in place strong testing, disease surveillance and public health measures. Therefore Brer Anansi can’t answer yes to the Director General’s third question.

The preliminary report, referred to in an article in this newspaper on the state of Government buildings throws light on Grenada’s unreadiness to meet the fourth criteria outlined by WHO, that is schools, workplaces and other essential buildings have established preventative measures.

The state of disrepair of these buildings negate any attempt to install preventative measures. The situation with the Ministerial Complex and its central air conditioning unit should be of serious concern to all who work in and visit that building.

Evidence of spread of the virus through air conditioning ducts in South Korea, Hong Kong and China are well documented in respected scientific journals. Therefore, workers at the Ministerial Complex, banks and other buildings with central air conditioning, are sitting ducks, in the event of an outbreak or epidemic spread on the tri-island.

Equally concerning is the failure of health authorities to undertake a concerted public education campaign throughout the length and breadth of the tri-island state to engage and educate communities on the dangers posed by Covid-19 and the need for behavioral changes as a result.

Apart from the PAHO-sponsored campaign and a few private businesses ads very little has been done by authorities. Why can’t local talent and artists be employed to get the message out to communities?

The new school term is fast approaching, you have now opened up the borders to medium risk countries where there is clear evidence of a current significant spike in infections. Brer Rabbit needs to act with purpose and determination now.

The failure of brer rabbit to effectively carry out his functions has lay bare the serious weaknesses in the local health authority and is negatively impacting on Brer Anansi’s performance as head of the Village Council.

This is in stark contrast to the situation with the village elder from a neighbouring village Trinidad and Tobago where, buttress by the stellar performance of his two subordinates in charge of his village health authority, he is seen in a very positive light in the face of an election campaign.

Brer Anansi often celebrated as a symbol of all knowledge and survival being able to turn the table on those who see themselves as powerful by virtue of their standing and colour must call Brer Rabbit to account for his failures.

Brer Anansi, though in advance age, has the benefit of wisdom and must not allow Brer Rabbit, considered a trickster who succeeds by his wit rather than his brawn provoking authority figures and bending social rules, using sound bites and buzz words rather than hard work, to make him and his Village Council look bad in the eyes of the villagers.

Brer Anansi knows very well the villagers would not forgive him if one dies on his watch. This pandemic has the potential to ravage Brer Anansi village. Being the symbol of all knowledge Brer Anansi must be aware of the Brer Rabbit and the tar baby story and its role reversals and mythical interpretations.

Who is Brer Fox? Has Brer Anansi morphed into Brer Fox in the tar baby story? Notwithstanding the intrigue, the buck stops with both Brer Anansi and Brer Rabbit in this instance.

Special Correspondent