Those who can’t learn from the past are condemned to repeat it.
After the initial outbreak of the Spanish Flu in the Spring of 1918 restrictions were relaxed in the Fall to facilitate troop movements for the war and by November of that same year a second more deadly wave spread across the world killing much more people than the first wave.
The story is told how the US State of Philadelphia prematurely ended its quarantine in September of 2018 to throw a parade of troops, where over two hundred thousand residents lined the streets to boost the war effort. Within 72 hours every hospital bed in the city was filled with over four thousand five hundred people infected.
When I looked at the Ministry of Health’s press conference on Saturday and listen to the utterances of the minister, I immediately remembered that, “Those who can’t learn from the past are condemned to repeat it”.
I was alarmed at the content and tone of the minister and his two minions and I asked myself haven’t they looked at the very recent experiences of Singapore, Hong Kong and South Korea where after relaxing restrictions, they had spikes in infections and in the case of Singapore over five thousand new infections.
Did the minister not listened to the WHO Chief who said in reference to the coronavirus pandemic, “the worst is yet ahead of us”. I continue to ask myself – is the minister aware of what is happening in Jamaica, our Caricom neighbour to the north with a jump from imported cases to exponential community spread of the virus?
Jamaica has reported 305 confirmed cases as of April 26th, of which over 40 are imported and over 120 of the remaining identified cases are in a workplace cluster.
The press conference on Saturday revealed a serious lack of understanding of disease epidemiology and pandemic by the Minister and his minions.
The Minister must remember that Grenada has a dependent open economy that relies on trade in goods and services with the rest of the world.
Tourism is one of the largest sectors in the economy. Is the virus not present in over 200 countries and rampant in all of our major trading partners and source markets for tourism including the United Kingdom and United States?
Did one of his minions failed to remind him that St. George’s University, an educational services institution accounts for 20 percent of the island’s economy with over 5000 foreign students, most of which are from the United States?
Grenada can never turn the corner Mr. Minister until there is a vaccine and the pandemic is under control. The UWI Covid-19 Task Force suggest from the point of first community transmission intense spread of the virus could last from 2 to 4 months.
The spread in the region is expected through the summer with sporadic outbreaks if containment efforts hold or intense epidemic spread if containment efforts are breached.
Mr. Minister, this is not the time to lessen restrictions since we have not turned the corner as yet. The battle has just started and the initial salvo of imported cases can be best described as a scrimmage – the major assault will be community spread and from your utterances and Government’s actions to date our defenses are no way ready for that traumatic assault.
A serious understanding of disease epidemiology and pandemics would suggest this is not the time for a victory lap. This is the time to plan for the worst and hope for the better. This is the time to increase surge capacity by expanding physical facilities, get more isolation beds, ventilators and PPEs, expanding contact tracing capacity and test, test, test.
At last count according to CDC Worldmeter, Grenada had only done a faction of real test compared with Dominica 345, St. Lucia 344, and St. Kitts 234. Since it was reported that Grenada now has the capacity to conduct its own testing why have we not increased the real testing – not screen testing? What are the constraints?
Should we not test randomly persons from communities where the first set of imported cases stayed? Should we not have tested frontline workers on the air and seaports including customs, immigration officers, Airport Authority workers and airlines employees?
Should we not test doctors, nurses and health officers in district health centers and clinics? Should we not test workers at food distribution companies, supermarkets, Dockworkers particularly those small inter island ships that offload at the Caricom port?
According to the science in order to stem community spread you must test, test, test both diagnostic (PCR) and antibody to determine the number of persons infected and the number of persons who have been exposed to the virus and didn’t know it.
Proper planning to curb community spread can only take place when there is an accurate count on the level of infections nationally.
This would be a complex undertaking requiring broad capacity and talent not confined to party supporters or “those that are comfortable with”. It would require a genuinely inclusive national effort requiring all hands on deck.
Recently, PAHO called on member countries, of which Grenada is a member, to expand their testing measures for Covid-19. PAHO Director, Dr. Carissa Etienne said mass testing is important since it will allow countries to accurately determine how many persons have been infected.
Dr. Etienne further said that enhanced testing will allow authorities to break the chain of infections. Therefore, the question to the minister is, why the Covid-19 Response Committee has not taken steps to ramp up real testing on a mass scale?
This to me is rather disturbing and puzzling at the same time since mass testing will not only allow you to get a firm handle on the level of infection, it will also allow you to plan properly for reopening the economy.
That is why I question whether the minister and his minions really understand the epidemiology of this pandemic. Whether or not the results for recent cases come back positive or not it will be foolhardy to believe that there are no asymptomatic carriers within the population or persons who may have been exposed to the virus and not aware of it.
Therefore, Mr. Minister, proper pandemic planning would assume that there could be silent community spread and as such caution should be exercised when considering relaxing restrictions.
The experience of Singapore where after being hailed as one of the countries that has got its coronavirus response right with low numbers of confirmed cases, saw a dramatic spike in infections to over five thousand, nine hundred (5,900) cases according to John Hopkins University.
Singapore thought it had contained the initial imported spread from China by instituting quarantine measures, contact tracing, increased public awareness, installation of isolation wards in hospitals and not allowing positive patients back into the community.
The result, confirmed cases were relatively low at just over 200.
However Singapore testing effort failed to reach clusters within the migrant worker communities where the virus was apparently hiding undetected. This led to a dramatic spike in infections within a short space of time.
The lesson here is once restrictions are relaxed prematurely and social distancing measures breakdown in a situation of inadequate testing the virus will spread from person to person with incredible speed.
This was exactly the case with the Spanish Flu pandemic in 1918.
After the first wave of infections in March of 1918, restrictions were relaxed to facilitate the war effort between September and November and a second wave of infections killed three times the amount of people in the first wave.
Mr. Minister, those who can’t learn from the past are condemned to repeat it.
Rather than announce Grenada had turned the page it would have been more prudent to extend the restrictions for another 2 to 3 weeks and during this time ramp up PCR testing for high risk groups mentioned earlier in this article and antibody testing in the general population.
The Government during this time also should appoint a high level committee to commence planning for the reopening on the economy. The committee should be mandated to hold discussions with all the sectors in the economy with a view to determining the timing and logistics, in terms of social distancing measures required to operate going forward in absence of a vaccine.
The terms of reference of the committee should include preparation of a phased timetable for opening the various sectors in the economy. It is also imperative that Government and the committee should seek to engage SGU which accounts for 20% of the economy to discuss the return of students and the functioning of the school within this new normal.
If the results of the ramp up testing shows that there is little or no community spread and systems can be put in place to test students before they leave their home country and when they arrive in Grenada then the fourth term that starts at the end of June can be used as a test to determine how a restart of the school can be arranged.
The point here is that reopening of the economy cannot be as simple as relaxing restrictions and adding businesses to the list of who can open and how long they can open for. This would be a complex undertaking requiring broad capacity and taken and should not be confined to party supporters or “those that you are comfortable with”.
It requires all hands on deck.
President Obama in his endorsement of Vice President Joe Biden and referring to the coronavirus said the virus has an ability to unmask various realities in the US society. Grenada would be no different with various realities such as lack of capacity in Government Administration in particular healthcare, finance, education, agriculture and social development.
The situation with Covid-19 is no way similar to hurricane Ivan as the entire global financial and economic system is under severe stress, the entire supply chain network, global transportation, finance, education, agriculture and social development have been unmasked over the last month.
The situation with Covid-19 is much different to hurricane Ivan, the global multilateral, financial and economic system is under severe stress.
The international supply chain is broken and international transport nearing collapse. However if the Government failed to learn from its past experiences it would be condemned to repeat it again at an incredible cost.
I listened to callers, on a program with Ministry of Education officials, point out the weakness in the recently launched online initiatives and I said to myself – look at how Covid-19 exposed the weak capacity in that ministry?
I reviewed the Ministry of Finance stimulus package, listened to the minister’s utterances and compared it to that of St. Kitts and Nevis and I said to myself – look at how Covid-19 has exposed the lack of capacity in the ministry.
If we are to listen to the science, as the Prime Minister said we should, tourism revenues could be in decline through to first quarter of 2021. The entire revenue base of the country could be in decline through to at least December 2020.
In addition to decline in tourism revenues, the economy will suffer another body blow due to a drop in the frequency and level of remittances from diaspora centres like New York, London and Toronto because of massive job losses and economic recession in those centers.
With traditional donors having to redirect huge amounts of resources to fight Covid-19 in their jurisdictions while their economies are in an induced economic coma they will be unable to provide direct assistance or replenish the multilateral organisations, such as the World Bank and Caribbean Development Bank that provide assistance to developing countries. The result will be a very difficult and challenging next 18 to 24 months as the government struggle to access financing for countercyclical fiscal policy measures.
This will require a truly inclusive national effort to overcome; and if the government fails to learn from the hurricane Ivan experience it will be condemned to failure resulting in tremendous social and economic hardship for Grenadians.