Dwayne Devonish | Smart virus testing necessary for economic reboot
OP-ED CONTRIBUTION: COVID-19 AND THE ECONOMY
FOR MOST countries in the Caribbean, the current testing for COVID-19 has not reached levels suitable for ascertaining an accurate picture of the state of outbreak and spread of the infection.
This situation is largely due to the limited testing capacity or resources available and restricted access to testing supplies internationally.
Testing has been restrictively focused on assessing severe and highly symptomatic cases, high-risk groups, and cases revealed through robust contact tracing.
Unfortunately, this approach to testing means that we will be unable to possess a decent representation of the population of confirmed cases in a country – which makes it difficult for resource/capacity planning in our healthcare systems, as well as determining the best time to engage in a slow, controlled reopening strategy of our economies.
It is common knowledge that asymptomatic persons are still highly infectious – perhaps representing more than 50 per cent of true cases, based on existing evidence – and that they primarily represent the main ‘vehicles’ for transmission in communities, as they and others are typically ignorant of their condition. This category is less likely than symptomatic persons to take the necessary precautions in the public space.
The testing community should allocate a small portion – 30-35 per cent – of the ‘scarce’ but hopefully growing testing resources towards those who do not exhibit the typical ‘warning signs’ of the infection.
If we are really to know the true state of community-level transmission, a mixed criteria testing regime which involves focusing resources on assessing symptomatic, referred, or traced cases, including front-line healthcare workers, and random samples of asymptomatic cases in the general population, guided by some pragmatic and scientific set of criteria, is needed.
Dominica has begun to take this approach seriously in their testing regime. One benefit of random, community-level testing approach is that if a person with no clear symptoms was randomly selected from the population and found to be positive, we would have better evidence of community transmission, better opportunities to improve and update current contact-tracing efforts and activities, better data on informing decisions on whether to update or expand current healthcare resources for treating those affected by the disease, and better information for calibrating shutdown or reopening decisions regarding social and economic activity in the country.
One other benefit is that if multiple asymptomatic cases in the population are confirmed through random population testing, one might expect a more favourable change in the public response to the current distancing and safety measures, including staying home, physical distancing and wearing masks, as members of the public would have a better understanding of the true nature of the multiple risks and avenues of transmission of the virus.
Standardising data reports
Barbados has reported conducting over 1,000 tests, but it remains unclear as to whether this figure captures the number of tests performed or the number of persons tested.
Some countries are providing the World Health Organization’s data and communications machinery with the number of tests performed, inclusive of repeated tests on a single individual, while some are providing the number of persons tested – an unfortunate symptom of how most countries have handled their data-recording and reporting systems on this pandemic.
Both metrics are critical for the benefit of the public and the national surveillance teams in many countries, as these data would offer a better picture of the testing coverage and state of the infection rate to date.
All Caribbean countries should include data on both metrics when disseminating information on testing results or statistics on the COVID-19 situation to their various publics. Such data will help us truly assess and appreciate the nature of the testing behaviour and coverage, to date, within respective countries.
Conditions precedent
Several models are in place, internationally, for restarting an economy.
The full-reboot approach is where a country waits for zero cases and then restarts the economy with minimal restrictions, but with prohibited international travel.
There is the large-scale restart of social and economic activity, but with prevailing strict isolation measures for vulnerable populations and stringent but tolerable distancing measures in effect – which is recommended for low-income countries like those in the Caribbean, for the short to medium term, whose ability to quickly ramp up healthcare and testing capabilities is highly constrained.
Another consideration is a graduated or phased approach, where countries relax restrictions in a strategic, deliberate and incremental fashion based on the evolution or progression of the outbreak in the country, the level of readiness in the healthcare system and its machinery, and the level of readiness or preparedness of the public, commercial entities and other institutions.
I propose the graduated approach. However, prior to the lifting of any restrictions on social and economy activity in a country, it is important that several key criteria on national readiness be assessed and monitored through a national monitoring or surveillance system.
This system should examine three sets of readiness factors in a country: the level of healthcare readiness; the level of organisational and business readiness; and the level of public readiness.
Healthcare readiness speaks to the level of testing coverage and capacity and healthcare response capabilities, and the state of the outbreak; that is, the number of cases revealed over a period of time in a given country.
Organisational and business readiness concerns how easy, feasible and affordable it would be for organisations and businesses to meet and sustain compliance to requirements of physical distancing, having adequate supplies of handwashing facilities and disinfecting resources, and protective equipment – especially for customer-facing staff.
Assessing organisations’ capabilities and technological resources for facilitating remote work, or teleworking, and other forms of flexible working arrangements, and their e-commerce and online commercial capabilities to meet customer demand, would be critical here.
Public readiness is predicated on the level and quality of information and communication mechanisms or strategies in operation – to be utilised by state agencies to keep the public apprised on a regular and consistent basis – and the level of compliance with distancing and safety protocols demonstrated by the general public.
Dwayne Devonish is a senior lecturer in management studies at The University of the West Indies, Cave Hill campus, Barbados.