DEADLY NUMBERS GAME - Gov’t stands by COVID-19 stats even as black-market testing threatens efficient response to pandemic and points to higher figures
In the last two weeks, there have been a reported 1,046 locally acquired cases of COVID-19 in Jamaica.
Multiply this number by eight and there is an estimated 8,368 people who Government believes are currently infected and can actively pass the coronavirus from one person to the next. These figures do not include imported cases of COVID-19, those of visitors to the island.
People in the locally acquired group would not have travelled overseas but somehow contracted the virus from infected associates or even strangers. Many are asymptomatic, while some will get sick and recover in roughly 14 days. But the majority will never be tested even as the Government announces an expansion of authorised private testing facilities locally.
It is the stark underbelly of what national epidemiologist Dr Karen Webster-Kerr described last week as a slight increase in the number of COVID-19 positive cases detected across the island in recent weeks, which will only increase as more private facilities get the green light from the Ministry of Health and Wellness to conduct antigen and polymerase chain reaction (PCR) tests.
“Over the last two weeks, it appears there has been a slight increase in cases. Some parishes are showing a higher increase in cases and we have spoken about Manchester, St Ann, and St Catherine, for example, still recording quite a few cases, but they (St Catherine) have been at a plateau for a few days,” said Webster-Kerr, as she sought to explain a 1:8 ratio used to gauge detected COVID-19 cases versus those estimated to be undetected over the period.
“This is determined by a number of things: reporting patterns of persons, positivity rate ... . So if the positivity rate is high, it means that we are not confirming enough people. If it is high, it means that the number of unconfirmed cases would be greater,” continued Webster-Kerr.
“It is actually a possible range from a low of probably three times to 30 times [the reported cases], with eight being sort of the median or the average. What we would look at for now is what has occurred in the last two weeks, because between infection and showing symptoms is up to 14 days,” she explained, adding that such calculations are also guided by disease surveys that have been done in Jamaica in the past.
Last Tuesday, this “globally accepted” epidemiological formula for COVID-19 analysis was all Health Minister Christopher Tufton was prepared to offer when asked about the presumed scope of a COVID-19 testing black market that threatens crucial calculations for assessing the impact of the novel coronavirus disease on the Jamaican populace.
Nonetheless, Tufton stood behind his ministry’s COVID-19 numbers which, up to Friday, said there were 14,772 confirmed cases with 336 deaths since last March. Active cases stood at 2,413. Still, positive cases found at unauthorised sites are not included in this data.
“The ministry does not include unauthorised tests. We do, however, have an established healthcare infrastructure involved in monitoring the status of the virus in the population and we have confidence in those numbers,” Tufton said in response to Sunday Gleaner queries.
Asked about possible sanctions that could be taken against doctors who conduct COVID-19 tests without authorisation, Tufton admitted that some doctors were allowed to do so without official authorisation, but noted that this was not because the ministry was not able to handle the high demand for testing islandwide.
“Nothing prevents a doctor from doing a test and there is nothing that prescribes where he can do it. That’s the challenge,” said Tufton.
“But we can use public education and information to expose concerns and advise the public as we have been doing. It is also about which tests would be acceptable by airlines,” he continued, hinting that the approach is more towards regularising private testing sites than levelling sanctions against them, as some countries are now demanding negative test results for incoming international passengers.
DONE THE RIGHT WAY
President of the Jamaica Medical Doctors Association (JMDA), Dr Mindi Fitz-Henley, also shied away from demanding sanctions against doctors conducting COVID-19 tests without authorisation even while spurning their unethical activities, noting that long term, such behaviour can jeopardise the country’s overall health and safety.
“As to whether there are legal ramifications, I don’t know, but I think it would be unethical and I think that all doctors need to be approved by the Government before they can be doing these testings. The issue is that if we are not sure who is doing the testing, then we are not sure if they are reporting the results to the Ministry of Health, and that will skew all the numbers that we have,” she charged.
“We won’t know the current positivity rate. We won’t know how one area is doing in comparison to the other, and we won’t know if one parish – St James or St Elizabeth – has a higher count than they actually do,” she said. “We understand that they are doing this to help persons, but it needs to be done the right way so we can ensure that the numbers can be accurate.”
Like Fitz-Henley, doctors who engage in the unauthorised COVID-19 testing, some of whom are employed in the government sector, welcomed the expansion of the testing system by the Government last week.
“The main concerns now are the length of time that the approval or accreditation will take and the availability of approved test kits,” offered one doctor, who was forced to close his unauthorised antigen testing site following a recent Sunday Gleaner exposé.
Last week, the health ministry and the Jamaica National Agency for Accreditation outlined 12 minimum requirements of testing providers before accreditation can be granted. Among the standards are that the provider must have arrangements that specify the information needed on the request to ensure appropriate examination and result interpretation; and the provider shall maintain records for all personnel to reflect the appropriate qualifications applicable to the task performed.
One of the unapproved PCR test sites visited two weeks ago by this reporter using a fake name was operated by Para Caribe Consulting Limited, which sought to clarify that “like other healthcare providers, we have over the years been submitting samples to authorised laboratories for specialised testing, such as chickenpox antibody levels and CD4 counts”.
It added in a release: “At Para Caribe, we recognise the clear need for verification of the identities of persons seeking medical laboratory investigations, including COVID-19-related tests. As we grapple with the dynamic variables associated with the COVID-19 pandemic, we are now beginning to implement a rigid identification system to safeguard the integrity of our sampling process.”