T&T took its first step on its road to recovery from the COVID-19 pandemic this week. However, with this, comes an increased need for ramped-up surveillance testing, said Dr Joel Teelucksingh who also suggests antibody testing needs to be introduced to map the course of the virus among hidden cases within the community if they exist.
“The insidious nature of the COVID-19 infection means that there may be many persons who are asymptomatic—that means persons who may not have those classic signs and symptoms of fever, cough and shortness of breath but may be superspreaders and that’s one of the problems, especially as we think about lifting and easing these lockdown measures,” the internal medicine doctor said.
Dr Teelucksingh also explained that as more of the populous returns to their daily lives as the recovery progresses, there is the possibility of an “explosion of cases.”
The last confirmed case of COVID-19 in T&T, case 116, was on April 26; 18 days ago and four days longer than the upper end of the incubation period which the World Health Organisation (WHO) established for symptom onset in an infected person.
In a Zoom interview, virologist Dr Christopher Oura explained that while this may be a good sign that T&T is on its way out of the pandemic, there other variables which could be the source of new infections: illegal immigration and, as Dr Teelucksingh suggested, hidden cases.
This is why he further urges that citizens with any sign of respiratory symptoms be tested.
However, while there have been numerous calls for increased testing, there is one problem. The only tests approved by the Ministry of Health for detecting the virus locally is the polymerase chain reaction (PCR) tests, which both the Minister of Health Terrence Deyalsingh and Chief Medical Officer Dr Roshan Parasram have iterated on multiple occasions isn’t a viable option for detecting the infection in asymptomatic carriers.
It was explained that asymptomatic individuals would not have the necessary viral load to be detected by the test and would result in a “false negative.” Despite this, Dr Teelucksingh indicated the practice of testing asymptomatic people may not be a futile endeavour. He cited recent studies which reveal that asymptomatic carriers are most infections 24 to 48 hours before symptom onset. This he said could be done in conjunction with antibody testing to capture not only new cases but track previously hidden ones.
For the first two months of the pandemic in T&T, legitimate testing could only be done through the Caribbean Public Health Agency (CARPHA) strictly adhering to the guidelines set out by the WHO, which led the rejection of some samples. Surveillance testing began on April 14 with more relaxed testing criteria than CARPHA. On May 1, testing was able to be done locally through the University of the West Indies testing site at the Eric Williams Medical Sciences Complex.
As of May 13, there have only been 2071 persons tested through the Ministry of Health’s various testing programme; a number which represents less than 0.15 per cent of T&T’s 1.4 million citizens. This figure has come under heavy public scrutiny with cries that not enough testing was being done, especially compared to other countries; even within the Caribbean.
Up to yesterday, Barbados had 85 cases with seven deaths but tested some 3,185 people (population of 286,641). Bermuda has 121 cases, 8 deaths but tested some 4,642 people (population 63,968). Aside from other variables such as testing capacity, virologist Dr Oura said the reason for their figures could be the classification of infection spread these countries had.
Countries such as Barbados and Bermuda are classified as “Cluster Cases” which, according to the WHO, means cases were cropping up in “clusters in time, geographic location, or common exposure.” T&T is currently listed as experiencing “sporadic” transmission. This, according to the WHO, means the country experienced “one or more cases, imported or locally detected.” Cases reported in T&T have been from persons who imported the virus or those who have had contact with these persons.
However, experts have indicated that increased testing would be essential to verify this is still the case.
Citizens need to
Increased testing can’t occur if citizens don’t resent themselves to be tested. The Chief Medical Officer previously stated the Ministry has noted a decreased number of people presenting themselves for testing. Clinical psychologist on the UWI COVID-19 task force, Dr Katija Khan explained that persons may be abstaining from presenting themselves due to a fear of being quarantined and hospitalised. She urged members of the public to not view this as a punishment but as a selfless act to protect themselves and their loved ones.