Dear Editor,
As I begin to write, I am reminded of a Martin Carter piece in 1958, when he opined that ‘just as the man on the peak of a mountain sees a different world from the man in the valley, just so should we, from our particular context of being, see something more and something different from anybody else.’ I should mention that I do not reside in Guyana at the moment and the observations and concerns I am sharing with you and your readers originate from a perspective influenced by my involvement with, and experience in advising on health issues in Guyana and many other countries in this hemisphere.
We now have at least 25 days to await the result of the national elections held on March 2, 2020, and I suggest that we use this interim period, while the counters ponder the corrections to their initial counting errors, to reflect on an issue that may have potentially grave consequences for the land of our birth.
The first reported case of COVID-19, in the USA was filed on January 21 in Washington State. This was followed by the first reported case in New York on March 1. The estimated incubation period, which is the time from exposure to the virus to presentation of symptoms, is between 2 to 14 days.
The first reported COVID 19 case and death in Guyana was on March 11, last. It was the unfortunate case of a lady who had travelled to Guyana from New York a few days earlier. Reports suggest that she had not travelled out of the city which means she had to have encountered an infected individual towards the end of February in New York. We can conclude, therefore, that the first person who got ill in New York was exposed to the virus as early as February 15, 2020, which was just a few days before our fellow Guyanese was infected. That illustrates how easily the virus is transmitted from one person to another, given the over 327,000 cases now reported in New York.
On March 25, the Deputy Chief Medical Officer in Guyana announc-ed that people exhibiting symptoms of COVID-19 infection, who travelled abroad, would be tested. Those symptoms include a cough, shortness of breath or difficulty breathing, fever, headache, muscle pain etc.
On March 31, the Mayor of Georgetown stated that he would not be implementing lockdowns or curfews in contrast with neighbouring towns. A few days later, on April 2, a national curfew was announced by the President, with the closure of bars, restaurants, places of entertainment etc. between 6pm and 6am daily.
By April 8, there were 29 cases diagnosed positive in Guyana, including a report that Mr. John Lewis had been diagnosed post-mortem with the disease. His wife had died 12 days earlier, which in all probability was also a result of the virus.
The number of tests done increas-ed to 464 on April 27, and almost doubled to 714 with 93 cases on May 6, a 13% positivity. We also need to look closer at the 10 deaths among the 93 positive cases, which in epidemiology is known as the lethality rate, and is 10%. These rates in Guyana are very troubling as they are much higher than that of the USA where the lethality rate is approximately 6% and for that matter, our 10% rate is the highest in the Caribbean and many other countries in the world.
Deaths from COVID-19 lag infections, the estimate is that there are approximately 5 to 10 people with undetected infections for every confirmed case. In other words, the estimate is that there are many more infected people, who despite the curfew, are circulating and transmitting the disease.
So now we come to the case, reported recently in the news, of a 63-year-old male patient at the Palms Geriatric Home on Brickdam, who died at the Georgetown Public Hospital on May 1. Assuming that he may have been infected two or three weeks before being admitted to the Georgetown Hospital, he had to have been infected while at the Palms sometime in mid-April, after the national curfew was put in place on April 2, and I assume, a restriction of visitors was imposed at the Home.
This now begs the question, how was he infected at the Palms? He had to be infected by either a doctor, nurse, maid, porter or someone with whom he was in contact at the Palms who may or may not have been asymptomatic. I doubt it would have been another patient, but on the other hand, if he was not isolated whilst he was in the Palms and at the George-town Hospital, he could have infected other patients, doctors, nurses, maids, porters etc. who are now incubating the disease and will soon become symptomatic.
Crises like these are national emergencies, and necessitate discussions among clinicians, laboratory staff and epidemiologists who can make evidence-based decisions on where and whom to test. From the numbers reported, there are not enough tests being done among asymptomatic persons of the at-risk population (here we can think of maids, porters, doctors, nurses and contacts of patients).
We need to congratulate all health workers who provide attention during this period and those working in the Intensive Care Units, while bearing in mind the additional focus on other prevalent diseases, especially among those working in the interior of the country.
But they need personal protective equipment to both protect themselves and provide the care everyone deserves. There is an urgent need for the private sector to step in and provide materials and equipment such as masks and other supplies before we are again distracted in another twenty five days with what could be the final count of the national elections held over two months ago.
Given the domination of COVID-19 in the news with the severity of the spread of the disease in other parts of the world, one must raise the question of the kind of preparation put in place and, particularly, what contact tracing was and is being carried out after the first case was detected in Guyana. If so, one must question the efficiency and effectiveness of the effort, given the continuation of the spread of the disease.
Indeed, it would be useful if we could see the plans and guidelines for testing, and quarantine of all persons positive in the environs of the outbreaks of cases, as well as for isolation and testing of contacts.
We have seen efforts to make everyone aware, limiting the number of people associating, use of masks and maintaining distance among strangers, but still observe on a daily basis, the pleas of the Chief Medical Officer for attention to the messages.
We need the community to be aware of and ensure the curfew and restrictions are adhered to, if need be, with the assistance of the police. People are away from work and school to maintain distance from each other, and not because someone, somewhere decided they deserve a long holiday.
We must have a combined clinical and epidemiological approach, taking into account people’s behaviour, to address the ongoing epidemic and prevent an even greater health tragedy occurring in Guyana.
In closing, can we be made aware of the number of tests available in the public and private health systems, and the estimated need for test kits and supplies to deal with Covid-19? What of mobilization of persons who have sewing machines to make face-masks, financing and support from the private sector, inter alia the cloth stores, rum, timber, shipping and oil companies, as well as the steps being taken by the Ministry of Finance to address the identified shortfalls, including food for those who now receive no pay?
Our time is limited, we only have three weeks before we are back to the discussion on vote counting.
I assume the dictates of March 25 have been superseded and we are no longer ‘Waiting for Aunty to Cough’ (Samuel Selvon, Trinidad, 1923-1994), before we do a test for Covid-19.
Yours faithfully,
Keith H. Carter
