Dear Editor,
According to information accessed from the Ministry of Health website on Sept. 26, 2020, 73 individuals have now died of COVID-19. There are also 2,079 cases of COVID-19 of which 1,224 (approx. 59%) in Region 4 alone, even though that region accounts for less than 45% of the country’s population.
Except for the “COVID-19 dashboard” with crude summary numbers, there is a substantial lack of critical data regarding the epidemiology of COVID-19 in Guyana. The political authorities and their directorates should provide the following key set of data/information that are necessary to understand the status of COVID-19 to justify public health policy decisions in the country:
1) When did testing start in Guyana and where? This will help in understanding disease trends.
2) What is the infection rate, hospitalization rate, fatality rate, and the distributions by age categories, gender, race/ethnicity, political administrative regions, and by rural/urban populations?
3) How is positivity rate calculated? Some people get tested multiple times and therefore, the number of people who have been tested will produce a different rate than the number of total tests done.
4) What are the reproducibility rates of the tests? They will also have to shed light on the different test kits and the labs where the tests are done. There are also “technical variability” issues from the technician performing the tests, akin to “blinded” Patho-logists who are given a standard tumor stain with established diagnosis to read, but have significant error rates in their abilities to make the correct diagnosis. The coefficient of variation is needed.
5) What are the criteria for testing and who pays for the tests?
6) What surveillance and data analytical systems do they have in place to assess trends of the disease in the population? What segments of the population have the highest rates of the disease?
Just from the “COVID-19 dashboard” itself, there seems to be bias regarding Region 4 where most of the political elites and their families reside because approximately 59% of the cases come from that geographic area alone. Most likely, the 59% is due to the disproportionately higher number of tests done in Region 4. I will not be surprised if Georgetown alone accounts for 95% of the cases in Region 4 because that is where the bulk of the spending and testing are done. With more testing, more cases will be discovered. A portion may also be false positives. Depending on the sheer volume of testing in a specific geographic area, it could lead to false interpretations and conclusions about the disease in the whole country. To avoid the limitations of crude numbers, the infection rates, hospitalization rates, and fatality rates are required to get an understanding of the magnitude of the disease by age categories, gender, race/ethnicity, political administrative regions, and by rural/urban populations. Only with a data-driven scientifically rigorous approach, can effective strategies be implemented.
In Guyana, for people who are tested “true” positive what is the standard of care treatment protocols in place for practitioners? What medicines are approved for treatment? How is the government preventing the wrong use of medicines against COVID-19 that can do more harm than good?
Since there is so much controversy about policies related to school children, the authorities should provide the infection rates, hospitalization rates, and fatality rates by age categories applicable to school children by gender, race/ethnicity, and geographic location. Then the people can decide whether the policies are driven by science or something else.
In Guyana, data is in a “black box” and seems to be guarded national secrets. For transparency and scientific purposes, a “Guyana National Dataset” (GND) linking multiple datasets in standardized formats for independent analysis should be an immediate priority. The GND will provide a great opportunity to deal with future public health outbreaks, social, economic, race/ethnic disparities, and training platform.
Yours faithfully,
Somdat Mahabir
