Conventional Wisdom and Anti COVID Strategy

TESTING! TESTING! NO TESTING!
Part V

One central claim on this review of official strategy is that not all ‘new active cases’ are being captured. I presume that that is one reason why numbers rise whenever social controls are relaxed. This is referenced in paragraph V of Part 111, and in the last paragraph of Part 1V. The facts of the matter should invite us to consider if the strategy is not akin to playing extreme Russian roulette with Covid-19 firing thus: Testing! Testing! No Testing!

There is a belief among some persons in Trinidad and Tobago that PCR testing in the absence of ripe cases of infected persons is useless. It may even be counter-productive by delaying the lifting of the curfew, the SOE and switching back on economic activity. We have one example in the person of Dr. Faud Khan, a medical doctor and a former member of parliament. He is reported as telling us the following:

…The more people go to get tested when they are showing mild to no symptoms, the more the infection rate will rise and the longer the country will have to remain in punishing restrictions such as  the SOE and curfew. Khan said Covid testing is a pyramid scheme as one person, who may be negative or positive gets tested, then all contacts linked to that person have to get tested. (Dr,) Khan said that the more you test the more the numbers go up. Khan implored that only people who have symptoms go to get tested  — [Faud Kahn]

Dr. Khan argues that more (PCR) testing exposes more cases and this in turn encourages government to more impose punishing social and civil restrictions. In Dr. Faud Khan’s logic the more we know about the true number of infected persons the worse it is for us. Unfortunately Dr. Faud Khan’s view is not sound enough to justify a public health strategy built on the least amount of ‘new active cases’ data. He thinks it is akin to building a pyramid. The real problem is that Dr, Khan’s strategy for PCR testing only when Covid symptoms are obvious avoids asymptomatic cases.  

However,  widespread the conventional wisdom is held, there is clear evidence that the practice of PCR testing in Trinidad and Tobago falls within Dr. Faud Khan’s logic. As of June 22, 2021 the total PCR tests administered in Trinidad and Tobago was 218, 568 with 91, 687 done in private institutions. Public health sector testing numbers totaled 126,881. To get some sense of the significance of the numbers bear in mind that June 2021 marks 18 months of the pandemic, and the population is about 1.4 mn persons. That means 15.612 percent of the population were tested in total, and 9.06 percent via public health laboratory facilities. Our scientists must tell us what factors justify those percentages as adequate testing to yield actionable information on the infection rate among the residents.  On that date 176,849 persons or 12.6 percent of the population had received 1 vaccination dose, while 39,142 persons or 02.7958 percent of the population had received 2 doses. Testing levels are small percentages of the population size. Vaccine doses lagged behind testing, but it is catching up. And new active cases collected after the first 4 weeks after lock down are shown below:

Factors that Work in Tandem to Waste the Best Laid Anti COVID Plans 
(Part V)

The foremost threat to a resurgence of the Covid 19 virus is an excessively restricted access to free testing for those who show no obvious indications associated with the virus.

The vast majority of John Public lack the means to pay $TT900 to $TT1,600 for PCR tests. In passing given a total private sector tests of 95,474 as of June 26, 2021 at an average fee of $1,450 per PCR test yields a total of $TT 138,437,300. Covid 19 PCR tests are a very lucrative business. It is hoped that there continues to be no evidence that public policy on PCR testing is in any way compromised by the attractiveness of these gains.

Public laboratory testing facilities, as distinct from facilities where test samples are taken may simply not be enough. In Trinidad and Tobago approved laboratory testing facilities identified by government are:

• Caribbean Public Health Agency (CAPHRA),
• UWI Molecular Laboratory, School of Veterinary Medicine in the Faculty of Medicine
• Medical Laboratory at Eric Williams Medical Complex
• Sangre Grande Hospital Laboratory
• Scarborough Hospital General Laboratory. 

In a population of 1.4m persons, public testing has never crossed a total 100,000 tests in the 17 months ending on May 03, 2021. Total private and public testing then was 181,698, of which 80,562 test results were performed in private laboratory institutions. In early June 2021, the number of PCR (Polymerase Chain Reaction), tests done was 206,150, divided between private tests at 88,787 and public at 117,363. The poverty of our performance here is adequately appreciated.  Given the absence of widespread free PCR testing with a policy that gives it a strategic role, it is likely that the total number of persons vaccinated includes persons who were never tested and who were asymptomatic.  Given the manner in which vaccine supplies have restricted the scope of our public health policy to accelerate vaccination, free PCR testing could have been an advanced early warning system. Free PCR tests have the following advantages:

• It lifts the burden of effective contact tracing since every person will want to know his/her infection status.
• It can strengthen the forecasting efficiency of official virus monitoring models by making increased data on new cases available.

Covid-19 vaccine related issues also can have a critical impact on the efficiency of official government strategy. The vaccine is no panacea and it has a limited effective life span. Big Pharms make one claim of substance: That is if you take the vaccine you will not die from Covid -19. 

• Antibodies in the vascular system of a person declines over a period of six months which means a person can be infected numerous times.
• New variants of the Covid-19 vaccine may develop resistance thus rendering older vaccine doses obsolete. The new Delta strain can infect vaccinated persons.
• Fully vaccinated persons can be infected. If we are to believe the government’s official line residents of Trinidad and Tobago should rely on the government’s  claim that the best vaccine is the one in front of you. An unvaccinated person is a threat to society because”… the virus loves you.” (PM Keith Rowley,  June 5, 2021, GOVTT Press Conference)

The US and the State of Massachusetts have a different experience, and therefore approach. According to Mary Markos writing on the Greater Boston area, as of June 17, 2021 there have been 3,791  persons testing positive who were fully vaccinated. These are referred to as”… breakthrough cases” out of 3.7 million vaccinated cases. The US Centers for Disease Control and Prevention reported a total of 10,262 breakthrough cases as of April 30, 2021. At that time 101 million persons were vaccinated. In Boston

“..health experts are urging vaccinated people to get tested for Coronavirus, even for the most mild symptoms, both to keep track of the virus and potential mutations as well as to check the spread,”

In diametrical opposition to Dr. Faud Khan’s scientific view and the GOVTT’s minimalist approach to testing, spokesperson from the Boston health authority recommends testing on the ground that: 

Testing to identify current infection is critical to controlling Covid 19. People with current infections can spread the virus to others and identification of cases and close contacts to others is a foundation of public health response — NBC Boston News

Boston is currently experiencing a rise of the resistant Delta Variant of the Covid 19 virus from India. 

The uncontestable conclusion is that unrestricted access to free public testing by unvaccinated or vaccinated persons without clear corona Virus symptoms  strengthens the public health system of any country by encouraging target beneficiaries to exercise the choice to know if they are positive or negative carries of the virus COVID-19.