It will take more than mass testing to flatten the curve in Guyana

Aug 27, 2020 Letters

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Dear Editor,

Permit me to express my concerns pertaining to the COVID-19 response in Guyana. It will be remiss of me to not lend my voice and offer potential solutions at this critical time in our history. The pandemic has disrupted the lives of people across the globe. Some felt its effects more severe than others. In the Guyanese context, we were unfortunate to be struck with both a health crisis and an election crisis at the same time. I am thankful that the latter has since resolved which means that the new administration has the full capacity to address the former more frontally.
From March 5th, 2020 I have watched in dismay at the response of both the government and the citizens to COVID-19 in Guyana. While many Guyanese still are apathetic to the guidelines the cases continue to rise. Based on the information available on the Ministry of Public Health’s dashboard at the time of penning this letter the total positive tests of COVID-19 in Guyana were at 1060. Likewise, the total tests conducted were 7373 of which 14.4 percent were positive. Also, of those being tested positive 2.9 percent (31) have died. To date, Guyana is yet to test more than 1 percent of its estimated population of 748,000.
Considering these glaring revelations, it means that we should expect our cases to rise well into the tens of thousands and thousands of Guyanese losing their lives to COVID-19 if we continue along this trajectory. In this regard, I welcomed the plan by the new administration to increase both the capacity (human and technical resources) and testing of the public. I believe the data gathered from mass testing will help to propel the development of a more robust approach towards the management of the virus in Guyana.
However, while it is commendable, there are still significant deficiencies in the government’s approach to curbing the spread of COVID-19. For example, the Gazetted Health Emergency order on the 14th of August 2020 fails to address the deficiencies in the previous administration’s response. Sadly, if said deficiencies are not addressed at the soonest, we can expect the infection and death rates to climb exponentially in the months to come.
As a medical practitioner I believe that any response to a health crisis should focus on not only curative methods but preventative methods. Further, Steps must be taken to address the psychosocial and socio-economic impact of this virus on the Guyanese people. It is against this backdrop that I believe that the following steps can be taken to significantly improve Guyana’s response to COVID-19 and ultimately flatten the curve:
1. Build capacity for mental health services – Capacity around counselling, therapy, and facilities for mental health assessments should be built and strengthened. Additionally, training of staff, potentially beginning with persons already familiar with mental health services (doctors, nurses, etc). Over the next years we can anticipate a further deterioration in the mental health in Guyanese due to the socio-economic and psychosocial impact of the pandemic. Without the adequate avenues to address this will create another health crisis – a mental health crisis.
2. Community directed approach to prevention of Spread- The creation of community watch groups coupled with targeted information about COVID-19 and Public Service Announcements that cater to the specific communities are needed urgently. Additionally, the Neighbourhood Democratic Councils can develop their own management protocols in keeping with standards adopted from a national and or International guidelines. Such protocols should include steps to monitor and mitigate the movement into, out of and throughout the communities. This can be monitored with oversight from Regional Democratic Councils and Government.
3. Complete lock down of hotspots – It is imperative to restrict the movement of people in hotspot areas. This with effective contact tracing can alleviate the spread of the virus in these areas. This cannot be achieved without enforcement of such restrictive protocols. To offset the economic impact this will have on these communities it will require support from central government to finance such.
4. Increase testing and Capacity – Of course testing in hotspot areas with data gathering to identify the degree of community spread is imperative to managing COVID-19 as well as general testing. The data gathered can then be used to establish protocols to make point 3 effective as well as to gauge the effectiveness of the overall response.
5. Institutional Isolation – I do not believe home isolation is ideal in the Guyanese context as Guyanese do not grasp the concept of self-isolation. It is evident with the number of persons still flouting the stay at home orders. This could be due to poor education on COVID-19 or just ignorance of consequences. Therefore, institutional isolation for at least for 14 days in the first instance, in more humane facilities would be ideal and more practical. Maybe the use of hotels, the new hospital, and government-approved facilities that meet the criteria can be used.
6. Border Protection -The protection and patrol of the borders with Brazil, Venezuela and Suriname should be a priority. Most of the cases in the hinterland region are as result of these borders being poorly patrolled and protected. Therefore, by limiting the use of these borders and more robust patrol we can significantly reduce our imported cases.
7. A role for the creative industry – To offset the psychosocial impact and to educate the general public the government should seek to further engage the creative industry. I do note the program by the Ministry of Public Health Quintin Quarantine Quartet. Getting the creative industry involved in creating PSAs and other programs that will educate as well as bring much needed entertainment relief for Guyanese will be helpful. Such programs should be reproducible in creole, and the various indigenous dialects to deepen the impact and reach a wider audience. Recreational activities whether virtual or in physical spaces (with strict physical distancing) is needed. The monthly Spice and Clove show is a good example.
8. The health response – At the forefront of managing this pandemic is the healthcare sector. It is abhorrent that Healthcare workers are working and putting their lives at risk daily without any risk allowances. Healthcare workers do not have access to adequate PPE and put themselves at risk and family at risk as a result. Further, the healthcare facilities need a more robust protocol on treatment of patients in general and for COVID-19 patients. All patients admitted to hospitals across the country should be swabbed. Additionally, the use of virtual consultations should be explored to limit the need for patients to attend physical clinics. I have noticed that GPHC were using the plasma from recovered patients to treat positive patients. Maybe more research into developing this and to assessing the impact it has and productivity of such a treatment plan. Also, Guyana should look to other regions with successes and see which can be adapted in the Guyanese context.
While I am cognisant that I am not privy to steps being taken to address the pandemic, I believe the suggestions above can help to shape such protocols and guidelines. I still implore all Guyanese to practice social and physical distancing. Practice proper hand hygiene and wear a mask in public correctly. As much as it is the responsibility of the Government to keep its citizens safe. The social contract dictates that the citizens act responsibly to ensure their own safety, survival and prosperity.
In the end it will take ‘one one dutty to build this dam’. As a result, it will require all Guyanese to flatten the curve.

Yours truly,
Dr. Terrence Isaacs, MBBS

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