Faine Richards

faine.richards@guardian.co.tt

Pub­lic health of­fi­cials should ex­pand COVID-19 test­ing to tar­get asymp­to­matic pa­tients to gath­er ad­e­quate da­ta to de­ter­mine if the coun­try has any com­mu­ni­ty spread of the coro­n­avirus, two mem­bers of a re­gion­al COVID-19 task force have said.

Pro­fes­sor Ter­rence Seemu­n­gal, a spe­cial­ist in res­pi­ra­to­ry ill­ness, and Dr Christo­pher Oura, who stud­ies the trans­mis­sion of virus­es, said the Min­istry of Health should “re­lax” its ad­her­ence to the World Health Or­gan­i­sa­tion (WHO) guide­lines for test­ing since the cur­rent da­ta is too nar­row to make de­fin­i­tive con­clu­sions.

“My feel­ing is that un­less we test more, we won’t be able to know when we have spread in the com­mu­ni­ty un­til it be­comes bad,” Seemu­n­gaL told Guardian Me­dia in a joint in­ter­view with the ex­perts yes­ter­day.

Af­ter T&T be­came en­snared in the glob­al reach of the coro­n­avirus just over a month ago, some peo­ple be­gan ex­press­ing con­cern that the true num­ber of in­fec­tions was not known be­cause test­ing has been too con­ser­v­a­tive. The Op­po­si­tion has seized on the sus­pi­cion in re­cent days, call­ing for more test­ing and ac­cus­ing the gov­ern­ment of “mis­lead­ing” the pub­lic.

Chief Med­ical Of­fi­cer (CMO) Dr Roshan Paras­ram has in­sist­ed there is no ev­i­dence of com­mu­ni­ty spread, which oc­curs when peo­ple are not sure how or where they have be­come in­fect­ed.

But Oura point­ed out that T&T still knows lit­tle about one cat­e­go­ry of trans­mis­sion: peo­ple who are in­fect­ed but nev­er show signs of COVID-19.

“We need to un­der­stand whether there is this un­der­ly­ing asymp­to­matic spread,” the UWI vi­rol­o­gist said.

“We hope we haven’t got it be­cause we don’t have many peo­ple dy­ing in hos­pi­tal, we haven’t got peo­ple at the mo­ment with lots of se­vere clin­i­cal signs that would be con­sis­tent with many oth­er coun­tries.

The CMO might well be cor­rect in what he says, I’m not say­ing he is wrong in any way. But I think at this stage we need to be sure that this is not the case.”

In the US, re­search cit­ed by the Cen­ter for Dis­ease Con­trol and Pre­ven­tion has shown the num­ber of asymp­to­matic car­ri­ers could be as high as 25 per cent. Paras­ram and Health Min­is­ter Ter­rence Deyals­ingh have re­peat­ed­ly said the coun­try is fol­low­ing the test­ing reg­i­men rec­om­mend­ed by the World Health Or­gan­i­sa­tion (WHO). Lab­o­ra­to­ry test­ing guide­lines is­sued on March 22 said the case de­f­i­n­i­tions for test­ing a sus­pect­ed case are: some­one with acute res­pi­ra­to­ry ill­ness who has trav­elled, who had con­tact with a con­firmed or prob­a­ble case and some­one who has no “al­ter­na­tive di­ag­no­sis” for the symp­toms.

“The health sys­tem in any coun­try is re­spon­si­ble re­al­ly to the coun­try, it’s not re­al­ly re­spon­si­ble to the WHO,” Seemu­n­gal said.

“WHO’s role is guid­ance. In a case like this they have adopt­ed a very con­ser­v­a­tive ap­proach and we have the health of a na­tion to con­sid­er. They will have the world pub­lic health sys­tem to look at it so they will have their rea­sons for that, but we have to look at our sit­u­a­tion here in Trinidad, what the cost would be if this dis­ease got out of con­trol giv­en that we have al­ready had a cost to so­ci­ety be­cause of the ‘lock­down,’ if I could use that term loose­ly. An eco­nom­ic cost.”

Oura added that da­ta from ex­pan­sive test­ing could shape pub­lic health guide­lines as the coun­try con­tem­plates a road map to re­open­ing the bor­ders and re­ac­ti­vat­ing the econ­o­my.

Some coun­tries have al­ready ex­pand­ed test­ing be­yond the WHO pre­scrip­tions. Ice­land, con­sid­ered one of the suc­cess sto­ries of the pan­dem­ic, has of­fered COVID-19 test­ing to any­one who wants it.

The wide net has pro­duced da­ta that show half of the in­fect­ed per­sons there nev­er had symp­toms. Ice­land has rough­ly one-quar­ter of T&T’s pop­u­la­tion, with just over 1,700 cas­es and nine deaths.

While the coun­try now has one of the high­est per capi­ta rates of con­firmed cas­es in the world, it has been able to man­age the pan­dem­ic be­cause it test­ed more peo­ple per capi­ta than any­where else.

Nei­ther Seemu­n­gal nor Oura ad­vo­cat­ed for T&T repli­cat­ing Ice­land’s ap­proach.

“The last thing we want is every­one with a snif­fle or haven’t got­ten any clin­i­cal signs want­i­ng to be test­ed,” Seemu­n­gal not­ed.

“It’s ex­pen­sive, and we’re al­so deal­ing with lots of peo­ple hav­ing to [con­duct] the test­ing, this par­tic­u­lar anti­gen test­ing is quite dif­fi­cult to do.”

Both med­ical ex­perts said it is dif­fi­cult to set a tar­get for the num­ber of tests that should be done since there is not enough da­ta on the rate of trans­mis­sion to make such a fore­cast. Seemu­n­gal sug­gest­ed us­ing a “loos­er” case de­f­i­n­i­tion that ex­pands the cri­te­ria on the symp­toms that would qual­i­fy some­one for test­ing.

“So they go to their doc­tor in the com­mu­ni­ty with, for ex­am­ple, symp­toms like loss of taste, loss of smell, or even di­ar­rhea be­cause some pa­tients, a small num­ber in stud­ies that have come out, do on­ly have gas­troin­testi­nal symp­toms and the doc­tor de­cides they need it but they can’t get a COVID-19 test for some­one like that.

“So what I’m say­ing is to re­lax it a bit. You will ex­pect that in the first few weeks un­til the med­ical pro­fes­sion gets a feel for the dis­ease be­cause we don’t have that feels right now, there may be a bit of over-test­ing, but once things set­tle down and they com­pare the re­sults they get back with the symp­toms of the pa­tient, they get a feel for when they need to do the test and then they fol­low that.”

He said where peo­ple can af­ford it, they could be asked to pay a por­tion of the cost for the test.