Exploring lessons from COVID-19 — Part 2


Exploring lessons from COVID-19 — Part 2

Canute Thompson

Thursday, April 23, 2020

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In Part 1 of my reflections on the COVID-19 crisis, published on March 24, 2020, I examined the psycho-spiritual issues and argued that the crisis presents an opportunity for us to look at the things we value as well as reaffirm the indispensability of neighbourliness as a critical platform on which our lives depend. In today's reflections I will examine some issues related to the management of the pandemic.

Let me once again affirm that COVID-19 represents a crisis never seen in our generation. And, given its novel nature, protocols are continuously being updated and decisions on what matters lie within the province of medical experts and those which are subject to governmental authorities remain the subject of debate.

The Jamaican government is to be credited for getting some things right, but is also deserving of criticism for getting some things wrong. Both areas represent opportunities for lessons in planning and management. Among the things the Government got right are the:

(a) early closure of schools;

(b) issuing of advisories to practise social distancing;

(c) orders banning large social gatherings;

(d) recommendations and later requirements on working from home; and

(e) measures to mitigate the economic impact, especially the provisions for financial support for the most vulnerable.

While these measures are largely commendable and could not be taken until there was evidence of the presence of the virus, attention must be given to what steps should have been taken in anticipation of the arrival and the virus.

But there are two flies in the ointment, one having to do with measuring efficacy and the other constitutionality. On the question of efficacy, the contention is that having taken steps to mitigate rapid spread, the only way of knowing if those steps have had the intended impact is to test for the virus.

The constitutional question was raised by constitutional expert Dr Lloyd Barnett, who argued that some of the measures, specifically those which interfere with freedom of association and movement breach the Charter of Rights, and as such those measures cant only meet the constitutional threshold if a state of emergency were declared. I am prepared to bet, however, that by the time this article gets published we would be under some form of nationwide lockdown, or state of emergency. I am okay with being wrong.

The Miami Herald and the World Health Organization (WHO) have given the Government high marks for its management of the COVID-19 crisis. While the natural response of the country, generally, but particularly the political Administration and its supporters will be to celebrate, a cold, fact-based analysis of the performance of the Government is vital, lest we fail to learn the lessons from what has not been handled well.

There are at least four major areas in which the Government's performance is weak or very weak, and even bordering on frighteningly worrying. These are:

(1) The decision not to have closed call centres earlier: The Government decided not to implement a complete lockdown of call centres, one of the most densely populated work settings. At the time of writing, nearly 70 reported cases were found to be connected to that arena. By the time this piece gets published they may be on temporary lockdown, but the horses would have already left the stable.

(2) Inadequate personal protective equipment (PPEs): In his statement at the press conference at which the Government announced the confirmation of the first case, Health and Wellness Minister Christopher Tufton stated, inter alia: “On the readiness of the island's health system, the ministry has assessed the readiness of our health facilities to meet the anticipated increase in demand on services [and] continues to address existing gaps, including with respect of additional supplies and equipment; though, at the present time, we have enough personal protective equipment in the island for our health facilities. We also have adequate stores of respiratory medicine for the next three months.”

While COVID-19 is novel, the coronavirus itself is not, and the standard infection control and prevention procedures apply to COVID-19. In 2015, the Centers for Disease Control and Prevention issued guidelines for the management of the Middle East Respiratory Syndrome Coronavirus (MERS-CoV). Those guidelines, which would be known to the experts in the Ministry of Health and Wellness, and which have been reiterated since the advent of COVID-19, define health care workers as “…persons, paid and unpaid, working in health care settings whose activities potentially place them at risk for exposures to a patient… Examples of such activities include those that require direct contact with patients and exposure to the patient-care environment, including: being in the patient, triage, or examination room, or other potentially contaminated areas; and handling blood, body fluids (except sweat), secretions, excretions, or soiled medical supplies, equipment or environmental surfaces”. In short, almost every employee at a hospital or other health facility falls into that definition. The PPEs those workers would need include gloves, gowns, respiratory protection including respirator N95 masks, eye protection, heavy duty gloves, shoe covers, etc. Less than two weeks after the minister's March 10 statement that there were enough PPEs at health facilities to serve for three months, there were reports of a shortage. A few weeks later we were begging money to buy PPEs.

So, one must ask if the Minister knew what he is talking about.

(3) Inadequate testing and testing kits: This area is a complex one. While, the WHO recommends that countries should “test, test, test”, there are varying practices, with some leaning on testing only those people who show severe symptoms, and others once the person meets some preset standards for testing such as travel to an area with the virus. The epidemiological evidence shows, however, contrary to our Chief Medical Officer Jacquiline Bisasor-McKenzie's early assertions, that a person who is asymptomatic can have the virus. Thus, deciding to test only persons who are symptomatic risks spreading the infection by carriers not showing symptoms.

But the experience of the USA is paramount in assessing the importance of testing as a means of measuring the extent of the problem. On March 1 there were 76 cases of the virus in the USA, which was five times the 15 cases only two weeks before on February 15. But between March 1 and March 27, about four weeks, the number of cases skyrocketed to an unbelievable 101,657 cases. The explanation for this is found in the fact that testing was ramped up.

The Government has undoubtedly been slow, perhaps timid, in testing. As at March 27, reports suggest that a mere 250 people had been tested, up from less than 100 a few days prior. The authorities report that 3,000 test kits are available, but orders of five times that amount have been made. The question is, why was there not adequate preparation by early orders of more kits. Having far fewer kits than would be necessary is not a condition imposed on us against our will, it is the result of choices we made. This must go down as a poor management by the Government.

(4) Inadequate infrastructure: One critical area of readiness of health facilities would be isolation wards or designated areas for the treatment of patients. I invite the minister to state the health facilities, apart from the University Hospital of the West Indies, where there exist coronavirus isolation areas. My checks show that no other exists which meets the standards for the management of the coronavirus. It is not unreasonable to expect that, as part of the preparation, the Government would have moved with urgency to upgrade facilities and designate a certain number of beds per hospital to serve as COVID-19 patient beds.

So, while the Government's performance in some areas is commendable, particularly in terms of actions to contain spread, by not testing in large numbers it is impossible to objectively assess the efficacy of those measures. In addition, the concern about the constitutionality of some of the measures, outside of declaring a state of emergency, cannot be treated lightly. It is either we are a country of laws or we are not. Time will tell if we dodged the bullet. With 143 confirmed cases and five deaths (@ 14/4/20), there is cause for concern. The odds are that there will be sharp increases. Responsibility for the increase cannot be blamed on unruly citizens or uncooperative BPOs. The Government will have a shoulder a part of the responsibility. That what leaders do.

Canute Thompson is chair of the People's National Party's Policy Commission, as well as head of the Caribbean Centre for Educational Planning and senior lecturer in the School of Education, and co-founder and chief consultant for the Caribbean Leadership Re-Imagination Initiative, at The University of the West Indies, Mona. He is also author of five books and several articles on leadership. Send comments to the Observer or canutethompson1@gmail.com.

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