What next?

After social distancing measures have been ignored by some sectors of the population, the government has introduced a one-month lockdown for the entire country. It had been under pressure from various quarters to adopt this strategy both for the reason already cited, as well as on account of the well-known shortcomings in our healthcare system, which make it difficult for it to cope in the present situation, let alone if the number of COVID-19 cases reaches 20,000, as has now been projected.

If conditions were not already bad enough for Guyanese workers, particularly the selfemployed who account for a significant proportion of the workforce and who do not have the cushion of NIS, they will be worse now. Yet the government does not appear to have applied its mind to what kind of provisions could be put in place for the extreme hardship these measures will cause.

In addition to the 6pm to 6am curfew, there are restrictions on social activities and all services will remain closed except for essential ones. The public service as well as statutory bodies and state-owned enterprises will continue to operate, although employees will have to work remotely from home unless otherwise directed. Certainly one would have thought that special arrangements would have to be put in place for pensioners collecting their pensions, as these comprise the most vulnerable section of the population, as well as anyone else entitled to NIS benefits.

In terms of those organisations listed under essential services, it is to be noted that the private media have been omitted. One presumes this is an oversight rather than a devious way of introducing censorship. The Guyana Chronicle, which is a state entity, is able to continue to print. It might be noted that both Barbados and Trinidad included the private media in their categories of essential services.

The real problem with lockdowns is not that there aren’t justifications for introducing them, it is how do you get out of them. When the lockdown is lifted after a month – or possibly even longer if the government deems that necessary – the question to be asked is whether the virus will return. The answer unfortunately is that it will.

The story of Britain is a cautionary tale. It would seem that the government there initially took a herd immunity approach – the same one which Sweden, almost alone among European countries is still adopting. The theory is that herd immunity would come into effect once 60% of the population had been infected. This tactic was abandoned, however, after computer modelling by Imperial College suggested that before this point was reached anything between 200,000 and half a million people would have died.

Considering that this was a socially unacceptable figure, the government quickly changed direction, introducing progressively more stringent measures to contain the virus, and then flatten

the curve, as it is called, so that the National Health Service would not be overwhelmed by COVID-19 cases in a sudden peak. It has come under a slew of criticism, however, over its failure to test large numbers of the population for the virus, in particular the front-line members of the NHS itself, only 2,000 of whom had been tested up to the end of last week. In addition, the special kits which would test who had had the virus and consequently might have immunity to it, have not made their appearance as yet, although they had been promised very soon.

In response to the criticism, Health Secretary Matt Hancock has pledged to test 100,000 people a day by the end of the month. Experts have said, however, that this target is unlikely to be met, because among other things, the UK has to import the reagent required, and there is an international queue for that.

This aside, according to Anthony Costello, a professor of global health at University College London writing in the Guardian, testing on its own is not enough. It would also need a programme of community surveillance and contact tracing, otherwise you could be faced with a series of flare-ups followed by national lockdowns, “a pattern that could go on for years – until we have a vaccine.” Community surveillance, he wrote, would ensure that people who had the virus and those they had come into contact with could be quickly identified and isolated to prevent it from spreading.

Prof Costello quoted an anonymous epidemic expert, who said, “Finding these viruses is like guerrilla warfare. If you don’t know where the virus is hiding you cannot control it. We must use a bundle of measures to chase it. We must organise teams of friendly community workers to find people with symptoms, test for the virus, isolate and treat them, and trace their contacts. Workers must check on them in their homes every one or two days.”

The global health professor contrasted the UK’s wrong direction with that of China, which after a faulty start was able to arrest transmission after two months, beginning towards the end of January. As everyone has observed, as an authoritarian state China was better able than a democracy to enforce a total lockdown, as well as to mobilise thousands of community workers at the same time. Prof Costello described how almost 40,000 health workers were flown in to Wuhan and Hubei from across China to help with community surveillance. “The government developed apps to monitor peoples’ symptoms and their compliance with quarantine, and set up 24-hour TV channels in every province to update people on data, progress and prevention,” he wrote.

In other words, if you can’t test, which is the ideal, symptom-based reporting will do. And this is an important lesson for Guyana, which is unlikely to

secure all the testing equipment it will need. The Ministry of Public Health is to launch a self-test App today and this could be helpful. What it would also need is any number of teams of community workers, including volunteers, to undertake community surveillance and visit everyone reporting suspect symptoms at home every one to two days. These should be organised on a local or regional level, because if centralised, nothing will happen.

One supposes that the current central hotline arrangement is intended to function as part of an incipient community surveillance programme, but if so, it is not really fulfilling its purpose. China and South Korea had electronic means of monitoring people, but in Guyana’s case, the check-ups will have to be physical.

As such, community workers should all be provided with personal protective equipment, which even, it is said, many of those operating in the health sector currently do not have. One cannot help but feel, however, that while Guyana could not possibly manufacture test kits, the production of hooded gowns and masks made to specifications cannot be beyond us if the right material is supplied. This is an area where the private sector perhaps could be approached for help.

Furthermore, the public would need to have a much clearer idea than it has currently exactly what the symptoms of the coronavirus are. The government should do what the NHS in Britain does and snow the media, both private and public, with simple diagrams of what are the likely symptoms and what are not. These should also be posted on websites and on the appropriate social media sites. Of course, all of this would assume that the COVID-19 hotline was functioning, which, as mentioned above, according to reports it is not. There have been complaints that sometimes the calls are not answered, and on other occasions, if they are, they are not followed up on. One suspects that there are simply not enough personnel to undertake the follow-ups. Again, it can only be suggested that there should be regional hotlines, that these should be monitored on a 24-hour basis, and that response teams should also be recruited on a local basis.

One can only feel that a more comprehensive and effective community surveillance programme than currently obtains should not be under the control of a government official. Forget the politics. What we would need is a good administrator, not a politician and not a health official, and someone with that kind of track record is likely to come from the private sector. Unfortunately the needs in the chaotic and illprovided health sector would have to be addressed by the government.