Alfred Dawes | Time to reopen the economy

In my last piece, I questioned the utility of lockdowns as a means of combating COVID-19. Indeed, the World Health Organization (WHO) has revisited this strategy and recommended against it as a primary means of fighting the pandemic. Yet there has been no paradigm shift in using the number of cases rather than the number of sick and dying as markers for initiating more stringent measures.

As cases in Europe rise, we are reminded of how bad the first wave of the pandemic was and the need to avoid a recurrence. Meanwhile, in other countries, a cookie-cutter approach is being recommended even when they never experienced a deadly first wave and the rising case numbers are primarily asymptomatic or mildly sick patients.

It is time we reject this disastrous approach and move towards jump-starting our economy.

In the early stages of the pandemic, COVID-19 was deadly. We saw the overrun health systems and numerous deaths in New York, Manaus, Ecuador and Italy. But now, significantly, more people are infected worldwide than in those early days, yet the death rate is nowhere close to rates then.

There are various hypotheses as to why this is so. For one, we did not know how to treat COVID-19. Everyone with breathing complications was put on a ventilator and those who were not fit for ICU were left to destiny. Hospitals were flooded by panicked patients with mild symptoms, overwhelming resources and staff. Now that we have better treatment options and know that ventilators are not necessarily the best option for a large number of patients, we can triage better and those patients who were turned away from ICUs because of comorbidities and age – ironically, the ones more likely to die in the first place – can now receive the supportive treatment that can save their lives. We no longer routinely admit patients with mild to moderate symptoms, freeing up valuable hospital beds. Resources are better focused on the now clearly identified vulnerable.

VIRUS MUTATED

There could also be the possibility that the virus has mutated to become less deadly. This natural selection is possible because a deadly virus immobilises or kills its host before they can get far enough to infect many others, whereas a virus that produces mild symptoms will have a host healthy enough to travel far and wide to infect others and be the main source of an epidemic.

Whatever the reason, we are seeing a disease that is far less lethal than it was in March. This is not surprising when we look at the mortality rates of Ebola and SARS viruses initially and later, when they became far less lethal.

As we head into winter, flu deaths traditionally go up. Forty thousand Europeans die of the flu each year because they spend more time indoors and their mucous membranes become easier targets for the virus. With less influenza viruses circulating, yet the same ripe conditions for spread of a similar droplet-borne respiratory virus, it is natural to expect COVID-19 cases to rise in the winter.

Fortunately, we in the Caribbean do not have such climate-determined super spikes. We cannot let the misfortune of the North determine how we treat with COVID-19 during the winter months.

COVID-19 does not spread as efficiently in well-ventilated open spaces, in sunlight, with masks, social distancing, proper hygiene, and the avoidance of large crowds. We should therefore be able to resume classes, limited entertainment activities and sporting events and still avoid catastrophe by adhering to these principles. Turn off the A/Cs and open the windows and doors. Have classes under a tree, church under a tent. And to complement these strategies, widespread, repeated testing.

PCR NOT THE ANSWER

The way forward in this COVID world can only be through testing widely and retesting often. We have essentially reopened all sectors of the economy except education and entertainment. Outside of the economic impact of closing the entertainment sector, lack of an outlet will have serious psychological impacts on adults and especially children for years to come.

We are already seeing the widening of the gulf between the children of the haves and the have-nots. Schools must resume face-to-face classes if we are to have any hope of improving our education system.

Restoring normality while testing will allow us to identify and isolate infected persons, thus decreasing the number of persons out there spreading the virus, the identical goal of lockdowns. To achieve this, we must be able to test widely and test both symptomatic and asymptomatic persons.

Since 80 per cent of COVID-19 patients carry no symptoms, we are immediately reducing our identification rate to less than 20 per cent of infected persons if we choose to only test those with symptoms. That 80 per cent of undetected spreaders will be the cause of uncontrollable, untraceable spread.

Unfortunately, we have been programmed to think that the greater the sensitivity of a test, the better it is. And that is why we have fallen into the PCR trap. The PCR was never designed to be a diagnostic test. It is simply too sensitive, expensive and cumbersome to execute. One can test positive even if they are not infectious and are shedding dead virus particles for weeks. This can result in persons being quarantined long after they are no longer in danger or can spread the virus.

The PCR test is too expensive, $18,500-$30,000 privately, to be of use for repeated testing of clusters of exposed, and the Ministry of Health and Wellness, like every developing nation’s health service, has grappled with resources for PCR testing. The PCR has also failed to return results in a reasonable time in order to alert positive patients of the need to isolate and enable efficient contact tracing.

Even with the high sensitivity of PCR tests, because of the limited availability, the Centers for Disease Control and Prevention estimates are that only 10 per cent of those who have the virus are identified by PCR tests in the USA. So the test with 99 per cent in the lab is delivering only 10 per cent in the field.

If we had antigen tests at costs below $3,000 and widely available, it becomes practical to test widely and repeatedly in order to identify and isolate infectious persons from workplaces, schools, nursing homes and even in families with vulnerable loved ones. Antigen testing can also enable a person whose result turns negative after a few days to return to work earlier instead of the standard 14-day isolation that damages productivity and income.

Businesses that have COVID-19 cases can now test and retest staff members who were exposed and keep them on the job if negative, rather than shutting down entire departments and offices repeatedly over the next year or two.

OPPORTUNITY WITHIN THE CRISIS

Creating testing bubbles around the most vulnerable will allow the population to achieve herd immunity and infection levels to fall without the doomsday scenario predicted by the experts.

Vaccines cannot be the answer, as flu vaccination reduces the risk of flu illness by between 40 per cent and 60 per cent among the overall population, and we still do not know if immunity from a COVID-19 vaccine will last.

This pandemic provides Jamaica with an opportunity within the crisis to catch up with our wealthier neighbours if we navigate it the right way. We need to think outside the box and reject the dogma and conspiracy theories that have been failing us so far.

Let us push forward as a nation with what we know is successful here.

Let us get back to school, let us get back to work and let’s get back to play.

n Dr Alfred Dawes is a general, laparoscopic and weight loss surgeon, and medical director of Windsor Wellness Centre & Carivia Medical Ltd.; Fellow of the American College of Surgeons; former senior medical officer of the Savanna-la-Mar Public General Hospital; former president of the Jamaica Medical Doctors Association. @dr_aldawes. Email feedback to columns@gleanerjm.com and adawes@ilapmedical.com