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

Dear Editor,
Permit me to express my concerns pertaining to the COVID-19 response in Guyana. It will be remiss of me not to lend my voice and offer potential solutions at this critical time in our history.
The COVID-19 pandemic has disrupted the lives of people across the globe. Some felt its effects more severely than others. In the Guyanese context, we were unfortunate to be stricken with both a health crisis and an election crisis at the same time. I am thankful that the latter has since been 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 are still 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 was at 1060. Likewise, the total tests conducted was 7,373, of which 14.4 percent were positive. Also, of those 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 would lose their lives to COVID-19 if we continue along this trajectory. In this regard, I welcome the plan by the new administration to increase both the capacity (human and technical resources) and testing of the public for COVID-19. 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 Health Emergency order gazetted on August 14, 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 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 impacts of this virus on the Guyanese people. It is against this backdrop that I believe 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, train 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 of the Guyanese people due to the socio-economic and psychosocial impact of COVID-19. Without adequate avenues to address this, another health crisis will be created – a mental health crisis.
2. Employ a community- directed approach to prevention of the spread. The creation of community watch groups, coupled with targeted information about COVID-19 and Public Service Announcements that cater to the specific communities, is needed urgently.
Additionally, Neighbourhood Democratic Councils can develop their own management protocols in keeping with standards adopted from 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. Completely lockdown hotspot areas. 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 those 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 COVID-19 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 14 days in the first instance. In more humane societies, quarantining 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. Protect the border. Protecting and patrolling of the borders with Brazil, Venezuela and Suriname should be a priority. Most of the cases in the hinterland region are as a result of these borders being poorly patrolled and protected. Therefore, by limiting the use of these borders through instituting more robust patrols, we can significantly reduce our imported cases.
7. Let the creative industry play a role. To offset the psychosocial impact and to educate the general public, the government should seek to further engage the creative industries. I do note the programme by the Ministry of Public Health, Quintin Quarantine Quartet. Getting the creative industry involved in creating PSAs and other programmes that would educate as well as bring much needed entertainment relief for Guyanese would be helpful. Such programmes 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) are 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 and their families 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 in particular. 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 was using the plasma from recovered patients to treat positive patients. Maybe more research should go 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 what 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 practise social and physical distancing. Practise 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 the efforts of all Guyanese to flatten the curve.

Yours faithfully,
Dr Terrence Isaacs, MBBS