Buried and Blind

In mid-March, World Health Organisation (WHO) head Dr Tedros Adhanom Ghebreyesus told global governments, “Test, test, test!” Testing he said is the “backbone” of the global fight against the coronavirus. He declared it is impossible to “fight a fire blindfolded” and observed that hand washing and social distancing cannot, on their own, defeat the epidemic.

Testing is a major weapon in our slender armoury against the new, mysterious virus, dubbed COVID-19, US expert Dr Anthony Fauci argued in an interview last Sunday. He said identifying cases through testing “in real time” must be widespread before opening economies. The more tests that are conducted, the more people with the infection can be identified and isolated at home or elsewhere and cannot contribute to the spread of the deadly, debilitating virus. Testing alone is not enough. Testing has to be accompanied by tracing the contacts of people found to be contagious.

While the ability to conduct testing and tracing varies from country to country, depending on their resources, health care systems and societies, the will to test and trace often depends on politicians. After some hesitation over economic consequences, most countries closed schools, universities, sports facilities, places of worship, shops and factories and ordered non-essential employees to stay at home. This narrowed infection rates but did not do away with the need for testing and tracking infections as they emerged.

South Korea, with a population of 51.7 million, is the globe’s most dedicated tester and tracer. Seoul announced its first case on Jan.20 and attempted to curb the potential spread by tracking victims’ movements through use of credit cards and by viewing CCTV footage. However, infections ballooned a month later after a case was found to belong to a local church which held a mass funeral for an elder. At the time of writing, South Korea has conducted more than half a million tests, or 9,800 per one million people. It has had 10,500 confirmed cases, 13,700 suspected cases, 7,400 recovered patients and 214 deaths.

South Korea has contained the outbreak by strict testing and wide contact tracing. Close contacts of identified cases and patients with minimal symptoms are required to isolate for two weeks. Local teams call on them twice a day to make certain they stay put and are managing their symptoms. Moderately-affected Koreans are quarantined in government shelters where they are observed and treated. High risk patients with underlying illnesses are given priority for hospitalisation. Patients who recover are tested twice and, if negative, are released.

India, the world’s most populous democracy, is not following the “test, test, test” model. Cases have multiplied in India as a whole, with more than 6,700 confirmed and at least 200 fatalities. India has carried out 177,564 tests, but these amount to only 129 per million of its population of 1.38 billion.

The southern state of Kerala, the first state in India to report a case, has a population of 34 million. Its health care system, the best in India, prepared for pandemics and adopted aggressive testing, contact tracing and isolating of infected people. Screening took place at airports, particularly of passengers arriving from epicentres such as Iran and South Korea who were obliged to isolate at home. Migrant workers trapped in the state by the national lockdown have been lodged in shelters and millions of cooked meals are distributed to the needy. Kerala allocated $2.6 billion (Dhs9.6b) to battle the disease.

The number of new cases in the first week of April fell 30 per cent from the end of March. Kerala accounts for only two deaths in India; 34 per cent of positive patients have recovered. The curve in Kerala appears to have flattened while it is rising steeply elsewhere in India. The Washington Post quoted Shahid Jamal, a virologist and infectious disease expert, as saying that “Kerala’s approach was effective because it was ‘both strict and humane ... Aggressive testing, isolating, tracing and treating — those are ways of containing an outbreak.’”

Divided by Turkey’s occupation of the north, the Mediterranean island of Cyprus presents two separate but similar scenarios. The internationally-recognised Republic in the south, with a population of 899,000, and the Turkish occupied area of the north, with 300,000 residents, have both followed WHO instructions on testing, tracing and isolating.

Even before the virus arrived on the island there was screening at the Republic’s two airports. Its first two cases confirmed on March 9 were men returning from Italy and Britain. Further cases were found among Cypriots arriving from Greece and Germany. On March 13, all borders were closed for 15 days to all but nationals who were, on arrival, quarantined and forced to isolate for 14 days in hotels controlled by National Guardsmen. On March 15 the first death was announced.

The Republic ramped up measures, closing crossings with the north, imposing a lockdown, requiring those under 65 years leaving their homes to receive permission by SMS and those above 65 to carry a form giving name, age, identity card number and purpose. Exercise and visits to pharmacies, doctors and shops are permitted. A curfew has been imposed from 9pm to 6am after violators were caught by police patrols. At the end of each day, the Health Ministry reports the number of cases, who had been infected, the number of contacts traced and untraced, number of tests conducted and deaths. There have been 621 cases and 17 deaths at the time of writing.

On March 10, the Turkish Cypriot area identified its first case, a German woman belonging to a group of tourists. The Turkish Cypriot authorities have followed the same procedures adopted by the Republic. At the time of writing 100 cases, including 30 German tourists, were confirmed, 44 recovered, and there were four deaths.

The US has miserably failed the test and trace test. Former head of the country’s Centers for Disease Control and Prevention (CDC) Tim Frieden wrote in the New York Times that in late January as the virus savaged China, Dr Nancy Messonnier of the CDC warned that the US must prepare for a “pandemic.” A month later, she declared, “The disruption to everyday life might be severe.” The White House ignored her words, failed to test and trace, order the production of protective gear and ventilators and communicate to 330 million citizens the need to distance and isolate.

Frieden’s first recommendation to fellow experts was to use “the classic disease detective work that is needed to understand and contain COVID-19.” He argued that the US effort remains far behind the needs of the country.

Donald Trump — who prematurely focuses on reopening the US economy — contends the focus should be on testing of recovered COVID-19 victims who might have the antibodies needed for treatment of infected cases and vaccines. This will not defeat the virus without identifying and tracing existing cases which are certain to soar if people return to work before the virus is contained.