The Silent Danger: Asymptomatic Patients

 

The Silent Danger: Asymptomatic Patients - Dr. Hosten of Fit for Life Medical Services Explains

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Hefty Sanctions for Non-Compliant Tourists

Written By: Central Health - Grenada

Grenada’s boarders, through a phased process, are opening. A legitimate concern for many would be non-compliant tourists.  Non-compliance in this instance could range from breaking quarantine to not wearing masks. Although, our visitors must be welcomed as they escape to relax and explore our beautiful island,  they must comply with our laws. According to Dr. George Mitchell, head of the National COVID-19 Response Team, via actions through parliament, the current monetary sanctions for non-compliance will increase.

This revelation occurred on Friday July 17, 2020, when Central Health – Grenada interviewed the Coordinator of the National COVID-19 Response Team as part of its online series entitled, COVID-19 & Those Most At Risk. “The sanctions that that have been on the books for many, many years were deemed inadequate. Just not enough to deter persons and so this is going to be brought to Parliament,” said Dr. Mitchell. He went onto say, “I suspect that very early next week the fines surrounding breaking quarantine etcetera will be revised and will be implemented upwards.” 

Grenada has to take steps to move on.  The way our world economics is designed, we have to smartly create a new normal. COVID-19 will be around for a while and so the process of welcoming tourists to our island is part and parcel of the overall process. Having said that, as far as Dr. Mitchell and his team are concerned, if you are coming from what they have deemed as Yellow or Red Zones, meaning that there is active transmissions there, expect to be quarantined for a certain period of time. “Unlike the St. Vincent experience, where people were allowed to go home, and they have their peculiarities about them - that they were allowed to go home, Grenada is not about to take that kind of chance. I’m sorry - no. We are not about to take that kind of chance. If you are coming from an area where there is active transmission, and you want to come and have fun, then your fun of course would be enjoying our beautiful island - but from your secured location.”

Earlier this month, the Ministry of Health outlined its phased approach for opening the Boarders - Low Risk(OECS Countries), Medium(CARICOM, UK, Canada) and High(US or visited the USA 14 days prior to arrival) arrivals would be permitted during different time periods. Our visitors or those returning home, would have to bear additional costs, outside of their airfare, and adhere to strict procedures. In fact, traveling via aircraft requires serious planning. Everyone entering Grenada must have certain things and accept our laws and procedures:

1. Download key forms - https://covid19.gov.gd/required-incoming-passenger-forms/

(a) Incoming Passenger Home Quarantine Application

(b) International Passenger Health Declaration Form (must sign)

2. Negative PCR Test (Yellow Zone - 7 days prior & Red Zone - just before arrival)

3. Prepare to be tested upon arrival (Yellow Zone - rapid test & Red Zone PCR Test)

4. Pay to reserve quarantine location (government approved sites only) - meals not included.

5. Download Grenada's Contract Tracing App

6. If positive upon arrival, expect to cover all costs for retaking tests - first testing is free.

To watch Central Health – Grenada’s interview with Dr. Michell – click here.

For a full recap travel protocols – click here.

A Question of Protection: The Future of COVID-19 Vaccinations for Grenada

Written By: Central Health - Grenada

Vaccinations are important. They help prevent and control the spread of infectious communicable diseases and illnesses. However, numerous news reports have made it clear that once COVID-19 surfaced and spread rapidly around planet earth, causing over 12 million cases and over 500,000 deaths worldwide the race to develop a vaccine took off. Millions and millions of dollars are being invested into developing a vaccine to control the spread of COVID-19, even while the virus mutates. Notwithstanding, part of the process for verifying the effectiveness of vaccinations is to encourage humans to enroll in clinical trials. These facts raise two questions:

1.    What measures have been put in place to protect Grenadians from becoming ‘guinea pigs’ in an ill-intentioned scientists or individuals’ clinical trial?

2.     What reassurances will nationals be given regarding the source of the COVID-19 vaccination supplied to our region – considering our genetic makeup may be different from those tested?

As part of an ongoing online series entitled, “COVID-19 & Those Most at Risk,” Central Health – Grenada interviewed, public health practitioner E. Francis Martin (DR), MD., MPH., on the aforementioned concerns. 

Whereas Dr. Martin acknowledged that the vaccination protocol and schedule used in Grenada is guided by the technical support of PAHO/WHO, he made it very clear that currently there is an absence of legislation that deals with the protection of human sampling. “There is a concern for the region, in a sense that our small islands -  we don’t have strong legislation that speaks to the use of human sampling or use of human subjects for research purposes. So, I will make a blanket statement to say that because we have weak legislation for human sampling, a company can request to use the Caribbean as human subjects. It would be left up to the national governments and the public health and ministries to make a final decision on it,” said Dr. Martin

When asked by the Founder of Central Health – Grenada, Roslyn A. Douglas, MA, DTM whether Grenadians should have concerns about the source of the vaccine, Dr. Martin legitimized the question, stating that medications that work well for persons with one genetic makeup may not work well for another, “It is true that if your genetic sequencing puts you in a different gene pool, a vaccine that works in “A-area geographically,’ may not necessarily work in “B – geographical area.”

To watch the entire 10 minute interview segment visit Central Health – Grenada’s YouTube Channel – click here. 

For permission to publish this article email: centralhealthgnd@hotmail.com 

Opening Businesses & Borders: Here are some questions

By: Central Health - Grenada

Candid questions regarding the opening of businesses and borders can be found below.

The scientific terms are symptomatic, pre-symptomatic and asymptomatic. In layman’s terms, these are three ways a person can become infected from someone with COVID-19.  As piecemeal permission is being granted for the re-opening of businesses and eventually our borders, Grenadians really need to exercise caution. We do not have the all-clear for normalcy – not by a long shot. The fact remains, COVID-19 has killed more people globally in a shorter span of time than the flu. The main reasons are differences in incubation period, modes of transmission, rapid deaths, and plenty of unknowns due to insufficient time to study the virus.

Three ways get COVID-19: Without taking the necessary precautions, such as  wearing protective gear, hand washing, cleaning frequently touched surfaces, avoid touching one’s face with unclean hands and exercising physical distancing (6 feet), you can get the virus through contact with the following persons:

1. Symptomatic: You can contract the virus from someone exhibiting symptoms. 
2. Pre-Symptomatic: You can also get it from an infected person, which according to the World Health Organization (WHO) says the time between a person is exposed and when they first exhibit symptoms. 
3. Asymptomatic: You can also get it from someone who has it and is not showing any symptoms at all.

The problem with the latter, there has not been enough time to research how long they remain asymptomatic. So, for this mode of transmission we are truly operating blindly.

Johns Hopkins University & Medicine’s Coronavirus Resource Center reported that as of May 24, 2020 there have been 345, 036 global deaths caused by COVID-19. The World Health Organization (WHO) estimates that 290,000 to 650,000 people die of flu-related causes every year worldwide. This means from approximately December 2019 to May 2020  - roughly five months, COVID-19’s death record is already at 50%. 

In Grenada, from March until relative recently, everything came to a screeching halt. We needed to slow the opportunities for transmissions, as the health care system could not handle sudden mass illnesses. Who could forget the day Hon. Minister Nicolas Steele blew a complete gasket, when many at the beginning of this saga seemed flippant at the Ministry of Health’s warnings? That evening he sent us all to our rooms for two weeks – in the first instance. A pin could drop in Grenada and someone could hear it.

The strategy worked, although it was tough on many: efforts to balance shopping days; the pushing and shoving; the panic buying; walking with groceries on your back, for those that did not have transportation; and not able to access cash for several weeks. Nationals stuck at sea were eventually permitted to return home, after going through mandatory pre-cautions. You name it we went through the trial, errors and successes while leaning on ‘the science’. Grenadians emerged with zero deaths, to date.  Then, smiles started to fade rapidly because people were suffering economic hardship. For many their mantra is, “If I do not work, I cannot eat.” The fact is, no nation can remain cut off from the world indefinitely, but opening our borders means people are potentially bringing their germs and viruses with them.

As the nation attempts to take baby steps forward, some questions arise.

1.     What will be the screening process for travelers entering and leaving Grenada?

2.     What plans are in place to protect Grenadians from being used as guinea pigs for vaccine clinical trials?

3.     After borders are opened and should a second wave of cases hit our shores:

a.     Will the shutdown measures be repeated?

b.     What will be the phases?

4.     St. George’s University(SGU) says they will release a statement, however:

a.     What will the Grenadian employees be required to do to remain employed – as they interact with the students?

b.     What will the students be required to do, to protect employees?

5.     Outside of SGU:

a.     What measures will be put in place to protect staffers who may lose their jobs after voicing concerns about safety in the workplace?

b.     Can a hotline number be developed for employees to safely report when being forced to work outside of permitted hours, or their jobs being threatened for voicing concerns?

6.     What observations-measures have been put in place to ensure businesses, schools and other entities follow the health and safety regulations?

7.     If parents are uncomfortable returning their child to school:

a.     Will there be consequences for non-compliance?

b.     What systems will be put in place for cramped classrooms?

c.     If a parent chooses to Home School, will that be permitted?

8.     What measures will be put in place to protect teachers from students and vice versa?

9.     Other countries besides China are developing vaccines:

a.     What is the typical process for accepting and issuing vaccines?

b.     How long will it take for the approval process?

c.     Should Grenadians have concerns about the source of the vaccine will that be considered?

d.     Could a Grenadian be given the choice to accept or decline a vaccine based on source?

e.     Will the source of the vaccine be disclosed?

10.  Testing:

a.     Are there plans to test more than 1% of the population?

b.     The tests that are being used, which country sourced them?

11.  Bus drivers:

a.     Will the bus drivers be permitted to adjust their prices during this limited state of emergency?

b.     How will the sanitization of buses be monitored as they enter the terminal after trips?

It will be interesting to see if these questions are addressed. Equally interesting would be to find out what other questions citizens have at this time, and how can they get answers. During press briefings journalists can ask questions, but citizens have questions also.

For permission to publish this article email: centralhealthgnd@hotmail.com 

Should You Get Infected: “Give yourself a fighting chance”

Article By: Central Health - Grenada

Photo By: Gicel Charles

A proponent of eating locally grown foods, Executive Secretary of the Grenada Food & Nutrition Council (GFNC) gave numerous benefits of fruits, vegetables and provisions grown in Grenada that can help boost the immune system namely: Vitamins A, B, C, D and E; plus minerals such as Iron, Zinc, Selenium and Copper; and to get 30 minutes of sunshine a day. 


Recently featured on Central Health – Grenada’s online series entitled, "COVID-19 & Those Most At Risk," Lydia Browne encouraged all citizens of Grenada to  choose healthy food options, especially locally grown, “If you know you have not been eating in accordance with what we have been advising all these years, then you know it is important for you to at least start putting some of these vital nutrients into your body. At least give yourself a fighting chance – should you get infected.”


As the majority continue to comply with the Government of Grenada’s regulations, while we fight to prevent COVID-19 from spreading, citizens must remain confined to their places of residence and yards – except on shopping days.  However, in addition to eating healthy locally grown foods, GFNC also recommends that we get some sunshine, either directly – by sitting in the sun, through starting a kitchen garden or doing yard work  - daily, “Going outside and working in the garden, and doing some yard work is going to be so important even beyond just growing something. When you are taking care of a garden, you are being physically active, and that is also important – at this time.  So, you are getting the physical activity and then you are getting an addition again, you are

Photo By:CH-G

getting the sunshine.”


Regarding life prior to COVID-19 the Executive Secretary went on to say that many were not getting enough exposure to sunshine, “We think we live in the sun our Vitamin D is covered, but how many of us spend 30 minutes in the sun every day? We spend most of our time indoors, in air condition and by the time we leave work in the afternoon the sun is about to go down, or we get into our vehicle, and so we are really not getting that sunshine.” 


To learn about the GFNC recommendations of local foods that can aid in boosting your immune system - click here..

-END-

For permission to use this article email centralhealthgnd@hotmail.com 

Contact Tracing: There’s an App for That

By: Central Health - Grenada

During an interview with a citizen of South Korea as part of an online series entitled, “COVID-19 & Those Most At Risk,” Central Health – Grenada learned that South Korea uses a Smart Phone App to track airport arrivals who embarked from countries with high incidences of COVID-19.  This Self-Diagnosis Mobile App allows users to record if they develop a cough, sore throat, temperature and difficulty breathing (dyspnea).   In fact, you cannot leave the airport without downloading it.

All persons arriving receive a two-page document that provides the required protocol. Instructions range from who should take a designated airport bus to who is required to be tested and it ends with the information to download the App for both Android and iPhone users. To view document – click here.


South Korea has received positive press and general respect from around the world for its quick action in stopping the initial spread of COVID-19.  When asked what citizens had to do to assist with that process, Jenny Lee said she had to use the App, “I had to actually download the App about three weeks ago because I flew in from San Francisco. We were told to wear masks, stay inside a lot and avoid large contact with people, and report when we can to the government if we have any health issues.”  


Lee went to say, persons arriving from Europe had to go to a special facility as the outbreak was far worse than that of her destination. Meaning, they went to a quarantine area not into the general public.  Lee was allowed to go to her home, which is equivalent to Grenada’s two-week self-quarantine and instructed to put into the App, which is connected to the authorities, if she developed any of the four symptoms. If you do indicate that you have a symptom you are given the option to speak to medical personnel who will discuss over the phone your symptoms; give consultation and/or direct you to get tested at a nearby site. “I actually went to get tested because I thought I had kind of a sore throat. My results came back within 20 hours and I was tested negative so I knew I was okay but I still stayed in my room just in case.” To see full interview - click here.


The helpfulness of this App has caught the attention of Google and Apple. According to https://9to5google these two tech giants are working on a cross-platform solution, “When two people are in close range, their phones will exchange anonymous identifiers that change daily. If an individual gets diagnosed with COVID-19, they can have their device transmit a list of everybody they’ve been in contact with to the cloud. Meanwhile, the second person’s phone will periodically download a list of everyone that has tested positive in their area. If a match occurs, they will be notified and prompted to contact health authorities.”


How this App will work in Grenada’s context is yet to be seen, or if it can.  Further, during press briefings on COVID-19 on island, there has been a reluctance to share which community or parish  infected or affected persons reside. The decision to withhold seemed to be based on our population size, ways of movement  and especially to prevent ostracization of said persons.  If that App can be downloaded globally, there will be no way to stop that information from becoming public knowledge, unless someone develops an App that is appropriate for our cultural context. 


- END - 

For permission to publish email: centralhealthgnd@hotmail.com 

Should Grenada Cancel Carnival?

 By: Central Health - Grenada

 

Every year, directly after Carnival, many Grenadians and its nationals catch a bad cold.  This ‘carnival cold’ is such the norm, it is commonly given the name of one of the popular Soca or Calypso tunes of that year. In light of the rapid spread of the Coronavirus around the world, should Grenada cancel Carnival?

To date, Grenada’s Ministry of Health has done an admirable job in keeping the Coronavirus (NOCOVID-19) out of Grenada. Effective Sunday February 2, 2020 a travel ban was put into place.  Nationals coming from China may return, however they are automatically quarantined for 14 days – symptoms or no symptoms.  All foreigners attempting to enter Grenada from China, may not do so until 14 days have passed. To date, those quarantined, proved not to have the illness, and one by one are being released after their quarantined period ends.  

Additionally, effective February 26, 2020 Grenada’s Ministry of Health released a statement saying our island is now on an Importation Transmission Watch (ITW), which includes assessing exposure to risks monitoring events in the region, and providing pre-travel training.  This move to ignite this protocol is appropriate since NOCOVID-19 is not limited to just China. This decision is in keep with the protocols of Caribbean Public Health Agency (CARPHA), the Pan American Health Organisation (PAHO) and the World Health Organisation (WHO). So it is clear, Grenada’s Ministry of Health appears to have their finger on the pulse of this situation. However, as of February 27, 2020 Grenada’s travel ban is limited to just China.

On February 26, 2020, CNN provided a report of countries around the world that have confirmed cases of the Coronavirus, here are a few examples:

Italy =322

Hong Kong =89 cases

South Korea = 89 cases

Japan = 147 cases + 691 cruise ship

Singapore =91 cases

Baharain=26 cases

France =16 cases

Iran=95 cases

Taiwan =32 cases

It’s a delicate balance - the revenue gained from Carnival versus a health crisis within our tri-island state. Should Grenada cancel Carnival or adjust its travel ban to include those countries that are being watched under the ITW? Is it safer to have less persons attend Carnival or cancel it all together?

The Centers of Disease Control and Prevention (CDC) says there are three ways the Coronavirus is spread person to person:

• Between people who are in close contact with one another (within about 6 feet)
• Via respiratory droplets produced when an infected person coughs or sneezes.
• These droplets can land in the mouths or noses of people who are nearby or possibly be inhaled into the lungs.

Their website also states that although it is not the main way, it can be spread when a person touches a surface where the virus is on and then touch, "their own mouth, nose, or possibly their eyes." Large public events will automatically put people in close proximity and raise the occurrence of secondary forms of transmission.

It will be interesting to see what is decided in the upcoming days or months.

-END-

Practice Sneeze Etiquette On The Bus

By: Central Health – Grenada

Considering hundreds of Grenadians travel on buses every day, and seated in close proximity to one another, all passengers should practice Sneeze Etiquette to prevent the spreading of germs. There are some people who hold no bar when sneezing, and seem oblivious to how much germs they are spreading in an enclosed space.  Although Grenada’s Ministry of Health has implemented a travel restriction on persons departing from China, part of the World Health Organization’s (WHO) constitution implies that citizens must co-operate to reduce the spread of general illnesses. 

The Centers for Disease and Control and Prevention’s (CDC) fact sheet entitled, ”Do Your Part to Slow the Spread of Flu” says sneeze droplets can travel as far as six (6) feet. Their website also states that, “Serious respiratory illnesses like influenza, respiratory syncytial virus (RSV), whooping cough, and severe acute respiratory syndrome (SARS) are spread by: Coughing or sneezing.” 

When asked what type of precautions passengers should take on the bus, Managing Director and Resident Physician of St. Augustine Medical Services Dr. L.N. Amechi says, “The best thing to do is to cough or sneeze into tissues and discard them into a paper or plastic bag which you are carrying for that purpose.  In the absence of tissues use a handkerchief, towel or “rag”. Last resort, cover your mouth with your sleeve and cough or sneeze into your elbow.  Always carry hand sanitizer, and clean your hands after every cough and sneeze.”  

Dr. Johansen Sylvester’s advice matches Dr. Amerchi’s, he said that if using a cotton cloth/bandanna these materials must be washed in bleach or disposed of at the end of the day. He also said do not sneeze into a cuffed fist and throw away used tissues as soon as possible, “When you sneeze turn away from others especially the elderly or very young.” Dr. Sylvester went on to say, “Avoid sitting in the very middle of the bus and reduce handing or holding on to the seats, when not necessary.” The physician also encourages bus drivers and passengers to use hand sanitizers, and especially after exchanging money.  He also recommends gargling with warm salt water two to three times per day, especially just before bedtime.

Most health practitioners, favour washing hands with soap and water. However, if not possible a hand sanitizer with at least 60% alcohol can help prevent the spread of germs.

Should Grenada Consider a 14 Day Ban on Travelers from China?

By: Central Health – Grenada

Although Central Health – Grenada’s focus is educating nationals about Chronic Non-Communicable Diseases, it is important to acknowledge that the World Health Organization (WHO) on January 30, 2020 declared the new coronavirus outbreak a public health emergency of international concern. Therefore, it is important to share general facts about how this decision came to be, as our tri-island state is not immune to the possibility of it affecting us and appreciate how travel bans are decided and ultimately approved. 

Well-structured organizations, such as the World Health Organization, usually assemble an elite team of qualified persons to provide recommendations to Dr. Tedros Adhanom Ghebreyesus the Director – General. He in turn reviews all the facts within their reports and in particular their recommendations. His decision must embrace the principles of the WHO’s constitution, two of which are whether the health situation requires: 

• Active co-operation on the part of the public.
• To remind governments that they have a responsibility for the health of their peoples which can be fulfilled only by the provision of adequate health and social measures. 

To read the others – click here  

At the meeting held on January 30, 2020, arranged by the Director- General, in addition to the said Emergency Committee, representatives from the People’s Republic of China’s Ministry of Health provided a report. Two key points extracted from their reported are: 

• There were 7711 confirmed and 12167 suspected cases throughout the country. Of the confirmed cases, 1370 are severe and 170 people have died. 124 people have recovered and been discharged from hospital. 
• There were now 83 cases in 18 countries. Of these, only 7 had no history of travel in China. There has been human-to-human transmission in 3 countries outside China. One of these cases is severe and there have been no deaths. 

Those numbers may have increased or remain same since then. 

Although the coronavirus is still an evolving situation, the committee made noteworthy recommendations, here are poignant ones:

• It is still possible for the virus to spread.
• The outbreak now meets the criteria for a Public Health Emergency of International Concern
• Countries need to put in place strong measures to detect disease early, isolate and treat cases, trace contacts, and promote social distancing measures commensurate with the risk.
• Provide support to low- and middle-income countries to enable their response to this event, as well as to facilitate access to diagnostics, potential vaccines and therapeutics.
• WHO should provide intensified support for preparation and response, especially in vulnerable countries and regions, rapid development and access to potential vaccines, diagnostics, antiviral medicines and other therapeutics for low- and middle-income countries should be developed.
• Investigate the animal source of the outbreak.
• Investigate the clinical spectrum of the disease and its severity
• Investigate the extent of human-to-human transmission in the community and in healthcare facilities, and efforts to control the outbreak.
• It is important to study the possible source of the virus, to rule out hidden transmission and to inform risk management measures.
• Enhanced surveillance in regions outside Hubei, including pathogen genomic sequencing
• WHO should assess how best this outbreak can be contained globally. 

After reading these recommendations, it is interesting that the Emergency Committee does not recommend any travel or trade restriction - or at least at this time. However, should a country make a restriction, they must inform the WHO within 48 hours as to why that decision was made and be ready to accept the WHO’s feedback. 

What is interesting, on the day the Director-General declared the Coronavirus a public health emergency of international concern our neighbour - Trinidad & Tobago imposed restrictions on travelers from China. Their Health Minister Terrence Deyalsingh said, “Persons who are presently living in China or visiting China, regardless of your nationality, will not be allowed to enter Trinidad and Tobago for 14 days after leaving China.” As far as their Health Minister is concerned, the virus has an incubation period of 14 days, so if your passport is stamped/recorded to have left China, regardless of nationality, you cannot enter Trinidad until those 14 days have passed. 

When asked about Grenada’s position, Dr. Francis Martin – Acting Chief Medical Officer for the Grenada Ministry of Health said, “Grenada’s position is to follow the advice of our lead public health agency, as it relates to travel restrictions on the sub region. Those agencies being Caribbean Public Health Agency and World Health Organization- PAHO.” 

The Caribbean Public Health Agency’s fact sheet entitled, “Coronaviruses–what you need to know,” does not provide any travel restrictions, but does say a person should check their local Ministry of Health for information or CARPHA’s website for guidance for travelers. Additional information included: “If you travelled to a country where cases of the novel coronavirus was detected, watch yourself for symptoms within 14 days after you left that country. If you develop symptoms and feel sick with fever, cough, or difficulty breathing, you should:

• Seek medical care right away. Before you go to a doctor’s office or emergency room, call ahead and tell them about your recent travel and your symptoms.
• Wear a mask if available.
• Avoid contact with others.
• Do not travel while sick if possible.
• Cover your mouth and nose with a tissue or your sleeve (not your hands) when coughing or Wash hands often with soap and water for at least 20 seconds to avoid spreading the virus to others.
• Use an alcohol-based hand sanitizer if soap and water are not available. 

It will be interesting to see how the WHO reacts to Trinidad & Tobago’s 14-day travel restriction. Perhaps if approved, it may allow for other island.

 - END-