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Where do we stand in Guyana? What steps have been taken?

Where do we stand in Guyana? What steps have been taken?

Dear Editor,

To date, we have not made any posts pertaining to COVID-19 (Corona Virus Disease 19). The current situation has caused me to do so on Thursday, March 26 2020.
COVID 19, caused by the SARS CoV2 virus, is new to man and as such, we have NO immunity. This makes it very dangerous to everyone since there is no immunity even for the newborn or the elderly. Everyone is susceptible and everyone CAN get this disease. No one seems to be exempted. Since this disease condition is new, knowledge is EVOLVING and what might be news today can change sooner than we can imagine.

What do we know? This disease has a very high infection rate. It is spread from one person to another and it has to get into our airways to make us sick. We also know that once it gets into a country and starts spreading, up to 80% (as is projected in Madrid, Spain) can get sick.

What is even scarier is the numbers of persons who get seriously ill and the death rate for those infected. According to CDC, approximately 20% of those infected will get seriously ill with the elderly and those with comorbid conditions (diabetes, hypertension, cancers etc) being in the high-risk group. The death rate at this time ranges from 1% to 6% in different countries (data from countries with more developed health systems than ours – China, Italy, etc.).

The U.S. coronavirus epidemic is predicted to infect between 160 million and 214 million people over a period of more than a year, i.e., between 49% and 65% of their entire population. Frightening statistics! Worse still, it is projected to kill anywhere from 200,000 to 1.7 million people in the country.

And that’s the USA, a country that is vastly more prepared than we are. According to the NY Times, at the beginning of March, there were 70 positive cases with ‘limited testing’ being done. As of Thursday (25th March) afternoon, at least 75,178 people across every state, have tested positive for the virus, with 1,069 COVID-19 related deaths in the US.

How many Guyanese could get infected? Based on the statistics so far, it could be as low as 49% and as high as 80%. This translates into 367,000 to 600,000 Guyanese becoming infected (taking 750,000 to be our current population). If 20% gets really ill, that translates to between 73,000 to 150,000 persons getting critically ill. Gruesome picture. Even if 10% of those infected get seriously ill, that will be 36,500 to 75,000 individuals. That is also taking into account 8-9% of our population are over 60 years (2012 census).

Where do we stand in Guyana? What steps have been taken? How prepared are we? What is our capacity to deal with this pandemic?
Where we stand? We have private hospitals that say that they are ill prepared to manage COVID-19 patients (and maybe will not manage at all). In the Health System (Public and private), we have a total of 40 ICU beds and 30 working ventilators. These are an absolute necessity for management of critical COVID-19 patients. So what can 30 ventilators do for over 30,000 patients needing ventilators? How will the few be chosen? And then some of those ventilators are in the private health care system, not available to the COVID patients. So we are totally unprepared on that front!

What have we done so far? Closed the airports to external travel and closed schools. Is that enough? By far not enough! Public places are still open. Government facilities that are non-essential are still open and people have to go to work. Persons are NOT paying attention to the Ministry of Public Health!

So what can be done?
Establish a proper task force. At this time of political uncertainty, the head of such a team should be the CMO or the PAHO/WHO representative, someone the entire Guyana will trust! Both of these individuals are Public Health Specialists. The task force needs to capitalize on the expertise of all available persons with knowledge and experience in dealing with public health issues; – Cholera – 1992, Whooping Cough – 2007, Chikungunya – 2014, Zika. Whilst these diseases bear little resemblance to COVID-19, the public health approach is what matters. Most of these qualified and experienced professionals are no longer with the Public Health System but are available. Bring in the Epidemiologist(s) from UG and elsewhere.

The educational efforts so far has been totally ineffective. Persons are still ignoring the advice given. Schoolchildren are not going to school but they gather together to play games, fly kites, etc. The elders are going to places of worship in large numbers. The markets are still bustling. It is as if WE DO NOT HAVE A CRISIS IN GUYANA! It means that the communication is ineffective.

In 2014 with the Chikungunya outbreak in Region Six, (as the then head of the BRHA), we realised that TV and newspapers ads were not enough. We used street corner meetings, where a high vehicle with powerful sound systems were used at every street corner. Persons were in their homes but could have heard the messages. These ‘meetings’ lasted not more than 20 minutes each.

In Region 6,for example, five or six such vehicles working from 6 in the morning to 8 in the night with persons alternating, can cover the third most populated region in one or two days. The message needs to be repeated often until persons get it! These meetings also could be used to sensitize the population as to when and which TV/radio stations they can get updated information from. We may not have the facilities to treat but we can sensitize and educate to help prevent COVID-19.

In addition, organisations such as PAHO/WHO can guide persons to online courses to educate themselves and provide updates. The sites that are recommended so are the WHO/PAO website and CDC. The Ministry of Health’s CMO should have a page on which information and updates must be posted. At this time, THERE MUST BE NO SECRETS!

The faith based organisations, non-governmental organisations and youth groups have to be involved. Every community needs to identify the most vulnerable, the elderly and sickly who lie alone, the mentally challenged and those with chronic diseases and lend support. Help them with essential items like food and medicines whilst encouraging them to stay at home.

This is the time to truly show that WE CARE! The Berbice Regional Health Authority had a register of all the bedridden persons, all the mentally challenged and all those over 60 years as of 2014 living in Region 6. That data if still available can be used to identify some of those most vulnerable and can be used to help.

In addition, since we have no government structure that is recognised by all Guyanese, a proposal should be made to which both parties that can form the government, offering relief to the most vulnerable, must agree, so whoever is finally declared the winner of the 2020 General Elections, will implement the deal. This must include financial and other relief measures. A proposal will be made by us following this article.

At this time, all the Neighbourhood Democratic Councils (NDCs) and Municipalities can take the lead role in organising for the most needy in their communities. Take control of your communities and organise so that the impact can be minimised. In the case of the Chikunga outbreak, the NDCs and Municipalities in Region Six were integrally involved with the BRHA in the fight. Now this collaboration between health and Local government organisations is more needed. Meetings can be done online via Skype, WhatsApp and other media/platform.

Yours respectfully,

Yog Mahadeo

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