No symptoms, no tests

New gov’t policy halts community testing

THE GOVERNMENT has put a hold on testing non-symptomatic residents for Covid-19 - even if they are in quarantine because they have been in contact with an infected person.

Weekly News reporter Delana Isles seeks answers this week as to why this decision has been made and what the risks are from limited testing.

IT HAS long been known that people can have Covid-19 and not show symptoms, posing a significant threat to public health.

But there remains some confusion as to what extent these people can spread the virus to others – and for how long after becoming infected.

Governments around the world are grappling with the changing dynamic surrounding Covid-19, as research is conducted and new discoveries are made daily.

The World Health Organisation (WHO) and the Centre for Disease Control (CDC) are themselves constantly changing and updating their guidelines as studies reveal new findings.

Many of these changes surround isolation periods and whether testing is necessary for those who are in quarantine or self-isolation.

Particularly those who have come into contact with an infected person but are showing no symptoms.

To date, the WHO advises that polymerase chain reaction (PCR) testing of asymptomatic or mildly symptomatic contacts can be considered in the assessment of individuals who have had contact with a Covid-19 case, with these screening protocols being adapted locally.

Data from the WHO to date suggests that 80 percent of infections are mild or asymptomatic, with just 15 percent experiencing severe infection, requiring oxygen and five percent are critical infections, requiring ventilation.

Local situation Here in the Turks and Caicos Islands, the Government is following the standard, and preferred, 14-day quarantine and self-isolation period.

And it has been found - through inquiries by the Weekly News - that many of those in quarantine or self-isolation are not being tested for Covid-19 by the Public Health Agency.

Why this is the case, this publication has been unable to ascertain, as questions to the Government have gone unanswered.

Speaking with several quarantined people, many revealed they are worried about the lack of testing, even as they are not showing symptoms.

Some are also unsure whether they can spread the disease unknowingly to their loved ones who may be vulnerable after finishing their quarantine period.

A call to the hotline number provided by the Ministry of Health confirmed that all of those in quarantine are not being tested, and people are free to leave - upon clearance by health officials - once the isolation period is up.

The official who answered the hotline number stated: “What they have decided to do, they are not testing the asymptomatic people, so if you are not exhibiting any kind of symptoms you wait until the 14 days, then you will be released from quarantine.

“But we are not going to test you unless you come down with symptoms.”

When questioned whether private testing can be sought following the quarantine period, the official stated that the Government does not recommend testing at the private laboratories.

“It’s up to you if you want to go, but it’s not recommended. The private test is to tell you if you had the disease and that you develop antibodies, that is what they are doing. It is not recommended by the Ministry of Health.”

While the private labs have not been authorised by the Government to conduct any in country testing, the Weekly News has learned that people can still go to get samples taken at the private facilities around the territory.

These samples will in turn be sent off to the United States for testing to be conducted at accredited laboratories there. The results will then be returned via Fedex within five to six days.

This method can also be used for those who need to travel.

Community testing Press enquiries to government officials over the past two weeks have yielded no update as to when community testing can or will ever be done.

As it stands, testing in the country is sporadic at best, even as the quarantine numbers climb, and the positive cases increase.

At time of press on Thursday (July 23), there were 62 active cases of the virus, 212 quarantined at home, 22 isolated at a facility, two hospitalised, two deaths, 21 recoveries and 975 negative results.

Chief Medical Officer Dr Nadia Astwood reported that 62 percent of Covid-19 cases in the Turks and Caicos Islands are asymptomatic.

During a press conference on Monday, Minister of Health Hon. Edwin Astwood said the Government is looking at ensuring that private facilities are able to conduct in-country testing.

This is so that they can concentrate on the testing of people who want to get tested but have no symptoms - community testing.

He indicated that the Public Health Department is constrained in its capacity to conduct the amount of testing that is needed.

He admitted that while they were conducting testing of everyone in the community who came into contact with an infected person, they have had to stop this.

“Just like every country in the world, when you have outbreaks and in an investigation you have to move from testing asymptomatic persons… or just wanted to travel, to go to the hot spots.

“You have to fight the war that is presented to you, and once you have a surge in cases you have to divert your resources to finding those persons who are infected, who are sick and the contacts of those persons.

“So, even though we want to test everyone, once we have cases evolve we have to divert our forces to them.”

Astwood defended the new no test policy by presenting brief information as to similar strategies being employed in the United States - which has significant capacity - and Jamaica, which has more capacity than the Turks and Caicos Islands does.

“In Jamaica… they say they are not testing people unless you are symptomatic or you are contacts of contacts.

“Jamaica has 46 private labs, 52 public labs, and over three hundred laboratory staff, and they are saying… we have to divert all of our resources to the outbreak first and then we will go back to regular testing.”

Currently the Turks and Caicos Islands has one laboratory at Cheshire Hall Medical Centre conducting testing.

The Government currently has about three machines conducting the tests, with a very small complement of laboratory staff physically preparing the samples to be entered into the machines.

What it means to be an asymptomatic carrier The WHO has admitted that it does not know if, when and how often asymptomatic carriers of Covid-19 spread the virus.

During a press conference in June, WHO officials said they are still following countries that have reported asymptomatic cases and whether these people are spreading the virus.

Studies have found that people can contract Covid-19 and be truly asymptomatic - this means that the virus infects them and runs its course without ever producing symptoms.

Studies have also shown that people can be contagious in the first several days of having the virus, before they show symptoms.

One study estimated that more than 40 percent of novel coronavirus cases were transmitted in the pre-symptomatic phase (before symptoms appear).

A survey from the CDC reports that 54 percent of people who tested positive for Covid-19 could not recall how they got it.

Similar instances of this are now being reported by the TCI Government, where a significant portion of the newly confirmed cases have no known epidemiological link, as indicated in the daily update from the health ministry.

The CDC study further outlines that the remaining 46 percent of survey respondents who tested positive reported that they had close contact with someone who was sick, such as a family member, before they developed the disease.

The report concludes by saying this ambiguity “underscores the need for isolation of infected persons, contact tracing and testing during ongoing community transmission, and prevention measures including social distancing and use of cloth face coverings”.