A Test In Time Saves 9

The first pandemic in 100 years, we are blinded by the rapidly evolving impact of CoVID-19, and our only redemptive source of vision is knowledge. The very bedrock of this knowledge is built through testing. Without a clear and instructive understanding of our threat, we are unable to assess its impact, and our responses will be blunted, misfired and misdirected. In the face of this global terra incognita, we must seek fidelity to evidence-based fact, be guided by objectivity and realize that only the truth will set us free.

Emerging markets neither have the existing resources nor the ability to rapidly improve capacity in response to global healthcare crises

Frontier and developing markets often have overburdened healthcare systems, which are typically poorly resourced in comparison with their high-income counterparts. Such regions tend to have suboptimal diagnostic and therapeutic capabilities, lacking intensive care and life support resources for severe respiratory cases of CoVID-19 infection. This gravely compromises clinical efforts and curtails responsive management of disease and mortality reduction. When such tenuous healthcare systems are strained, the feral consumption of diagnostic and therapeutic resources can effectively destabilize national health systems. Furthermore, the compounding nature of adverse social determinants of health exacerbate the levels of devastation unleashed by such widespread illness. Higher levels of overcrowded housing, underdeveloped sanitization infrastructure and inadequate infection control systems create greater risk for unmitigated contagion.

In addition to having limited existing diagnostic and therapeutic capabilities, developing countries are often unable to deploy the economic machinery required for effective response. Unlike China, most developing states would not be able to mobilize the necessary resources to construct hospitals in a matter of days. Smaller developing nations simply do not have the capacity to respond with high levels of urgency and self-efficacy, and must face the risks of spiraling disease burden.

Effective risk mitigation strategies in pandemics involve thorough & comprehensive testing

In seeking a solution, we must first acquaint ourselves with the boundaries of the problem. We test for sexually transmitted diseases not simply for diagnosis and treatment, but with implicit expectations that the knowledge gained will influence our subsequent behavior. As we face a threat of pandemic proportions, the global stakes are much higher, and our collective welfare is inextricably pegged to our capacity to test.

Countries that have instituted thorough testing regimes – acknowledging that they have also embraced risk mitigation strategies - have managed to effect early containment. South Korea, Singapore and Taiwan have all displayed comprehensive and uncompromising approaches to testing that the West would do well to emulate. This has given such countries the providence of detecting nodes of infection early in the lifecycle of contagion, thereby affording the opportunity to disrupt the chains of spread. This has saved lives.

Unsurprisingly, countries with lethargic and delayed approaches to testing have been rewarded with staggering hospitalization rates and, correspondingly, overwhelmed healthcare systems. Perhaps the most threatening consequence of under-testing is that it may confer a false sense of security - and unwarranted claims of success - in response to deceptively comforting statistics. With stakes this high, it is prudent to temper positivism with a generous dose of caution.

The Caribbean must increase its testing capacity to effectively respond to CoVID-19

In addition to disproportionate socioeconomic vulnerability to pandemics, Caribbean states are unfortunately poorly positioned to conduct high-throughput testing. Such countries often lack adequate equipment and personnel needed to effect comprehensive testing strategies. Furthermore, their low purchasing power and costly supply chain dynamics present challenges in accessing the optimally desired volume of tests. Moreover, their supply dilemmas are further complicated by low bargaining power as small, fragmented countries which must compete with large, wolfish institutions for scarce essentials.

Caribbean states have displayed a range of approaches to testing, with countries that have implemented the widest testing measures - such as Chile, Panama and Costa Rica - having the most known cases of CoVID-19. Predictably, such countries have robust regional pedigree in healthcare and strong public sector involvement in health directives. Conversely, countries, such as Mexico, Guatemala and Nicaragua have failed to prioritize testing and are in a particularly vulnerable position. Despite individual differences, the Caribbean and Latin America as a region conducts an approximate 600 tests per million citizens, compared to Singapore’s 7000 tests per million citizens. The region does not stand to be punished for its undertesting, it stands to be punished by its undertesting.

In testing, veritas

Any strategy to contain and mitigate CoVID-19 must be established on a foundation of exhaustive testing. Ignorance, though blissful, will ultimately redound to our collective detriment and we are better off with cruel truth than comfortable delusion. Only grounded in a solid understanding of disease burden, can we then take an informed stance to intelligently interrupt contagion and blunt the social and economic impact of the pandemic. With stakes this high and a future unknown, being data-driven and thorough in our decision making is not only wise, it may very well be the difference between life and death.

Author: Dr. David Walcott

M.D. (Hons) || Ph.D (Oxon) - D. Phil in Clinical Medicine || M.Sc. (Oxon) - M.Sc. In Integrated Immunology || ECA Fellow (INSEAD)