Choosing who lives

Healthcare workers are having to choose who lives and who dies at this point in The Bahamas’ fight against COVID-19, according to former Minister of Health Dr. Duane Sands. 

When asked if decisions are being made on who will live or die as a result of overcrowding in hospitals, Sands said: “The answer, unfortunately, and I say this with a high degree of certainty and I understand the implications of my comment, the answer is yes; that is happening now.”

He made the comments on the Guardian Radio show “The Hitback” with Nahaja Black yesterday.

“When we look at the impact of COVID, we cannot just simply look at COVID cases and deaths from COVID, because the person with the heart attack that could not get emergency care, the person with cancer who neglected his or her symptoms because they could not get in the hospital for that endoscopy or for that chest x-ray, is still dead.”

As of Wednesday, there were 112 confirmed COVID-19 deaths in The Bahamas. Twenty-two people were determined to have died with COVID, but from other causes, and another 15 deaths were under investigation. One-hundred twelve people were also hospitalized.

Sands said compared to other countries, The Bahamas is doing poorly in a number of areas.

“When you look at the number of deaths per million in The Bahamas, we’re at least twice the world average,” he said.

“What does that mean? It means that we are doing badly. And if you look at confirmed cases relative to actual cases, there is no question that the number of confirmed cases is a fraction, a percentage of the total number of persons either with or who have had COVID in The Bahamas.

“So, if you were to ask me conservatively, how many cases are there, or have there been of COVID-19 in the Commonwealth of The Bahamas, either confirmed with an RT-PCR or not, I would say the number is at least 10,000.”

He added, “The numbers are going to continue to expand. So, we don’t know when we are going to get to the end of this road.”

With a test positivity rate of 21 percent as of Wednesday, Sands said The Bahamas is far from knowing the extent of the spread of COVID in the country.

He said a test positivity rate of less than two percent would indicate officials have tested well enough to be certain about where cases and clusters are.

Sands said he tried to increase testing during his time as minister of health, but noted that global shortages of resources made it difficult. 

“We were trying to increase testing at a time when it was incredibly difficult to get the resources needed, swabs test kits, etc.,” he said.

“And so, we were pulling out all the stops to be able to continue the ability to test. But, this pandemic is a pandemic in evolution. So, the issues in March were different than the issues in June, which are different from the issues in August.”

Sands said the availability of reliable antigen tests now allows for cheaper and more widespread testing.

“There are now…high-fidelity, highly reliable antigen tests which surrender some of the sensitivity of an RT-PCR but is far, far cheaper, between $10 and $15. They’re easier to administer.

“…And so, now instead of a $150 charge, maybe a $50 cost, you can do a test for a $10 or $15 charge, that is $3 or $5 cost. Now you’re talking about a game changer.”

Pan American Health Organization (PAHO) Director Dr. Carissa Etienne recently endorsed the use of antigen testing, Sands noted.

Sands said countries that have more successfully managed COVID, like Barbados, have not only tested more and traced more efficiently, but also gotten the public to buy into the message. 

He said the government should “use honey instead of vinegar” to get people to buy into a national strategy.

“I think we would begin to see that the numbers are going to go down because people start to live the mantra that ‘this begins with me,’” he said.

Sands believes the country became complacent when the case count remained at 104 for several weeks earlier in the year. 

As COVID appeared to be under control in The Bahamas, the government reopened the country’s borders, even as cases were surging in the United States.

Since then, more than 5,000 cases have been confirmed in what health officials have called the second wave of infections. 

When the borders first reopened, travelers were required to test negative for COVID-19 within a week of travel to enter. However, a policy that allowed Bahamian citizens and residents to leave the country for less than 72 hours and return without a COVID test has been cited as the reason for the local surge in cases.

However, Sands said there is no evidence that that is the case.

“I don’t believe that the data is robust enough to confirm causality,” he said.

He added, “Yes, people went to the United States. Yes, people came back home. But do not assume that just because people did that, that is the reason why we had a problem with COVID.”

Sands said the government should own up to its mistakes and apologize.

“It’s never too late to say, ‘I’m sorry’,” he said.

“It’s never too late to say, ‘You know, there were some missteps that were made and it was not intentional. We thought that this was the right thing to do. It turned out not to be.’”

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