A decline in COVID-19 testing in recent days is the result of decreased testing demand, according to Dr. Merceline Dahl-Regis, special health consultant to the Office of the Prime Minister.
In the last week of October (between October 25 and 31) 1,978 tests were completed, according to the Ministry of Health.
In the first and second weeks of October, more than 2,500 tests were completed each week.
In the third week, there were 7,378 tests recorded, although many of those represented tests taken previously. The Ministry of Health noted on October 18 that due to receipt of negative results from laboratories and a data cleansing exercise, an additional 3,907 tests were added to the total number of tests completed in country.
(On some days, the private labs, which have been completing the bulk of the testing, report only the positive cases, officials have said.)
In August, into September, an average of more than 2,000 tests were being performed weekly.
What accounts for the decreased demand that Dahl-Regis pointed to when questioned by National Review on Monday? Are the numbers of new cases slowing because community spread is finally slowing?
“…The Ministry of Health demonstrated in its last press conference that the average weekly new cases are declining. With this, based on the current national testing protocol, we expect that the demand for testing would also decrease,” said Minister of Health Renward Wells in a video message circulated to the media on Monday night.
Wells touted “the rapid decline in COVID-19 cases” in The Bahamas, which he said is due to “direct government action”, “diligent and hard work of our healthcare sector and the adherence of the protocols by the Bahamian people”.
“We note that there has been a reduction in the average number of cases from approximately 90 cases per day down to 45 cases per day over the past week,” he said.
“Over the past two days, we have recorded 21 and 24 cases per day respectively. It is noted that this reduction is by no means as a result of a decrease in the number of tests performed.”
But let’s not just take his word for it.
While 21 and 24 are nice low numbers — compared to what we have been recording in The Bahamas, most particularly on New Providence, in recent weeks — those low numbers did come as a result of a reduction in the number of tests performed, according to the numbers presented by the Ministry of Health.
Two hundred and three tests were completed on Sunday, according to health officials, resulting in the 24 positive cases mentioned by the minister.
The day prior, 189 tests were conducted, resulting in the 21 positive cases.
In the four days prior, noticeably more tests were completed on each day.
On October 30, 442 tests were completed. On October 29, 254 tests were completed.
On October 28, 233 tests were completed and on October 27, 444 tests were completed.
Importantly, Harvard Global Health Institute experts have highlighted that in order to reopen an economy safely, there should be a daily minimum of 152 tests per 100,000 people.
“For The Bahamas, that equates to 600 tests per day,” former Minister of Health Dr. Duane Sands previously noted.
At a Ministry of Health press conference on October 16, health officials were asked about meeting this standard.
Deputy Chief Medical Officer Dr. Delon Brennen explained, “Testing and the testing numbers as to how many people are tested is a multifactorial issue. It is dependent on a number of things.
“As everyone knows, we have a national protocol in place when it comes to public sector testing, and we conserve our resources to make sure we will have the laboratory capacity to make sure we will be able to do this moving onwards in the future.
“And in addition, there are persons who present themselves for testing in the private sector that don’t require necessarily that same protocol, so it’s not as if all of the testing comes from one particular area, one particular approach…so one has to consider the protocol-based approach that goes out and searches out persons that need to be tested or who present to healthcare facilities to be tested and then those who are testing for work or for travel and other purposes. And so, our numbers are made up of a combination of things.”
Chief Medical Officer Dr. Pearl McMillan followed up by stating that The Bahamas was meeting the standard. In fact, she said we were “way above” the recommended 152 per 100,000.
“We would not say that we have the full capacity that’s required, but based on our protocols, and based on the numbers that I’m being provided, we are above the 152 per 100,000,” McMillan said.
In his message on Monday night, Wells said the national testing protocol has not changed.
“Our experience has been that predominantly those who are symptomatic present for testing,” he said. “Contacts of positive cases are tested only if they become symptomatic.”
Testing in the public sector has been far from robust.
In September, health officials provided data that showed Doctors Hospital Health Systems (DHHS) has been conducting the vast majority of testing in The Bahamas.
When DHHS was handling up to 1,600 or more tests per week, the public system was at its peak processing 350 tests.
This means that the vast majority of those who were being tested were individuals who had the means to pay for testing. At that time, a test cost more than $200.
Health officials have not provided recent data to show what percentage of tests are being done by private labs, but acknowledge that they (the private labs) continue to handle most of the testing.
Prime Minister Dr. Hubert Minnis skirted a question last week on whether the government is considering offering free testing for the wider population, saying Princess Margaret Hospital is already offering free testing.
The answer insulted the intelligence of the Bahamian people, as the hospital does not even test patients upon admission, which healthcare professionals have acknowledged has led to the novel coronavirus spreading throughout the facility.
Given that health officials have pointed to decreased testing demand, we asked Doctors Hospital CEO Charles Sealy what might be accounting for that.
Sealy said the shift could be because cheaper rapid antigen tests are being offered as of last week. An antigen test is $15 compared to the $130 for the RT-PCR test.
The numbers of RT-PCR tests, the gold standard of testing, are the ones added to the national count.
Positivity rate
On Monday night, Wells reported that the positivity rate over the last two weeks has declined from 32 percent to 12 percent.
“A higher percentage suggests a higher transmission of the virus. Hence, a lower percentage suggests that the rate of transmission has been reduced by nearly one third,” he said.
The World Health Organization (WHO) recommends that the positivity rate remains below five percent for at least two weeks before governments reopen their economies.
Even at 12 percent, The Bahamas was more than double what is recommended.
While Wells patted himself and the government on the back on Monday for a 12 percent positivity rate, he was out the gate too early in heralding a trend.
His ministry announced yesterday that there were 31 new cases on Monday and 140 completed tests. Using the method of calculating the positivity rate that’s being used by our officials, that’s a positivity rate of 22 percent.
Speaking with reporters yesterday, the minister insisted that the positivity rate “as of today” was still down to 12 percent. We suppose no one showed Wells the latest data released by his ministry; either that or he is living in a parallel universe.
“The reality is the spread of COVID in-country is down,” he insisted. “That is the absolute reality.”
In August, as new cases exploded in the weeks after the opening of the country’s borders, the positivity rate was consistently above 20 percent.
In a Q&A session for the Johns Hopkins Bloomberg School of Public Health, David Dowdy, an associate professor, and Gypsyamber D’Souza, a professor in epidemiology, noted the percent positive will be high if the number of positive tests is too high, or if the number of total tests is too low.
“A higher percent positive suggests higher transmission and that there are likely more people with coronavirus in the community who haven’t been tested yet,” they noted.
In a New York Times article, Ashish Jha, the director of the Harvard Global Health Institute, pointed out, “You want to drive the positive rate down, because the fundamental element of keeping our economy open is making sure you’re identifying as many infected people as possible and isolating them.”
In some places, as reported by The New York Times on Monday, concerns have arisen about the reliability of positivity rates.
“Through increased or decreased testing, or by selectively choosing who does and doesn’t get tested, this number can fluctuate sharply, giving many health experts pause as to how much it really says about infection in a specific area,” the article by Sharon Otterman and Sarah Maslin Nir observed.
Wells said on Monday a decline in the positivity rate is evidence that the restrictive measures the competent authority put in place earlier this month are paying off.
“All indicators being monitored by the Ministry of Health point to success in mitigating the spread of COVID-19,” the minister said confidently.
The minister’s boast coincided with the so-called reopening of the tourism sector with unclear and confusing protocols that do not provide cause for any confidence that our officials have implemented the safest path to re-energizing our main industry.
Health officials have also acknowledged that this reopening will lead to an increase in cases, although the tourism minister claims the government has devised a set of protocols that will ensure visitors do not place any strain on our already over-capacity healthcare system.
We should see in the coming days and weeks whether the current restrictive measures give us the kind of payout we need.
What seems clear is the minister — seemingly desperate to demonstrate sound management of the COVID-19 crisis — was premature in taking his victory lap.
For the sake of us all, we want the government to succeed in its measures to fight the virus, but clear data and steady trends are most important in pointing to where we are at.
Vacuous boasting is more a political ploy than a sound and believable report on our true state of affairs.
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source https://thenassauguardian.com/grain-of-salt/
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