A couple of youths wearing masks to protect against the spread of the new coronavirus walk in the streets of Port-au-Prince, Haiti, on Monday, March 23, 2020. Dieu Nalio Chery AP
This is not the first time that Zanmi Lasante, which runs the 320-bed University Hospital in Mirebalais under the guidance of renowned medical anthropologist and infectious disease expert Dr. Paul Farmer, has been willing to go out on a limb in the name of the Haitian population during its 30-year-plus existence.
Similar decisions about screenings and treatment were made by the nonprofit healthcare provider in the ‘80s and ‘90s in regard to HIV/AIDS and tuberculosis, and in the past decade in response to the cholera epidemic after the 2010 Haiti earthquake.
The University Hospital in Mirebalais is one of the few health facilities in Haiti currently equipped to care for patients sickened by the coronavirus, and received Haiti’s first two positive COVID-19 patients, both of whom have since recovered. It also runs other healthcare facilities and works on the Haiti-Dominican border, where thousands of Haitians have crossed unchecked since both nations closed the border last month to prevent the spread of COVID-19.
Campa said Zanmi Lasante is aware that “the gold standard” remains the polymerase chain reaction, or PCR test, which is more accurate but much slower and can take days to get results. Any positive cases found through the 15-minute rapid test will then be transferred over for PCR testing, she said.
DOCTORS DIVIDED ABOUT BENEFITS OF RAPID TESTING
The use of rapid testing in the battle to stop the spread of COVID-19 remains a divisive one among clinicians and public health specialists. During Monday’s coronavirus briefing in Port-au-Prince, Dr. Patrick Dely, who is responsible for the ministry’s epidemiology and laboratory section, addressed the rapid testing debate.
“Every country adopts measures that goes with their reality; their means and the resources they have, ” Dely said. “Your response cannot be based on what you see others are doing.”
Dely said there are three types of tests that can be done to detect the coronavirus. But given the studies on both the rapid antibody and antigen tests, the country runs the risk of missing 40 percent of positive cases with a false negative result. Haiti, he said, has chosen to go the more accurate route of the polymerase chain reaction, which only its National Laboratory is currently entrusted to do. The lab he said, has the capacity to run about 800 tests a day.
Not everyone agrees with this direction. Reginald Boulos, a Haitian businessman and physician with a master’s in public health, said given the reality of the country and the ministry’s own admission that Haiti now has community transmission, “it’s unrealistic to think that we can continue to do” the PCR tests
The country, he said, needs to employ the South Korea model, where face masks in public are mandatory and the crisis is being managed by “testing, testing testing” with a rapid antigen test. Unlike the antibody tests Zanmi Lasante plans to use to show the prevalence of the disease in communities, Boulos believes the antigen test provides more accuracy.
“We need to change approach; coronavirus cannot be a clinical approach and this is what we’re doing right now. We need a public health approach in Haiti; not just a clinician to have a nice laboratory being able to do 200 tests after three weeks. What does that say for a country with 10 million people?” Boulos said. “We are not testing the country. We aren’t really testing the people who we should be testing. People don’t even know where to go and get tested.”