By Jacqueline Charles
The deadly novel coronavirus is so prevalent in Haiti, where a fever has been raging for weeks, that a top authority on public health is now saying there’s no need to test anymore to declare that someone is infected.
That assessment is stirring debate in medical circles where some agree that providing symptom-based care is the way to go given the extent of the transmission, and others argue Haiti needs to ramp up testing to contain the spread.
The controversial view also has raised questions about whether Haiti, which has been struggling to manage COVID-19, is becoming so overwhelmed with the rapidly accelerating number of cases that it’s now taking a markedly different approach to the coronavirus than its neighbors and the World Health Organization’s “test every suspected case” directive to contain the spread of transmission.
Since Haiti confirmed its first two infections on March 19, the number of laboratory confirmed cases have spiked to 3,334 with 51 deaths in the population of nearly of 11 million. The country, however, has only tested 7,351 suspected cases — far less than the 94,000 performed in the neighboring Dominican Republic where there are 19,600 confirmed cases and 538 deaths in a population of roughly the same size. Both countries share the island of Hispaniola.
All patients presenting with symptoms here have over 80 percent probability to have it,” Dr. Jean William “Bill” Pape, co-president of Haiti’s presidential response commission told the Miami Herald. “Almost all patients with [symptoms] of COVID-19 test positive. Hence no real need to perform the test.”
Pape’s argument is based on his analysis, he said, of cases in the Port-au-Prince metropolitan region. The epicenter of the pandemic in Haiti, the capital region has 80 percent of the confirmed infections. Port-au-Prince is also where Haiti’s only two COVID-19 testing laboratories, GHESKIO, run by Pape, and the other by the government, are located.
A trailblazer in the fight against HIV/AIDS treatment in Haiti, Pape said he’s applying his past experience as a clinician treating acquired immune deficiency syndrome, to his approach with COVID-19, which is caused by the SARS-CoV-2a virus and can trigger mild to deadly respiratory tract infections. He was treating HIV positive Haitians at his GHESKIO research and health center for two to three years before a reliable test was available using, he said, just a clinical diagnosis.
Currently, he is treating 31 patients, including six physicians, who have COVID-19. With the exception of two who needed to be hospitalized for low oxygen saturation, all are being treated at home, said Pape, who on Sunday almost lost his downtown GHESKIO site to a raging fire.
“They all are able to monitor their oxygen saturation at home and we are expanding this technology in slums with community health agents. Hence it is necessary to expand a clinical definition of COVID-19,” he said. “It makes it possible to account for them and provide proper care to them. This is the case for all epidemics.”
Pape’s focus on curing patients rather than trying to find where they are to manage the course of the epidemic, has some fellow physicians and public health specialist wondering if Haiti is throwing in the towel because it cannot meet the growing testing demand as infections surge.
Last month, Pape’s co-president on the commission, Dr. Lauré Adrien, who also is executive director of the Ministry of Public Health and Population, ignited controversy when he told Haitians that there is no “fever epidemic” spreading in the country. There is only COVID-19, Adrien said, and the high body temperatures Haitians are seeing should be automatically linked to the disease.
“They have lost control of the disease,” said Dr. Junot Félix, who runs a health consulting firm in Port-au-Prince and is a critic of the government’s response. “There is no other way to manage an epidemic than to test the people so that you can follow the virus…isolate them and trace and test their contacts.”
He called Pape’s clinical approach, and the declaration by Adrien that all fevers are linked to COVID-19, as “not making any sense.”
“You can’t say someone has a fever and you give them medicine and don’t test them,” Félix said. ”The first thing you need to fight an epidemic is information…How are you going to manage an epidemic if you do know where the sick people are and how it’s moving?”
On Friday, the head of the government’s water agency, who had tested positive for the disease, revealed in a radio interview that after months of saying patients needed to test negative to be cleared, the health ministry had changed its protocol, according to his doctor. Patients can now resume normal activities after eight days with no symptoms, Guito Edouard said he was told.
Neither Adrien nor a ministry spokesperson responded to a Herald inquiry seeking confirmation of the change. Two members of the scientific cell advising the government’s response, said they are working on a recommendation to clear patients without a second test — which is still being done elsewhere in the Caribbean — based on studies on when someone is no longer considered contagious. The members acknowledged that Haiti, which has only managed to acquire 19,500 diagnostic tests so far, also does not have enough tests.
Alarming spike in COVID-19 cases
Haiti is still in the early stages of the pandemic, which experts say could peak this summer.
But in just one month, the number of Haitians testing positive for the coronavirus has dramatically increased from 100 cases and 11 deaths on May 4, to 2,924 confirmed cases and 50 deaths a month later, on June 4.
The medical aid group, Doctors Without Borders /Medecins Sans Frontieres, said while the rise is alarming, the real infection numbers are most likely higher. Official statistics, for example, aren’t capturing those dying undiagnosed for the virus or whose deaths in rural and slum communities, after experiencing COVID-19 symptoms,are going unreported. Continue reading