SVG’s local COVID-19 cases traced to asymptomatic person

The five cases of local transmission of COVID-19 in St. Vincent and the Grenadines were traced back to an asymptomatic person, Medical Officer of Health Dr. Roger Duncan said on VC3 on Wednesday. 

“Well, the relationship is by contact,” Duncan said in response to a question from the host regarding the link between the patients.

“So all these people were in contact with each other or some people in that group at some point in time,” he said.

Health officials identified a “cluster” of local transmission after Case #13, who had no recent travel history, tested positive for the disease.

A further four persons tested positive in the community, which health officials have not identified by name, but which both government and opposition politicians say is the South Central Windward community of Greiggs.

Speaking on the programme, Chief Medical Officer, Dr. Simone-Keizer Beache said that health officials have completed their contact tracing in the community, as all of the recent tests have been negative.

Duncan said that his team, however, remains alert.

Duncan, who is responsible for contact tracing in relation to COVID-19, said that when Case #13 emerged there were some difficulties in establishing the source of the infection.

“… because this is somebody who had no travel history who had not been anywhere, who had not been involved in anything that we thought would have been high-risk for exposure.

“And that’s where it became a little challenging for us because we now had to go back to look backwards. And you have to look as far back as you could go to calculate dates.

“If you know what the incubation period is, you could begin to determine possible points of exposure, type of exposure. And we go back and when we went back, we were able to trace that person to somebody who had come into the country, who we have now determined was COVID positive at some point because they had antibodies.”

Duncan said that from there, health officials “went along the contact tracing route, looking for all these contacts and looking for what we could find.

“It’s hard work; it’s a little painstaking and it’s not something that is easy to speak about publicly, or we ought to speak about publicly.”

Duncan said he has spoken against stigmatisation and discrimination of persons in relation to COVID-19.

“And so many conversations I’m hearing is sort of disturbing, especially from — not so much the content of the conversation, but to some extent who the people who actually having these conversations are people who I think should know better, who probably should be a little bit more tolerant, understand, a little more emphatic. It’s really worried to me that we are that level of people with like this kind of empathy.”

He said that while it was hard work, his team completed the contact tracing.

“We took our time; we did it. And everybody involved in this from case 13 to 17 were extremely cooperative, extremely helpful. They shared with us; they explained to us; they showed us; they pointed out to us; they did everything that we expected of them. So we’ve been able to link all these cases to one particular source. And again, this was an asymptomatic person, who was just there.”

Duncan said he is not a big fan of the expression “asymptomatic”.

“I think at some point there are some people who are pre-symptomatic… You have not yet developed symptoms; could very well be.”

He said that in some of the contact tracing, he has discovered “that if you were to sit with them a little while longer, they will remember, ‘Well, I had a slight cough, but it only lasted half of the day. And I did feel chilly. I thought I had a fever.’”

He, however, warned that there is a risk of recall bias “because if you start to probe them, people would think things — that they’ve had it”.

Duncan, however, said:

“But there’s that very mild symptom that you have, you might ignore the people who are actually pre symptomatic. So it’s the point where you are not symptomatic yet.

“But there are, indeed, asymptomatic people who are shedding virus and the critical thing here is that because they’re shedding virus and have no signs and symptoms they are not really suspect, so they could gladly go around and they could, infect, Jean, and Mary and Tom and Mary, Tom and Jane gone to further infect three more people each and so forth…

“And then if all these people remain asymptomatic then that’s really where the problem is. And that is why the message for us still remains the same. Wash your hands, keep your hands clean, keep your hands out of your face as much as you could. Good respiratory hygiene and good respiratory etiquette.”

Duncan said he was “pretty much convinced” that most of the local transmission “had to do mostly with hand hygiene rather than respiratory spread…

“The evidence is not conclusive. I’m not saying this is exactly what happened. But that’s my view, based on the limited information we have now,” he said.

Speaking about the mechanism put in place in the community to prevent further spread of the infection, Duncan said:

“Well, I think if you were to judge from what we’ve been doing thus far, we’ve never been bringing out any big stick and beating anybody…”

He said that his team has been trying its best to have dialogue with residents.

“And the dialogue has been taking place with families and groups of people. And the whole idea is how could we look out for each other? How could one person in the home make a difference?  If we say when you come home, make sure you wash your hands, if you’re going out, you make sure you wash your hands, if you’re ill let us know and so you can stay away from us.”

On the other hand, the ministry has been conducting tests for the illness.

“… we’ve also been testing; we’ve been looking … we’ve been using rapid tests, we’ve been using them and we’ve been looking for people.”

Duncan said that health care workers have been really active.

“And it doesn’t matter the size of the community, the healthcare staff in that community. We’ve moved in other healthcare workers even for a period of time to add more feet on the ground, put more hands on the depth, and try and see how much more we can get done,” he said.

Meanwhile, Keizer-Beache said that the testing regime in the community in which the cluster emerged has been completed.

She said that Duncan is a very good contact tracer and he and his team have followed all the leads.

“And we have gotten to the point where all of the tests have been negative,” the chief medical officer said. “So when you get to that sort of place where you no longer getting any positive tests coming back, that’s when you know you have exhausted that and we think we have definitely tracked everybody and we’re now thinking that that is contained.”

Duncan added: “We are still alert though. Pipelines are still open, conversations are still being held.”