On COVID-19 tests and quarantine: those rapid tests won’t cut it

By Phillip C. Jackson ([email protected])

After days of searching I finally found online what one can discern the much-touted government-issued protocols for the repatriation of sailors stranded on cruise ships to their country, St. Vincent and the Grenadines. These protocols are expected to be met by cruise companies in the repatriation of Vincentian workers on their ships. Here is the list or steps:

1. the total number of persons to be repatriated;
2. the mode of arrival (air or sea);
3. the full name, date of birth, passport number, contact number and address in departing country;
4. a certificate of health issued by national health authority of the country of departure — including details of current health status, their exposure to any COVID19 positive or suspected cases, any objective screening for COVID19 — the name, the date and the facility;
5. address of the proposed site of 14 to 21 days of quarantine;
6. the contact number of persons residing where the person proposes to stay in SVG or who can facilitate inspection of proposed quarantine site;
7. commitment of repatriating company or individual to pay for the accommodation of those persons without an appropriate quarantine site and the repatriating company to secure an alternate site approved by the ministry of Health, Wellness and the Environment.
8. Protocols have also been established for the disembarkment of repatriated individuals depending on their mode of arrival into St Vincent and the Grenadines.

The two most important protocols related to the safe and responsible repatriation of our sailors are numbers 4 and 7. Protocol 4 requires an independently verified screening for COVID-19, namely, the gold standard PCR test for the viral agent (SARS-CoV-2).

Now assuming a sailor found to be NEGATIVE follow stipulated distancing and quarantining procedures implemented by ship during his/her transit, then two main things follow:

1. It can be safely assumed that the individual is NOT SICK with COVID-19 and
2. Such an individual would not, classically require further quarantining, or worse, centralised managed quarantine on arrival in his home country. But government may for whatever reason demand such.

These two implications of the results of testing have further implications on mode of quarantine and RESPONSIBILITY for costs related to the quarantine process.

As a general rule, a country is responsible for the quarantine process as a matter of urgent national health security during a pandemic. However, in this specific case the following should apply.

IF a sailor is tested NEGATIVE THEN he/she IS NOT SICK with COVID-19. Therefore, their QUARANTINE and any related medical expenses in their home county under existing rules and conventions CANNOT be the responsibility of their EMPLOYER (the cruise company).

If in the case of negative-tested sailors, the government still insists on centralised quarantine or any other mode of quarantine, this cost should be borne by the government or the sailors, if they agree.

In the contrary scenario:

IF a sailor is tested POSITIVE, even if he/she is asymptomatic, THEN he/she is considered SICK with COVID-19.  Such an individual SHOULD be QUARANTINED and ISOLATED. In this case their quarantine and any related medical expenses in their home county under existing rules and conventions SHOULD be the responsibility of their EMPLOYER (the cruise company).

It would be a grave error in logic, medical science and negotiations to not proceed with the stated protocols in a dichotomous manner, especially relating to STEP or Protocols 4 and 7. I dealt with this matter on a Facebook post on May 4, 2020. The reader may consult this (see below) for a deeper perspective.

Following the official pronouncements over the past weeks, it appears that the Government of St. Vincent and the Grenadines (GOSVG) did not properly make a distinction in mode of quarantine and responsibility for quarantine costs contingent on the results of Step/Protocol 4 i.e. test for Sars-CoV-2 virus. If that contingent distinction was made and the differential treatment of the issue published, then I would be very happy to update this note.

What I do know is that a newspaper article of May 12, 2020 speaks of a very recent legal opinion on the repatriation and quarantine issue, produced by the Office of the Attorney General. The article stated that the legal brief was dated April 2020, with no specific mention of the exact date.

The brief contains language that seems to contemplate differential mode of quarantine and related cost contingent of the PCR test for the COVID-19 virus. See excerpts below:

“Where Vincentian nationals contract COVID-19 on board a vessel, therefore, they have contracted it as a result of their employment, and the ship owner is inescapably liable and must provide medical care and lodging,” it said.”

“It also noted that because no one knows which seafarers are sick or not, ship owners must administer COVID-19 tests.”

This new language rightfully contemplates a necessary relation between Step/Protocol 4 (Testing) and Step 7 (Mode and responsibility for quarantine) and seems to suggest a dichotomous and subordinating relationship leading to differential treatment like I suggested above.

It is unfortunate that such a crucial clarification came so very late in the public discussion and debate. The lack of sufficient clarity on the matter has led to a lot of public confusion and debate. This is a natural outcome of the failure of the authorities to properly explain and rationalise the so-called 8-point protocols including the relationship among and between each one especially numbers 4 and 7.

As it seems, in the case of the cruise ship landed on May 9, the GoSVG has settled for an updated testing regime using rapid test for antibodies rather than the actual PCR tests for the actual virus. This is at best a makeshift adaptation that MUST be addressed soonest.

A rapid test as a sufficient basis for decision-making on mode of quarantine is problematic. While a positive rapid test (assuming accuracy) suggests that a person was previously exposed to the virus and has since developed antibodies; a negative test tells us absolutely nothing about the person’s virus status. An individual tested negative for the antibody using the rapid test kit may actually be positive for the virus through a recent infection, yet these persons are allowed to go to their homes for quarantine. We must arrest this situation immediately. The implication of this is that all sailors who went home on basis of the negative rapid test result SHOULD stay home and follow the guidelines. I strongly encourage you sailors to please do this properly and faithfully.

It is in the interest of the ship owners to get the PCR test done as it not only allows our medical personnel to get proper actionable evidence, but to the matter of responsibility for quarantine and other related expenses, it allows them an objective basis for that negotiation.

At any rate, this interim protocol using rapid tests should only be used as a very last resort. I call on cruise companies and the GoSVG to do all in their powers to ensure the PCR test is done prior to the next landings.

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