No rush for return to normalcy
David Burt has stated that the Covid-19 lockdown is unlikely to extend beyond May 2. The Cabinet is to meet today to discuss which restrictions will be relaxed and which will remain in place.
While many will be relieved that the four-week shelter-in-place is beginning to come to an end, no one should assume that this signals a return to life as it was before the Covid-19 outbreak, or even something close to it.
Great care needs to be taken with relaxation of the rules. At best this signals the end of the beginning of the crisis, not the end of the crisis itself.
Indeed, with the number of confirmed positive tests at 110 as of yesterday and with one further death announced on Sunday, it is fair to ask whether this is the right time to lift the lockdown at all or whether this will cause a further spike in cases.
No one really knows how the virus will spread once shelter-at-home rules are eased and members of the public increase their social interactions.
While some countries such as South Korea and Taiwan have been able to ease restrictions without seeing a spike in cases, others such as Singapore have been less successful. Other countries like New Zealand and Australia have restricted cases and deaths to a remarkable extent through vigorous and long-term lockdown approaches.
So two questions need to be asked now:
• Has Bermuda flattened the curve sufficiently to consider relaxing the lockdown?
• If so, what restrictions can be eased and what can we learn from other countries about best practices?
So far, it appears that community-wide transmission is not occurring. This is of no solace to nursing home residents and their families or to employees of homes where, as the Premier has understated: “mistakes were made”. But, despite the tragic losses in the homes, there does not appear to be wider or less predictable transmissions.
Nor did Bermuda record any deaths between April 13 and Sunday. However, is not entirely clear if all people who have died under apparently normal circumstances since then have been tested for Covid-19 or if the virus exacerbated an existing condition. And with people in intensive care now, there is no certainty about whether the mortality rate is slowing. This is especially so given the risk of further cases in nursing homes.
The truth is that no one knows how widespread the virus is until wider testing takes place. In the meantime, Bermuda, from the Government down, is relying on fragments of information, including the frankly terrifying modelling that has been carried out.
The other factor weighing on the Cabinet’s minds, like other world leaders, is how long Bermuda can sustain itself while in lockdown. This is not just an economic question, although the economy is a critical part of it.
It also concerns when and if children can safely return to school, when and if elective surgeries in the hospital can resume, when basic human contact in everything from sport clubs to restaurants to churches to private homes can begin again, even in limited ways.
But the economy does matter as well. Labour minister Lovitta Foggo has stated that the Government has paid out about $10 million to 7,500 people claiming the Covid-19 unemployment benefit.
This demonstrates the gravity of the problem. First, it suggests that at least 20 per cent of the working population is now jobless, which must be a record for Bermuda. It is simply not sustainable, even with the unemployment benefit for people to meet their obligations and support their families at this level of unemployment.
Nor it is sustainable for the Government. It has rightly introduced the unemployment benefit, but its ability to meet this obligation for more than a couple of months is doubtful. Further, this does not count the almost certain drop in tax revenue for everything from tourism to company fees.
So despite the risks, Bermuda has to begin to ease restrictions to avoid economic disaster. But this needs to take place in a carefully monitored and managed approach.
It’s worth looking at what countries such as Taiwan or South Korea have done to see what practices Bermuda should adopt.
First, they embarked on early and aggressive testing and particularly targeted arriving passengers, along with strict quarantine requirements for new arrivals.
That did not mean that travel was entirely banned, at least at the outset, but that all visitors were treated as posing a risk. Many of them have also introduced techniques that some may find overly invasive. For example, arriving passengers must turn over their mobile phones on arrival. A tracking device is inserted and the arriving passengers can then be tracked to ensure they are adhering to the mandatory 14-day curfew.
Other measures include mandatory temperature tests at most entry points to public places and mandatory social-distancing in restaurants and other public gathering places.
As a result of measures like these, Taiwan never implemented a lockdown and while life in that country of 19 million is not normal, it is much more normal than most countries.
Neither South Korea nor Taiwan have tested as many people on a per capita basis as Bermuda, even with its fairly belated testing regime, yet neither country has experienced the level of mortalities on a per capital basis that Bermuda has.
Indeed, Taiwan has recorded a mere six deaths from some 400 cases. Bermuda has recorded six from 110 confirmed cases. Taiwan, next door to China, has 19 million people. Bermuda, on the other side of the world, has 65,000.
To be fair, Asian countries such as Taiwan, South Korea, Hong Kong and Singapore, which generally get credited for good management of coronavirus, did not handle previous virus crises like Sars as well, and they learnt from their mistakes.
Because Bermuda did not carry out aggressive testing of arriving passengers early, it must now test more to cover community transmissions.
After a slow start, Bermuda now seems to be testing at a rate of about 60 to 100 people a day and this will no doubt increase as the drive-through centre at Southside gets into full swing.
Testing is finally moving from those showing symptoms or who have been in close contact with people with the virus to emergency and essential workers and residents of what are clearly the most vulnerable places — nursing homes.
Prisons must be next.
At this point, testing should begin to be extended to the general population and asymptomatic persons. Only then can health authorities get a real picture of how many people, in fact, have the virus, and therefore what the infection spread is and what the risks are, with all of the caveats that come with that.
With hardware stores, plant nurseries and pet stores now offering limited services, national security minister Wayne Caines has also said office supply companies will be next. Consideration should be given to restaurant delivery services to open — although it is too soon for kerbside collections since the idea is to encourage people to continue to remain within their own homes and to practise social-distancing. Deliveries should also be carried out with minimal contact and prepayment.
Procurement and implementation of temperature testing at shops and offices is also essential.
It seems unlikely that certain parts of society will be able to reopen soon. If and when scheduled air travel to the island resumes, tourists will be unlikely to willingly undergo 14-day mandatory quarantine. Equally, based on medical advice now, it is hard to see schools reopening in the near future.
Many of these types of activities will require reliable antibody testing, which remains questionable — a recent US study showed that only three of 14 antibody tests were reliable — or better yet a reliable treatment, which may not come for months. Of course a vaccine is the best course, but there is no indication yet that one is even on the horizon.
None of this is very good news for Bermuda. The only real way forward is to move cautiously, to expect mistakes and to learn from them, and, above all, to be patient. There will be competition now, and frustration, to reopen services as other countries on different places on the virus-fighting scale do so.
Bermuda should not treat this as a race. Countries that were slow to introduce social-distancing have paid the highest price. Now the countries that try to reopen too fast may well do the same.
Bermuda, having learnt some hard lessons over failing to test early enough, should not be among those who pay for being too eager to return to normal.
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