Testing times – are we failing?
The common cliché about facing a twofold challenge is that it is like flying an aeroplane at the same time that you are building it.
Managing the Covid-19 crisis is the epitome of this because Bermuda's leaders have to work to contain the virus and “flatten the curve” of infections at the same time that they have to plan how to bring the island out of lockdown and back to some semblance of normality.
So far, the Government has received a fair amount of credit for the first part, which can be likened to flying the plane. And there has been some justified reluctance towards being overly critical of the Government's performance since this is, after all, uncharted territory and few people would want to be in the hot seat right now.
But the answer to the second part — the building of the plane or reopening of the community — lies in testing. And here the Government is not being entirely forthright.
To be fair, the Bermuda Government is hardly alone in its lack of preparedness for the Covid-19 outbreak, and little Bermuda is pretty far down the pecking order when it comes to getting hold of test kits, supplies and personal protective equipment.
But the reality is that, despite the announcement yesterday of the shelter-in-place regulations being extended to May 2, Bermuda cannot stay in lockdown for ever.
Absent a vaccine, which is months or years away — if one can ever be developed at all — the only way for Bermuda to start to come out of the lockdown or even to know precisely where the island stands, is to test.
In the first instance, people with likely Covid-19 symptoms and those they have been in close contact with need to be tested.
Second, and very nearly as urgently, frontline health workers and staff and residents of nursing homes need to be tested. There may be 1,000 people or more in this group. That will ensure that frontline medical care can take place and that the areas most at risk of infection — nursing homes — have been vetted and anyone confirmed with the virus has been isolated.
Then the arduous task of testing the general population needs to begin.
To date, 453 people have been tested in Bermuda. Since last Wednesday, the number of tests jumped to 50 per day, which the Premier has described as “aggressive”. Bermuda has a population of about 65,000 people.
If this “aggressive” rate of testing continues five days a week every week — we don't seem to test on weekends, or at least not on Easter weekend — it will take 260 weeks, or more than five years, to test every resident.
If we test seven days a week at this rate, it will take 185 weeks or 3½ years.
David Burt has said he hopes to reach the target of 500 tests a week, which, while better than 250 or so a week, still means Bermuda will take months to capture much of the populace.
Clearly, it is not necessary to test every single person, and over time the availability of testing kits and additional materials such as swabs will increase. But to test half the population will still take months, if not the best part of a year.
Why does this matter? People will not return to work or school, to shop, travel or to play sport unless they feel reasonably safe in the knowledge that they will not be encountering people who are infected.
Bermuda cannot return to normal until a reasonable level of personal health is established.
Bermuda cannot wait months or more for this to happen. The only way to establish that level of safety is to test more, both with the tests being carried out at present and with the antibody tests that show a person has a reasonable level of immunity.
Right now, Bermuda is not carrying out aggressive testing. On a worldwide scale, it ranks approximately 50th in testing per 100,000 people. However, Bermuda ranks thirteenth in the world for mortality rates with 7.5 deaths per 100,000 people. That is higher than the United States, and higher than Iran.
Certainly, because of the small size of Bermuda's population, these rates can be misleading — one death can skew them.
When Bermuda had recorded four deaths, it was approximately 20th and just below the US.
Nonetheless, the numbers show that Bermuda has a deadly serious problem. The causes are fairly clear: many of the initial cases were imported from the New York area and Britain on flights, and these are two of the worst-impacted places in the world.
Bermuda also has an ageing population replete with people with the chronic diseases that make them most vulnerable to Covid-19.
Our susceptibility to the disease is therefore understandable. It is easy with hindsight to say Bermuda should have been better prepared and should have been scouring the world for test kits and PPE. The Government can be criticised for not doing more sooner.
But the Government was not alone in this, and can be said to be doing better than the Trump Administration, although that is about as low as a bar can get without having it lying on the ground.
The prevailing question is: what to do now?
The first step is to admit we are not testing enough, rather than claiming Bermuda is aggressively testing.
The second step is to do something about it: to redouble our efforts to get testing kits, to tap every millionaire and top businessman to use their resources and contacts to find the kits we need and to get them here.
This is urgent. We cannot afford to extend the lockdown for months on end. Bermuda needs to know that there is an end in sight.
Leaving aside for a moment the foolishness of some people and the pettiness of others, most people appear to have abided by the lockdown and, therefore, we can assume it has had some impact on reducing the spread of the virus.
The two-week extension hopefully will have a further impact, but it is probably too soon to know for sure if the curve is flattening.
But that is only one phase in this campaign.
The next phase is to start to reopen the island without having to revert to another lockdown later. That can be done only with much more aggressive testing than 50 people a day.
Iceland has tested 36,000 people, or the equivalent of 10,000 out of every 100,000. Gibraltar, which is smaller than Bermuda with a 33,000 population, has tested 1,649 or the equivalent of 4,900 per 100,000. The Isle of Man has tested 2,085, the equivalent of 2,400 per 100,000.
Bermuda has tested 453 people, the equivalent of about 700 per 100,000.
It is not good enough. We have to do better and quickly.
There will be those who will criticise this newspaper for being too disparaging. They will say that this is unnecessarily divisive and that the Government is doing the best it can in dealing with an unprecedented crisis for which there is no set playbook.
Some of that may be true. But there are other countries that are managing it better than we are, and we need to learn from them and apply their lessons as quickly as we can.
Lives depend on it, and this newspaper will not shy away from its responsibility to say so.