The sister organization of Boston-based Partners In Health in Haiti says it will begin using rapid tests to screen for the coronavirus in the Caribbean nation in hopes of being able to more quickly identify hotspots and determine who in the population may need to be isolated.
Zanmi Lasante says the group’s decision comes after “much consideration” and after weeks of waiting, to no avail, on the Ministry of Public Health and Population. It had asked health officials for authorization to use a 15-minute rapid test that can detect antibodies in the blood to confirm current or past exposure to COVID-19, the infection caused by the coronavirus.
“We have a moral obligation to battle this virus and do the best that we can for the people of Haiti,” said Elizabeth Campa, senior health and policy adviser for Zanmi Lasante. “As such, we will begin using the rapid test as a screening mechanism at our health facilities and at the border.”
On Monday, Haitian health officials reported that they now have 24 confirmed cases of the respiratory disease and said the country’s first death, a 55-year-old man with no travel history and underlying health issues was confirmation of community transmission. Globally the disease has infected nearly 1.3 million, killed 70,000 people and sent billions to shutter themselves at home.
Compared to the neighboring Dominican Republic, which has tested more than 4,000 people and registered 1,488 positive COVID-19 cases and 68 deaths, Haiti has only administered 257 tests. The issue of testing has led for calls for the ministry to much more quickly identify people who have the flu-like virus.
This is not the first time that Zanmi Lasante, which runs the 320-bed University Hospital in Mirebalais under the guidance of renowned medical anthropologist and infectious disease expert Dr. Paul Farmer, has been willing to go out on a limb in the name of the Haitian population during its 30-year-plus existence.
Similar decisions about screenings and treatment were made by the nonprofit healthcare provider in the ‘80s and ‘90s in regard to HIV/AIDS and tuberculosis, and in the past decade in response to the cholera epidemic after the 2010 Haiti earthquake.
The University Hospital in Mirebalais is one of the few health facilities in Haiti currently equipped to care for patients sickened by the coronavirus, and received Haiti’s first two positive COVID-19 patients, both of whom have since recovered. It also runs other healthcare facilities and works on the Haiti-Dominican border, where thousands of Haitians have crossed unchecked since both nations closed the border last month to prevent the spread of COVID-19.
Campa said Zanmi Lasante is aware that “the gold standard” remains the polymerase chain reaction, or PCR test, which is more accurate but much slower and can take days to get results. Any positive cases found through the 15-minute rapid test will then be transferred over for PCR testing, she said.
Doctors divided about benefits of rapid testing
The use of rapid testing in the battle to stop the spread of COVID-19 remains a divisive one among clinicians and public health specialists. During Monday’s coronavirus briefing in Port-au-Prince, Dr. Patrick Dely, who is responsible for the ministry’s epidemiology and laboratory section, addressed the rapid testing debate.
“Every country adopts measures that goes with their reality; their means and the resources they have, ” Dely said. “Your response cannot be based on what you see others are doing.”
Dely said there are three types of tests that can be done to detect the coronavirus. But given the studies on both the rapid antibody and antigen tests, the country runs the risk of missing 40 percent of positive cases with a false negative result. Haiti, he said, has chosen to go the more accurate route of the polymerase chain reaction, which only its National Laboratory is currently entrusted to do. The lab he said, has the capacity to run about 800 tests a day.
Not everyone agrees with this direction. Reginald Boulos, a Haitian businessman and physician with a master’s in public health, said given the reality of the country and the ministry’s own admission that Haiti now has community transmission, “it’s unrealistic to think that we can continue to do” the PCR tests
The country, he said, needs to employ the South Korea model, where face masks in public are mandatory and the crisis is being managed by “testing, testing testing” with a rapid antigen test. Unlike the antibody tests Zanmi Lasante plans to use to show the prevalence of the disease in communities, Boulos believes the antigen test provides more accuracy.
“We need to change approach; coronavirus cannot be a clinical approach and this is what we’re doing right now. We need a public health approach in Haiti; not just a clinician to have a nice laboratory being able to do 200 tests after three weeks. What does that say for a country with 10 million people?” Boulos said. “We are not testing the country. We aren’t really testing the people who we should be testing. People don’t even know where to go and get tested.”
More testing coming in Haiti
Boulos said the Association of Automotive Importers recently donated $80,000 to expand testing in Haiti and increase the number of beds for COVID-19 patients. The donation went to GHESKIO, a research, treatment and training facility in Port-au-Prince, which had been seeking $200,000 for its COVID-19 response.
“We made one condition: to increase the 1,000 tests to 2,500 and [Dr. William Pape] has agreed to that,” GHESKIO said.
Pape, the founder of GHESKIO, confirmed the donation, which he said will not go toward the purchase of rapid tests but the more accurate PCR tests.
The rapid test “is a catastrophe,” said Pape, who is a member of the scientific committee put in place by Haitian President Jovenel Moïse on the country’s COVID-19 response.
“If they were used, we would hospitalize many patients who do not need to occupy unnecessary beds. At the same time, we would tell people who are infected that they are not and they would go around infecting others.” Pape said. “The PCR test we are using is very accurate.”
Pape said the ministry of health is right to follow the WHO/PAHO recommendations to only test people documented by a trained epidemiologist to have signs and symptoms of COVID-19.
“The nurse performing the test is highly exposed and must be properly protected, trained and certified. This is the best strategy when you have limited testing kits,” he said.
The Ministry of Health, Pape said, has ordered more test kits but they are not available for sale outside the U.S. Kits approved by the Food and Drug Administration have been ordered from South Korea, but the real issue is that test kits are sold separately from extraction agents, which are essential to conduct the test. There is a global shortage of extraction agents.
In addition to the donation by the Haitian private sector, Pape said the dean of Weill Cornell Medicine in New York “has graciously collected for us all extraction agents from their research labs” as well as personal protective equipment for healthcare workers.
“This should all arrive early this week to increase tremendously our capacity to perform tests in Haiti,” he said. “Many more testing sites are being set up.” (https://www.miamiherald.com/news/nation-world/world/americas/haiti/article241797766.html
