DR CURVIN J FERREIRA, CMO – The war on the Coronavirus crisis is not over…

Dr Ferreira is the Acting Chief Medical Officer.  Better known in his substantive post as a specialist Gynaecologist Obstetrician at the Dominica/China Friendship Hospital – formerly the Princess Margaret Hospital and of course in his private clinic, Dr Ferreira, British Trained Obstetrician, takes this interview in his capacity as Dominica’s Chief Medical Officer – Acting.

If there was any doubt that his passion lies in Gynaecology and Obstetrics, one only needs to look at the sea of photographs of babies and children which covered an entire wall in his office.  When asked whether those were photos of children he had delivered he quipped “some”.

A calm and measured approach….our reporter said that she felt inspired by Dr Ferreira’s compassion and commitment to eliminate the Coronavirus in Dominica.

Modest and unassuming Dr Ferreira made it clear from the outset that the planning, approach and decision making was not just the Ministry of Health & Wellness (the Health Team) but a multi-disciplinary team and that at the head of that team was the Prime Minister.

“He chaired every meeting and he listened attentively to and accepted advice from his Health Team and provided the full support and interventions needed to put in place a robust plan of action designed to eliminate COVID from Dominica”.

Dr Ferreira was especially impressed with the input from the PM and Cabinet and stated “to me this is exemplary leadership.  We (the Health Team) always felt that we had the full backing of the government.  The PM especially”.

When asked about the success of the government’s approach to the COVID pandemic Dr Ferreira’s view is that one must exercise caution since, in his opinion, “we are in the eye of the storm”.

“I would hesitate to say we have been successful since as we have seen most nations who claimed success with COVID have, within a short time, had to deal with COVID coming back with a vengeance and bringing them to their knees”.

Asked to give a general overview of the approach and/or protocols adopted by the Ministry of Health and Wellness in dealing with this pandemic  Dr Ferreira stated, “we realised and decided very quickly that it was essential for us to test persons showing symptoms and to take steps to isolate those persons without delay. We also knew that contact tracing was very important and that in addition to dealing urgently with persons showing symptoms was just as important to deal with contact tracing as a matter of urgency and that is exactly what we did.  Persons were tested based on their symptoms”.

He pointed out that several persons not displaying the standard symptoms (fever, dry cough and respiratory issues) were tested, including one person with loss of sense of smell which is not a common symptom of COVID 19.

“We then set about tracing persons who had been in contact with persons who tested positive as well as contacts of those contacts. In other words, our search was not just for persons that had come into contact with the person who tested positive for COVID, but also the persons who had come into contact with those persons”, Dr Ferreira explained.

Ferreira confirmed that some 400 COVID tests have been carried out to date. He equated that to approximately 0.75% of the population of Dominica and stated, “out of that we got 16 positive cases”.

He explained that equally as important, was the need to ensure that effective protocols and arrangements were in place to quarantine or to isolate people who tested positive and those who had come into contact and especially those who had recently arrived in Dominica.

From Dr Ferreira’s point of view, intrinsic to the success of Dominica’s handling of COVID19, were the front liners – doctors, nurses, the police, the fire service, healthcare workers across all disciplines – from the cleaners and ward aides, the staff at the Health Centres. He stressed that without this multi-disciplinary team, the results achieved to date may not have been so efficient and effective.

The Chief Medical Officer spoke about the facilities in Portsmouth –  one used to isolate persons who have tested positive for the COVID virus and the other is the quarantine area which he explained is used for persons who have come in from “outside”.  The small isolation unit at the Dominica-China Friendship Hospital is also to accommodate persons testing positive for the virus but who may be unwell and/or may require intensive care. Dr Ferreira was quick to point out to our reporter that to date none of the persons who tested positive for the virus have needed intensive care.

Given that, at the time of the interview, there were only two persons remaining at the facility in Portsmouth and that there had been no new cases of COVID-19 reported for a period of more than 14 days, our reporter asked Dr Ferreira if he would characterize Dominica’s actions to stop the spread of the virus as a success.

Dr Ferreira reflected on this point momentarily and explained that the government and the Health Team are concerned that there may be persons in the community who are not symptomatic (meaning that they do not have symptoms) but may still be carrying the virus.

“Despite the precautions that we took, testing persons on entry into Dominica, two positive cases still slipped through’’. he pointed out.

Ferreira said it is precisely for this reason that he is cautious about hailing the activities to date as a success.  One got the clear impression that nothing short of a complete elimination of COVID in Dominica would be good enough for Dr Ferreira’s definition of “success”.

“Our worry [government/health team] is that there may still be others in the communities”, the top health official stated.

Asked about the plans in place for further testing, Dr Ferreira explained that the government and health team want to get a better idea of the penetration of the virus within the population and the process is underway to randomly test persons across the country. In the communities where persons previously tested positive for COVID19, he said the plan is to test a greater proportion of residents in those communities.  The CMO suggested that health officials may look to randomly test between 20 to 30% of those communities;  a much higher proportion of testing in those areas where persons previously tested positive.

The plan, according to the information obtained from Dr Ferreira is to randomly test at least 1% of the population (at least 700 people).

“We are moving into the next phase,” he said. “In phase one, we were waiting for persons to develop symptoms and then we would go to them.  Right now we are in our second phase – we are going to look for persons who have the virus but have no symptoms instead of waiting for them to come to us and this is an extremely important exercise which we must complete before we can completely relax the restrictions.  It is crucial to our successful control and elimination of this virus that we have a good understanding of how our communities are affected.  He reiterated that it is crucial to, as a minimum, have a representative sample of at least 1% of the population.”

Dr Ferreira is confident that by the date of publication of this article, random testing will be being rolled out across the country and he explained in detail, the two types of tests.

“We will use PCR testing.  The PCR test detects whether the person is actually infected and we can tell very early on, even before the person starts experiencing symptoms whether they have the virus.  This will assist us in gaining a clearer picture of the virus within the population.  We are also looking at antibody testing.  Antibodies are substances that are developed by the body after the body has come into contact with a particular germ (in this case the Coronavirus) and those antibodies will attack and kill any reemergence of that germ or in this case the virus in that person,” he stated.

Questioned about the availability of testing kits, Dr Ferrera said he is confident that there will be enough testing kits to test at least one percent of the population. “We have been given some kits by our friends – the Venezuelans and the Chinese”.

Ferreira is hopeful that testing can cover a larger sample of the population.  He is concerned that 1% may not be a sufficiently representative sample.  Our reporter gleaned that the availability of testing kits will determine the total number of persons who will ultimately be randomly tested.  There is little doubt, however, that at least 1% of the population will be tested.

In Delices, where the index case was identified, Dr Ferrera told our reporter that health officials would also be looking to randomly test about 20% of that community.

It was reassuring to obtain confirmation from Dr Ferreira that all seniors citizens in care homes are going to be tested and it seems highly likely that those working with the seniors in those settings will also be subject to testing.

“The public thinks that the war has been won.  They are tired and it is important for us to educate the public on the possibility of this virus coming back with a vengeance.  We need to be prepared [for the second wave] and that is why we are carrying out community testing,” .

Dr Ferreira’s emphatic response to the likelihood of a second wave was “I have no reason to believe otherwise”.  In sharing his concerns about a second wave of the virus, he made reference to the epidemic 100 years ago – the Spanish flu – “it was on the second wave that it killed so many millions of people”.

Asked about the recent relaxation of the current restrictions and the plans in place in the event of a second wave Dr Ferriera’s response was…. “my personal view is that we should relax the restrictions when we have ramped up our community testing.  I would recommend that restrictions remain in place to the end of May 2020.  I would like to see us go a good 6-8 weeks without having a case.  If we have a resurgence of the virus then we will have to impose even more severe restrictions.   We will advise the PM to bring in more restrictions”.

Our ‘normal’ will be a new normal because even though we let all the restrictions go within the country the fact is that we have had imported cases so, our restrictions should remain and even be more drastic at the ports of entry.

The plan is to test and to separate those who are positive.  Test. Test. Test and separation.  This all we can do and wait until some effective means of treatment is discovered or some vaccine is produced” so says Dr Ferreira.

In terms of Dominicans wanting to return home in the coming days Dr Ferreira was adamant that “Nobody should enter Dominica without being tested.  Our people who are coming home on the cruise ships will be quarantined and then followed up because no test is 100%.  We are aware that even the so-called gold standard of test may have up to a 20% failure rate.  You may have the condition and we miss it based on the result of that test.  As a failsafe any person who is admitted to the COVID facility following a positive test result must undergo two PCR nasal swabs tests and both must come back negative before discharge from the facility and this is to specifically reduce the possibility of an erroneous negative result.

So we will test.  We should have the result within 24 hours and then 7 days later the people in the community will follow you up to see if you are ok and after 14 days if you are not ill then the person is free to move around.  That would be my recommendation.

Personally I would recommend is that people coming in should pay for the test.  We are having to test you so you should pay for the test.  I do not think it is right that the rest of the taxpayers should have the burden of paying for the test”.

The Chief Medical Officer had this message for the public:-

“I really believe that the Dominican public have cooperated well and I think this is based on the “Maria” experience.  They’ve just been through this traumatic thing and they learnt all the systems – how to follow the curfew etc so I think the Maria experience prepared our people for this thing.  It’s not just our preparations in the Healthcare team or politicians.  It’s really the people who should be given some credit for following the requests and directives.

However, this is no time for rejoicing.  I see our success as only being partial and I fear that if we do not keep our guard up then we are going to have the worst of COVID in a second round.  The public need to remain vigilant and continue to practice all the things that we have been teaching, social distancing, sneezing and coughing etiquette, not touching your face; all those things should continue to be adhered to.  We cannot go back to our normal way of life until we have found some other way to prevent COVID by means of a vaccine or some way to treat and prevent it from killing people”.

Note from the Author of this Feature:

Albert Schweitzer said, “we should all be thankful for those people in our lives who rekindle our inner spirit”.  My spirit is rekindled.  I was left with little doubt that we can be proud of our government, our Health Team under the Ministry of Health and Wellness and provided that we continue to follow directives and restrictions put in place to protect us from harm, we might actually come of out this pandemic as one of the few countries to record NO DEATHS from this horrific virus!

 Appreciation has never been more important than now. Each of us – Dominicans at home and abroad please express your appreciation of the tireless work going on behind the scenes to keep us safe from COVID-19 – work that is continuing even as you read this article.

We are none of us perfect and often fall short of the glory of God.  However, the management of this world pandemic by this small country in the Caribbean deserves our applause.  Let us recognise our own contributions – staying at home, wearing masks, following protocols and continue to adhere to the restrictions in place because we have seen with our own eyes that it has worked.

 Let us support those working tirelessly on our behalf to rid us of this demon in our midst.

 It is not without significance that, it appears that Dominica is one of the first countries in the Caribbean to carry out community testing.  We are probably ahead of the rest.

Photos by Cecil Clarke.