Doctors recommend mandatory vaccinations for all frontline workers; stricter travel protocols

The medical fraternity in Barbados is recommending mandatory vaccinations for frontline healthcare workers, visa restrictions and a 10-day quarantine for visitors from India, and a third test for all travellers on day-eight of their stay on the island.

These are among a series of recommendations on travel and the economy contained in a document issued Monday by the Barbados Association of Medical Practitioners (BAMP).

In the three-page document, BAMP President Dr Lynda Williams announced that the association was recommending “mandatory vaccination of frontline healthcare workers, ideally, but not necessarily, in the context of a choice of vaccines”.

With respect to a third test for travellers, Dr Williams explained that BAMP took into consideration that people will convert to COVID positivity between five and eight days.

“We propose that, with an electronic contact tracing app fully operational, all travellers (fully vaccinated and unvaccinated) should have a third test on day eight, if they are still on island. The third test may function as the departure/exit test if it falls within 72 hours of departure. This test would be a Rapid PCR test and would increase community disease surveillance,” she said.

Turning her attention to BAMP’s new travel protocols recommendations, the spokesperson for the medical practitioners identified “countries of interest”, with South Africa, Brazil and India topping the list.   

Dr Williams pointed out that this category of countries should reflect those with increases in cumulative cases per 100 000 but also those with steep increases of the Delta, Gamma or Lambda COVID-19 variant among their unvaccinated population.

“In addition, all countries with low testing rates, relative to the size of the population and no genomic surveillance, should also be included on this list. The consideration of which countries should be considered ‘countries of interest’ should be reevaluated weekly and the criteria for inclusion or exclusion should be publicly known.

“We suggest a division into countries of interest and countries of concern, with the latter category being reserved for those with the highest rates of transmissible variant per capita e.g., South Africa, Brazil, India. The latter would be subject to visa restrictions and ten-day quarantine,” the BAMP head stated.

Dr Williams also said that while the association understands that the concept of a travel bubble is to facilitate movement from countries with low infection rates within the region, the doctors were also urging constant monitoring of the situation.

She warned that insufficient testing and contact tracing may lead to a failure to detect a rise in cases.   

“We must be willing to nimbly react and to remove countries from the bubble, should this occur. Which countries remain in the bubble should be determined weekly,” she added.

BAMP went on to make another proposal, acknowledging that the availability of standard PCR tests at the country of origin had become an issue, particularly with travellers from the United States and Canada.

Dr Williams noted that in these countries an administered standard PCR test is not only expensive but, in some cases, requires significant travel to obtain.

“We therefore recommend that all travellers get the best available test in the country of origin. A standard PCR test done 72 hours or less before arrival is still preferred. Where this is not available, a Rapid PCR or Lateral Flow test can be administered or obtained by observed self-swabbing, as close to the time of travel as possible (24 hrs before travel or at the airport prior to departure). Tests that will not be accepted include: unobserved, self-administered tests, COVID home-test kits and LAMP tests,” the BAMP president stated.

She also addressed the matter of travellers who are fully vaccinated (FV).

“If the FV traveller has not passed through a country of interest within 21 days, they should prepare to quarantine for a maximum of three days on arrival. The best Rapid PCR or a standard (NAAT) PCR test on island would be administered as the second test administered no less than 48 hours after arrival. While in quarantine, FV visitors will be confined to hotel or villa space with GPS electronic monitoring bracelets tracking movement. They would not be allowed to use a public beach, gym or spa on the property.”

However, the BAMP president stated that fully vaccinated nationals and residents should be allowed to apply to the Chief Medical Officer to quarantine at home if they live alone or have exceptional medical circumstances.

“All other FV Barbadians and residents should pay significantly reduced rates (Government subsidized) for a three-day quarantine at a designated hotel,” Dr Williams suggested.

She said the protocol for the unvaccinated or partially vaccinated traveller should remain at five days in quarantine at their expense within a hotel room.

“The exit test from quarantine would be administered on day five,” the medical community representative added.

Dr Williams also commented on the deadly variants which are wreaking havoc across the world and what Barbados needs to consider in that respect.

“We believe that the rise in the Delta and the even more transmissible Delta Plus variants in our source markets presents a unique threat to Barbados’ fragile health system. The higher attack rate and reproduction number of newer variants implies that in a population with just under 30 per cent vaccinated, community spread could lead to a sharp rise in cases in the months ahead,” Dr Williams warned.

“Several case series and reports indicate that, particularly with the Delta variants, a small proportion (1-9%) of people with full vaccination may have breakthrough infection. The available vaccines seem to effectively reduce transmission of all variants but this reduction may not be large enough to protect a predominantly unvaccinated population. We should no longer consider the rates of infection of COVID-19 in a monolithic way when looking at what is happening in countries, but consideration should be given to the rates of vaccine uptake and the infection rates in the unvaccinated.”

She noted that countries with insufficient testing and low or no genomic surveillance may appear to have low infection rates but may have a high proportion of latent and undetected variant infections.

The controversial issue of mixing vaccines was also addressed in the document.

Dr Williams said that while the hard evidence for this remains unverified by large clinical trials for effectiveness, the scientific premise for a better immunologic reaction by mixing vaccines is sound.

“Therefore, we recommend that we only accept mixing of mRNA vaccines (Pfizer and Moderna) and AstraZeneca (AZ) followed by Pfizer vaccine or the other way around, until more studies are published,”  she stated.

Among the series of other recommendations is that no testing of travellers be done on arrival at the Grantley Adams International Airport; that satellite testing facilities be created at selected hotels, with oversight by the Best dos Santos Public Health Laboratory and assistance from the Barbados Tourism Marketing Incorporated (BTMI) to facilitate ease of testing of all visitors to the island; and that the cost of testing on arrival and on departure should be borne by visitors or incorporated into their cost of stay.

BAMP also recommends that locals and residents returning from travel be tested at the Gymnasium at no cost;  that there be an integration of all private testing laboratories into the testing capacity with real-time reporting; that bubble tours for cruise passengers should only involve fully vaccinated persons (crew, passengers, transporters, those at attractions); and vaccination status should be verified by the Port Health Authority and/or the COVID Monitoring Unit, preferably using electronic upload of vaccination certificates.

It is also proposed that airlines and cruise ships confirm vaccination status of crew on flights or cruises and that routine surveillance of frontline/essential workers who are unvaccinated should be mandatory, either every week or every two weeks, according to risk profile.

(emmanueljoseph@barbadostoday.bb)