COVID-19: Problems that Demand Solutions

It’s easy enough to identify problems. Coming up with solutions? A little more of a challenge.

The decision to move to a week-long lockdown was rolled back, partly because of immediate and serious backlash, and partly, perhaps, because it’s no longer clear what the lockdown would achieve. I was one of those who was critical of it. The good thing is that the government responded to the people, and made adjustments.

The most recent press conferences have been a change from the trend of late to have ministers chastise the public for their bad behaviour. These latest press conferences are an exercise in trust restoration: we are given data about the disease and its spread in our country. More critical, though—and more remarkable (and perhaps politically brilliant)—we are being given the responsibility to act on our own behalf. 

We are given information, and we’re also being given freedom. 

We’re being treated as adults. With responsibility for self-governance. And while that’s scary for many—for those of us who can comfortably barricade ourselves in homes, we feel safer during lockdowns because we know the virus’ spread is being limited—I will argue that it is the right thing at this time. 

Because here’s how epidemics work. 

When a new disease finds its way into a population—as COVID-19 has done across the world—the only thing that will stop its spread is the development of innate resistance to the disease within each human being. In other words, each person has to develop antibodies that make them immune or resistant to the disease. When the disease is new, there are no antibodies at all and people succumb (they may die if the disease is a killer, or they may suffer if it is not). But as more people are exposed, more people produce antibodies, and tolerance to the disease increases. When enough people build up enough tolerance, the spread of the disease will be limited. This is what the term ‘herd immunity’ means.

There are two main ways of building up that herd immunity. One is exposing as many people as possible to the disease. This is the risky, but natural, way. This is the route Sweden and some other northern European countries have gone. This route guarantees that a number of people will die from the disease, but the overall result (theoretically at least) is that the population as a whole will become more tolerant to exposure to it.

The other is to develop a vaccine and give it to as many people as possible. Vaccines introduce a controlled amount of the disease into people’s systems, enough to help them create antibodies, but not enough to make them fall ill. The idea is that vaccination not only develops herd immunity, but it also reduces the number of deaths from killer diseases. The problem is that getting to the point where you have a vaccine that walks that fine line of making a person ill enough to produce antibodies but not ill enough to suffer and die—is a long and involved process. It isn’t something that is best done in desperation. 

The alternative, which is what we have been practising to this point, is reducing the death toll and the level of illness in a population by reducing the amount of interpersonal contact. 

This helps control the spread of the disease. But it doesn’t address the social side effects: joblessness, evictions, lack of access to food and water, reduced revenue for the citizens and the government, psychological challenges, social unrest, potential economic collapse.

We cannot move forward in this new reality if we are going to continue to depend on our government to legislate our behaviour. 

We, the citizens, must join the struggle and begin to police ourselves. 

But that still leaves us with the problem of a spike in cases, an increasing death toll, and the question of what to do about both the pandemic and the economy. 

So this week, I’m going to throw out some ideas to help us move closer to solutions.

Community Spread

The main issue of concern about this second wave of COVID-19 infections is the fact that it is spreading, rapidly, through community contact. The way we’ve addressed this is so far by limiting citizens’ ability to come into contact with one another—through the use of curfews and lockdowns. But as we’ve seen, these solutions are no longer ideal, and they’re no longer working. So what else can we do instead?

I’ve given it some thought and have come up with ten suggestions. That’s all they are: suggestions. Debate and discussion are welcome, because they definitely aren’t answers!

1) Effective public education about how to avoid spreading and contracting the disease

Thanks to Annie Spratt for sharing their images on Unsplash.

Wait, you may say, we’ve been educated, and people are not following the rules. OK, there’s something in that observation. But I’m going to argue that we haven’t done enough of it yet—or the education hasn’t happened virally enough. Maybe we haven’t explained this stuff satisfactorily or enough. “Fake news” spreads via memes, easily posted “articles”, video, etc etc. Effective public education has to do the same.

In the first place, we need experts to talk often about what we know about the disease (and what we know is changing). Bahamians are getting their information from social media, and not all of the information is reliable (most of it, I’d venture to say, is complete nonsense). Instead of simply saying that we shouldn’t pay attention to fake news, produce enough REAL information that the fake news is balanced out and people start making choices that will protect them and others.

2) Effective public education on what to do if you contract the disease.

Many people get mild cases of COVID-19. Many are asymptomatic. At the moment, we don’t have enough information about what to do if you feel unwell or if you think you might have contracted the disease. We also don’t have enough places we can go to check it out; when doctors’ offices are closed, we all have to rely on a few clogged phonelines or wait for press conferences.

We should be aiming to help people who have mild symptoms manage them themselves—and empowering them to do so. Start a public education campaign which teaches people how to manage and treat the disease on their own.

3) Increased access to community health services.

Rather than closing down clinics and doctors’ offices, these places should be opened with strict health protocols. Public and private clinics could be designated to treat different kinds of illnesses. Some could be reserved for actual or suspected cases of COVID-19, while others could be reserved for other medical issues. The healthier we maintain our population, the less impact CV19 will have.

4) Personal empowerment.

Thanks to Ian Stauffer for sharing his image on Unsplash.

I guess what all the above suggestions have in common is this one thing: Equip all citizens with the means to protect themselves from the virus, avoid spreading the virus, and taking care of their own medical concerns without worry.

5) Develop local support systems.

Perhaps the biggest challenge we are facing at this time is that Nassau has no local-level support systems. Relief cheques have been made available, but they have to be collected from a single location which, while apparently central, is far away from many people’s residences. Moreover, with the curfew and emergency orders in place, there are no buses running. This adds a burden of anxiety and stress to those who can least afford it. In addition, it guarantees that a large group of people will be forced to congregate in a single place. 

In 2018, a government-mandated committee submitted a proposal for the development of local government for New Providence. Under this proposal, New Providence was divided into five separate districts, and each district was further subdivided into 7-11 zones. Each zone was made up of a cluster of polling divisions. The purposes of this proposal were varied, but one important one was to help government services reach citizens more effectively.

We need to be thinking about more than simply providing resources to assist people in these difficult times; we need to be considering how to get those resources to people within their communities. This has two benefits. The first one is that it may make Bahamians feel as though their government actually cares about them and their well-being. Rather than simply being told to make their way to a hard-to-reach, overcrowded central location, needs can be met closer to home.

This proposal could be used to set up district and zone distribution centres. It’s already been utilized with regard to food distribution, but even so, the district model requires citizens to travel fair distances under challenging circumstances. The distribution of relief cheques and of food packages could be managed more efficiently if the proposed zones were to be activated. Each zone (which under the local government proposal submitted in 2018 would be represented by a district council member) could take responsibility for the people within its borders. Those people would go to a zone office to collect their cheques, to pay their bills, collect their food, etc. At the same time, public servants from police to social workers to community nurses to youth officers could be assigned to specific zones with the task of identifying and cataloguing the economic and medical needs of the people in those zones. In this way, people’s immediate needs could be monitored and met more efficiently.

A final thought in this regard. Is there some way to repurpose the bus system to turn it into means of delivering resources to the people rather than taking people to the resources? This would be a healthier way to put buses to work. Of course, there is the challenge of paying for these services. But it’s worth a discussion at least.

6) Develop and publicize alternative sources of foreign exchange.

The biggest hit to our nation from COVID-19 is the depletion of our foreign exchange reserves. While we were fortunate enough to begin the year with a cushion, the fall-off in tourism means that these reserves have been very hard hit indeed. Simply reopening the borders and attempting to revive tourism is not going to solve this problem, because the resorts have to deem it safe to open. What has to be considered are ways to empower Bahamian citizens to bring in foreign exchange themselves.

First, let’s see how the restrictions on Bahamians holding foreign exchange accounts in local banks could be lifted (this may or may not have the desired effect, and it will require amendment of legislation—but that may be a good thing in the long run). And second, the impediments placed on the export of goods (it is extraordinarily hard to export goods from The Bahamas) as well as on the transfer of foreign exchange earned from online transactions to local banks need to be removed. This will allow alternative sources of foreign exchange from the usual ones from tourism. In particular, this would boost the cultural economy. At the moment, many young cultural entrepreneurs are working almost exclusively with digital transactions, but it is unclear whether the benefits of those transactions are getting into the Bahamian economy as a whole. This is an area worth further investigation.

7) Redeployment of police, and reframing of penalties for curfew or lockdown infractions.

The use of the police as a punitive arm of government has backfired. Too many people have been arrested and even jailed for the simple act of trying to feed themselves or their families, and the penalty for infractions is, frankly, absurd. 

A government which seeks to fine people who are already economically strapped for attempting to make money has automatically lost the loyalty of those people, who are effectively being punished simply for trying to exist. Further, a government which seeks to incarcerate people—place them in close, unhygenic contact with other people—during a pandemic is ensuring the spread of the disease rather than stopping it. 

Police should be repurposed in such a way that it makes opening the society a possibility. The wearing of masks must be written into legislation, and the wearing of masks must be enforced. This can be done on various positive ways: through the provision of masks to people who do not have them by peacekeepers, and through the creation of community service penalties rather than fines and incarceration. People who are caught without masks could be given the task of working in zone distribution centres rather than hauled before the courts to be fined or jailed.

8) Increased cost-effective public access to CV19 screening and testing.

Thanks to Obi Onyeador for sharing his work on Unsplash

This could be done in stages. Screening and testing are two different things. In the first instance, screening means using simple tools to identify people who are symptomatic and keeping them away from others. Testing temperatures is one way of doing this; it helps separate people who may be feverish from people who don’t have symptoms. But because many people who may be carrying the disease do not show symptoms, we need the ability to do rapid tests for CV19. 

9) Strict enforcement of quarantine measures.

Increased freedom will mean increased exposure to the disease. And although the idea behind this is to develop herd immunity, it is irresponsible for those people to continue to move freely in the population. As a result, the strictness of the lockdowns that have been experienced by the whole population, whether they have been exposed or not, needs to be shifted. When one is placed in quarantine, there should be no wiggle room, no exceptions. This must apply equally to the peacekeepers (remember the slide which shows how integral police officers and defence force officers are to the spread of the disease in Grand Bahama) and to the general public. Any uniformed officer who breaks quarantine has forfeited the right to serve, and should be fired on the spot (yes, I said it). Enforcement should be geared towards transgressors, not the people who are working to limit the spread.

10) Finally, production and dissemination of useful, relevant data.

This goes back to points 1-3, really. But it’s a point on its own, because it’s no good having information if the information isn’t easily accessible or shareable. We live in the age of information, and one of the things that helps the public of 2020 to make decisions is data. In the absence of information from the authorities about what is happening in The Bahamas (a unique place, where we have almost as much border as land, and where community spread is almost the exclusive means of transmission), people will fill the gap—with dubious information, bogus numbers, and conspiracy theories. The more well-sourced, verifiable data we can collect and produce, the better equipped the Bahamian citizens will be for this fight.