Should Grenada consider a 14-day ban on travellers from China?

Although Central Health-Grenada’s focus is educating nationals about Chronic Non-Communicable Diseases, it is important to acknowledge that the World Health Organisation (WHO) on 30 January 2020 declared the new coronavirus outbreak a public health emergency of international concern.

Therefore, it is important to share general facts about how this decision came to be, as our tri-island state is not immune to the possibility of it affecting us and appreciate how travel bans are decided and ultimately approved.

Well-structured organisations, such as the World Health Organisation, usually assemble an elite team of qualified persons to provide recommendations to Dr Tedros Adhanom Ghebreyesus, the Director-General. He, in turn, reviews all the facts within their reports and in particular their recommendations. His decision must embrace the principles of the WHO’s constitution, two of which are whether the health situation requires:

• Active co-operation on the part of the public.
• To remind governments that they have a responsibility for the health of their peoples which can be fulfilled only by the provision of adequate health and social measures.

To read the others, click here.

At the meeting held on 30 January 2020, arranged by the Director-General, in addition to the said Emergency Committee, representatives from the People’s Republic of China’s Ministry of Health provided a report. Two key points extracted from their report are:

• There were 7,711 confirmed and 12,167 suspected cases throughout the country. Of the confirmed cases 1,370 are severe and 170 people have died; 124 people have recovered and been discharged from hospital.
• There were now 83 cases in 18 countries. Of these, only 7 had no history of travel in China. There has been human-to-human transmission in 3 countries outside China. One of these cases is severe and there have been no deaths.

Those numbers may have increased or remained the same since then.

Although the coronavirus is still an evolving situation, the committee made noteworthy recommendations, here are poignant ones:

• It is still possible for the virus to spread.
• The outbreak now meets the criteria for a Public Health Emergency of International Concern
• Countries need to put in place strong measures to detect disease early, isolate and treat cases, trace contacts, and promote social distancing measures commensurate with the risk.
• Provide support to low- and middle-income countries to enable their response to this event, as well as to facilitate access to diagnostics, potential vaccines and therapeutics.
• WHO should provide intensified support for preparation and response, especially in vulnerable countries and regions, rapid development and access to potential vaccines, diagnostics, antiviral medicines and other therapeutics for low- and middle-income countries should be developed.
• Investigate the animal source of the outbreak.
• Investigate the clinical spectrum of the disease and its severity.
• Investigate the extent of human-to-human transmission in the community and in healthcare facilities, and efforts to control the outbreak.
• It is important to study the possible source of the virus, to rule out hidden transmission and to inform risk management measures.
• Enhanced surveillance in regions outside Hubei, including pathogen genomic sequencing.
• WHO should assess how best this outbreak can be contained globally.

After reading these recommendations, it is interesting that the Emergency Committee does not recommend any travel or trade restriction, or at least at this time. However, should a country make a restriction, they must inform the WHO within 48 hours as to why that decision was made and be ready to accept WHO feedback.

What is interesting, on the day the Director-General declared the Coronavirus a public health emergency of international concern, our neighbour, Trinidad & Tobago, imposed restrictions on travellers from China.

Their Health Minister, Terrence Deyalsingh, said, “Persons who are presently living in China or visiting China, regardless of your nationality, will not be allowed to enter Trinidad and Tobago for 14 days after leaving China.” As far as their health minister is concerned, the virus has an incubation period of 14 days, so if your passport is stamped/recorded to have left China, regardless of nationality, you cannot enter Trinidad until those 14 days have passed.

When asked about Grenada’s position, Dr Francis Martin, Acting Chief Medical Officer for the Grenada Ministry of Health said, “Grenada’s position is to follow the advice of our lead public health agency, as it relates to travel restrictions on the subregion. Those agencies being Caribbean Public Health Agency (CARPHA) and World Health Organisation-PAHO.”

The Caribbean Public Health Agency’s fact sheet entitled, “Coronaviruses – what you need to know,” does not provide any travel restrictions, but does say a person should check their local Ministry of Health for information or CARPHA’s website for guidance for travellers. Additional information included: “If you travelled to a country where cases of the novel coronavirus were detected, watch yourself for symptoms within 14 days after you left that country. If you develop symptoms and feel sick with fever, cough, or difficulty breathing, you should:

• Seek medical care right away. Before you go to a doctor’s office or emergency room, call ahead and tell them about your recent travel and your symptoms.
• Wear a mask if available.
• Avoid contact with others.
• Do not travel while sick if possible.
• Cover your mouth and nose with a tissue or your sleeve (not your hands) when coughing, or Wash hands often with soap and water for at least 20 seconds to avoid spreading the virus to others.
• Use an alcohol-based hand sanitiser if soap and water are not available.”

It will be interesting to see how the WHO reacts to Trinidad & Tobago’s 14-day travel restriction. Perhaps if approved, it may allow for other islands to adopt the same measure.

Central Health-Grenada