Currently, the tip of the iceberg best describes Jamaica’s COVID-19 journey.

The COVID-19 experience and spread in countries are reflective of a wide spectrum of decision-making, including Government engagement and direction, implementation of best epidemiologic and health care practices, an understanding of the severity of the disease, and the willingness of a country’s citizenry to aggressively comply with disease reduction strategies.

On arrival in Taiwan, every person entering the country must present evidence of a very recent negative COVID-19 test. Before exiting their arriving vessel, each passenger must have a temperature check. If a negative COVID-19 test result is not provided, the arriving passenger is tested and placed in quarantine until the test result returns negative, allowing quarantine discontinuation.

Refusal to be tested is rarely an option. Any such refusal usually results in denial of landing and entry to the country. If the COVID-19 test result of the arriving passenger is negative, compliance with all protocols aimed at reducing disease transmission is mandatory.

These may include mandatory tracking of all movements, adherence to frequent monitoring and reporting of temperature, wearing of appropriate facial covering, strict hand hygiene protocol, and tight regulations regarding free movement once in the hotel. Congregate meals are not allowed. Room service is mandatory for all meals. Mandatory COVID-19 testing before departing the country is required.

The Bahamian Government requires presentation by arriving travellers of a negative COVID-19 test result, obtained within 72 hours of arrival to assure airline booking and entry into the country. If the duration of stay is for greater than five nights another COVID-19 test must be obtained while still in the country. The cost of testing is borne by the traveller. Adherence to the established World Health Organization (WHO) standards for COVID-19 transmission reduction is required. If the repeat COVID-19 test returns positive, a private aircraft must be engaged for transport out of the country when an immediate departure is required. Getting the repeat COVID-19 test is a hassle-free process.

More recently the Canadian and the US governments implemented a negative pre-arrival 72 hours COVID-19 testing protocol.

Many countries, including Jamaica, which failed to anticipate and properly plan for reasonable changes in the international travel obligation regarding COVID-19 have been scrambling to fulfill this COVID-19 pre-arrival testing prerequisite. Unfortunately, the Jamaican Health Minister Dr Christopher Tufton recently labelled the “new COVID-19 measures imposed on Canadian visitors trying to return home a a travel restriction tactic”.

Canada, it may be interpreted, was trying to deter international travel, and consequently negatively impact the economies of countries heavily reliant on tourism. Wisely, the Minister of Tourism Ed Bartlett quickly grasped the weight and urgency of the situation and immediately intervened to minimise the fallout from the new global international COVID-19 travel realities.

Had Jamaica meticulously contained the pandemic, the fear of acquiring COVID-19 in the country would now be minimal. More importantly, however, had the Jamaican policymakers anticipated and prepared for universal pre-arrival testing for those engaged in international travel, the impact of these new policies would be minuscule. Having not implemented an easily accessible, strong, and reliable COVID-19 testing system, the country is now trying to catch up. Meanwhile, supplies of COVID-19 testing re-agents are in short supply, much more expensive and difficult to source. With the minister of tourism having now engaged stakeholders to address these dilemmas, the country remains hopeful the horse has not already bolted the gate.

The need is to urgently engage respected community physicians as part of the COVID-19 testing network. These physicians should be in all major towns allowing easy access to those wishing to have a COVID-19 test completed in a reproducible, ethical, standardised, and efficient way.

Inter-rater reliability testing may be required to ensure result consistency, and minimise unacceptable, or illegal activity. In the best interest of the country guidance by unenlightened medical societies steeped in archaic thinking dismissing the wisdom of engaging community physicians in the COVID-19 testing architecture must be ignored.

Expect Jamaica’s COVID-19 death toll to rise significantly

The US failed to mitigate the community spread of COVID-19 resulting in an exponential rise in the death toll. Similarly, Jamaica can anticipate a burgeoning of its COVID-19 infections and deaths. Religious gatherings demonstrate a lack of understanding of COVID-19 disease mitigation protocols thus becoming super spreader events. Worship leaders studiously adhere to the six feet separation mandates but fail to recognise the six feet distance also requires mask wearing, an exposure time of less than 15 minutes, and no singing or loud talking. Unmasked worshipers can be observed passing close to each other. There should be one way traffic. Sharing of microphones without disinfecting between users is not infrequently observed. Congregants not infrequently are closer than six feet apart, while singing loudly, or otherwise engaging in conversation.

The man on the street has become exhausted by COVID-19. Taking his chance and going maskless, not bothering to observe social distancing or proper hand hygiene practices. Policymakers seem resigned to this fate. Alarmingly the community spread of COVID-19 increases.

Well-resourced countries are competing for the limited supply of expensive vaccines now available. Jamaica will be hard-pressed to acquire adequate supplies of the vaccine for the entire population. The crushing economic toll resulting from the debilitating effects of the pandemic on the once vibrant tourism sector cannot be underestimated. To survive we must redouble our efforts to minimise community COVID-19 spread by meticulous adherence to risk reduction strategies, aggressively expand easy access to COVID-19 testing options for tourists, and Jamaicans, while maintaining COVID-19 testing integrity.

Jamaican policy health care leaders must daily engage pilots travelling the world, compatriots worldwide in their field, the Pan American Health Organization, the WHO, and others in the Jamaican diaspora to keep abreast of the ever-changing COVID-19 realities as they consistently fashion, and constantly update local COVID-19 policies.

Jamaica, it is going to be a very long and difficult COVID-19 night, but for the prepared, forward thinking, and determined, a bright morning awaits.

Dr Leon Wright is a Jamaica-born infectious disease consultant based in the diaspora.