First, do no harm

| 24/07/2020 | 66 Comments

Aristophanes Duckpond writes: Our government has done an excellent job in preserving the health of the community up to this point. They did so by putting human life first, by implementing long-proven public health measures, and by adopting proven ‘gold standard’ protocols to minimise the importation of coronavirus.

Preserving the health of our community while bringing back tourism from countries with higher levels of COVID-19 presents additional challenges. However, those challenges are best met by the same principled application of science, medicine and ethics, if unnecessary risks are to be avoided and lives are to be preserved.

Experimentation on Cayman’s population is not the answer.

COVID-19 may be relatively new, but pandemics are not. Over the past 2,000+ years, a number of basic principles for governmental decision-making in the context of epidemics and pandemics have emerged. Our government should follow these principles.

The Greek version of the more than 2,000 year old Hippocratic treatise on Epidemics contains the admonition; “ὠφελέειν ή μὴ βλάπτειν”. Over the past 500 years, the wisdom of that admonition has come to be understood as the requirement that those making decisions that can affect people’s health, should, ‘First do no harm’.

The decisions of our government in the first months of the COVID-19 pandemic were certainly consistent with the principle of ‘First do not harm’. However, it was not at all clear during the press briefing of 17 July, or in the press release of 23 July, that our government is still being guided by that same principle.

That ‘gold-standard’ for preventing the importation of Sars-CoV-2, (the virus that causes COVID-19), has been, and remains, a minimum 14 days enforced isolation/quarantine combined with PCR testing. What has been proposed for the opening of our borders, commencing September 2020, appears to abandon that ‘gold standard’ for something that is not only experimental, but inherently and unnecessarily, risky as well.

If I understood Dr Lee’s presentation on 17 July correctly, the government’s proposed strategy that would require only a negative PCR test within 72 hours prior to travel, and then a follow-up PCR test 5 days after arrival, would fail to detect 7% of the infected people, (i.e. that the proposed protocol would only detect 93% of arriving infected people before those people were released into the community).

The proposed protocol’s 93% detection rate seems highly optimistic given that the incubation period of Sars-CoV-2 is up to 14 days. Even if it is correct that only 7% of infected persons arriving would not be detected by the proposed protocol, that 7% of infected arrivals would be free to spread disease within our community.

In contrast, the ‘gold standard’ that requires a minimum of 14 days enforced isolation/quarantine following arrival, plus PCR tests encompassing that period, limits the number of arriving infected people who would be released into the community to approximately 1% or less.

What then of the ‘button’ technology suggested as an alternative to the last nine days of the 14-day enforced isolation/quarantine period plus PCR testing that has been proven to be effective?

Simply put, there is nothing even close to scientific proof that having people sign up to wear a button will do anything at all to limit the importation and dissemination of Sars-CoV-2 throughout our islands, even if they actually wear it for the required 14 days.

The government has not pointed to, nor have I been unable to find, any peer-reviewed scientific or medical publication, or any WHO or PHE or CDC or FDA or NHS publication, that indicates that any ‘ button’ technology has been approved for use as a mechanism for the detection of Sars-CoV-2 as part of border security.

Neither has any such publication validated any ‘button’ technology as a substitute for isolation/quarantine in limiting the spread of COVID-19. Further, I was not able to find any evidence that any recognised scientific or medical standard setting body anywhere has authorised that use. Further still, I have not even found any credible retailer of such ‘buttons’ that even claims that any such button can detect Sars-CoV-2.

On 23 July the government put out a statement regarding the proposed ‘button’ technology that included the text (emphasis added):

BioIntelliSense is excited to work with the Cayman Islands Government on creating a scalable technology-enabled response to monitoring for symptoms associated with COVID.”

Work with our government on creating??? Clearly that does not suggest a proven technology.

Government ought to be focused on utilising protocols that have been proven to work, rather than experimenting with public health. If government wants to experiment, let them maintain the 14-day plus PCR testing  ‘gold standard’ while testing the ‘button’ in the background on the first 5,000 arrivals to see if the ‘button’ has any utility at all.

Even if the proposed ‘button’ technology is able to detect elevations of heart rate, breathing rate or temperature as suggested, such observations are utterly non-specific and foreseeably meaningless. Further, it is now widely recognised that Sars-CoV-2 can be transmitted by people with no symptoms. How does a ‘button’ make Cayman safer in that context?

Government has presented no evidence that the efficacy of what they are proposing, will be even 50% of the efficacy of out current ‘gold standard’ in limiting the further importation of Sars-CoV-2.

Government has no way of knowing what percentage of persons who sign up for an easy way ‘button’, will take it off in the first few hours and head out to party. We need only observe the current level of alcohol related compliance with mask and social distancing requirements to assume that buttons will be off shortly after the first drink is consumed.

What does government propose to do if a ‘button’ reports a slightly elevated heart rate? Send public health officials out to immediately administer PCR tests each time? The notion is laughable. We simply do not have the resources to monitor any ‘alerts’ the buttons produce, assuming of course that any follow-up to ‘button alerts’ is even contemplated. 

It is therefore difficult for me to see how the proposed substitution of an unproven protocol in place of proven disease prevention protocols, is vastly different from a de facto experiment on non-consenting human subjects within our population, Caymanians and residents alike.  

I am one Caymanian who does not consent to being a guinea pig in any experiment that in any way risks the our health on any unproven technology or any unproven COVID-19 containment protocol. We have a COVID-19 containment protocol that works.  We should stick with it.


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Category: Viewpoint

Comments (66)

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  1. Anonymous says:

    Aristophanes Duckpond, thank you for this well presented View Point! I fully agree with you and hope that others, who take the time to read it, will likewise understand and appreciate you so eloquently expressing the views of many who reside here. Moreover, I pray that our government will pay attention to this opinion piece and refrain from moving to open our borders as planned.

  2. Anonymous says:

    If you can only think of yourselves then you can’t speak for anyone else. We expats get it. You don’t like us. You don’t need us. You don’t want us here. You want us to leave the island and just go. We are just in your way. Lots of us have left already. Many will leave shortly. Those with homes here will return. Those with jobs here will return. Those who want to visit will return. Because we want to. Most of us have made a life here like you. Most of us earned the right to live here unlike many of you and when we return we now know how you feel about us. Now you are in our way.

  3. Anonymous says:

    Following the money, who is the proposed supplier of the biobutton?

    • Anonymous says:

      I am wondering if the buttons are safe? What effect they will have on the heart rate, blood pressure etc. are they used in other parts of the world to track viruses.? Is this a novel idea? No pun intended.

  4. Annie says:

    No tourism yet. No foolish penny wise protocols with unproven ‘ button’ BS. We are 4 plus months of hard work to get to where we are. Keep our borders closed. Be smart, not greedy. Think of our children, and seniors, not your bloated wallets.

  5. Anon says:

    I don’t see how Cayman can ever just open up because the CIG has preserved a completely vulnerable population. The proposed opening plan is almost certain to fail. The only way to end an epidemic of a highly infectious disease with no vaccine is to get to herd immunity. I’ve suggested before that Cayman could establish a “tourist zone” on the island with 14 day quarantine for any worker in and out of the zone. Workers would live permanently in the zone. Another approach would be to send younger Caymanians (who suffer no, or few adverse effects from the virus) to Miami, test them until they catch the virus, and then bring them back after recovery. Either approach would eventually achieve herd immunity.

    • Anonymous says:

      It has been proven that herd immunity does not work. Furthermore, how big do you think Cayman is to have a zone set up specifically for tourists?
      Essentially you are suggesting locals should have their lives disrupted for the sake of tourists? I would love to know which district would willingly allow their community to be turned into “the zone”.

      It ain’t happening.

  6. Anonymous says:

    I don’t think the “button” will detect asymptomatic wearers 😢

    • Anonymous says:

      Of course it won’t. But if the geo fencing works it might detect people breaching quarantine. But like an ankle tag, only more politically correct. Honest, we are just monitoring your well being – not whether you have sneaked out for a sly beer. Oh BTW we are monitoring your heartbeat and respiration so will also be able to detect if you get up to any “recreational activity “ in quarantine as well, but not to worry, no cameras.

  7. Anonymous says:

    The suggested failure to detect only 7% of the infected people arriving using the governments proposed method is suspect.

    This is what the CDC says:
    The rate of false negative nucleic acid tests, a type of viral test, after exposure have been reported as: day 1: 100%; day 4: 67%; day 5: 38%; day 8: 20%; day 9: 21%; and then rising to 66% on day 21. See: https://www.acpjournals.org/doi/full/10.7326/M20-1495

  8. Anonymous says:

    What are the criteria that government intends to apply for bringing in non-residents? Is it strictly wallet thickness?

    Cayman should only be bringing in tourists and other non-residents from areas where they are randomly testing at least 5% of the population per month, and where the positive rate on PCR testing is 1% or less.

    • Anonymous says:

      Relax. You think too much about your island of waste, environmental degradation and cancer.
      Besides, tourists are not “thing” your government brings or doesn’t bring. You might end up begging them to come.

      • Anonymous says:

        5:06 Never. We are happy to see them leave

      • Anonymous says:

        Many people love and return to our “island of waste”. Even you care enough to follow our news site and comment, no doubt waiting to sink your toes in the sand if you aren’t already here puttering around. So do yourself and everyone else a favor, hush your mouth.

  9. Anonymous says:

    Government should publish the number of deaths and hospitalisations they are prepared to accept in order to achieve this re-opening. They could then show us how those numbers were used in developing government’s re-opening protocol.

  10. Anonymous says:

    Has anyone considered that once flu season arrives, the efficacy of magic ‘buttons’ may disappear? Buttons, fitbits and other technologies that can be adapted to measure frequently occurring and entirely non-specific indicators such as a rise in body temperature, necessarily have a low specificity, ie. they are incapable of telling a common cold from influenza and Covid.

    If government wants to achieve something other than distracting the gullible, they should be looking at high specificity technologies. For example, several breathalyser technologies that are specific for Sars-CoV-2 and can provide results within seconds are now being trialled in Europe and Israel.

    • Anonymous says:

      High specificity technologies won’t work in a country stuck in stone age. Just look at post office, customs, license plates fiasco, etc.
      Everything that is more complex than simple mental tasks will fail. They can’t even put mail in the right boxes.

  11. Anonymous says:

    I am a long time visitor and enjoy my trips to the island. However , I think it is a foolish decision to open up right now. I live in the US and I can tell you that things are not good over here. It is baffling to me that your Government is still willing to open your borders after you all worked so hard to get to this point. I understand that their are people struggling and some have depended on tourism for a long time, however, it may be time to revamp your business plan and target those already within your islands. Support and encourage one another. That is one thing that I love and admire about Caymanian people, your resilience, determination, and spirit. Try to find new and innovative ways to support local because opening your borders to welcome tourists (primarily from the US) with a shaky re-opening plan is not a good.

    • Anonymous says:

      resilience, determination, and spirit? LOL

    • Anonymous says:

      You sound very much like you are a Caymanian masquerading as a “long time visitor”. Who from the US speaks like this, unless you are not what you appear to be….??
      Oh and by the way…”that is the one thing that I love and admire about Caymanian people.” are 3 things and none of them apply to Caymanians….. Bit of a giveaway really!

      • Anonymous says:

        You just sound hateful. There are many people, like myself, who have had great experiences in the Cayman Islands over the years! I have made many friends there who exemplify exactly what I said above. The few negative experiences I have had have been due to Canadians and fellow Americans who were blatantly rude.

        Maybe if you removed the hate in your heart for Caymanians and act like a decent human being they will be receptive to you. You cannot expect people to show respect and kindness when you are spewing nothing but negativity and hatred.

        Grow up!

        • Anonymous says:

          Hmmm. So your reaction is immediately to try and become the victim of hate when nothing like that was directed towards you. Interesting.
          Sorry but nothing you have said makes sense and certainly doesn’t fit the profile you claim to represent.
          And by the way I am Caymanian. No hatred in my heart for my countrymen, (or anyone else for that matter) but there is realism.

          • Anonymous says:

            There is no hate in suggesting that they are not actually a frequent visitor to our islands when it’s clear they are writing with an agenda.
            I still believe the writer is a troll, looking to stir up the kind of response you have provided. Congratulations.
            Why then would they say that I am hateful when nothing like that has been stated? Think about it. You and your emotions are being played. The only person ramping up the emotion is them, not I. Are you really this naive when anonymous posts can be from anyone pretending to be anything??
            The only person mentioning anything to do with Caymanian vs expat divisions is you – why? Why would you bring this up when it has nothing to do with any comments here?

  12. Anonymous says:

    Very well said! Couldn’t agree more. Government is going to be a blubbering mess when this virus invades our shores again through their beloved tourists. It’s incredibly frustrating when the vast majority are against this, as we are most things, and the Government disregards our concerns. I do feel for those in the tourism industry, however, the risk is far too great. My job is also affected by tourism but no amount of money is worn the risk. We are just getting to a place where people feel safe and like they can have some normalcy, now Government intendeds to mess that all up.

  13. Anonymous says:

    As a professional I couldn’t agree more that these buttons are a joke, and even if the FDA has approved them for (exclusive to all other applications it was originally designed for), the “detection and monitoring of CoVid-infected individuals”, including asymptomatic carriers of the virus (which it HAS NOT), how can we trust that anything coming out of the United States right now is even true when you have a country that is completely out of control in every regard to this disease, and is being directed and coerced to say or do whatever their idiotic President tells them to, including injecting bleach or other caustic agents into your body to eradicate the virus.
    I couldn’t agree more with this original post. Allowing ourselves to become an experiment at this stage is unthinkable. At the very least we should not allow residents of the United States of America (many of whom are my friends and yours), into our country until either they get their act together and bring their own version of the pandemic under control, or, until an effective vaccine is produced and administered to entirety of their population. Surely we can survive a few more months. The alternative could be “us” going back into a total lockdown and losing all the ground we have made. Anyone still remember what that was like? Solidarity Cayman.

  14. Anonymous says:

    Get over it Pat.

  15. Anonymous says:

    The BioSticker is FDA cleared. While it is not specifically a coronavirus monitoring/detecting device, it monitors crucial vitals, physiological biometrics, and symptomatic events that, upon changing, can alert physicians to said changes. While it may not seem reasonable to you, for people who want to return (or visit) asking them to quarantine after having a negative test will become tedious.
    https://biointellisense.com

  16. Anonymous says:

    There may be a Bio-button but once you open this new webpage there is no Back-button

  17. Anonymous says:

    Gotta open up sometime…but ya, the bio-buttons are useless and just being put in place for a false sense of security.

    • Anonymous says:

      And you know this to be true because God made you Caymanian? You may live in total ignorance if you want to but most people living on the earth today are educated and smarter than that.

    • Anonymous says:

      Please explain, why do we have to open up. Thousands of wealthy persons are willing to come in through quarantine. They can fill the apartments, the restaurants, and government coffers. Why not embrace them?

      • Anon says:

        Really? How many really wealthy people do you know who are willing to be locked up by the government in a room for 17 days? There are other places which are open particularly in Europe which have very low case numbers.

        • Anonymous says:

          Who is being locked up for 17 days you idiot? It’s 5 days in quarantine with this proposed plan.

          • Anon says:

            Responding to 8:48 – Thousands of wealthy persons are willing to come in through quarantine.
            Hardly!

      • Anonymous says:

        So, 8:48 you seem to be thinking that “the thousands wealthy persons” get special favors and exemptions from this virus? Really now?!

  18. Anonymous says:

    There are many different interpretations of the Greek phrase mentioned in the Viewpoint article. It is NOT and NEVER has been accepted as a literal interpretation of “Do no harm”!
    A more accurate translation from the original Greek Hippocratic Treatise is “to have with regards to disease two objectives in sight: to be useful or at least do-no-harm”. If we took it as the Viewpoint writer intends then doctors would never do any medical procedures where there were any risks, irrelevant of the good these procedures would do for the patient. The clause has now largely been accepted as meaning that it is important to find the right balance when dealing with difficult medical decisions.
    Why is this important in this context? Simply because the writer’s view is that nothing should change from where we are now. This is an untenable position for Cayman as a country to take.
    When we knew so little about Covid-19 early on it made sense that the government was conservative in their approach and played it safe. However the world now has over 6 months experience of dealing with the virus and we have learned a lot in that relatively short time.
    Will the government get it exactly right? Probably not. Have they shown a willingness to learn from their own and others mistakes and incorporate them into their strategy? Yes, I think they have.
    The sad thing is that everyone (including the writer) is focused on the bio-button when in reality they should be more focused on the excellent testing and tracing regime Cayman has put into place. This is what will limit our risk and deal with problems when they occur.
    We are living in a bubble but that bubble is not sustainable for anything more than a few months. We cannot isolate ourselves of from the world for much longer and we need to come up with realistic ways of living with Covid-19 for the foreseeable future. I welcome the government’s cautious but pragmatic approach to solving this problem.

    • Anonymous says:

      Actually, the status quo would be comfortably sustainable for the 75% of our unaffected economic engine, humming along productively.

      The reward of our having done the difficult suppression work is that there is very little community transmitted virus at large….here. It’s a huge relief, and we’re all honoured to have been a part of it. There’s no problem to solve in that regard. Especially not one of imaginary HNW tourists beating down our door to pay $750/night to spend 5 days locked up in a 800 sq ft hotel room.

      It really smells like the urgent September 1 deadline is being authored by only one conspicuous sore-loser billionaire benefactor, whose minions are regularly found behind the strings of our marionette Ministers. All the risk will be borne by the general public of the Cayman Islands, including substantial risk of visitor Biobutton non-compliance; angry visitor lawsuits, and medical warehousing, just to keep the taps flowing at the vulture heir hotels.

      I don’t care how much he’s paying them, it’s not worth it.

      • Anonymous says:

        LOL! Where does your fantastical 75% come from? Every part of our economy relies on international interaction. Construction industry is either building for foreigners or people who rely on off island spending, whether tourism or from financial services. Don’t believe me, go and look at the construction sites working today and tell me how many are really selling to Caymanians to live in, rather than to rent as investment properties or being sold to non Caymanians. Real estate industry is driven by foreign spending in one way or another. Tourism is 100% driven by off island sources of revenue. Even financial services is dependent on sourcing the majority of qualified professionals from off island. Government finances are completely dependent on all the private sector areas above for vast majority of their revenue.
        What world do you live in where Cayman can survive cut off from the world for anything other than a relatively short time? Whatever you are smoking I want some because it shows you can defy reality forever!
        Every time you spend CI$10 in a supermarket the vast majority of that money is heading off island as we import everything here. Every time you pay a CUC bill the money goes off island as the majority is fuel cost.
        If the money isn’t coming onto the island how long can we keep spending and sending it off island for?
        This isn’t about your conspiracy theories about Dart (who you couldn’t name for some reason….), its about the reality that unless we figure a way of opening up the island to international travel and business we are 100% screwed.

      • Anonymous says:

        Don’t open up Cayman Islands to Tourists until January 2021, by then we will see things better how the U S and the rest of the world are doing with the Coronavirus

        • Anonymous says:

          January is arbitrary. How about we do not open up until it is safe?

        • Anonymous says:

          Canada are the EU countries are doing OK now with the coronavirus. We should open up to them November 1, however, the USA is a long way from solving their public health crisis so keep the doors shut to Americans until next year when hopefully they will start dealing with the problem with a national strategy.

      • Anonymous says:

        Then you 75% are going to start having to pay tax to pay the 25%’s bills… you in? No thought not.

      • Noname says:

        I would’nt go as far as saying our financial sector is humming along just fine. First we are still on the EU’s blacklist and our coming off that list in October still is far from certain.

        What the EU expect is a public Registry of Beneficiaries across the board which will lead to our financial sector to move off the island in an instant to more welcoming skies.

        Staying on the blacklist certainly WILL damage the financial sector on island even more in terms of reputation and capability to operate.

        The EU’s position is not only explained by the CRS compliance angle unfortunately, they want revenge for different reasons : 1) Brexit , 2) The lack of enforcement on island 3) The very fact that some sector of the economy on island is unfortunately still a safe harbour for ML operations. (Crypto currency exchanges that are not even bothering to comply with blockchain ledgers among a few choice matters).

        CIMA tries as best they can to regularize the situation as best they can but they are struggling against a massive complex heavily implicated and rife with irregular practices and massive non compliance regarding the present regulations. As long as the agency is not given powers that can allow them proper enforcement they will struggle to enforce proper compliance.

        Without granting CIMA to suspend licence to practice at firm level to go against non compliance of some assicates; little can be done at this point in time!

        IMHO i think the CIG is over relying on the financial sector on island for its revenues, the fees collected for bank licences bear witness that the sector is on the brink to move out if cost of doing business here keep on creeping upwards, and at this stage more transparency is the LAST thing they want.

        As to the return of tourism on the island we are facing a different matter entirely , first the present protocols are nothing short of nonsensical and will certainly not encourage visitors to come to our little island. The biobutton is a project and far from proven in terms of effectiveness especially since CAL runs its traffic through MIA which is a hot spot !

        As to qualify one of the main benefactor of the island as to qualify as a vulture , there is only so much flack such benefactors are willing to deal with before moving their interests out.

        Bear in mind he is not alone and most the present HNW in a similar scale and they have done little to better the island.

        I think the September 1st date is indeed rushed and that present agencies are ill equipped to manage flow and have built capabilities to respond on a timely manner to demand. But as to incriminate people for the push there is a leap of faith here that i would not be doing. Yes, MoT’s greed shows at every turn and occasion that is indeed unfortunate and somewhat disgraceful it damages our image and the whole sector, I will grant you that.

        Blaming shrewd investors for buying over leveraged highly indebted businesses, all the more that such operations were in clear violation of local laws on the island will not help fix the island’s finances in the short or the long run!

        As to your accusations of corruption, I guess the whole readership would like more substance of those claims brought to light.

  19. Anonymous says:

    This is becoming tiresome. Focusing on COVID19 and overlooking real threat to Grand Cayman residents- CANCER.

    • Anonymous says:

      Heart disease has cancer beat 2 to 1 in the rest of the world. All other forms of death has Covid beat 5 to 1. But there is a reason for all of them and it’s working.

  20. Anonymous says:

    it doesn’t ‘work’ for the thousands of people in the tourism industry – or indeed other small or medium businesses that are more than struggling right now – and those that are unable to feed and clothe their families?

    Perhaps a trip out your ivory tower would bring a little realism to your thinking.

    Could I suggest you start volunteering for Meals on Wheels, ARK or the Cayman Food Bank??

    • Anonymous says:

      There are no longer thousands of people in the tourism industry. There are however thousands of foreign nationals here with nothing to do, who need to leave, and thousands of local people who need to be retrained and redeployed.

      • Anonymous says:

        “Retrained” to do what exactly? I love it when people assume you can just “be trained” for something. A lot of jobs and careers require college education (4 years at least) or a year (at least) of formal vocational training at an actual vocation institution or years of experience in the field. The jet ski driver can’t just “retrain” to be a lawyer, accountant, architect, carpenter, plumber or whatever else you want in a heartbeat. It’s not sim city…real life takes time and there are ZERO mechanisms here (of merit) to train anyone for anything so how is that going to work?

    • Anonymous says:

      How does the wider tourism industry figure they’ll benefit at all from having the customers sequestered/tortured in their rooms wearing tracking devices? The only benefactors in this nightmare are hotel operators, their in-house room service, security companies, and whoever is collecting sales commission on Biobuttons. The satisfaction exit surveys won’t be good reading, and we will almost certainly spawn a new wave of local transmission.

  21. Anonymous says:

    With an abundance of caution, we should allow back all Caymanians, and other lawful residents, with a genuine reason to be here, allowing them to compassionately quarantine with the biobuttons at their home address, so long as they don’t abuse the protocols, and with proof of some curbside support plan for 5 days (ie. not with nannies and helpers coming and going from inside their home). This should NOT be open for recreational tourists and fun time seekers. This is not party time dot gov dot ky.

    Like all things Covid-19, the Biobutton idea should be a test run for 2 weeks with a limited quantity of buttons. We don’t want to read that Moses or Dart have negotiated a top-secret deal for 500,000 Biobuttons expecting the air traffic…

  22. Anonymous says:

    Well said!

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