A top public health officer on Friday insisted that tough measures were needed three years ago amid fears that a potential widespread outbreak of COVID-19 could have overwhelmed Cayman’s health services.
Dr. Samuel Williams-Rodriguez, the director of primary care at the Health Services Authority, told a Grand Court civil hearing that the enforced quarantine of a then 8-year-old boy for almost a month in 2022 had been appropriate.
He added there was also uncertainty about how effective existing vaccines would be against the then-prevalent Omicron variant of the coronavirus, which was identified as being more easily spread, but less likely to lead to hospitalisations and death.
Williams-Rodriguez said, “We were not convinced at that time that an outbreak would mean a large number of hospitalisations and deaths.”
The doctor was speaking on the second day of a three-day hearing about the legality of the boy’s quarantine.
The family of the boy filed a petition in the Grand Court in 2022 against the attorney general, the health ministry and the Health Services Authority that claimed the child’s human rights had been breached when he was forced to isolate long after he was likely to be able to infect other people.
The HSA was later removed as a respondent.
The plaintiffs also questioned the need for a clear PCR test as a condition of release from quarantine.
The court earlier heard from Dr. Daniel Halperin, an expert in epidemics and infectious diseases from the Gillings School of Global Public Health at the University of North Carolina, Chapel Hill.
Halperin told the court by video link that Omicron was “easier to acquire and easier to transmit” and it was “quite likely” that was what the child had contracted.
He told Marilyn Brandt, the deputy solicitor general, who appeared for the respondents, that it would have been “reasonable” to lift restrictions on the boy after anywhere between five and 10 days of quarantine.
He added that the risk of infection to others at that stage “was clearly not sufficient to have justified ongoing isolation”.
Halperin said it also made little difference which variant of the coronavirus an individual had.
He explained, “We’re only talking about a day or two days at most, so I don’t think it was that important which variant they had. I don’t really see how that changes the picture.”
Halperin added the Omicron variant had earlier onset and that the infectious stage was also earlier, which meant that by day seven most people were no longer infectious, although they might still show a positive result on a PCR test.
Rupert Wheeler, who appeared for the plaintiffs, has argued the boy’s quarantine at home in 2022 exceeded the government’s powers to contain the pandemic.
Wheeler highlighted that the most common international standard at the time was five to 10 days of isolation for the dominant Omicron variant of the virus.
He claimed that the different treatment of travellers to Cayman who arrived at the relevant time amounted to discrimination against the boy.
Wheeler highlighted that an unvaccinated traveller who came to the island during the crisis was quarantined and released after 10 days if they had a negative lateral flow test.
He said the child, who had not been vaccinated, had been unlawfully discriminated against because he was ordered to remain in isolation past 10 days although he too had taken a lateral flow test that came up negative.
Halperin told the court that PCR tests were “valuable” for detecting COVID-19 but that they “were not very useful at all for determining if someone is still infectious”.
He added, “Whether [the boy] had an active case of COVID and was infectious, I would say ‘no’.
Halperin said under cross-examination by Brandt that it was possible the boy could still have been infectious after seven days, but that was “incredibly rare”.
He added very few places had required a clear PCR test to exit isolation as had been asked for in Cayman.
Professor Maria Zambon of the UK Health Security Agency said by video link she had not heard of a country with long periods of quarantine mandated.
She agreed that Wheeler was correct to say that, after 14 days, the risk of spreading the virus was at 1%.
She added countries had taken different approaches to ending quarantine periods, with some time dependent, some using symptomatic testing and others opting for a testing strategy.
Zambon added, “You can mix and match to give yourself a higher degree of certainty.”
She said, “The choices that are made [based] on the susceptibility of the population you’re trying to protect.”
Zambon agreed with other experts that the risk of infection from the boy involved in the case was low.
She said that the boy’s viral loads at day 10 were “not what you would call high, but they are within the policy area in the Cayman Islands which allow for some discretion”.
Zambon said, “The policies used in the Cayman Islands were unusual. That doesn’t mean they were wrong. Just unusual.”
The hearing continues.
