Right Steps & Poui Trees


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Ministry of Health & Wellness Ends Daily Covid-19 Updates: A Few Comments & Concerns

Last week Wednesday (September 28, 2022), the Ministry of Health & Wellness (MOHW) announced that it would be discontinuing its daily Covid-19 updates:

The release was a brief one and didn’t give any reasons for the discontinuation, simply saying that it would take effect on Saturday, October 1, 2022, and that “[t]he updated numbers will instead be published in the Ministry’s Surveillance Bulletin, published weekly on the Ministry’s website at moh.gov.jm.”

Although the MOHW website hasn’t posted any more of the daily updates since the announcement on Wednesday, the Ministry’s Twitter account did post one on Saturday, which is presumably the last of the long series of daily updates.

I do want to comment more at another time about the fact that for most of the past two and a half years, the MOHW has been providing daily Covid-19 updates in one format or another and the value that this has had, despite gaps in or problems with the updates. Christmas Day, New Year’s Day, public holidays, weekends…the update was posted daily, almost without fail. Someone or some team needs to be acknowledged for that. And I also want to say more about other aspects of the updates themselves.

But in this post I want to raise some concerns that I have about the discontinuation of the daily updates or Clinical Management Summaries, as they are officially called, and the proposed method for sharing the Covid-19 numbers in the future.

The MOHW release said that the Covid numbers will be published in the MOHW Surveillance Bulletin, which is published weekly on the MOHW website, at the bottom right hand corner.

The Weekly Epidemiology Bulletin is published by the National Epidemiology Unit of the MOHW and is a useful record of information for each epidemiological week of the year. It provides information about Class One Notifiable Events (e.g. accidental poisonings, maternal deaths, cases of tuberculosis, tetanus & zika), gives an influenza report and has a report on dengue, among other things.

One concern that I have is regarding how much of the information that is currently provided in the daily Covid-19 updates will be provided in the weekly bulletin. The bulletin already provides a year-to-date total of confirmed cases, which is given for both the current year and the previous year, as seen on the page below:

Epidemiological Bulletin for Week ending Sept 10, 2022, p. 5

But will more information than that be provided, as with the page dedicated to dengue in the Bulletin?

Epidemiological Bulletin for Week ending Sept 10, 2022 p. 7

The current daily Covid summaries provide quite detailed breakdowns – confirmed cases, female and male numbers, age range, number and types of tests, positivity rate, parish distribution, hospitalization data, information about deaths and recoveries. How much of that will be included in the weekly bulletins?

The answer to all of that will be seen when the first of the weekly bulletins containing the Covid update is published.

Another concern I have is about the timeliness of the reporting in the future. The MOHW press release says the Surveillance Bulletin is posted on the MOHW website weekly, which may give the impression that each week the Bulletin for the previous week is published. This isn’t so. The Bulletin is produced for each Epidemiological Week of the year but it takes a while for the Bulletin to be produced and posted on the MOHW website.

So, for example, the most recent Bulletin currently posted on the website is for Epidemiological Week 36, which is the week ending September 10, 2022. It was posted on the website on September 26, 2022, sixteen days after the ending of that week.

And this is the pattern, as the chart below shows. There is a time lag of about 2 to 3 weeks between the ending of the Epidemiological Week and the date on which the Bulletin for that week is published on the MOHW website.

You can see it here again for an earlier period in the year:

If this continues to be the pattern, it means that by the time the Covid-19 updates are published on the MOHW website, the information in them will already be 2 to 3 weeks old. And whereas this isn’t a problem from a record-keeping perspective, it is a problem for anyone who is trying to assess what the current trends are in the pandemic…which has not yet ended, despite what many would want to believe.

We are in a period when we have been told it is our personal responsibility to assess our individual risk and to follow the protective protocols based on our assessments…as individuals, families, institutions, businesses. Whether we wear a mask at all or in particular spaces. Whether we avoid crowded spaces indoors or outdoors or at all. Whether having a meal at a restaurant is a reasonable risk to take. Or going to a particular government office or waiting room at a business place. Or whether it is advisable to attend an in-person event/meeting or to select a virtual option, if one is provided, or not to attend, if a virtual option isn’t available. Etc. Risks which may be reasonable when there are low numbers may not be as reasonable when there is an upward trend in numbers.

To have less information or information which is already 2 or 3 weeks old by the time you see it reduces your ability to make real time assessments of the risks. The situation would already be 2 or 3 weeks further on, by the time an increase in cases or an increase in hospitalizations or an increase in deaths is seen in the published bulletin.

I was not surprised by the MOHW’s announced decision to end daily Covid reports. It is in keeping with the trend in many countries. In our region, Barbados also announced on Wednesday that it would be ending its daily Covid updates, as of September 30, 2022. In fact, I wonder if this issue came up for discussion at the recently held Annual General Meeting of the Regional Health Communication Network.

It would be good to hear from the Ministry its reasons for this decision and what it sees as the purpose of the Covid-19 updates going forward. I would also be interested in hearing if a weekly update along the lines of the current weekly monkeypox updates isn’t a viable option.

When dealing with public health issues, as a general principle, greater access to information is better than less access. When dealing with most public issues, in fact.


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350 Words or Less: A Picture Worth Some Number of Words…

While on Twitter today, I saw a photo attached to a Ministry of Health & Wellness tweet…

…that I thought was worth some number of words, if not a thousand. Here it is…

L to R : Minister Chris Tufton, Permanent Secretary Dunstan Bryan, Dr Karen Webster-Kerr, Professor Peter Figueroa, Dr Joy St. John

It was taken on September 15, 2022, at the opening ceremony of the recently held 66th Health Research Conference of the Caribbean Public Health Agency (CARPHA), which took place in Jamaica.

Note who in the front row are wearing masks and who are not.

Wearing masks: National Epidemiologist, Professor of Public Health, Epidemiology & HIV/AIDS at the University of the West Indies, Executive Director of Caribbean Public Health Agency

Not wearing masks: Minister of Health & Wellness, Permanent Secretary in the Ministry of Health & Wellness

Interesting.


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That Tree at UTech…

There are many beautiful trees on the University of Technology (UTech) campus and one of the most beautiful is the iconic elephant ear tree in front of the Faculty of the Built Environment (FOBE)…

It is clear that the tree was taken into consideration when the building was designed…

Picture taken from FOBE website, 2022-2023 Orientation video

…which was very appropriate for a building that would house the Caribbean School of Architecture and the School of Building and Land Management.

The tree and the building are in close contact…

…on the upper floors.

It is a wonderful, spreading tree…

…with an impressive trunk…
…solid branches…

…and masses of such delicate leaves….

The pods under the tree show why these trees are called elephant ear trees (Enterolobium cyclocarpum). The oldest tree at Hope Gardens is an elephant ear tree that is more than 200 years old. I wonder how old this tree is.

A beautiful sight/site, whether you look in towards it…

…or out from under it….
That venerable tree at UTech must have been witness to so much change over time. May it stand for many more years!


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GOJ Release Regarding Cost of Commonwealth Secretary General Campaign: An ATI Perspective

On Sunday, August 7, 2022, the Office of the Prime Minister (OPM) issued a press release entitled “Jamaica’s Commonwealth Secretary General Campaign Clean, Transparent, Principled” in which it gave information about the cost of the campaign for Commonwealth Secretary General undertaken by Minister Kamina Johnson Smith.

The release is not posted on the OPM website and wasn’t tweeted by the OPM Twitter account. I have posted below a copy of the text:

Often when I read statements released by government entities, I think of Access to Information (ATI) requests that could be made to get more information about the topic being dealt with. Here are some of the requests that could be made based on this release:

Paragraph 2

  • Documents containing the “already established travel plans and engagements” in place for Minister Johnson Smith prior to the announcement of her candidature (As at January 1, 2022? March 1, 2022?)
  • Documents containing the budgeted costs for these planned trips and engagements
  • Documents containing the actual costs for these planned trips and engagements

Paragraph 3

  • Documents indicating specifically when and where the Minister’s candidature was launched in London in April 2022
  • Documents indicating the cost of the launch
  • Documents detailing the “corporate Jamaica” entities that gave assistance for the launch & the nature and value of that assistance

Paragraph 4

  • Documents indicating the specific dates of each of the 4 engagements mentioned in this paragraph & the dates when they were first added to the Minister’s schedule.
  • Documents containing the budgeted cost of each of the 4 listed engagements
  • Documents containing the actual cost of each of the 4 listed engagements

Paragraph 6

  • Documents setting out the travel schedule undertaken by the Minister covering 7 countries/8 governments in Africa
  • Documents indicating the cost of (each of) these trips/meetings

Paragraph 7

  • Documents giving a detailed breakdown of the $18, 267, 575.07 expended on the campaign. (Many of the categories for the breakdown are already suggested in the press release itself. However, actual documents/vouchers/etc from the various ministries & govt agencies can actually be requested under the ATI Act. A consolidated account/report compiled in response to this request isn’t the only way to go, if an applicant wants more detail.)

Paragraph 8

  • Documents providing details of the expenditure for the Commonwealth Heads of Government Summit in Rwanda of (i) $12, 827,897 by the OPM, (ii) $7,715,585.37 by the Ministry of Foreign Affairs and Trade and (iii) $5,131,386 by the Ministry of Tourism.
  • Documents providing details of the expenditure by the government for the previous Commonwealth Heads of Government Summit, in the UK in 2018

Paragraph 9

  • Documents referring to any aspect of the FINN Partners contract with Minister Johnson Smith and/or the services provided by FINN Partners. (This would include any internal memos, emails or any other form of communication.)
  • Documents providing information about the individuals or entities from “corporate Jamaica” who were party to the arrangement with FINN Partners.

Paragraph 11

  • Any documents evaluating the ways in which the campaign “served to strengthen bilateral relations and further enhance Jamaica’s reputation on the international stage.”

No one applicant might want to submit all of these possible ATI requests, and there are other requests that are not on this list that another applicant might be interested in submitting. This, however, illustrates that there is a lot of information that this release does not provide and that the ATI Act provides a mechanism by which further, more detailed information can be accessed.

I want to make clear that I am not here questioning Minister Johnson Smith’s qualifications, experience or suitability for the post of Secretary General. I have a lot of respect for her and her abilities.

What I am seeking to do is to point out that even where the government or one of its agencies says that it has been transparent in some regard, there are often many other pieces of information that can be requested for full transparency. To ask for further details is legitimate and the ATI Act provides the means for doing so, if someone wants to request that further information. And that does happen quite naturally in the course of seeking information about a matter…a document that is provided or released may lead to requests for further documents or information.

In a paradigm of open government, which recognises that people have a right to access all the information held by the government, with a few, specific, limited exceptions, it would be troubling for requests for information to be seen as somehow unpatriotic or to be discouraged. If the people are entitled to the information, go ahead and give it. Give as much of it proactively as is possible. Government bodies don’t have to wait on ATI requests to release information that is being asked for publicly. And follow-up questions and requests for additional information should be expected.

I have always liked Section 6(3) of the ATI Act, which says that an applicant for access does not need to give any reason for requesting access. It is an important protection for citizens, as they do not have to justify to the State the reason that they want access to any particular document or piece of information. The State should grant access or deny access in accordance with the Act. The information belongs to the people. It is held in trust by the State for them. They have a right to access it. The State has a duty to provide access.

Flawed as it is, in need of strengthening as it is, the ATI Act is one of the most important pieces of legislation to be passed in Jamaica in the past quarter century, as I repeatedly maintain. And we need to pay close attention to the pending review of the Act to ensure that any amendments to it strengthen, rather than weaken, its provisions.


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Once Upon a Sunset…

Leave me alone, please! Yes, yes, sunset photos are a dime a dozen. But watching the sun set is one of the things I love to do. Taking photos of the sunset sky is another thing I love to do. And sharing sunset photos is something else that I love to do. So…

Once upon a sunset, a woman noticed the evening light against a cluster of palms….

She grabbed her camera and climbed the stairs to the roof of her house. From that vantage point, she saw the sunset sky…

She smiled…and looked closer…click…

She played with the zoom on her camera and looked at the trees, the hills, the clouds, the light…

From speakers somewhere nearby, oldies but goodies were playing. John Holt was singing: “I love you, darling, and that’s no lie, oh-oh, Stick by me and I’ll stick by you…”

Once upon a sunset, on a roof in Kingston, Jamaica, life felt really good….


Medical Association of Jamaica’s Recent Webinar on Long Covid

On Sunday, May 22, 2022, the Medical Association of Jamaica (MAJ) held a webinar on Long Covid: Its Manifestations, Identification & Management. It was organized by the MAJ’s Pandemic Response Task Force and was held in partnership with the Association of General Practitioners of Jamaica and the Caribbean College of Family Physicians, Jamaica. It was aimed at updating physicians on the effects of Long Covid on major organ systems.

There were eight presentations, which covered cardiovascular, respiratory, neurology, endocrinology, rheumatology, nephrology, psychiatry and gastroenterology and illustrated how varied the manifestations of Long Covid may be. The presentations were given by Jamaican medical experts and drew on both information based on what is being seen in other countries and on the experiences of the doctors here in Jamaica, with local case studies being given. The discussion of the local experience is invaluable.

Reminders were given that information on Long Covid is based on what is currently known and being seen, and that it is being updated on an ongoing basis, as further studies are done and observations are made. But what was repeatedly said and shown is that a percentage of people who contract Covid-19 experience long-term symptoms and conditions after the acute phase of the infection has passed. Each of the eight presenters set out some of the long term effects being seen on the major organ system they were focusing on. As one presenter said, this is not the flu. And MAJ President, Dr Brian James tweeted, “…very sobering! COVID is not innocuous.”

A question raised was whether the Ministry of Health and Wellness (MOHW) is prepared (or preparing) for the impact on the health system that Long Covid is likely to have.

It is absolutely essential for medical practitioners to have this increased awareness and information about Long Covid. That goes without saying. Perhaps these days a routine question that all patients seeing a doctor need to be asked is whether they have had Covid or symptoms that could have been Covid.

But having watched the webinar, I came away even more convinced than before that the wider public urgently needs information about Long Covid. There are people who have had Covid-19 who may not be fully aware that some of the health problems they are experiencing may be as a result of that infection. Families may have to adjust to a family member needing ongoing care and support that they didn’t need before. Children in school may have increased attention problems or brain fog. Workers may have ongoing fatigue which affects their ability to carry out duties as before. Etc.

The MOHW has a lead role in providing this kind of public education about Long Covid, a role which it has not fulfilled so far. Organizations like the MAJ will obviously have to continue carrying out their own mandates. And perhaps communities, institutions, organizations and groups will need to organize smaller meetings and opportunities for their members to get information and to have questions answered.

Our government may want to pretend that the pandemic is over. It may want everything to go back to “normal” or to some semblance of “normal”. The old normal already had its problems with the provision of health care. The new normal is one that includes Long Covid, whether we want it to or not.


Update: WRONG Copy Tabled – The Emergency Powers (Parish of St Catherine) (No. 2) Regulations, 2022 Tabled in Parliament

UPDATE: TODAY (JUNE 22, 2022) IT HAS BEEN REPORTED THAT THE WRONG COPY OF THE SOE REGULATIONS WAS TABLED IN PARLIAMENT YESTERDAY. MEMBERS OF PARLIAMENT HAVE BEEN CALLED TO A SPECIAL SITTING OF THE HOUSE TOMORROW FOR THE TABLING OF THE CORRECT REGULATIONS. SO THE REGULATIONS BELOW WILL BE REPLACED WITH THE CORRECT COPY.

Gleaner article: MPs called back to Parliament after gov’t tables wrong SOE regulations

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The Emergency Powers (Parish of St Catherine) (No. 2) Regulations, 2022 were tabled in Parliament by Minister of National Security Horace Change this afternoon (June 21, 2022). These are the regulations now governing the State of Emergency declared last Friday, June 17, 2022.


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Constitutional Court Rules Parts of 2018 Emergency Powers Regulations Unconstitutional: Roshaine Clarke v A.G. Judgment

This morning (June 17, 2022), the Constitutional Court handed down its judgment in the matter of Roshaine Clarke v Attorney General of Jamaica, a matter dealing with the constitutionality of parts of the Emergency Powers Regulations, 2018, which governed the State of Public Emergency under which the Claimant had been detained.

Interestingly, hours before the Court handed down its judgment, Prime Minister Andrew Holness announced that a new State of Emergency (SOE) had been declared, for the parish of St Catherine.

A live audio feed from the court was provided.

This is part of a welcome development in which live feeds have been provided in a few cases of great public interest. It would be good for this to happen in many more instances.

A Press Summary was provided to highlight aspects of the case and ruling:

The written judgment was handed down.

Emergency Powers Regulations 2018

For ease of reference, I am providing a link to an earlier blog post with a copy of the Emergency Powers Regulations, 2018.


Long Covid in Jamaica: A very brief ATI story

I have been concerned for some time now about the absence of information coming from the Ministry of Health & Wellness (MOHW) about Long Covid in Jamaica. The topic has rarely come up at MOHW Covid Conversation press conferences, which is disappointing given that Jamaicans are experiencing Long Covid and I think it is really important that people are made aware of the possible effects of this condition. Individuals, parents and families, school communities and workplaces are in need of information to guide responses to dealing with Long Covid.

April 29, 2022

I wanted to know what information the MOHW had on Long Covid and so on April 29, 2022, I submitted the following Access to Information to Ministry:

May 2, 2022

The MOHW responded promptly on May 2, 2022, acknowledging receipt of my requests, but there was a little bit of a hiccup because the email went to my spam file. They were very helpful when I made contact some days later to confirm that my request had been received. (It was one of three I had made on the same day.)

May 31, 2022

On May 31, 2022, I emailed again asking for an update:

June 7, 2022

On June 7, 2022, I received a letter dated June 3, 2022, via email, giving an update on the status of my request and asking for a 30-day extension in time to complete the response to my request:

So no information about Long Covid from the MOHW so far. Sometimes, however, explanations about why you haven’t received the requested information provide information in and of themselves.

I now know, for example, that our National Surveillance Unit has not been routinely collecting data on Long Covid. This means that Jamaica is very much in the dark about the extent of the public health challenge that we face in dealing with this post-viral condition. How do we prepare for it if we don’t know the extent of what we are facing so far?

This is not good enough. People are facing this challenge in their lives already, whether as individuals, as friends and family, as those responsible for schools and workplaces, as colleagues.

I wait to see what other information I may receive.