Last week nearly 5000 new cases of Covid-19 were reported by the Ministry of Health and Wellness. One hundred and sixteen (116) deaths were reported, a figure which doesn’t reflect the exact number of deaths for the week, as it includes a number of people who died prior to last week and doesn’t include all those who died that week. Hospitalizations reached a high of 739, with many people reported as being moderately, severely or critically ill. The MOHW announced on Friday that all public hospitals would be accepting emergency cases only and general services would be suspended until further notice; this was because of the overwhelming increase in numbers of Covid-19 patients needing to be hospitalised. On Wednesday’s edition of All Angles on TVJ, staff at the Savanna-La-Mar Hospital spoke about the shortage of oxygen being experienced at that facility. In a press release this afternoon, the MOHW confirmed reports in traditional and social media that hospitals were short of oxygen and some had actually run out. (Press release is posted below.)
With the crisis now facing the health sector, with hospitals unable to cope with the numbers of Covid-19 patients, with resources being stretched thin and staff being overwhelmed, there are those who want to push a narrative that this could not have been foreseen; that it is hindsight to say that wrong decisions were made in relaxing the Covid restrictions in the way that they were relaxed in June and July. That we couldn’t have known how bad a 3rd wave would be.
When I hear that narrative, I think back to the presentation that CMO Dr Jacquiline Bisasor-McKenzie made at the MOHW’s Covid-19 press briefing on April 29 this year. At the time I took it as a public warning to the country – politicians and the public at large – of what science, medicine, public health were indicating about a 3rd wave. A warning that we needed to maintain strong restrictions and not open up too quickly, if we were to avoid a disastrous 3rd wave.
She spoke about the importance of bringing the reproductive number down to below 1, in order to reduce transmission of the virus, and the importance of strong public health measures to achieve this.
“That is what we want. No transmission. A reproductive rate that is tending towards zero. And that is why we had to have stronger measures put in place to bring down the numbers quickly because we were surpassing what our health system could manage.”
“So this graph is a little bit fussy but what it shows is the effect of the measures that we had put in place and how it is that after we had imposed restrictions on public gatherings, in terms of the use of places of amusement, when the reproductive number was high, close to 2, we would have introduced those measures and you would see the blue line would have dropped down below 1. When we would have increased our curfew hours – the curfew hours are in the orange – and you would see that when we increased the curfew hours as well, the blue line is down. However, when the curfew hours are decreased, when the measures – and ususally what happens is that we see that whatever we are doing is working – the restrictions are working, the numbers start trending down and then we start to feel that we need to open up and we need to allow more movement. And as soon as we do that, we see the reproductive rate going up and then shortly after the reproductive rate starts going up, then our numbers start going up again. So it is very important that we recognize that the use of restrictions, the use of curfew has positively impacted the decrease in the number of cases and to get the epidemic under control.”
“And what will happen if we do not maintain our restrictions? There is the possibility of a 3rd wave. We see that several countries have gone into a 3rd wave. I mean countries like Italy, Germany, Hungary, France, Poland, Spain, India, Pakistan, Bangladesh, Indonesia, Phillipines, Brazil, Peru, Iran; they have all gone into third phases.
And why has that happened? Because as soon as there was a decrease in the number of cases, persons started to become complacent and we started to lift restrictions. More movement. Persons started to feel that they had to have the freedom to have gatherings and there were mass gatherings in many of these countries. We can see very, very clearly what has happened in countries like India, where with the release of restrictions in February, they have now gone into a 3rd wave. It can happen to us.
It can happen to us because, as Minister has said, the test results have come back; it does indicate that we have quite a bit of the UK strain in country, which means that there is a high level of transmisssion coming up out of that strain. We have seen that the exposure in the 20-29 and the 30-39 age group is pretty high with a large number of infections. So if it is that we are not careful and do not continue to have measures that decrease exposure, then we can go into a 3rd wave.
And what will a 3rd wave look like? Our starting point is not going to be as low as it was in August last year or even in December of last year. We’re going to have higher starting points that are going to result in possibly very, very high rates…
Dr Bisasor-McKenzie laid out some of the indicators of what a 3rd wave could look like; she laid them out back at the end of April, 4 months ago. As many as 10,700 cases in a peak week, 180 deaths one week after a peak week and 1900 beds needed 2 weeks after a peak week.
Last week Thursday (August 26, 2021), National Epidemiologist Dr Karen Webster-Kerr said in an interview on Nationwide News Network that we were about 2 weeks away from the peak of this 3rd wave that we are now in. She said that in the coming week we could have as many as 140-150 deaths and a number 10-20 deaths higher the week after that.
And what are our numbers currently? Using the figures given in the daily MOHW Clinical Management Summary reports for Sunday, August 21 – Saturday, August 28, 2021, last week we had:
Total new cases: 4830 (This has exceeded the peak week of the 2nd wave, which had 4082 new cases; Saturday’s number of 929 is the highest single day total since the start of the pandemic.)
Positivity rate: Ranged from a low of 41.3% to a high of 50.7%, the first time it has gone above 50%. (The high in 2nd wave was 39.8%)
Hospitalisations: Went as high as 739 (This is confirmed cases only; the number in slide presentations combines confirmed and suspected cases, so would be higher than this.)
Deaths: 116 (This is the number of deaths REPORTED during the week; it includes some deaths which ocurred earlier than last week but were only reported last week. Also some deaths that occured last week have not yet been reported.)
All these indicators are going in the wrong direction.
It is clear that the scenario now playing out during this 3rd wave was certainly contemplated as being possible for Jamaica. Our Chief Medical Officer described what could happen during a 3rd wave, what could lead to a 3rd wave and what needed to be done to reduce the chances of a 3rd wave. At the time, the variant she spoke about was the UK or Alpha variant, which caused our 2nd wave. Within short order, it became clear that the more transmissible Delta variant (which originated in India and caused their devastating 3rd wave) was likely to be carried to Jamaica, probably from the US or the UK. The CMO, the National Epidemiologist, the public health professionals at the MOHW certainly would have forseen what would come with our 3rd wave.
Others in the society also warned about what could result from relaxing the restrictions too early, too fast and too far. It is possible to debate the reasons for the relaxation of the measures, the competing arguments around the decision. But let us not pretend that it is only with hindsight that one could say that the decisions made were wrong.
Yesterday Jamaica’s Ministry of Health and Wellness issued a press release stating that the country’s public hospitals would be accepting emergency cases only, until further notice. The large number of people confirmed with or suspected of having Covid-19 who need hospitalisation has resulted in the hospitals exceeding their Covid-19 isolation capacity. So other hospital spaces and resources have to be dedicated to treating people with Covid-19. General hospital service has been suspended, including elective surgeries, and people who can be cared for at home are being discharged. The Chief Medical Officer (CMO), Dr Bisasor-McKenzie, is quoted as saying that “The rising demand for oxygen also threatens to overwhelm the supply.”
This decision by the MOHW signals that the country has entered into a new phase in the 3rd wave of Covid infections in Jamaica but it does not come as a surprise if you have been following the news and numbers in the past couple of months. And the news and numbers over the last week or two have clearly shown the deepening crisis.
People in government and outside of government have been speaking about the increasing numbers of Covid-19 cases, the increasing numbers of hospital admissions, the pressure for space within the hospitals, the pressure on staff within the hospitals. These comments and information have come through official statements at government press conferences, through media interviews, in press releases, on social media.
A small sampling of examples…
And today a number of media houses have carried reports that there is a severe shortage of medical oxygen in the country, which is now affecting the supply to hospitals, some of which are said to be out of oxygen. There has not at this point been an official statement on this from the Ministry of Health & Wellness.
There is an urgent need for a press conference to be held focusing on the dire crisis in the hospitals. Despite the many warnings that this was where we were heading, now that we are here, the public of Jamaica deserves a full update. This is particularly urgent in light of the fact that the Dr Karen Webster-Kerr, National Epidemiologist, has said that this 3rd wave won’t peak for another two weeks. That thereafter it is likely to take several months to come down from that peak. That, although she is reluctant to give predictions about deaths, we are likely to see 140-150 deaths over the next week and an additional 10-20 on top of that number the following week. (She was speaking in an interview on Nationwide News Network on Thursday, August 26, 2021). This means that the pressure on the hospitals is likely to continue for weeks to come, increasing further before it decreases.
It is Saturday night. The curfew started at 6pm. For the next 3 days, Jamaicans are under 24-hour curfews, with the curfew ending at 5am Tuesday morning. Tomorrow – Sunday – would be a good time to hold a press conference. Let us know what time. Most of us will be at home…
The Delta variant, which for some time has been assumed to be in Jamaica, has now been confirmed to be here.
The number of new cases and hospitalisations have been been rising steadily.
In the third week of August, new cases were over 500 per day on all days but one, the positivity rate was over 40% on 5 days of the week and hospitalisations had gone from 204 on August 1 to 573 on August 21.
At a press conference called by Prime Minister Holness last Thursday (August 19, 2021) to announce changes to the Covid-19 measures, Chief Medical Officer Dr Bisasor-McKenzie gave a presentation, which has been variously called sobering, alarming, frightening. Covid-19 indicators are all going in the wrong direction, with our vaccination levels too low to have any significant collective impact on the effects of this wave.
The slide below from her presentation set out some sobering, alarming, frightening projections for increases in confirmed cases and deaths, if the reproductive rate remained at 1.4, and for daily hospital admissions, if the reproductive rate remained at 1.3.
The deaths reported by the Ministry of Health and Wellness (MOHW) during August have been going up at a steadily increasing rate. For the first week, 26 deaths were reported, 78 for the second week and 88 for the third. The totals for weeks 2 and 3 are already above the weekly reported deaths seen during the height of the 2nd wave in March this year. And we are not yet at the peak of the current wave….
The parishes with the highest reported deaths so far in August are Kingston & St Andrew (KSA) and Westmoreland, with 47 and 28 respectively.
(I want to make clear that I describe the numbers as REPORTED deaths because it is often not possible to tell from the Clinical Management Summaries the day on which deaths actually occurred.)
I have included a map of Jamaica showing the parishes, for ease of reference.
The report issued today, with yesterday’s data (Sunday, August 23, 2021) saw a record number of new cases being confirmed – 879, the highest single day total since the start of the pandemic. (The highest number prior to this was 878, recorded on March 7, 2021, during Jamaica’s 2nd wave.) Hospitalisation have reached 607 and 14 additional deaths were reported.
The days of lockdown announced will hopefully help to bring the numbers down. But they will not affect the deaths already likely to result from the high numbers of infections in the past few weeks. The increase in deaths typically lags behind the rise in cases by a few weeks. As Prof Peter Figueroa said in an interview on Nationwide News Network last Friday :
“We have a very serious surge of COVID cases, a lot of persons in hospital. The hospitals are close to being overwhelmed with the number of persons being admitted with COVID. This surge is looking worse than the last surge that we had that peaked in March of this year.”
Prof Peter Figueroa, Nationwide News Network interview, 20-8-2021
Our hospitals and medical personnel are being overwhelmed. And as Prof Figueroa and other medical and public health professionals have said…it is going to get worse before it gets better. Actions taken now, by the government and the people, can help to reduce further infections and further deaths. But downplaying what’s happening, wishing it weren’t so or ignoring the science will not.
The early narrative about SARS-CoV-2 and Covid-19 offered us some comfort at the time; at least it didn’t seem to affect children as much and we were thankful. As the pandemic continued, we saw that though children were infected at lower rates than adults and if infected generally had milder symptoms, it was clear that some children who caught the disease could have severe enough symptoms to be hospitalised and some children died. Others had serious side effects that lasted beyound the acute phase of the disease. But still we took what comfort we could from the fact that these severe outcomes affected children at a significantly lower rate than they did adults.
The Delta variant of Covid-19, which is becoming the dominant strain of the virus in many countries, is changing the narrative. Children are contracting the disease at higher rates and are being affected more seriously. Countries such as the USA are seeing more children being hospitalised and more children dying.
Although Jamaica still has had no genomic sequencing results to confirm the presence of the Delta variant here, we have been told we can assume that it is here. We have been told this by the Minister of Health and Wellness, by the Chief Medical Officer and, most recently, by the Prime Minister. They have pointed to the increases in the various Covid indicators and to the travel between Jamaica and countries experiencing surges due to the Delta variant, primarily the UK and the USA.
Jamaica is in the early stages of a third wave and the indicators are surging.
The daily number of confirmed cases has been rising sharply. Last week Sunday the number of newly confirmed cases was 281; on Saturday there were 656 new cases. At a press conference last Thursday, August 12, 2021, CMO Dr Bisasor-McKenzie shared a slide of the hospital admissions and pointed out that the average number of admissions (shown by the pink line in the graph below) was now just over 70 per day. She pointed out that this rate was already higher than the rate of admissions at the peak of the surge in March/April this year.
Many of the hospitals are already beyond their Covid bed capacity and their ICU beds are full. The pressure on the hospitals is at an extremely high level.
One of the hospitals that has exceeded its Covid capacity is the Bustamante Hospital for Children, the only hospital in Jamaica dedicated specifically to children. On Thursday, Director of the South East Regional Health Authority (SERHA) Errol Green said that the hospital is over capacity, which poses a problem, as patients can’t easily be transferred elsewhere. Various measures are being used to reduce numbers, including discharging children who can be sent home and not doing elective surgery, only emergency surgery.
So what exactly is the situation with children so far during this surge?
There have been references by officials to more younger people and children being treated for Covid-19. There have accounts of children and babies being admitted to hospital. And if the Covid beds at Bustamante are full, it signals an increase in the number of cases. But we need some specific information from the MOHW.
How many children have been confirmed with Covid-19 in the past 6-8 weeks?
Is this an increase in the rate that the data has shown perviously? If so, by how much? (The daily Clinical Management Summaries refer to babies as young as 1 day old among those confirmed with Covid-19, but the figures don’t tell us how many children are among those infected. Could a breakdown by age be done on a regular basis?
How many children have been admitted to hospital with Covid-19 in the past 6-8 weeks? Is this an increase over the rate of admissions seen previously? How many cases have there been of critically ill children?
Have any children died of Covid-19 in the past 6-8 weeks? Are any children’s deaths under investigation for Covid-19?
How many Covid beds are there at Bustamante Hospital? How many paediatric ICU beds?
How many paediatric Covid beds are there at other facilities across the island? And paediatric ICU beds?
Is life sustaining equipment for treating children in adequate supply at Bustamante Hospital? Is it available at other facilities across the isaland?
With Bustamante Hospital full, are children still being transferred there for treatment?
How is the Covid-19 situation affecting treatment of children with non-Covid conditions?
At the MOHW press conference last Thursday, it was announced that a shipment of Pfizer vaccines is due to arrive in Jamaica this week. Because this is the only vaccine currently cleared by WHO for children, priority is being given to children in its roll out. Children 12 and older with co-morbidities and children 15 and older with parental consent will be allowed to get vaccinated. This is scheduled to start on August 23, 2021. This is an important development. It does not come in time, however, for children to be fully vaccinated before the scheduled start of the school year in September. And it does not cover children under the age of 12.
But with the surge in Covid cases not yet at its peak, it is not likely and not advisible that face-to-face classes start in September as previously planned. And that raises a whole additional round of questions and concerns. For another time.
For a number of months now I have been unable to keep up with posting the Disaster Risk Management Orders in a timely manner and am no longer going to try to do so. I will try to post them all for archival purposes, so that they are available here in the future if government websites eventually remove them, which has happened with other documents in the past.
If you don’t find the most recent Orders on my blog, I recommend checking two government sites, which are the two that post them most reliably nowadays – the Office of the Prime Minister & the Ministry of Justice‘s websites. The Office of the Prime Minister’s list is incomplete, however, not having some of the earliest orders. The Ministry of Justice’s list seems to be complete at this time.
Neither site has yet posted the current Order, which would contain the new measures announced by PM Holness on Monday of this week.
Below are links to Orders 6, 7 and 8 and their amendments. (One thing I need to follow up on is the absence of a first amendment to Order No. 6, as there is a second amendment.)
A few months ago, as the media reported on the surge of Covid cases caused by the Delta variant in first the UK and then the USA, some of us in Jamaica began asking whether the variant was present in Jamaica. There is a great deal of travel to Jamaica from these two countries – residents, members of the diaspora, tourists – and it seemed only a matter of time before we got cases of the Delta variant here. Was testing being done for the variant by the Ministry of Health and Wellness (MOHW) and, if so, what had been found?
Responding to a question at the MOHW Covid-19 press conference on July 1, 2021, Chief Medical Officer Dr Jacquiline Bisasor-McKenzie said the following:
“The Delta variant is something that we really are watchful for. We certainly don’t want to have that in country because we recognise that there is an increased transmissible rate and also that there is an increased chance of admission. And so in our population that is vastly not vaccinated, it does put us at risk.
In terms of the testing for the variant, we did, we sent off 200 samples to PAHO testing laboratory in Brazil last week. We have another 92 samples that we have sent off to the CDC. I’m not absolutely sure that that went off this week, but that was the plan, to send off another 92 samples to the CDC and another hundred samples to PAHO to be tested in Panama.
So we have three arrangements in place now. We really have had some problems in terms of getting the genomic sequencing done. And a lot of that delay has been because of transportation, not because we have not had willing partners to do the testing. But the transportation problems have delayed us getting the samples out, even to the extent that transportation routes, because they have to be longwinded, have resulted in damage to the samples that made not all of them at some times suitable for testing. So we believe that we have worked out something now, a more reliable transport method to get these samples out and we have three partners – the PAHO, CDC and CARPHA – to do the testing. So we do expect that at least every two weeks we should be getting out at least a hundred samples for testing.
The turnaround time once they receive the sample for PAHO, we have been told, is two weeks. The samples last batch went out last week. They are in receipt of the samples, so we are hopeful. We know that sometimes we get times and it may not turn out to be exactly that but we are hopeful that in another two weeks we will have that first set of results. And thereafter we should have results coming after.
We also have started to do some in house testing using kits that are donated by PAHO that enable us to choose the samples better for testing. So we have now a method in place where we can pick up whether or not there are mutations. So mutations can be quite varied and can sometimes not be of any significance at all. But we can now pick up if there are any variations from the normal wild type and those are the samples that we have been sending for testing for genomic sequencing to see if those mutations show any variants of interest or variants of concern.”
(Transcribed from PBCJ recording of July 1, 2021 MOHW press briefing)
This left me hopeful that, despite previous problems that had affected testing for variants, there was now a new system in place that would mean faster results that could help to inform government decisions and responses and help the public to better understand what we were facing. The time lag was still not optimal, but seemed better until we had the equipment needed to do genomic sequencing here.
However, there seemed to be a delay in the hoped for two week turnaround time for the results from PAHO and in a presentation on July 20, 2021, at the Joint Select Committee of Parliament dealing with Covid-19 and related matters, National Epidemiologist Dr Karen Webster-Kerr included this slide:
It showed that results had been received for samples sent to the CDC, but that no results had at that time been received for the samples sent to PAHO.
And to date we have not had any clear update on what has happened regarding those and any other subsequent samples sent to any of the three labs for genomic sequencing. The most we have heard is comments during various media interviews or at press briefings that we are still awaiting results from overseas partners. And that there is no confirmation through testing that the Delta variant is here, but that from other indicators we can assume that it is.
At the press briefing on Monday, August 9, 2021, held to announce the latest changes to the Covid restriction measures, Minister Tufton said, in response to a question from Jamila Maitland about test results and the Delta variant:
“As it relates to the test for the variant strain, I think we are on record of saying that we do believe that it is here based on the movement between countries where it is the dominant strain. We have not yet confirmed its presence based on the test results that we have gotten to date. However, those results up to this point were results that were a little dated because it takes a while to get back the results from where we send them. We are anxiously anticipating the results of tests that would hopefully reflect more what is present in the population. But we continue to advise caution.”
Minister Chris Tufton, at OPM press briefing, August 9, 2021 (transcribed from PBCJ recording)
It is now nearly six weeks since Dr Bisasor-McKenzie outlined the new arrangements for genomic sequencing testing and it is three weeks since the presentation and discussion at the Covid Joint Select Committee in Parliament. We really need a clear update on what has happened with the new arrangements and why it is that we haven’t seen any further results other than the CDC results shown on July 20.
I assume that the MOHW will be holding a press briefing on Thursday and that would be an appropriate opportunity for a full update. Some questions I would hope to hear answered would be:
Since the list shared shared on July 20, 2021, have the results of any samples sent for genomic sequencing been received from PAHO, CDC and CARPHA?
If so, when were these results received and what did they show?
If any results were received, what were the dates on which those samples were collected?
What samples have been sent for which results are still outstanding?
What has been the cause of the delay in receiving the results for samples sent? What has been or is being done to remedy this?
What impact do delays such as this have on the Ministry’s ability to make plans and decisions?
Specifically, is it still the case that there is no confirmation by testing that the Delta variant is present in Jamaica?
What is the current status of plans to be able to do genomic sequencing here?
August 6, 2021, the 59th anniversary of Jamaica’s Independence Day. Always a good day for reflection on how far we have come and how far we still have to go. Jamaica, my home.
Today I post a poem that was published in 2012 in a collection edited by Kwame Dawes, “Jubilation! – poems celebrating 50 years of Jamaican Independence”.
STILL WE SING
from a hill above the stadium
we watched the lights go down
seeds of fear already planted
in my grandma's heart
kept us away that night
the lights came on again
then fireworks greeted independence
even now, such hope
the country still a bone
that stray-dog leaders grip
in the garbage and gully water
of politics' narrow streets
one more hill for us to climb
and people still know
that while we sing, we work
- Susan Goffe