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.
“…not only would we have been utilising beds for Covid but we would now have been utilising beds that were for the other services. Not only would we have been using staff that, some of them newly hired to manage Covid, but we would have been utilising staff from other areas and we would have had the staff under considerable pressure. Also in terms of supplies to the hospitals, those would have been at a very high usage rate and so we would have been under a very high level of pressure to the health system when our numbers were in that very maroon red, above 600 beds being occupied. But if we went down to between 400-600, we are still in the red level because we still would have had considerable pressure on those same services in terms of other beds, in terms of the staff and in terms of supplies that were needed.
So even though we see that our numbers have come down, and we have fallen from 600,700, down to a little bit less than 400, we are only just now a little bit out of that red zone where we would have had high pressure on the health system. And it is not until we reach down to a level of about 150 will we be in the green zone where there is minimal disruption of health services. So we still have a considerable way to go in terms of moving from just under 400 beds occupied to 150 beds occupied for Covid. So there is still a lot of pressure there. It is while we are trending down, there is still a lot of work to do to get our numbers down to where we can safely manage within our health system.”
“So we were way above the very high transmission….Right now we have not reached down to 10%. So we are still in the very, very high transmission. We need to get down below 5% to get into the green, where we can feel comfortable to relieve restrictions.”
“Just to look at this slide, you can just imagine that if we were at a 2-3% positivity rate at the start of the 1st wave and we went up as high as 25% in the peak of that wave; for the 2nd wave we started, look where we started. We started at 10% on average positivity rate and we ended up at 39.8%. Now can you imagine if we were to go into a 3rd wave starting at a 15% positivity rate? It means that our number of cases would be far more than what we would have peaked at before.“
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…
Now it means also that as the number of cases go up, then we could have deaths going up as much as 180 deaths that could occur in a week, in a peak week, where we had 59 in week 11, which was the peak week of the 2nd wave and 31 in week 41 of 2020, which was the peak week of the 1st wave. Now 180 deaths in one week is something that we would not want to see.
It means also that there is going to be a severe stress on our beds and where we went up to 716 beds at peak, we could be going up to needing as much as 1900 beds. Do we have 1900 beds? We do not. We do not and we see what is happening in other countries. Hospitals are closing their gates because they do not have oxygen, they do not have beds. It can happen to us.
And now is the time that we have to ensure that we take the precautions, that we continue to maintain our restrictions, we decrease exposure, we wear our mask, we keep physical distancing, we stay at home, avoid gatherings – social gatherings, business gatherings, any type of gatherings – we avoid those gatherings to decrease exposure, so that we can keep our reproductive rate down, keep our positivity rate down, keep our hospitalizations down. Thank you, Minister.“
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.
LINK BELOW
PBCJ Recording of MOHW Press Briefing on April 29, 2021, at which CMO Dr Bisasor-Mckenzie made this presentation. Her presentation begins approx 13 minutes into the recording.
MOHW Press Release re Shortage of Oxygen
Right Steps & Poui Trees 