The most recent version of the Ministry of Education, Youth & Information’s (MOEYI) Manual for the Reopening of Educational Institutions – Version 3, dated August 2021 – isn’t currently posted on the Ministry’s website. I have only been able to find Version 1, dated May 2020.
I am posting a copy here because I think it would be useful for people to take a look and see what the Ministry has set out as the conditions under which schools should reopen, particularly considering the resumption of in person classes.
I’ll just share a few of my thoughts as I looked at the manual:
Overall there does not seem to be adequate attention paid to the airborne transmission of the SARS-CoV-2 virus, with more attention being paid to the sanitization of hands and surfaces, than to what is now known about aerosol transmission. I say this despite the section on masks.
The distance recommended for children in schools – desks, seating, removal of masks in classroom, etc. – is 3 ft. This is mentioned in multiple places in the document; an example here on page 11:
Yet in a section on page 34 dealing with protocols for the administrative staff, the distance referred to is the familiar recommended 6 ft:
In other situations outside of schools, social distancing of 6 ft is required. Why is 3ft considered safe for children indoors in schools, given what is now known about the airborne nature of the virus and in the context of the more transmissible Delta variant? Even the 6ft distancing raises concerns in indoor spaces for extended periods, where ventilation is inadequate.
Very little attention is paid in the manual to the issue of ventilation of classrooms and other spaces.
The section on Management of the Sick (pp 9-11) starts by saying “Develop and implement mechanisms to monitor staff and students who may become ill”, but doesn’t set out specifically the mechanisms that are required.
This bullet point on p. 9 deals with the requirement for an area to temporarily separate sick students and staff, which adheres to MOHW guidelines but doesn’t indicate where these guidelines are laid out.
This would seem to be a very important protocol to be specific about – how to deal with members of the school community who are ill, where there is the possibility that they may have Covid-19.
There is also the issue of reporting where there are confirmed cases of Covid-19:
No definition is given of “a school wide outbreak”? How many cases would constitute a school wide outbreak? How would they need to be distributed across the school? Would you not need to report individual cases before an outbreak became school wide, perhaps to prevent it from becoming school wide? And this speaks about reporting to the MOHW and the education regional office, but what about reporting to the school community, to the parents/guardians so that they are alerted that their child may have been exposed and therefore other members of the family as well?
There is no mention of testing protocols within schools, either on a routine basis or in the event of confirmed or suspected cases.
The section on Transportation on page 16 says very little about public transportation and the risk it poses to children who use it going to and from school. The MOHW has pointed to public transportation as one of the serious spreaders of Covid-19 infections. What measures are being taken by MOEYI and MOHW in anticipation of the increased cases of Covid-19 that are likely to result with the increased use of public transportation by children? How is this risk being dealt with?
Have the principals received the handbook about the use of Shadows, which is promised on page 19? Has a copy been made available to families whose children have Shadows?
These are some of the thoughts and questions that I have about the manual; there are others.
I am including below a copy of Version 1 of the Manual, dated May 2020.
Architect Ann Hodges has a letter in today’s Gleaner, a letter which focuses on the developments taking place on the street on which she lives – Lady Musgrave Road. In it, she expresses concerns that many people have, myself included, about the nature of some of the building that is taking place across the city. I have printed the letter in full below.
Letter of the Day – Highway or avenue?
THE EDITOR, Madam:
Why do we put so much money and effort into making roads better for cars and practically no money into making roads and sidewalks better for people?
It has become clear that we need a radically different approach to urban roads and transport. A transport system that relies on motor cars to move people through the city (good though it may be for revenue collection on import duty and fuel tax) is not sustainable.
The city is heating up due to trees making way for asphalt and concrete. Jamaicans need to consider how we can contribute to the fight against global warming and climate change, and providing shade and good public transport in our cities would be a good start.
I recently took a walk from one end of Lady Musgrave Road in St Andrew to the other. In some places the sidewalk is blocked by branches and rubbish, and sometimes the sidewalk disappears altogether and pedestrians are forced into the carriageway to cross over a gully or drain.
For a few sections, there are street trees, the last remaining survivors of the trees planted in middle of the last century. For these short shady sections, it was a pleasant walk. Vendors and other pedestrians were friendly and curious to know what a white woman like me was doing walking rather than driving.
WIDEN TO WHAT END?
Lady Musgrave Road, like many in cities throughout the world, is a street lined with a mix of commercial and residential uses and could, therefore, potentially be much more than a highway across town.
If we were to develop the sidewalks, with an even surface, plant trees to cool and remove the obstacles and heaps of trash, Lady Musgrave Road could be a beautiful pedestrian and vehicular boulevard, leading from Old Hope Road to the gates of King’s House, with views of Vale Royal on the way.
The Government has announced that Lady Musgrave Road is to be widened to two lanes in each direction. This will leave even fewer sidewalks and no trees. We have to ask, to what end?
Traffic on Lady Musgrave is currently moderate except at peak hours. At peak hours, as a Jamaican traffic engineer currently practicing in DC has explained, the capacity of Lady Musgrave to move traffic is dependent on how many vehicles can leave the road at its ends. We can stack vehicles two abreast along Lady Musgrave, but it will not help if they cannot then get through the lights at Hope Road.
Also, as we have seen elsewhere, a four-lane highway becomes a racetrack off peak, which leads our engineering team wanting to put up concrete barriers to avoid head-on collisions! This is a vicious cycle and not a viable solution.
LACK OF JOINED-UP PLANNING
Jamaica and Kingston are suffering from a lack of joined-up planning. We are seeing a race to high-density development without any plans in place for the parks or walkable streets that would allow residents to access services.
Why does the National Works Agency plan for vehicles without planning for pedestrians? What is our transport policy? Why are we not planning for a public urban transport system that even an MP or CEO would be comfortable using?
I speak of the street where I live but the principle and situation are the same throughout the city.
Kingston has a choice between being a green city or a concrete jungle. At present, the Government and developers, with the acquiescence of the planners, seem to have chosen concrete.
Jamaica’s Ministry of Health & Wellness (MOHW) had established a practice of weekly Covid-19 press conferences, usually held on Thursday evenings. For the past few months, however, this weekly practice has been less reliable, with gaps of a week or more occurring between press conferences. This was particularly problematic during the height of the current wave of the pandemic; fueled by the Delta variant, it has been the worst of the three waves Jamaica has experienced.
Yesterday was Thursday and I tweeted the MOHW a question about whether there would be a Covid Conversation (what the press conferences have been called for some time) and they responded saying no. This actually wasn’t much of a surprise, given that there had been a press conference last week and that the Ministry had been facing a lot of pressure and criticism from the public and in Parliament this week.
What was a surprise was to learn last night, via a Twitter thread by Gleaner journalist Jovan Johnson, that CMO Dr Bisasor-Mckenzie had given a recorded Covid-19 update, which was sent to the media by MOHW. This is not a common practice.
I am glad that this update was given. It is not a true substitute for a live press conference, but it does give the public some additional important information. Neither the text nor the video recording of the update has yet been posted online on the MOHW website. It was said that the video recording would be released by the Jamaica Information Service(JIS), but I have not seen a link on the JIS website. This all shows immediately the difference in access by the public compared to when MOHW press conferences are carried live by Public Broadcasting Corporation of Jamaica (PBCJ) and immediately posted on their YouTube channel. PBCJ has actually used some of the CMO’s recording in their news roundup today and in a special report.
I have posted here a copy of the text of the CMO’s update:
To illustrate the way in which these updates add to the information given in the daily MOHW Clinical Management Summaries, I will refer to this chart I compiled using some of the figures given in these summaries.
The hospitalization numbers in the daily reports show a strong downward trend but in her update yesterday, CMO Bisasor-McKenzie noted that daily hospital admissions have been increasing in the past week.
And she made the added comment, “This means that despite the trending down of hospitalizations, if the trend for admissions going up continues, our bed occupancy will increase.” This changes the perspective of our current situation somewhat.
Also of particular note in yesterday’s update are the comments about the delay in the availability of the 2nd dose of the Pfizer vaccine.
With so many ongoing issues, questions and concerns, it would be useful for MOHW to return to regular, weekly press conferences.
For convenience, I have included the statement below as well.
A brief amendment to the current Disaster Risk Management Order No. 10 came into effect on September 25, 2021. I have posted a copy of the gazetted amendment below.
Below is a copy of the Gazette of the latest Disaster Risk Management Order – No. 10, dated September 18, 2021. It contains Covid measures that are currently in force.
The gazetted copy of Disaster Risk Management Order No. 9, Amendment No. 2 is available online on the Office of the Prime Minister website, though not yet on the Ministry of Justice website. I have also posted a copy below. With many of the measures in this amendment expiring this week, another announcement by the Prime Minister is expected, perhaps in Parliament on Wednesday, when the House of Representatives resumes its sittings after the summer break.
I’ve seen or heard pieces of information in the media about where we now are in the 3rd wave. For example, last week in an interview on Nationwide News Network, National Epidemiologist Dr Karen Webster-Kerr spoke about the expectation that the peak of this wave would occur in 2 weeks’ time and she gave projections for deaths in the coming weeks. During a discussion on Nationwide on Wednesday, Prof Winston Davidson mentioned that the reproductive number was now at 1.1. (For full disclosure, I was one of the other participants in the discussion.) In today’s Gleaner there is an article that refers to information said to have been obtained from Dr Webster-Kerr and the Ministry of Health and Wellness (MOHW):
“A hair-raising 250 COVID-19 deaths occurred in August, with another 60 fatalities still under investigation, said Dr Karen Webster-Kerr, national epidemiologist. Scores of other deaths reported in August occurred months earlier.
August 26 was the deadliest day for the month, with 20 persons succumbing to the COVID-19.
However, the 296 COVID-19-related deaths for March outstripped August’s.
Data from the Ministry of Health and Wellness obtained by The Gleaner showed that another 20 deaths in March are under investigation.
With the country recording a total of 69,054 COVID-19 cases as at September 2 and a total of 1,568 deaths as a result of the disease, the ministry is reporting that the overall (2020 to 2021) COVID-19 case death rate is 2.3 per cent.
The death rate in August (1.6 per cent) plunged only because infections soared almost fivefold, month-on-month, to more than 15,300.”
At the Office of the Prime Minister’s (OPM) press briefing on Wednesday (1-9-21), Prime Minister Holness included 3 of the slides that are normally included in the MOHW PowerPoint updates and he commented on them, something which he has done before, though moreso in Parliament. Although both the Chief Medical Officer (CMO) Dr Jacquiline Bisasor-McKenzie and Dr Webster-Kerr were present at the press briefing, neither spoke from the podium or gave the ususal update.
(Perhaps this was in keeping with the brief nature of the press briefing…only 3 slides, and only two questions allowed in the Q&A.)
That is now more than two weeks ago, two weeks in which we have moved towards the peak of the 3rd wave. In that time there have been dramatic increases in the number of cases, the number of hospitalizations, the number of deaths. But we are being told that with the reproductive rate reducing and the positivity rate down from the high of 54%, there may be glimmerings of hope. This is exactly the time at which we need a full update from the CMO or the National Epidemiologist. To place us now in the context of indicators that the MOHW has used for so long.
Why haven’t we had one of these updates, at one of the times when we perhaps need it most, since the start of the pandemic?
We have been getting these periodically. They have been a useful way of tracking changes. Whatever problems some may have with aspects of the data, this is a way of following what the MOHW says the position is, what they are using to base decisions on, what the government is basing decisions on.
There was no MOHW Covid Conversation yesterday; Thursday is the ususal day for them if they are being held. No presentation at the OPM press briefing on Wednesday. No presentation at Parliament’s Joint Select Committee dealing with Covid-related matters on Tuesday; Parliament is on summer break. These are the three places that the public usually gains access to these updates. A presentation with commentary by Dr Bisasor-McKenzie or Dr Webster-Kerr would be best. But if that’s not going to happen, post the PowerPoint online on the MOHW website. In fact, press briefing or no press briefing, Covid Conversation or no Covid Conversation, Joint Select Committee or no Joint Select Committee, post it at regular intervals on the MOHW website.
During a crisis such as this pandemic, information to the public is crucial. With this Delta-variant-fueled 3rd wave, with our public hospitals not offering anything but emergency services, with bed capacity overwhelmed, with dangerous oxygen shortages, we are in a crisis within the crisis. We need more information, not less.
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.
Dr Bisasor-Mckenzie started by saying “I am just going to go through first of all some of the routine slides that you are used to, just providing you with an update and then we are going to look at some explanation of some of the figures and then to have a brief look at what projections could look like.”“We would have seen that we would have confirmed 122 new cases yesterday; that would have been published on our website this morning. It would bring our total number of confirmed cases to 45,414 cases. We are now at 770 deaths that have arisen out of Covid and we have a 1.7% case fatality rate. Our daily positivity rate, using yesterday’s figures is 15% and the average positivity rate since the start of the pandemic until now is 16.2%.”
Dr Bisasor-McKenzie pointed out that it was still the 20-29 and 30-39 age groups that were seeing the highest number of infections. She said the indications were that there wasn’t sufficient adherence to the preventative protocols and there was still a lot of movement, including illegal gatherings.She said, however, that it was still those over 50 who were at greatest risk of getting severe cases of the disease and dying from it. It was suggested that members of the younger age groups were getting infected and then passing the virus on to members of the older age groups.Dr Bisasor-McKenzie spoke about the link between comorbidities and death from Covid-19, saying that 98% of deaths so far were in people who had one or more comorbidity or risk factor. She reminded that age over 60 was a risk factor itself. She emphasized the importance of controlling underlying conditions and staying in as good health as possible.This slide showed the epicurve, with the indicators of the 2nd wave trending down. Dr Bisasor-Mckenzie said that it appeared that the measures put in place were having an effect in reducing the number of cases and of hospital admissions.This slide showed that there was a huge downward trend in the number of beds occupied by confirmed and suspected Covid-19 patients, as well as in deaths and the positivity rate. “If we look at the admissions and the overall bed capacity, the red line shows how we have increased the bed capacity since March last year and those are beds that are dedicated to the management of Covid cases. Most recently, in April where you have the step up, would have been the addition of the isolation beds in the field hospital at the Spanish Town Hospital and that would have increased our beds to over 600 beds. We would see though that the occupancy of those beds have been decreasing consistently since the beginning of April. However, all of these decreases are not reasons to relax. Let us look further.”The CMO reminded that not many of the beds for Covid patients in the hospitals were new beds. Many of them were beds that had to be taken out of general occupancy, beds that were normally used for surgical or internal medicine patients, for example. She said there would need to be a considerable reduction in the number of Covid patients to minimise the disruption to other services.
Dr Bisasor-McKenzie went on to say that when the number of beds occupied rose to its highest peak in March (shown by the white line in the slide), the number of beds occupied by Covid patients had gone over the number of beds assigned for Covid patients. There was then an extremely high level of pressure placed on the health system, the hospitals, because of this.
“…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.”Dr Bisasor-McKenzie reviewed what the positivity rate is and noted that in the 2nd wave it had gone up to near 40% and had come down then to in the teens. She reminded that countries were to be below 5% consistently for a period of time before relieving restrictions. She also reminded that an 8-10% positivity rate was regarded as an indicator of very high transmission and that during the 2nd wave our positivity rate had gone up to 38.9%.
“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.”Dr Bisasor-McKenzie pointed out that the last time we were in that green zone – the below 5% positivity zone – was in July and the beginning of August 2020, before the 1st wave. It had gone down to about 2 or 3% and that was where we needed to get back to, she said. “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.“This slide highlighted some of the points made by the CMO about the positivity rate trends.
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.”
Dr Bissasor-McKenzie didn’t comment on this slide….…or on this one.She spoke about the impact of the interventions and the tendency once they begin to take effect to want to relax the restrictions.
“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.”
This slide emphasized some of the points Dr Bisasor-McKenzie made about curfew hours and the reproductive rate while talking about the previous slide.This slide and the next are very significant in terms of projections about a 3rd wave. The CMO said:
“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…
“…where we could have the possibility of as much as 10,700 cases in the peak week, compared to 4000 cases in the peak week of the 2nd wave and just over 1000 cases in the peak week of the 1st wave.
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.
