On October 27, 2022, I made the following Access to Information (ATI) request to the Ministry of Health and Wellness (MOHW) for information about Covid-19 during the period October 1 – 22, 2022:
Today (November 3, 2022), seven days later, I got the requested information:
And here it is in a chart for the first 3 weeks of October…
That’s all, folks.
Except to say, if MOHW can provide me with this sort of information within a week, it should be able to provide the public with a weekly report of the previous week’s Covid-19 numbers, in the same way that it currently does for monkeypox.
Added on November 4, 2022
I realised that I had left the positivity rate out of the chart I made above. So I am adding a revised chart below…
When asked about the absence of new Covid-19 numbers since October 1, 2022, when the daily updates ended, the Ministry of Health & Wellness (MOHW) keeps saying that the information is being posted weekly on their website.
It isn’t.
The only two copies of the Weekly Epidemiological Bulletin posted on the MOHW website since the daily updates ended are the bulletins for the Week ending September 24, 2022 (posted on October 7) and for the Week ending October 1, 2022 (posted today, Oct 27).
This is not posting weekly and it means that for nearly 4 weeks – October 2 – 27, 2022, the MOHW has published no new Covid-19 numbers. We have no data on what has been happening with Covid-19 in Jamaica for the month of October. Not the number of confirmed cases, not the number of tests administered, not the positivity rate, not the number of people hospitalized, not the number of deaths reported. Nothing. We don’t know if the numbers are showing an upward trend, a downward trend or have remained pretty much the same.
And even if the MOHW posts the next Weekly Epidemiological Bulletin a week from today (November 3, 2022), it will presumably be the bulletin for the week ending October 8, 2022. Which means the information will already be nearly a month old by the time it is published. Not much use to anyone hoping to use such information to help assess the current risk, in order to adjust the precautions they take to protect themselves.
The government tells us to take personal responsibility, while reducing the information it shares that helps us to do just that.
Weekly Epidemiological Bulletin EW39 – for Week Ending October 1, 2022
For Bulletin EW 38 & EW 39, the MOHW has changed the format in which it now posts the Weekly Bulletin. It used to be possible to download a copy easily, with one click. That is no longer possible. Now you would have to save each of the 8 or 9 pages separately. Less easy access is not progress.
I am glad to see that the Bulletin now includes a full page dedicated to Covid-19 (p. 6). This is in addition to the cumulative number given on the page dealing with Class One Notifiable Events (p. 5).
The Covid Surveillance Update includes the number of confirmed cases for the week, as well as the totals to date. It indicates the sex and age range for these cases.
A chart indicating the occurence of cases over the course of the pandemic is included.
The list of outcomes includes the number of deaths for the Epidemiological Week (EW 39). However, it is not clear if that death actually occured during that week or if it was reported during that week but may have occured at an earlier date.
A chart is included showing the vaccination status of the people who have died – whether they were fully vaccinated, partially vaccinated or unvaccinated. This chart relates to deaths occuring since the vaccination programme began in March 2021.
The parish distribution of confirmed cases is given for the Epidemiological Week, as well as the total for each parish since the start of the pandemic.
The number of tests administered, which used to be given in the daily updates, is no longer being given. This is a gap in public information, as it doesn’t allow for tracking the adequacy of testing in the country. It also means that you have no idea what percentage of the tests administered has returned a positive result.
And, despite all the problems with it as an accurate indicator, no positivity rate is given.
Another number that is no longer being given is the number of people hospitalized. This is a significant gap in the public information, as over time it has proven to be one of the most reliable figures for tracking the ups and downs in the pandemic. It is also that number that has warned us when the hospital system is being overwhelmed.
It is interesting to note that the research paper referred to on p. 9 is related to the Covid-19 pandemic.
I have created a copy of Bulletin EW 39 2022, if you wish to download it with one click. I hope that MOHW will change the format on their website to allow for this once again.
The Covid-19 pandemic is not over. It is ongoing. The MOHW is now giving us Covid data that is already a month old by the time it is published. This is not good enough. While it may suffice for recording purposes, it is not good enough during an ongoing pandemic. The MOHW publishes a weekly update giving the data for the previous week for monkeypox. It should do the same for Covid-19.
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.
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
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.
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.
On March 17, 2022, when the use of the Disaster Risk Management Act (DRMA) for Covid-19 management orders ended, the general mask mandate ended.
On March 18, 2022, under the Public Health Act – Public Health Enforcement Measures (Coronavirus Covid-19) Order 2022 – a mask mandate for enclosed spaces came into effect and was scheduled to expire on April 15, 2022.
On March 22, 2022, Minister of Education Fayval Williams confirmed to Morning Agenda host Jodi-Ann Quarrie that the wearing of masks was no longer mandated for schools. Highly recommended but no longer mandated.
On April 15, 2022, the mask mandate under the Public Health Act Covid-19 Order expired and was not renewed.
On May 18, 2022, at a Ministry of Health & Wellness (MOHW) press briefing, Minister Chris Tufton officially confirmed what others had been saying, that Jamaica was now experiencing a 5th wave of Covid-19. He said the wave was probably caused by the highly transmissible Omicron BA.2 subvariant and had an inflection point of around April 20, 2022.
At the May 18, 2022 MOHW briefing, Minister of Education Fayval Williams confirmed that an increase in Covid-19 cases in schools was being reported.
On May 19, 2022, via a General Bulletin, the Ministry of Education and Youth (MOEY) informed school administrators that “the wearing of masks is mandatory at school effective immediately and until further advised.” The general public learned of this reintroduction via the media…social and traditional.
On May 20, 2022, while speaking at a handover ceremony in St James, Prime Minister Andrew Holness said that “It is going to be a requirement shortly for all of our citizens to return to wearing their masks.” This was widely reported in the media, with clips of the PM’s words.
On May 22, 2022, Jamaica Information Service (JIS) published a report about the PM’s statement titled “Gov’t To Reintroduce Mask Mandate”.
But here we are, on May 30, 2022, ten days later, with no mask mandate reintroduced and with no indication when…or if…this reintroduction of the mask mandate will take place.
Quite frankly, this inaction and lack of certainty is unacceptable. We have heard nothing further since Prime Minister Holness spoke about it. Was it an off the cuff statement to ease the pressure at the time but with no substance to it? Or has the PM changed his mind since? Or have the public health experts at the MOHW advised that the reintroduction of a mask mandate isn’t necessary, advice which they have supported with scientific data or references?
The PM has left us hanging. Not a comfortable position to be in at the best of times. And a Covid-19 wave, however gentle when compared to previous waves, is not the best of times. The public is entitled to some clarity on this. PM Holness? Minister Tufton? CMO Bisasor-McKenzie?
(And, yes, I know that we keep being told that these are policy decisions. And advice from the technical experts to the Cabinet is privileged. And that is the convention. But I increasingly question this convention, as decisions on serious public health matters during a pandemic are being made, with the public not entitled to know if our government’s decisions are in line with or contrary to the advice being given by public health experts.)
Below is a chart showing some of the MOHW numbers for the past 2 weeks.
And the report for yesterday has just been released…
The Office of the Prime Minister (OPM) Press Release – Wednesday, April 13, 2022
It wasn’t a surprise that some of the Covid-19 protocols were allowed to expire; the government had been signaling the intention to further relax the measures required. I don’t think it was a wise move to remove the mask mandate for enclosed spaces that the public has access to. It was also odd that whereas the mask mandate was removed for people in enclosed spaces, it is still required that people sanitize their hands before entering those enclosed spaces…when what we are dealing with is an airborne virus.
It was interesting that the announcement of the decision not to extend the pre-testing and masking requirements under the Public Health Act order was made via a press release from OPM, though the Public Health (Enforcement Measures) (Coronavirus COVID-19) Order, 2022 was issued by the Minister of Health & Wellness.
Ministry of Health & Wellness (MOHW) Press Release – Tuesday, April 19, 2022
With the requirement to wear masks in enclosed spaces coming to an end on April 15, 2022, on April 19, 2022 the MOHW issued a press release informing the public that masks would still be required in all health facilities, as would protocols for hand washing and physical distancing. The Ministry outlined its reasons for this.
Ministry of Health & Wellness (MOHW) Press Release – Thursday, April 21, 2022
On April 21, 2022, the MOHW informed the country that the Omicron BA.2 variant had been identified in 2 of 88 samples tested at the National Influenza Centre at the University Hospital of the West Indies. However, the samples were collected between January 1 – March 4, 2022, making them one and a half to three and a half months old by the time of reporting. So we know Omicron BA.2 is in Jamaica, but these sample results tell us very little about the situation in the country now, in mid-to-late April.
I wonder why the genome sequencing results we are getting from local testing are for such old samples. Is this the length of time the sequencing will normally take? Or has there been some glitch in the process that is causing the delayed results? Are any current samples being tested? If so, when will we get those results? It would be disappointing if we now have the capacity to test locally but are getting results with as long a delay as when we were sending samples to CARPHA, PAHO or CDC for sequencing.
COVID-19 data from MOHW for the past two weeks – April 14 – 27, 2022
The daily Covid-19 reports from MOHW are showing an upward trend, which is obviously cause for concern. Today’s report showed 115 confirmed cases in 24 hours, the first time since February 13, 2022 that the number has been over 100; that day there were 109 confirmed cases. And the positivity rate has now gone into double digits again; the last time it was in double digits was on February 16, 2022, when it was 10.3%. It has been above the recommended 5% for most of the past two weeks.
MOHW Covid-19 press conference today, Thursday, April 28, 2022
Perhaps the upward trend in the Covid-19 data is the reason for the press conference that has been called by the MOHW for this evening. Perhaps the intention is to reassure the country that the hospital system is able to cope with the expected increase in cases and to encourage people to follow the preventative protocols and to get vaccinated. I don’t know what else is on the agenda and if there will be any unexpected announcements or information.
Something I would like to hear more about is what is happening with Long Covid in Jamaica – what follow-up is being done, what data is being collected, what such data is showing, what support is being offered to people with Long Covid. We really need more information to be shared with the public…with individuals dealing with Long Covid, their families, schools, workplaces. Unfortunately, I am not very hopeful that this will be on the agenda.
Yesterday (April 11, 2022), the Ministry of Health & Wellness (MOHW) sent out a press release titled “Omicron BA1 Remains Dominant Covid-19 Strain in Jamaica”. When you read the release, you see that this statement is based on samples collected 2-3 months ago, between January 5 – February 12, 2022. So whereas the results say something about the situation at that point in time, they don’t say much about the situation now, in the second week in April.
“The Omicron BA1 strain of the COVID-19 virus continues to be the dominant strain observed in the Jamaican population. Samples collected between January 5 and February 12, 2022 and tested recently, showed that 100% of those samples yielded a positive result for Omicron BA1. Jamaicans are reminded that Omicron is spread more easily (twice as fast) than the original SARS-CoV-2 virus.
At the same time, vaccination remains the best defense against the COVID-19 virus and its variants, guarding against severe illness, hospitalisation, and death. To receive a COVID-19 vaccine, members of the public may visit the more than 250 access points across the island.
Up to 10 a.m. on Monday, (April 11) over 1.4 million doses of a COVID-19 vaccine had been administered in country. Of that number, 690,649 were first doses; 584,764-second doses; 93,989 single doses; 3,758 immunocompromised doses and booster doses 31,030.
Additionally members of the public should ensure that they remain vigilant in the practice of the other infection prevention and control measures, mask wearing, physical distancing and handwashing.”
I don’t know if these samples were tested here in Jamaica or if they were sent overseas for testing…to CARPHA, PAHO or CDC. There has always been a time lag between collection of samples and the genome sequencing results, which has reduced the usefulness of the results in assessing our current Covid-19 situation. The hope had been that the time lag would have been reduced once we got the testing equipment and the necessary training for staff. I am not sure what has been happening since the training was being done in January and why the results announced were not from more recent samples. Perhaps we will hear more from the Minister or the Ministry during the week.
In a few days, on April 15, 2022, some of the Covid-19 protocols that were preserved under the Public Health Act will expire. We should hear shortly whether any will be extended. The MOHW data for the past two weeks suggest that they won’t be, but we’ll see.
PS – After I had published this blog post, I saw that MOHW put out the figures for yesterday, April 11, 2022. So I updated my chart and added it below.
On Thursday, March 17, 2022, Prime Minister Andrew Holness announced that the use of the Disaster Risk Management Act (DRMA) to implement Covid-19 emergency measures would end the following day. He said that a few of the measures that had been in place would instead be administered under the Public Health Act but that all others would come to an end.
The Ministry of Health & Wellness (MOHW) issued a press release about the revocation of the DRMA Covid-19 Orders and indicated that a copy of new Public Health Enforcement Measures Order was attached to the release.
Some of the measures are scheduled to expire in a week’s time, on April 15, 2022 and the PM had indicated that a review is to take place to determine what will happen after that time. If the Covid data from the MOHW continues on the trend of the past few weeks, it is likely that the remaining measures will not be extended. The rising number of cases and hospitalisations in the UK, the USA and Canada is cause for concern, however, as in the past increases in those countries have been followed some weeks later by increases here in Jamaica.
Right Steps & Poui Trees 