Right Steps & Poui Trees


Jamaica: Increased #Zika Numbers & Some Questions

I wrote about zika on Tuesday (July 5) and here I am writing about it again, primarily because I heard Minister of Health Christopher Tufton talking with journalist Cliff Hughes on his programme on Power106FM yesterday, and there was some updated information that caught my attention.

Minister Tufton MOH photo

Minister Tufton

Cliff Hughes NNN photo

Cliff Hughes

Additionally, some other questions and concerns have been milling around in my head for a while, and I thought I would transfer them from brain to blog.

 

Ministry of Health Zika Update, as of July 1, 2016

At the beginning of the interview, Minister Tufton shared that his son now has zika, with mild symptoms so far, and he reiterated that the World Health Organization (WHO) projection is that approximately 70% of the population will get zika. He also noted that the majority of zika cases have mild symptoms, with approximately 1% being severe.

The updated figures for zika that he gave stood out for me, particularly the number of pregnant women with suspected zika infection, which was significantly higher than the figure he had given at the Ministry of Health (MOH) press briefing two days before. This sent me to the MOH website, but I didn’t seriously think I would find the new data there. O ye of little faith! The website had been updated today, and there was a document entitled Zika Update as at July 01, 2016. (Is a trend in posting regular updates now underway? That would be good.)

The following  changes are reflected between the June 25 & July 1 reports:

  • Number of notifications                      – from 2825 to 3088
  • Number of suspected cases                – from 2135 to 2183
  • Number of confirmed cases               – from 24 to 26
  • Number of suspected cases in pregnant women    – from 88 to 142
  • Number of notifications for GBS      – from 42 to 53

The most striking change was the reported number of suspected cases of zika infection in pregnant women, which had gone from 88 to 142.

MOH zika in pregnant women 1-7-16

Minister Tufton said it is expected that there will be cases of zika-related microcephaly in babies born later this year. With the first confirmed case of zika in Jamaica being in late January, it is thought that such cases may affect some babies born in September and beyond. He reminded that not all babies born to mothers who have had zika are affected by microcephaly, though he gave a possible figure of 10%. He said that the hospital system was being prepared for this eventuality and that counselling was being and would be provided to pregnant women.

MOH GBS 1-7-16

Speaking about the cases of Guillain-Barre Syndrome (GBS), the Minister told Cliff Hughes that not all cases of GBS require treatment in Intensive Care Units (ICU), but that there have been some severe cases requiring ICU care. He said that during a visit he made to Kingston Public Hospital (KPH) this week, there had been 2 or 3 patients with GBS in ICU there.

Some Questions for the Minister

 

 

 

In speaking with Mr Hughes, Minister Tufton indicated that he and others at the MOH were committed to handling the zika outbreak with transparency, having learned lessons from the handling of the chikungunya epidemic in 2014. He said:

Jamaicans need to know what they are confronting, what the risk factors are and what they need to do in preventing and, if they can’t prevent, how they need to follow up…We shouldn’t hide anything from the public; we should go out of our way to explain to the public the issues at hand. – Minister Tufton (transcribed from recording of interview with Cliff Hughes on Power106FM, July 7, 2016)

The MOH has been providing more information about zika than it did for ChikV and the Minister certainly seems to be committed to providing such information. With that in mind, I ask the following questions:

Blog questions 1

blog question zika

blog questions 2

(Click for copy of MOH Zika-update-of-as-at-July-1-2016)

 

 


From Long Ago: “‘Dandy’, dengne, dengue – or was it really chikungunya?”

My mother is a historian, Dr Joy Lumsden, and she has always shared that passion and perspective with her family throughout her life. Her interest is wide-ranging, though she has a focus on a particular period of Jamaican history. Joy Lumsden from websiteAs she said in her profile on one of her websites:

I finally retired in 2004 after nearly 50 years of teaching, 1956-91 at high school, and 1980-2004 at university level. During all that time, and still today, I have been researching Jamaican history, especially in the period between the Morant Bay ‘Rebellion’ and the 1938 riots. My doctoral thesis, which I worked on from 1975 to 1988, was on the life and political career of Dr J Robert Love, the Black Bahamian who played a significant role in politics and journalism in Jamaica between 1890 and 1914. My work on Robert Love introduced me to a highly significant but little researched period of Jamaican history, when 2-3 generations of tough, courageous and self-confident Jamaicans laid the foundations of the modern nation.

Last week I mentioned to her an article I had seen on a CDC webpage, in which the writer posited that chikungunya (ChikV) had been present in the Americas 200 years ago. Scott B Halstead: Reappearance of Chikungunya, Formerly Called Dengue, in the Americas Soon after, she posted on her Jamaica History website some information she had found about dengue and/or ChikV in the region during that time. I found it fascinating to read, given the heightened focus at the moment on the zika virus. And it was particularly interesting to read these excerpts, remembering that at the time it was still not known that these diseases were vector borne viral diseases, transmitted by the Aedes aegypti mosquito.

The full post can be read on the website at:

‘Dandy’, dengne, dengue – or was it really chikungunya?

Below I have copied one excerpt from a 1828 document:

Jamaican History website 2

Jamaican History website 3

 


7 Comments

But Won’t They Panic If We Tell Them?- Communication re #ZikaVirus & other health emergencies

I found myself nodding in agreement frequently as I watched a presentation given by Dr Barbara Reynolds at the US Centers for Disease Control & Prevention’s (CDC) Zika Action Plan Summit which was held in Atlanta, GA on April 1. The title of Dr Reynolds’ talk was “Crisis and Emergency Risk Communication: What the public needs when risks are uncertain”. (Scroll down for link to presentations.)

As I watched the live stream of the presentation, I kept thinking back to a number of public health situations in the past couple of years when the Jamaican public would have benefited from better communication by Government agencies:

  • the chikungunya/ChikV epidemic in 2014
  • the Riverton dump fire in 2015
  • the problems in health facilities & deaths of premature babies in 2015.

And although the current situations with Zika virus and H1N1 influenza virus are being handled significantly better, there are still some ways in which communication can be improved.

Dr Barbara Reynolds’ Presentation

Dr Reynolds defined crisis and risk communication as “the kind of communication that leaders will do, along with their experts, to help people and communities make the best possible decisions when the information is imperfect and we’re under impossible time constraints.”  Early in her presentation, she made a very important statement:

cdc barbara reynolds

“And it may be actually surprising to learn that people can accept bad news more easily than they can accept uncertainty.”

 

I didn’t actually find this surprising, as from experience I know it is true. With bad news, you know more clearly where you stand and what actions you need to take; with uncertainty, you don’t know where you stand and decisions about what actions to take are that much more difficult. Dr Reynolds emphasized that during such times the public need to have the facts and need to be empowered by having not just the how of what to do, but also the why.CDC zika Reynolds slide for blog 1

 

In discussing common communication failures, she noted that “a poor operational response cannot be saved by good communication….[and] a good operational response can be spoiled by poor communication.” cdc zika Reynolds slide for blog 2Numbers 2 and 3 on this list  – late release of information & paternalistic attitudes – certainly were among the problems with the communication responses we experienced during the three health crises I mentioned earlier.

 

Dr Reynolds  said she had seen over the years that:

“people often talk about changing messages based on the fear that people will panic. Panic behaviour is actually very rare, but if it does happen the research tells us it happens when there’s no credible authority  and all options seem equal. So what we should be working towards is being as credible as possible at every stage along this response.”

She discussed six principles of Crisis and Risk Communication, which were a useful framework for developing messages.

cdc zika Reynolds slide for blog A4cdc zika Reynolds slide for blog 4

The issue of credibility and trust was raised repeatedly, and the need for these qualities in leaders and spokespersons communicating with the public. Dr Reynolds stated that:

“Condescension is the number one failure in good communication in a response.” 

cdc zika Reynolds slide for blog 5

She shared a number of communication lessons particularly relevant to the developing situation with Zika, where there is a lot still not known about the virus and knowledge is being added to almost on a daily basis.

cdc zika Reynolds slide for blog 6

Dr Reynolds began with and ended with the following message:

cdc zika Reynolds slide for blog 7

Jamaica’s Communication Responses

I believe lives were lost because of both the poor operational response and communication response to the ChikV epidemic. Despite prior warning years before, the Jamaican Government failed to prepare adequately for the possibility of an epidemic. And the poor communication response failed to inform the public adequately about the risks. The initial messages downplayed the risks, which was particularly dangerous for those with pre-existing medical conditions and vulnerable groups such as the elderly. There was also a failure initially to inform the public about the possible medium and long term effects ChikV could have on a percentage of people.

That experience has had an impact on the response to Zika virus to date, not solely because of the toll it took on the lives and health of Jamaicans, but also because of the political fallout. As continues to be shown , the full impact of Zika is not yet known to the scientists and medical practitioners, the public health authorities and political leaders or the public. In this situation, with more possible impacts being discovered and discussed on an ongoing basis, it is essential that the public is kept informed and updated.

Public health spokespersons have been far more visible and accessible, both regarding Zika and the H1N1 flu virus since the start of 2016. It is good to see and hear from the Ministry of Health’s current Chief Medical Officer Dr Winston De La Haye and other Ministry spokespersons on radio and TV and in the print media. Both the current Minister of Health Christopher Tufton and his predecessor Horace Dalley learned lessons from the experience of Dr Fenton Ferguson, whose handling of the ChikV crisis was devastating. I know that Jamaica has experts with the skills and experience to handle communication during public health emergencies, and we must benefit fully from this expertise.

One way in which we need to improve is in making information accessible in more permanent and official ways. For example, although Dr De La Haye and other Ministry of Health representatives give updates about numbers of confirmed cases, number of samples tested, etc, this data is not routinely made available on the Ministry’s website. So if you miss the update in the media, there isn’t a clear place to go to to retrieve it. It is also important that the public aren’t left to guess when the next update will be. More information is also needed regarding Jamaica’s state of readiness to deal with a possible increase in cases of microcephaly, Guillain-Barre Syndrome and other neurological disorders being associated with Zika virus outbreaks.

Zika virus is being increasingly regarded as a puzzling and complex virus, with possible severe effects, despite its relatively mild symptoms. Effective communication with the public is essential, though challenging.

Links to CDC Presentations

cdc zap reynolds

Dr Reynolds’ presentation is available here.

cdc zap you tube reynolds Video recording of Dr Reynolds’ presentation available here. (Starts at 3:54)

cdc zap web page Link to CDC Zika Action Plan Summit page with presentations & other resources

 

 

 


ChikV in Jamaica: Research & Information Needed – (And ATI Request)

This Gleaner’s online headline yesterday caught my eye; stories about ChikV tend to.

Gleaner ChikV headline 26-11-15

The article was about a study recently published in Neurology Journal, which looked at a particular aspect of “Chikungunya virus (CHIKV)–associated CNS [Central Nervous System] disease during the La Réunion outbreak, and assess[ed] the disease burden and patient outcome after 3 years.”

I would obviously want someone with the appropriate medical/scientific expertise to explain the relevance of this study to us in post-ChikV epidemic Jamaica.

Two statements particularly interested me, one from the Gleaner article & the other from the Neurology Journal abstract:

  • “…the infected persons with encephalitis had persisting disabilities. The disabilities included behavioral changes and problems with thinking and memory skills in infants and post-infectious dementia in previously healthy adults.” (Gleaner)

and

  • “In the context of a large outbreak, CHIKV is a significant cause of CNS disease.” (Neurology Journal)

Like hundreds of thousands of other Jamaicans, I had ChikV last year and know of many relatives, friends and acquaintances who also had the disease, with varying levels of severity. I had had dengue the previous year and was struck by the fact that the effects of ChikV lasted far beyond the acute phase, whereas I recovered from dengue relatively quickly. I also learned, mainly via online sources, of the medium and long term effects that ChikV can have, something which the Ministry of Health (MOH) seemed to downplay at the start.

I wanted to find out whether there was ongoing or planned tracking of medium and long term effects of ChikV  being experienced by people in Jamaica following the 2014 epidemic. So on April 18 this year, I made an Access to Information (ATI) request to the Ministry of Health and on May 14 received 11 documents from the Ministry.

MOH ATI (2)

The related documents ranged from Notes of Research Meeting held on Chikungunya November 20, 2014 at PAHO Building , UWI to notes of Chikungunya Research Working Group Meeting  Held at PAHO Building dated 29 April 2015. All the documents can be accessed here. (MOH ATI all chikv)

It is time, perhaps, for me to do some follow-up ATI requests, to see what has taken place in the intervening 7 months.

But the real request is for the MOH and the various other local and regional bodies to track, to do research and to keep us informed. ChikV is here to stay, we are told, and we need to know as much as possible about its effects and how they can be prevented and treated.