Right Steps & Poui Trees


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Covid Reflections: What has happened to genome sequencing test results?

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.

(I wrote about that presentation in Parliament in a post I made on July 22, 2021 – On the Verge of a Third Wave? – Jamaica’s Current Covid-19 Situation.)

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?

Let’s see.

PBCJ Recording of MOHW press conference held on July 1, 2021

PBCJ Recording of OPM press conference held on August 9, 2021


“…while there’s no confirmatory test, I am prepared to say that we should assume that the [Delta] variant is here…” – Minister of Health, Jamaica

At the Ministry of Health and Wellness (MOHW) press conference on Thursday, July 22, 2021, more data and information was presented indicating that Jamaica is beginning to experience a third wave of infections in the Covid-19 pandemic. The first wave peaked in terms of number of confirmed cases in September of last year and the second wave in March of this year.

From left to right: Permanent Secretary Dunstan Bryan, Minister of Health & Wellness Chris Tufton, Chief Medical Officer Dr Jaquiline Bisasor-McKenzie, National Epidemiologist Dr Karen Webster-Kerr

In her presentation, National Epidemiologist Dr Karen Webster-Kerr indicated that all of the main Covid-19 indicators were moving in the wrong direction:

MOHW slide – press briefing 22-7-2021

“And so the final slide is a summary of where we are for our main indicators. Our geographical spread level is medium. The bed occupancy is at high pressure. The Positivity is at high transmission level. The reproductive rate is increasing and we see this is exponential increase in both cases and hospitalization. Our vaccination level, where it is now, is too low to have an effect on transmission or significant effect on transmission.”

– Dr Karen Webster-Kerr, National Epidemiologist, MOHW press briefing, 22-7-2021 (transcribed from PBCJ recording)

Among the things noted in the presentation, were that:

  • one third of the communities across the country have cases of Covid-19, with Kingston & St Andrew, St Catherine and Hanover being the parishes with the highest numbers at this time
  • the level of hospital bed occupancy by confirmed and suspected Covid-19 patients had been falling but then plateaued recently and has climbed into the high level again in the past few days
  • the Reproductive Rate of transmission has increased from 1.1 in the previous week to the rate last week of 1.2, indicating an increasing rate of exponential spread; the rate of hospitalisations is also increasing exponentially
  • the Reproductive Rate has increased since the relaxation of interventions, which began on June 3 and were increased on July 1; the rate is now at 1.2.

It was in his comments following Dr Webster-Kerr’s presentation that Minister Tufton said that we could assume that the Delta variant was now in Jamaica:

“We do not have any evidence of the Delta variant being here from the tests that have been done but these tests are ongoing. We send samples out every week and while there is no confirmatory test, I am prepared to say that we should assume that the variant is here. And I am prepared to say that because the probability of it being here is probably greater than it not being here, based on the border access and the travel restriction removal, including coming from countries where the Delta variant is now the dominant variant – the UK being one or a main one but also now the United States. I am not talking about any particular sector. It’s not about tourism because the truth is as Jamaicans we travel very frequently, the diaspora. So once we have that kind of interaction, particularly in this case with a highly contagious variant of this virus, as outlined by the scientists, it is very likely. But from the tests that have been done we have not yet confirmed. But results will continue to come in and as soon as we confirm, we will make it known.” 

 – Minister Chris Tufton, MOHW press briefing, 22-7-2021 (transcribed from PBCJ recording)

Chief Medical Officer Dr Jacquiline Bisasor-McKenzie spoke about the rising indicators which signaled the increased pressure that is likely to affect the health system, the plans to meet this increased pressure and the challenges being faced.

Dr Bisasor-McKenzie’s presentation begins approximately 21 minutes into the press conference. See PBCJ recording below.

Minister Tufton advised that the Cabinet Sub-Committee dealing with Covid-19 was scheduled to meet on Saturday, July 24, 2021 and that the decisions made would be announced this week. We wait to hear the outcome of these deliberations, which is likely to have significant impact on how the 3rd wave of infections in Jamaica plays out.

PBCJ Recording of MOHW Covid-19 Press briefing 22 -7-2021


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On the Verge of a Third Wave? – Jamaica’s Current Covid-19 Situation

At the meeting of the Joint Select Committee on the Covid-19 Pandemic and Related Matters that was held at Parliament this week Tuesday (July 20, 2021), National Epidemiologist Dr Karen Webster-Kerr gave an update on Jamaica’s Covid-19 situation, using data as of July 19.

A copy of the slide presentation presented by Dr Webster-Kerr is available here:

Dr Webster-Kerr noted the increase in the number of new cases and the positivity rate that has been seen in the past couple of weeks.

She pointed out that the Reproductive Rate of the virus is once again over 1, now being at 1.1. This means that Jamaica is again experiencing exponential spread of the virus, albeit at a slow rate of spread. This rate could easily increase sharply without preventative measures.

One of the questions that has been asked frequently in recent weeks is whether the more contagious Delta variant is now present in Jamaica, particularly since it has now become the main strain of Covid-19 being seen in the UK and the USA, both being countries which see a lot of air travel with Jamaica. In Parliament last week, Minister of Health Chris Tufton said that genetic sequencing test results from samples sent to the CDC had not shown the presence of the Delta variant. When asked by Opposition MP Morais Guy, however, he was unable to say when those samples had been collected.

A slide in Dr Webster-Kerr’s presentation dealt with the samples sent for genome testing since December 2020 and indicated that the most recent results received were still those from the CDC.

However, in response to MP Guy’s question about how recent the samples were that had been sent for testing, Dr Webster-Kerr said that the samples sent to CDC on June 8, 2021, were mostly taken in May, with three from April and two from June. The samples sent to PAHO’s lab in Brazil on June 24, 2021, were mainly from April and May with a few from June.

This highlighted the point that the samples from which we have received results are too old to give any clear indication of whether or not the Delta variant is now in Jamaica.

Minister Tufton also responded on the issue of the samples and the Delta variant:

I think we have to be as straightforward with the country as possible, not just on the evidence based on the tests done but on the likelihood based on projections and circumstances. I think you raised an important point, Member [Morais Guy], on questioning the recency or age of the samples that were collected. And I think it’s quite clear that based on the dates around those samples the likelihood of picking up the Delta variant at that time would be less than it would be presently. And I think the most recent samples, the ones that are to go off, which would contain samples of June and hopefully July, would be our key insight, if you will, into whether the Delta variant is here.

These things normally not advisible to give a personal view but certainly based on the interactions that we are having as an open society with other geographic spaces that have the Delta variant as a dominant feature of those populations, I certainly believe that it is just more a matter of time before we detect that that variant is here. And I think the true, the same could be said for other populations throughout the world. This is the nature of the virus, this is how it spreads and once you are exposed with borders that are open of necessity, for trade or otherwise, you are going to have that level of exposure.

So I do believe that a more accurate reflection of what is present in the population as it relates to variant strains will come from the most recent batch of samples collected and I think the country should be advised of that and should continue to observe the protocols in anticipation that we are likely to have the Delta variant.

Minister Chris Tufton, Covid Joint Slect Committee, July 20, 2021 (Transcribed from PBCJ recording)

The Clinical Management Summary posted by the Ministry of Health and Wellness (MOHW) yesterday, giving the figures for Tuesday (July 20, 2021) added to the concerns being expressed. The number of new cases recorded was 111, which was the first time since May 27, 2021, that the number of new cases recorded in a day had gone over 100; it was 108 on that day. Also, the positivity rate was 16.1%; a rate higher than that had not been recorded since May 5, 2021, when it was recorded at 18.7%

In Parliament on Tuesday, Prime Minister Andrew Holness made a statement regarding the Covid-19 situation and indicated that the Cabinet Covid-19 Sub-Committee would be meeting on the weekend and that if the trends continued, tighter restrictions might be announced. Such an announcement might be made next week Tuesday.

In an interview with Dionne Jackson Miller on RJR’s Beyond the Headlines yesterday evening, epidemiologist Professor Peter Figueroa expressed concern about the point that Jamaica is now at, with an increase in cases and a Reproductive rate of 1.1.

We are facing an imminent surge of the Delta, it’s probably the Delta variant and that can be very swift with an increase in cases. We need measures immediately….I’m concerned because we cannot afford to watch and wait. When you look at the data, when you start to get an increase in cases, it rises rapidly.

Professor Peter Figueroa, Beyond the Headlines, July 21, 2021 (Transcribed from recording)

There seems to be a general consensus that if the Delta variant is not actually here yet, it will be sooner or later. And there are many who see the recent increases as an indication that we are already on the verge of a third wave of Covid-19 in Jamaica.

PBCJ RECORDINGS OF PARLIAMENT

Meeting of Joint Select Committee on the Covid-19 Pandemic and Related Matters – Tuesday, July 20, 2021

https://www.youtube.com/watch?v=A0YqkijcuaQ

Sitting of Parliament at which PM Holness made statement about current Covid-19 situation in Jamaica – Tuesday, July 20, 2021

https://www.youtube.com/watch?v=rAjn-ewhgoI&t=391s


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Jamaica’s #COVID19 Vaccination Plan: Two documents posted by the Government today

At a press briefing this morning (March 2, 2021), the Ministry of Health and Wellness representatives gave more details about Jamaica’s plans for vaccinating people against Covid-19. The first batch of vaccines is slated to arrive in the country this week and vaccination is planned to begin soon thereafter.

Left to right: Permanent Secretary Dunstan Bryan, Minister of State Juliet Cuthbert-Flynn, Minister Christopher Tufton, Chief Medical Officer Dr Jacqueline Bissasor-McKenzie. Also participating Dr Melody Ennis, Director of Family Health Services (Pictured at top right Antoinette Aiken, providing sign language interpretation)

Now posted on the Ministry of Health & Wellness website are an updated copy of the National Covid-19 Vaccine Deployment & Vaccination Interim Plan Version 1.0 and the Interim Vaccination Logistics plan. I have posted copies of both documents below:

Also here is the link to the PBCJ recording of the press briefing.


So Much Happening So Quickly! #COVID19 #Jamaica

A friend called me late Friday afternoon (March 13, 2020) simply to share her feelings of unease. We agreed that it felt as though we were on the brink of a major event or shift, that it felt as though we were living into a period of grave change. Much has happened since that call that bolsters the feelings we were experiencing that Friday the 13th afternoon.

Somewhere in the wee hours of that day, Jamaica’s Ministry of Health & Wellness had issued a press release giving a delayed update regarding the status of Covid-19 cases in the country, indicating that there were six new cases on the island.

MOHW press release - covid 19 update 13-3-2020

Jamaica has confirmed six new cases of the Coronavirus Disease 2019 (COVID-19) on the island.

The cases, which bring to eight the number of confirmed cases, include:

  • Two males, aged 63 and 67, who came into the island on March 7 from Trinidad, having travelled from Malaysia by way of Dubai and London. They presented at hospital on March 11.
  • One male, 36, who travelled from Manchester, England. He was taken to hospital from his hotel via ambulance on March 11.
  • One male, 31, a Jamaican overseas ship worker who came in from the Canary Islands via Portugal and Miami. He arrived in the island on February 25 and presented to hospital with symptoms on March 10.
  • One male, 58, who is the father of the first patient who was confirmed with COVID-19. He was discovered ill at home on March 11.
  • And one female, 34, who is a close contact, also of the first patient who was confirmed with COVID-19 on the island.

The Minister of Health and Wellness Dr the Honourable Christopher Tufton will meet with the media on Friday afternoon to provide further details. He is currently examining the level of preparedness for COVID-19 in western Jamaica.

Ministry of Health & Wellness Press release, March 13, 2020

https://www.moh.gov.jm/jamaica-confirms-6-new-covid-19-cases/

I had watched the rather bizarre press conference held by the US President at the White House that afternoon, which once again illustrated the problematic nature of the federal response to COVID-19 in that country. I had seen reports of the Cayman government’s measures announced that afternoon, in the context of their first confirmed case. (He was a passenger on a cruise ship, who had been hospitalized in Cayman with serious heart problems, who later showed symptoms of COVID-19 and unfortunately died. Medical staff were exposed to the virus while caring for him before he showed symptoms and the hospital has now been closed for two weeks.) The measures included no cruise ships being allowed for 60 days, schools being closed until April 27 and gatherings of 50 or more people being banned.

I had been waiting for the promised press conference by the Jamaican authorities to update the country on the new confirmed cases, initially announced for 2pm, but which got underway after 6pm. You can watch the full recording on the PBCJ YouTube page or on Prime Minister Holness’ Facebook page.

Holness covid 19 - 13-3-2020

Prime Minister Andrew Holness at COVID-19 Press Briefing, March 13, 2020

Some major developments were announced at that press briefing, at which the following officials also spoke: Minister of Health & Wellness Chris Tufton, Chief of Defence Staff of the JDF Rocky Meade, Commissioner of Police Antony Anderson, Chief Medical Officer Dr Jacquiline Bisasor-McKenzie, Attorney General Marlene Malahoo Forte, Permanent Secretary in the Ministry of Health & Wellness Dunstan Bryan, Minister of Foreign Affairs & Foreign Trade Kamina Johnson Smith, Minister of Local Government & Community Development Desmond McKenzie, Minister of Science, Energy & Technology Fayval Williams, Minister without Portfolio in the Ministry of Economic Growth and Job Creation with responsibility for Land, Environment, Climate Change and Investments Daryl Vaz and Minister of Tourism Edmund Bartlett.

Some of the developments announced included:

  • the declaration of the entire Jamaica as an area of disaster
  • the quarantining of the communities of Seven & Eight Miles, Bull Bay, St Andrew, because of need to check for evidence of community spread of COVID-19 (related to the first confirmed case in the country)
  • the adding of the United Kingdom to the list of countries on which travel restrictions have now been placed
  • the expansion of isolation areas across the country
  • efforts to increase the number of medical professionals to deal with the situation, including 21 specialist nurses arriving from Cuba on March 24 & requests for retired nurses to return to service
  • the restriction of visits to government golden age homes and infirmaries for the next 15 days
  • special arrangement for increased trucking of water to areas experiencing water shortagescovid 19 seven miles quaratine graphic

 

Since Friday, there have been additional developments related to COVID-19 here:

March 16, 2020 – 5 More Preliminarily Confirmed

In a press release sent out shortly after midnight this morning, the Ministry of Health & Wellness notified that there were 5 more preliminarily confirmed cases in the country. With the two cases confirmed yesterday (March 15, 2020), this brings the current total of confirmed cases in Jamaica to fifteen.

MOHW Covid-19 press release 16-3-2020

March 15, 2020 – 2 More COVID-19 Cases Confirmed; 17 test negative

Press Release from the Ministry of Health & Wellness

“The Ministry of Health & Wellness is reporting that two new cases of COVID-19 have been confirmed in the island. This is following the results from the National Influenza Centre, where 19 tests were conducted in the last 24 hours. Seventeen (17) of the cases tested were negative.

The country now has a total of 10 confirmed cases. One of the new cases was identified through contact tracing relating to the index case (Patient 1), while the second patient presented at hospital with a travel history to Trinidad and Tobago and had symptoms similar to COVID-19. Both persons were isolated and samples collected and tested.

The seventeen (17) other patients, who tested negative, included persons who are from Kingston and St. Andrew, St. Ann and Clarendon and who were identified through contact tracing from confirmed cases, where a similar protocol was observed to isolate and test.

Up to Saturday, March 14, 2020, 27 patients were in isolation facilities. They remain stable, including patients 1 and 2, who no longer have symptoms. Patients whose test results are negative will be released shortly.

The Ministry wishes to remind all persons, who suspect that they have had exposure to COVID-19 and are displaying symptoms to self-isolate immediately and contact the Ministry of Health & Wellness at 888-ONE-LOVE (663-5683) or 888-754-7792 for further instructions”

https://www.moh.gov.jm/2-more-covid-19-cases-confirmed-17-test-negative/

We’ll see what today and the week ahead bring.

 

 

 


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Information Sharing Events: #COVID19 #Jamaica

Yesterday (March 10, 2020) Jamaica announced that it had its first confirmed case of the coronavirus COVID-19, a young Jamaican woman who had arrived in the island from the UK…

“…on March 4, presented to the public health system on March 9 and has been in isolation since then.

Based on the patient’s travel history and symptoms, health professionals suspected COVID-19. A clinical sample was collected and sent to the
National Influenza Centre, where laboratory tests confirmed the diagnosis
today at approximately 11:00 am.”

Minister Tufton – Press Statement re Corona Virus March 10 2020

Today (March 11, 2020) the World Health Organization classified the COVID-19 outbreak as a pandemic.

“In the past two weeks, the number of cases of COVID-19 outside China has increased 13-fold, and the number of affected countries has tripled.

There are now more than 118,000 cases in 114 countries, and 4,291 people have lost their lives.

Thousands more are fighting for their lives in hospitals.

In the days and weeks ahead, we expect to see the number of cases, the number of deaths, and the number of affected countries climb even higher.

WHO has been assessing this outbreak around the clock and we are deeply concerned both by the alarming levels of spread and severity, and by the alarming levels of inaction.

We have therefore made the assessment that COVID-19 can be characterized as a pandemic.

Pandemic is not a word to use lightly or carelessly. It is a word that, if misused, can cause unreasonable fear, or unjustified acceptance that the fight is over, leading to unnecessary suffering and death.

Describing the situation as a pandemic does not change WHO’s assessment of the threat posed by this virus. It doesn’t change what WHO is doing, and it doesn’t change what countries should do.

We have never before seen a pandemic sparked by a coronavirus. This is the first pandemic caused by a coronavirus.

And we have never before seen a pandemic that can be controlled, at the same time.

WHO has been in full response mode since we were notified of the first cases.

And we have called every day for countries to take urgent and aggressive action.

We have rung the alarm bell loud and clear.”

WHO Director-General’s opening remarks at the media briefing on COVID-19 – 11 March 2020

Online link here

Within the last week there have been a number of events aimed at sharing information about the COVID-19 disease generally and about the disease in the context of Jamaica. Most of these events took place before the first case was identified in Jamaica and the situation is developing rapidly around the world and here as well. But I wanted to pull together in one place some of the information events here and that is the simple purpose of this blog post.

March 10, 2020 – Ministry of Health & Wellness Press Briefing on 1st Case of Coronavirus confirmed

MOHW Covid-19 press briefing 10-3-2020

Unfortunately the Public Broadcasting Corporation of Jamaica recording doesn’t start right at the beginning of the press briefing, but the full text of Minister Chris Tufton’s statement can be seen in the first document in this blog post. And there is a full recording on Prime Minister Holness’ Facebook page.

March 8, 2020 – Minister of Health’s National Statement: COVID-19 Comprehensive Response Plan

Minister Tufton COVID-19 National Statement 8-3-2020This National Statement was broadcast on Sunday night on most of the main radio and television stations. I cannot find the text of it on the Ministry of Health website, however. Perhaps they will post it at some point.

What I also haven’t yet seen is a published copy of the Comprehensive Response Plan document and I don’t yet know when or if the government intends to make it public. I think it should be made public.

March 5, 2020 – University of the West Indies (Mona) Faculty of Medical Sciences, COVID-19 Pandemic Preparedness Conference

UWI Faculty of Medicine COVID-19 conference 5-3-2020

Dr Tomlin Paul, Dean of the Faculty of Medical Sciences, chaired this conference at which seven presentations were made on a variety of aspects of the situation. The presenters were:  Professor Celia Christie, Dr Carl Bruce, Dr Sandra Jackson, Dr Karen Webster-Kerr, Dr Christine Clarke, Professor Wendel Abel, Professor J. Peter Figueroa and their presentations were followed by a Q & A session. It was a very informative event and was streamed live, which extended the reach greatly.

March 5, 2020 – Meeting of the National Disaster Risk Management Council

National Disaster Risk Management Council 5-3-2020

The Council is headed by the Prime Minister and at the meeting he and a number of other Ministers and agency heads made presentations focused on COVID-19.

The situation continues to evolve and the need for timely official information is ongoing.


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Births Fall in Jamaica in 2016…Because of #Zika Warning?

RJR birth decline in 2016 report - 4-5-17I heard the tail end of a report on RJR’s 5pm newscast yesterday (May 4, 2017), which said that there had been a significant decline in births in Jamaica last year. This seemed interesting in the context of the warning to delay pregnancy issued by the Ministry of Health (MOH) in January 2016, in advance of the country’s first confirmed case of the zika virus.

 

MOH warning to pregnant women 1-2016

During his Sectoral Debate presentation on May 3, 2017, Minister of Health Christopher Tufton tabled the first edition of Vitals, a new quarterly report published by his Ministry, which contains the following information:MOH reduced births 2016 chart

MOH reduced births 2016 text

(p.12, Vitals: Quarterly Report of the Ministry of Health – April 2017)

 

This 28% decline in the 4th Quarter of 2016 – nine to twelve months after the zika warning was issued – does on the face of it seem related to the warning. It certainly invites further study to understand how women and their partners responded to the warning and what part various factors, such as discussions and planning, increased use of contraceptives, access to abortion, for example, played in the subsequent decrease in births. It would also be interesting to compare this decrease in Jamaica with other countries which issued similar warnings. I also wonder whether there has been another recent year in which Jamaica has seen an annual decrease in births as large as 7.4%. (The RJR report mistakenly stated that the 28% decline was for the entire 2016, rather than only the 4th Quarter.)

Zika Update

The issue of Vitals also gives an update on the situation with zika in Jamaica up to the first week of April 2017:MOH zika update - Vitals 4-2017

It also reported on the cases of pregnant women with zika infections and the babies with suspected or probable cases of Congenital Syndrome Associated with Zika Virus (CSAZ).

There were 827 cases of notified Zika virus infection in pregnant women reported as at 10th April, 2017; 698 have been classified as suspected Zika based on the case definition. Of the 698 suspected cases, seventy-eight (78) have had positive PCR results confirming Zika virus infection. There were 170 notifications received regarding babies suspected as Congenital Syndrome Associated with Zika Virus Infection (CSAZ), 50 were classified as suspected cases of CSAZ (46 Microcephaly – 35 non-severe, 11 severe; 4 other congenital abnormalities). Three infants based on Pan American Health Organization/World Health Organization were classified as probable cases of CSAZ.

(p. 17, Vitals: Quarterly Report of the Ministry of Health – April 2017)

There is obviously more to be said about the cases of babies suspected to have been affected by the zika virus, including why the numbers were fewer than initially feared, how the cases of microcephaly compare to previous years in number and severity and how the programmes to support the babies, their mothers and families are proceeding.MOH Vitals 4-2017

Vitals – A New Publication by the Ministry of Health

 

When he introduced the new publication during his Sectoral Debate presentation, Minister Tufton said that he hoped it would be a source of information and a tool for accountability.Tufton sectoral debate presentation 3-5-17 Vitals

I welcome this new quarterly report and think that it can indeed be a useful source of information about a variety of topics that are part of the remit of the Ministry of Health. I hope, however, that it will be easily and widely available. I found the link to it on Minister Tufton’s Twitter account. Up to the time of publishing this blog post, it wasn’t available on the MOH website or via the Jamaica Information Service website. I hope it soon will be.

 

 

 


Ministry of Health Jamaica: 6 weeks of #zika numbers

On July 5, the Ministry of Health (MOH) in Jamaica began posting updates on its website regarding the number of zika cases. The first update was for data as of June 25, 2016 and since then the MOH has posted a further 6 updates, the most recent of which was posted on August 8 and contained the numbers up to August 5, 2016. All 7 updates are currently available on the MOH website, but for easy review I have included the chart below:

MOH zika updates June 25 - August 5 2016

One of the questions which remains for me is why there have been so few confirmed cases, given the steadily increasing numbers of reported and suspected cases. It would be useful for the MOH to publish data regarding the number of samples submitted for testing, the number of tests completed and the outcomes of these tests.

It would also be useful for the MOH to make public any reports on any problems being experienced with the testing that has been and is being done. I had asked some time ago, for example, about a doctor’s comment on having heard from two sources that a lack of a reagent had been hampering the testing of samples.

Sloper on FB

Dr Tufton had said via Twitter that he would check on that report. I haven’t heard an update from Dr Tufton on that reported lack of reagent, but it is entirely possible that I missed his update.

I heard CMO Dr De La Haye saying on a radio programme this morning (Nationwide News Network) that routine testing of all pregnant women could cost as much as J$100 million. If such an expenditure is being contemplated, it would be good to have an assurance that the process would be reliable.

The zika outbreak and its impacts continue to unfold, and the provision of information continues to be an important aspect of the government response.

 


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)

 

 


3 Comments

Jamaica: #Zika Update…On the Ministry of Health Website, No Less!

Christopher-Tufton-WebListening to the news at midday today, I heard a report of an update given by Minister of Health Christopher Tufton about the current situation with the zika virus here in Jamaica. As the news report was read, I madly tried to scribble down the figures being given…number of reported, suspected and confirmed cases, etc. I was particularly interested in the number of pregnant women reported with suspected cases of zika. I thought I heard 88, and began to comb the news sites online and on social media to see if I could track down the figure. No luck. I was about to send Minister Tufton a tweet or to call Power 106 to see if I could speak with someone in their news room.

And then I decided to check the Ministry of Health website, though I had little hope of finding any current figures there, based on past experience.

Eureka! Look what I found! A downloadable, written document entitled “Zika update as at June 25, 2016“, posted on the website today, July 5, 2016! Hallelujah!MOH zika update 25-6-16

 

Seriously though, this is a significant development in keeping the public informed, that on the same day the Minister gives an update to the media, a document containing the figures is posted on the MOH website. I sincerely hope that this is the beginning of a trend.

The full document (3 pages long) is available on the website and I have included it here: MOH Zika-update-of-as-at-June-25

Of particular note are the general update regarding number of cases, with 24 confirmed cases as of June 25, 2016:

MOH zika cases 25-6-16

and the number of pregnant women with suspected cases of zika:

MOH zika and pregnancy 24-6-16

Providing reliable, easily accessible official information to the public on a regular basis is essential during a public health situation such as this.