Right Steps & Poui Trees


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Covid Reflections: Delta Variant Confirmed & Deaths Increase Sharply in August

We are in our third wave of Covid-19 in Jamaica.

MOHW slide – OPM press briefing 19-8-21

The Delta variant, which for some time has been assumed to be in Jamaica, has now been confirmed to be here.

The number of new cases and hospitalisations have been been rising steadily.

In the third week of August, new cases were over 500 per day on all days but one, the positivity rate was over 40% on 5 days of the week and hospitalisations had gone from 204 on August 1 to 573 on August 21.

At a press conference called by Prime Minister Holness last Thursday (August 19, 2021) to announce changes to the Covid-19 measures, Chief Medical Officer Dr Bisasor-McKenzie gave a presentation, which has been variously called sobering, alarming, frightening. Covid-19 indicators are all going in the wrong direction, with our vaccination levels too low to have any significant collective impact on the effects of this wave.

MOHW slide – OPM press briefing 19-8-21

The slide below from her presentation set out some sobering, alarming, frightening projections for increases in confirmed cases and deaths, if the reproductive rate remained at 1.4, and for daily hospital admissions, if the reproductive rate remained at 1.3.

MOHW slide – OPM press briefing 19-8-2021

The deaths reported by the Ministry of Health and Wellness (MOHW) during August have been going up at a steadily increasing rate. For the first week, 26 deaths were reported, 78 for the second week and 88 for the third. The totals for weeks 2 and 3 are already above the weekly reported deaths seen during the height of the 2nd wave in March this year. And we are not yet at the peak of the current wave….

The parishes with the highest reported deaths so far in August are Kingston & St Andrew (KSA) and Westmoreland, with 47 and 28 respectively.

(I want to make clear that I describe the numbers as REPORTED deaths because it is often not possible to tell from the Clinical Management Summaries the day on which deaths actually occurred.)

Compiled from MOHW daily Clinical Management Summaries

I have included a map of Jamaica showing the parishes, for ease of reference.

Map of Jamaica showing parishes

The report issued today, with yesterday’s data (Sunday, August 23, 2021) saw a record number of new cases being confirmed – 879, the highest single day total since the start of the pandemic. (The highest number prior to this was 878, recorded on March 7, 2021, during Jamaica’s 2nd wave.) Hospitalisation have reached 607 and 14 additional deaths were reported.

The days of lockdown announced will hopefully help to bring the numbers down. But they will not affect the deaths already likely to result from the high numbers of infections in the past few weeks. The increase in deaths typically lags behind the rise in cases by a few weeks. As Prof Peter Figueroa said in an interview on Nationwide News Network last Friday :

“We have a very serious surge of COVID cases, a lot of persons in hospital. The hospitals are close to being overwhelmed with the number of persons being admitted with COVID. This surge is looking worse than the last surge  that we had that peaked in March of this year.”

Prof Peter Figueroa, Nationwide News Network interview, 20-8-2021

Our hospitals and medical personnel are being overwhelmed. And as Prof Figueroa and other medical and public health professionals have said…it is going to get worse before it gets better. Actions taken now, by the government and the people, can help to reduce further infections and further deaths. But downplaying what’s happening, wishing it weren’t so or ignoring the science will not.


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Covid Reflections: Children and this third wave

The early narrative about SARS-CoV-2 and Covid-19 offered us some comfort at the time; at least it didn’t seem to affect children as much and we were thankful. As the pandemic continued, we saw that though children were infected at lower rates than adults and if infected generally had milder symptoms, it was clear that some children who caught the disease could have severe enough symptoms to be hospitalised and some children died. Others had serious side effects that lasted beyound the acute phase of the disease. But still we took what comfort we could from the fact that these severe outcomes affected children at a significantly lower rate than they did adults.

The Delta variant of Covid-19, which is becoming the dominant strain of the virus in many countries, is changing the narrative. Children are contracting the disease at higher rates and are being affected more seriously. Countries such as the USA are seeing more children being hospitalised and more children dying.

Although Jamaica still has had no genomic sequencing results to confirm the presence of the Delta variant here, we have been told we can assume that it is here. We have been told this by the Minister of Health and Wellness, by the Chief Medical Officer and, most recently, by the Prime Minister. They have pointed to the increases in the various Covid indicators and to the travel between Jamaica and countries experiencing surges due to the Delta variant, primarily the UK and the USA.

Jamaica is in the early stages of a third wave and the indicators are surging.

Information taken from Ministry of Health & Wellness (MOHW) daily Clinical Management Summaries posted online.

The daily number of confirmed cases has been rising sharply. Last week Sunday the number of newly confirmed cases was 281; on Saturday there were 656 new cases. At a press conference last Thursday, August 12, 2021, CMO Dr Bisasor-McKenzie shared a slide of the hospital admissions and pointed out that the average number of admissions (shown by the pink line in the graph below) was now just over 70 per day. She pointed out that this rate was already higher than the rate of admissions at the peak of the surge in March/April this year.

Slide from MOHW press briefing August 12, 2021

Many of the hospitals are already beyond their Covid bed capacity and their ICU beds are full. The pressure on the hospitals is at an extremely high level.

Slide from MOHW press briefing August 12, 2021

One of the hospitals that has exceeded its Covid capacity is the Bustamante Hospital for Children, the only hospital in Jamaica dedicated specifically to children. On Thursday, Director of the South East Regional Health Authority (SERHA) Errol Green said that the hospital is over capacity, which poses a problem, as patients can’t easily be transferred elsewhere. Various measures are being used to reduce numbers, including discharging children who can be sent home and not doing elective surgery, only emergency surgery.

So what exactly is the situation with children so far during this surge?

There have been references by officials to more younger people and children being treated for Covid-19. There have accounts of children and babies being admitted to hospital. And if the Covid beds at Bustamante are full, it signals an increase in the number of cases. But we need some specific information from the MOHW.

  • How many children have been confirmed with Covid-19 in the past 6-8 weeks?
  • Is this an increase in the rate that the data has shown perviously? If so, by how much? (The daily Clinical Management Summaries refer to babies as young as 1 day old among those confirmed with Covid-19, but the figures don’t tell us how many children are among those infected. Could a breakdown by age be done on a regular basis?
The chart on the MOHW jamcovid19 website doesn’t report children as a separate group, as seen in the 10-19 group and it doesn’t allow for observing trends over time.
  • How many children have been admitted to hospital with Covid-19 in the past 6-8 weeks? Is this an increase over the rate of admissions seen previously? How many cases have there been of critically ill children?
  • Have any children died of Covid-19 in the past 6-8 weeks? Are any children’s deaths under investigation for Covid-19?
  • How many Covid beds are there at Bustamante Hospital? How many paediatric ICU beds?
  • How many paediatric Covid beds are there at other facilities across the island? And paediatric ICU beds?
  • Is life sustaining equipment for treating children in adequate supply at Bustamante Hospital? Is it available at other facilities across the isaland?
  • With Bustamante Hospital full, are children still being transferred there for treatment?
  • How is the Covid-19 situation affecting treatment of children with non-Covid conditions?

At the MOHW press conference last Thursday, it was announced that a shipment of Pfizer vaccines is due to arrive in Jamaica this week. Because this is the only vaccine currently cleared by WHO for children, priority is being given to children in its roll out. Children 12 and older with co-morbidities and children 15 and older with parental consent will be allowed to get vaccinated. This is scheduled to start on August 23, 2021. This is an important development. It does not come in time, however, for children to be fully vaccinated before the scheduled start of the school year in September. And it does not cover children under the age of 12.

But with the surge in Covid cases not yet at its peak, it is not likely and not advisible that face-to-face classes start in September as previously planned. And that raises a whole additional round of questions and concerns. For another time.