Ministry of Health & Wellness Ends Daily Covid-19 Updates: A Few Comments & Concerns

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.

Weekly Epidemiological Bulletin for EW36, posted on MOHW website

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.

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Three Covid Press Releases (April 13 -21, 2022 – One OPM, Two MOHW) & A Bit More

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.

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.

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.