Right Steps & Poui Trees


Leave a comment

Medical Association of Jamaica’s Recent Webinar on Long Covid

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.


1 Comment

A Week Later & for the Prime Minister, the Argument is Still Done

A week ago, on Sunday, January 9, 2022, Prime Minister Andrew Holness held a press conference to announce a Zone of Special Operations (ZOSO) in Parade Gardens in Central Kingston because of the levels of violent crime occurring in the area. When the press conference had been called the evening before, many wondered if it was being called because of the increase in Covid-19 cases that was happening as the 4th wave picked up momentum.

During the question and answer period, Gleaner reporter Tenesha Mundle asked PM Holness this question:

“Are we planning to return to lockdowns and, if lockdowns are off the table, what other strategies will be implemented to halt the current Covid-19 wave?”

PM Holness replied:

“I wasn’t planning on turning this into a Covid Conversation. But I know there is great tension in the air. And what it says to me is that people are not listening to what I have said. I’ve been very clear, in Parliament, very clear, absolutely, gone overboard to say we are not going back to lockdowns. So, be calm! And I’ve said what the strategy is. It is now in your hands! Go and take the vaccine! That is the strategy. We can’t hold you down and put the needle in your hand. If you get sick, you tek that responsibility. There is an option; we have vaccines all over the place. We have sites all over the place. I don’t hear one person complain that they can’t get the vaccine anywhere. Go and get vaccinated! Argument done!”

Argument done. Go and take the vaccine. That is the strategy.

In the week that followed, the situation has worsened:

  • We have had the highest reported number of new confirmed cases in a 24-hour period since the start of the pandemic (1968 on Jan 15, 2022)
  • We have had the highest positivity rate since the start of the pandemic (68.6% on Jan 13, 2022) and on 5 days of last week , the positivity rate was over 50%.
  • The number of people hospitalised with confirmed cases of Covid-19 moved from 294 at the start of the week to 446 by the end of the week.
  • In Parliament on Tuesday (Jan 11, 2022) in a statement in which he extended existing Covid measures without changes for another 2 weeks, PM Holness noted that although the country’s Covid bed capacity of 700 beds had not yet been reached, hospitalisations were increasing sharply and Covid beds might soon be full. (The slide he shared was a reminder that hospital beds are occupied by both people with confirmed Covid cases and those with suspected cases, who are awaiting test results. The daily reports from the Ministry of Health & Wellness give the number of people hospitalised with confirmed cases only; so the number actually is always higher on the ground.)

During the week, the heads of regional health authorities and some hospitals were in the news detailing some of the challenges that were being experienced in the health system:

In a Jamaica Observer article on Thursday (January 13, 2022), – University hospital under pressure from Covid patients – Chief Executive Officer at University Hospital of the West Indies (UHWI) was quoted commenting about the situation at the hospital:

Chief executive officer of UHWI Kevin Allen told the Jamaica Observer that the operations at the institution were becoming difficult as the fourth wave of the virus shapes up to wreak havoc. He reported that the system is further strained as roughly 90 nurses are at home, sick.

For patients and staff, Allen said the situation is “stressful, frustrating and difficult”. He encouraged staff to “hold it because the worst is yet to come”.

“We are putting systems in place and we are working to see how best we can ensure we hold it. We are not in breakdown days yet, but it is rough,” he said.

“The last report I have seen, we have some 90 nurses out of the system and that is crippling our operations. We have roughly 880 nurses and about 10 per cent have come down with the virus,” Allen added.

“We were already operating short with these skill sets, so to lose so many will impact on the quality of care. All the areas that we operate are full. The field hospitals are full, isolation is full, emergency is full with patients. We had to revert to using tents.”

On Friday (January 14, 2022), UHWI issued a press release notifying the public to expect delays at the hospital.

On Saturday (January 15, 2022), Minister Tufton posted a series of tweets about the situation at a number of hospitals he had visited, including Bustamante Hospital for Children, which was being affected by an increase in Covid-19 cases and reduced staff, due to infection and quarantine.

In an article in Loop News that same day – Covid Surge: Highest number of paediatric cases at Bustamante hospital – Senior Medical Officer, Dr Michelle-Ann Richards-Dawson was quoted as saying:

“We are currently in the fourth wave of the pandemic. We have been through three before but this one is different. The pace at which people are getting infected and symptomatic is alarming and therefore it is important that we vaccinate to protect ourselves and our loved ones”.

The Jamaica Medical Doctors’ Association (JMDA) issued a release expressing their concerns about the current situation…

…which was endorsed today by the Medical Association of Jamaica (MAJ)…

So with this and more having occurred in the last week, many people wondered if Covid-19 would be on the agenda of the Office of the Prime Minister press conference announced last night. However, it wasn’t.

This morning, PM Holness told the country that a ZOSO had been declared for some sections of Westmoreland, which has been plagued by violent crime. At the end of the press conference, the ususal question and answer segment took place. The final question was asked by Ricardo Brooks of Nationwide News Network.

Ricardo Brooks: Good morning, Prime Minister. The country’s positivity rate has topped 60% and hospitalization, the situation there is deteriorating. Do you still hold to the point that “Argument done”?

The Prime Minister answered: You have said it. Thank you!

That was all. And then the press conference ended.

At the point we are at in the 4th wave, this is not an adequate or appropriate response from Jamaica’s Prime Minister. We are told that the peak of the wave is not expected for another two or more weeks. The health care system is already on the verge of being overwhelmed by the increased number of cases and the staff shortages. The strategy that PM Holness offered last week – “Go and take the vaccine! That is the strategy.” – will not slow this current surge. He may feel he has spoken enough; he may feel frustrated; he may have had another appointment to go to. But this was a national press conference he called, to talk about another issue, yes. But he must have expected that he would be questioned about the Covid-19 situation and it would have been good if he had used the opportunity, on a Sunday morning, to have said something more useful.


Covid Reflections: With Public Hospitals Accepting Emergencies Only, We Have Entered Another Phase in Our 3rd Wave

Yesterday Jamaica’s Ministry of Health and Wellness issued a press release stating that the country’s public hospitals would be accepting emergency cases only, until further notice. The large number of people confirmed with or suspected of having Covid-19 who need hospitalisation has resulted in the hospitals exceeding their Covid-19 isolation capacity. So other hospital spaces and resources have to be dedicated to treating people with Covid-19. General hospital service has been suspended, including elective surgeries, and people who can be cared for at home are being discharged. The Chief Medical Officer (CMO), Dr Bisasor-McKenzie, is quoted as saying that “The rising demand for oxygen also threatens to overwhelm the supply.”

Curiously, this press release has not (yet) been posted on the MOHW website.

This decision by the MOHW signals that the country has entered into a new phase in the 3rd wave of Covid infections in Jamaica but it does not come as a surprise if you have been following the news and numbers in the past couple of months. And the news and numbers over the last week or two have clearly shown the deepening crisis.

People in government and outside of government have been speaking about the increasing numbers of Covid-19 cases, the increasing numbers of hospital admissions, the pressure for space within the hospitals, the pressure on staff within the hospitals. These comments and information have come through official statements at government press conferences, through media interviews, in press releases, on social media.

A small sampling of examples…

Dr Melody Ennis of MOHW was speaking with Dionne Jackson Miller on RJR
Nurse Patsy Edwards-Henry, President of Jamaica Nurses Association, was speaking with Sanjay Lewis on Power 106
MOHW PS Dunstan Bryan speaking with RJR
Slide shown at OPM press conference on August 9, 2021, while PM Andrew Holness spoke & said “I want us to pay attention to this graph. It shows our daily confirmed cases of Covid-19 in blue, while the red line shows the 7-day moving average of new hospitalisations. You can see that our daily hospital admissions are now at the same level as our previous peak in March/April 2021. We now have approximately 500 of 700 beds allocated for Covid-19 occupied islandwide and a number of our large hospitals are over capacity.”
(Transcribed from PBCJ recording of OPM press conference, August 9, 2021.)
Slide presented at MOHW press conference August 12, 2021. CMO Dr Bisasor-McKenzie said: “We can see now, compared to last week, that our bed occupancy now is at over 600 beds occupied with both confirmed cases and suspected cases…Our peak, March/April, we were at just over 700 and now we are just over 600.”
(Transcribed from PBCJ recording of MOHW press conference.)
In a report on August 17, 2021, JIS covered this point made by Dr Bisasor-McKenzie, where she said “We are fast approaching that peak, which will put us in a very dangerous zone in terms of the care for COVID patients in our hospitals. It puts us in a very high level of pressure on the hospital system.”
Dr Andrew Manning, Medical Association of Jamaica President, in a news report on RJR, August 16-8-21 – MAJ Alarmed at Record High COVID Positivity Rate
Slide showing hospital capacity – OPM press briefing on August 19, 2021 – CMO Dr Bisasor-McKenzie said. ” And this is what is happening in our hospitals. Across the regions, what we are seeing is that the four regions are in an alert phase in terms of Covid capacity. For the southern region, we have gone over the capacity for Covid beds; we’re at 162% occupancy. For the western region, 142%. For the north east region, 125% and for the south east region at 97%. It means that most of our major hospitals, our main hospitals, are really full….As you can imagine, our health care workers are tired, they’re frustrated, they’re overworked, they’re stressed.”
(Transcribed from PBCJ recording.)
This week Wednesday (August 25, 2021) All Angles on TVJ did a special report about the Savanna-La-Mar Hospital, which is struggling with an influx of Covid-19 patients. Dionne Jackson Miller interviewed members of staff – doctors, nurses, a porter, the CEO – about conditions at the hospital. It was a harrowing and moving programme.

And today a number of media houses have carried reports that there is a severe shortage of medical oxygen in the country, which is now affecting the supply to hospitals, some of which are said to be out of oxygen. There has not at this point been an official statement on this from the Ministry of Health & Wellness.

There is an urgent need for a press conference to be held focusing on the dire crisis in the hospitals. Despite the many warnings that this was where we were heading, now that we are here, the public of Jamaica deserves a full update. This is particularly urgent in light of the fact that the Dr Karen Webster-Kerr, National Epidemiologist, has said that this 3rd wave won’t peak for another two weeks. That thereafter it is likely to take several months to come down from that peak. That, although she is reluctant to give predictions about deaths, we are likely to see 140-150 deaths over the next week and an additional 10-20 on top of that number the following week. (She was speaking in an interview on Nationwide News Network on Thursday, August 26, 2021). This means that the pressure on the hospitals is likely to continue for weeks to come, increasing further before it decreases.

It is Saturday night. The curfew started at 6pm. For the next 3 days, Jamaicans are under 24-hour curfews, with the curfew ending at 5am Tuesday morning. Tomorrow – Sunday – would be a good time to hold a press conference. Let us know what time. Most of us will be at home…