Right Steps & Poui Trees


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Ministry of Education’s Manual for the Reopening of Educational Institutions – Version 3, August 2021

The most recent version of the Ministry of Education, Youth & Information’s (MOEYI) Manual for the Reopening of Educational Institutions – Version 3, dated August 2021 – isn’t currently posted on the Ministry’s website. I have only been able to find Version 1, dated May 2020.

I am posting a copy here because I think it would be useful for people to take a look and see what the Ministry has set out as the conditions under which schools should reopen, particularly considering the resumption of in person classes.

I’ll just share a few of my thoughts as I looked at the manual:

  • Overall there does not seem to be adequate attention paid to the airborne transmission of the SARS-CoV-2 virus, with more attention being paid to the sanitization of hands and surfaces, than to what is now known about aerosol transmission. I say this despite the section on masks.
  • The distance recommended for children in schools – desks, seating, removal of masks in classroom, etc. – is 3 ft. This is mentioned in multiple places in the document; an example here on page 11:

Yet in a section on page 34 dealing with protocols for the administrative staff, the distance referred to is the familiar recommended 6 ft:

In other situations outside of schools, social distancing of 6 ft is required. Why is 3ft considered safe for children indoors in schools, given what is now known about the airborne nature of the virus and in the context of the more transmissible Delta variant? Even the 6ft distancing raises concerns in indoor spaces for extended periods, where ventilation is inadequate.

  • Very little attention is paid in the manual to the issue of ventilation of classrooms and other spaces.
  • The section on Management of the Sick (pp 9-11) starts by saying “Develop and implement mechanisms to monitor staff and students who may become ill”, but doesn’t set out specifically the mechanisms that are required.
  • This bullet point on p. 9 deals with the requirement for an area to temporarily separate sick students and staff, which adheres to MOHW guidelines but doesn’t indicate where these guidelines are laid out.

This would seem to be a very important protocol to be specific about – how to deal with members of the school community who are ill, where there is the possibility that they may have Covid-19.

  • There is also the issue of reporting where there are confirmed cases of Covid-19:

No definition is given of “a school wide outbreak”? How many cases would constitute a school wide outbreak? How would they need to be distributed across the school? Would you not need to report individual cases before an outbreak became school wide, perhaps to prevent it from becoming school wide? And this speaks about reporting to the MOHW and the education regional office, but what about reporting to the school community, to the parents/guardians so that they are alerted that their child may have been exposed and therefore other members of the family as well?

  • There is no mention of testing protocols within schools, either on a routine basis or in the event of confirmed or suspected cases.
  • The section on Transportation on page 16 says very little about public transportation and the risk it poses to children who use it going to and from school. The MOHW has pointed to public transportation as one of the serious spreaders of Covid-19 infections. What measures are being taken by MOEYI and MOHW in anticipation of the increased cases of Covid-19 that are likely to result with the increased use of public transportation by children? How is this risk being dealt with?
  • Have the principals received the handbook about the use of Shadows, which is promised on page 19? Has a copy been made available to families whose children have Shadows?

These are some of the thoughts and questions that I have about the manual; there are others.

I am including below a copy of Version 1 of the Manual, dated May 2020.


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Chief Medical Officer’s Covid-19 Update for Oct 7, 2021

Jamaica’s Ministry of Health & Wellness (MOHW) had established a practice of weekly Covid-19 press conferences, usually held on Thursday evenings. For the past few months, however, this weekly practice has been less reliable, with gaps of a week or more occurring between press conferences. This was particularly problematic during the height of the current wave of the pandemic; fueled by the Delta variant, it has been the worst of the three waves Jamaica has experienced.

Yesterday was Thursday and I tweeted the MOHW a question about whether there would be a Covid Conversation (what the press conferences have been called for some time) and they responded saying no. This actually wasn’t much of a surprise, given that there had been a press conference last week and that the Ministry had been facing a lot of pressure and criticism from the public and in Parliament this week.

What was a surprise was to learn last night, via a Twitter thread by Gleaner journalist Jovan Johnson, that CMO Dr Bisasor-Mckenzie had given a recorded Covid-19 update, which was sent to the media by MOHW. This is not a common practice.

I am glad that this update was given. It is not a true substitute for a live press conference, but it does give the public some additional important information. Neither the text nor the video recording of the update has yet been posted online on the MOHW website. It was said that the video recording would be released by the Jamaica Information Service(JIS), but I have not seen a link on the JIS website. This all shows immediately the difference in access by the public compared to when MOHW press conferences are carried live by Public Broadcasting Corporation of Jamaica (PBCJ) and immediately posted on their YouTube channel. PBCJ has actually used some of the CMO’s recording in their news roundup today and in a special report.

I have posted here a copy of the text of the CMO’s update:

To illustrate the way in which these updates add to the information given in the daily MOHW Clinical Management Summaries, I will refer to this chart I compiled using some of the figures given in these summaries.

The hospitalization numbers in the daily reports show a strong downward trend but in her update yesterday, CMO Bisasor-McKenzie noted that daily hospital admissions have been increasing in the past week.

And she made the added comment, “This means that despite the trending down of hospitalizations, if the trend for admissions going up continues, our bed occupancy will increase.” This changes the perspective of our current situation somewhat.

Also of particular note in yesterday’s update are the comments about the delay in the availability of the 2nd dose of the Pfizer vaccine.

With so many ongoing issues, questions and concerns, it would be useful for MOHW to return to regular, weekly press conferences.

For convenience, I have included the statement below as well.


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Covid Reflections: Time for one of Dr Bisasor-McKenzie or Dr Webster-Kerr’s Covid-19 Updates

I’ve seen or heard pieces of information in the media about where we now are in the 3rd wave. For example, last week in an interview on Nationwide News Network, National Epidemiologist Dr Karen Webster-Kerr spoke about the expectation that the peak of this wave would occur in 2 weeks’ time and she gave projections for deaths in the coming weeks. During a discussion on Nationwide on Wednesday, Prof Winston Davidson mentioned that the reproductive number was now at 1.1. (For full disclosure, I was one of the other participants in the discussion.) In today’s Gleaner there is an article that refers to information said to have been obtained from Dr Webster-Kerr and the Ministry of Health and Wellness (MOHW):

“A hair-raising 250 COVID-19 deaths occurred in August, with another 60 fatalities still under investigation, said Dr Karen Webster-Kerr, national epidemiologist. Scores of other deaths reported in August occurred months earlier.

August 26 was the deadliest day for the month, with 20 persons succumbing to the COVID-19.

However, the 296 COVID-19-related deaths for March outstripped August’s.

Data from the Ministry of Health and Wellness obtained by The Gleaner showed that another 20 deaths in March are under investigation.

With the country recording a total of 69,054 COVID-19 cases as at September 2 and a total of 1,568 deaths as a result of the disease, the ministry is reporting that the overall (2020 to 2021) COVID-19 case death rate is 2.3 per cent.

The death rate in August (1.6 per cent) plunged only because infections soared almost fivefold, month-on-month, to more than 15,300.”

At the Office of the Prime Minister’s (OPM) press briefing on Wednesday (1-9-21), Prime Minister Holness included 3 of the slides that are normally included in the MOHW PowerPoint updates and he commented on them, something which he has done before, though moreso in Parliament. Although both the Chief Medical Officer (CMO) Dr Jacquiline Bisasor-McKenzie and Dr Webster-Kerr were present at the press briefing, neither spoke from the podium or gave the ususal update.

(Perhaps this was in keeping with the brief nature of the press briefing…only 3 slides, and only two questions allowed in the Q&A.)

The last of these MOHW Covid-19 updates that I can find is the one given at the OPM press briefing on August 19, 2021, by Dr Bisasor-McKenzie.

That is now more than two weeks ago, two weeks in which we have moved towards the peak of the 3rd wave. In that time there have been dramatic increases in the number of cases, the number of hospitalizations, the number of deaths. But we are being told that with the reproductive rate reducing and the positivity rate down from the high of 54%, there may be glimmerings of hope. This is exactly the time at which we need a full update from the CMO or the National Epidemiologist. To place us now in the context of indicators that the MOHW has used for so long.

Why haven’t we had one of these updates, at one of the times when we perhaps need it most, since the start of the pandemic?

We have been getting these periodically. They have been a useful way of tracking changes. Whatever problems some may have with aspects of the data, this is a way of following what the MOHW says the position is, what they are using to base decisions on, what the government is basing decisions on.

There was no MOHW Covid Conversation yesterday; Thursday is the ususal day for them if they are being held. No presentation at the OPM press briefing on Wednesday. No presentation at Parliament’s Joint Select Committee dealing with Covid-related matters on Tuesday; Parliament is on summer break. These are the three places that the public usually gains access to these updates. A presentation with commentary by Dr Bisasor-McKenzie or Dr Webster-Kerr would be best. But if that’s not going to happen, post the PowerPoint online on the MOHW website. In fact, press briefing or no press briefing, Covid Conversation or no Covid Conversation, Joint Select Committee or no Joint Select Committee, post it at regular intervals on the MOHW website.

During a crisis such as this pandemic, information to the public is crucial. With this Delta-variant-fueled 3rd wave, with our public hospitals not offering anything but emergency services, with bed capacity overwhelmed, with dangerous oxygen shortages, we are in a crisis within the crisis. We need more information, not less.


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Covid Conversations: Hindsight? Look at what the CMO said about a 3rd wave on April 29, 2021…

Last week nearly 5000 new cases of Covid-19 were reported by the Ministry of Health and Wellness. One hundred and sixteen (116) deaths were reported, a figure which doesn’t reflect the exact number of deaths for the week, as it includes a number of people who died prior to last week and doesn’t include all those who died that week. Hospitalizations reached a high of 739, with many people reported as being moderately, severely or critically ill. The MOHW announced on Friday that all public hospitals would be accepting emergency cases only and general services would be suspended until further notice; this was because of the overwhelming increase in numbers of Covid-19 patients needing to be hospitalised. On Wednesday’s edition of All Angles on TVJ, staff at the Savanna-La-Mar Hospital spoke about the shortage of oxygen being experienced at that facility. In a press release this afternoon, the MOHW confirmed reports in traditional and social media that hospitals were short of oxygen and some had actually run out. (Press release is posted below.)

With the crisis now facing the health sector, with hospitals unable to cope with the numbers of Covid-19 patients, with resources being stretched thin and staff being overwhelmed, there are those who want to push a narrative that this could not have been foreseen; that it is hindsight to say that wrong decisions were made in relaxing the Covid restrictions in the way that they were relaxed in June and July. That we couldn’t have known how bad a 3rd wave would be.

When I hear that narrative, I think back to the presentation that CMO Dr Jacquiline Bisasor-McKenzie made at the MOHW’s Covid-19 press briefing on April 29 this year. At the time I took it as a public warning to the country – politicians and the public at large – of what science, medicine, public health were indicating about a 3rd wave. A warning that we needed to maintain strong restrictions and not open up too quickly, if we were to avoid a disastrous 3rd wave.

Dr Bisasor-Mckenzie started by saying “I am just going to go through first of all some of the routine slides that you are used to, just providing you with an update and then we are going to look at some explanation of some of the figures and then to have a brief look at what projections could look like.”
“We would have seen that we would have confirmed 122 new cases yesterday; that would have been published on our website this morning. It would bring our total number of confirmed cases to 45,414 cases. We are now at 770 deaths that have arisen out of Covid and we have a 1.7% case fatality rate. Our daily positivity rate, using yesterday’s figures is 15% and the average positivity rate since the start of the pandemic until now is 16.2%.”

Dr Bisasor-McKenzie pointed out that it was still the 20-29 and 30-39 age groups that were seeing the highest number of infections. She said the indications were that there wasn’t sufficient adherence to the preventative protocols and there was still a lot of movement, including illegal gatherings.
She said, however, that it was still those over 50 who were at greatest risk of getting severe cases of the disease and dying from it. It was suggested that members of the younger age groups were getting infected and then passing the virus on to members of the older age groups.
Dr Bisasor-McKenzie spoke about the link between comorbidities and death from Covid-19, saying that 98% of deaths so far were in people who had one or more comorbidity or risk factor. She reminded that age over 60 was a risk factor itself. She emphasized the importance of controlling underlying conditions and staying in as good health as possible.
This slide showed the epicurve, with the indicators of the 2nd wave trending down. Dr Bisasor-Mckenzie said that it appeared that the measures put in place were having an effect in reducing the number of cases and of hospital admissions.
This slide showed that there was a huge downward trend in the number of beds occupied by confirmed and suspected Covid-19 patients, as well as in deaths and the positivity rate.
“If we look at the admissions and the overall bed capacity, the red line shows how we have increased the bed capacity since March last year and those are beds that are dedicated to the management of Covid cases. Most recently, in April where you have the step up, would have been the addition of the isolation beds in the field hospital at the Spanish Town Hospital and that would have increased our beds to over 600 beds. We would see though that the occupancy of those beds have been decreasing consistently since the beginning of April. However, all of these decreases are not reasons to relax. Let us look further.”
The CMO reminded that not many of the beds for Covid patients in the hospitals were new beds. Many of them were beds that had to be taken out of general occupancy, beds that were normally used for surgical or internal medicine patients, for example. She said there would need to be a considerable reduction in the number of Covid patients to minimise the disruption to other services.

Dr Bisasor-McKenzie went on to say that when the number of beds occupied rose to its highest peak in March (shown by the white line in the slide), the number of beds occupied by Covid patients had gone over the number of beds assigned for Covid patients. There was then an extremely high level of pressure placed on the health system, the hospitals, because of this.

“…not only would we have been utilising beds for Covid but we would now have been utilising beds that were for the other services. Not only would we have been using staff that, some of them newly hired to manage Covid, but we would have been utilising staff from other areas and we would have had the staff under considerable pressure. Also in terms of supplies to the hospitals, those would have been at a very high usage rate and so we would have been under a very high level of pressure to the health system when our numbers were in that very maroon red, above 600 beds being occupied. But if we went down to between 400-600, we are still in the red level because we still would have had considerable pressure on those same services in terms of other beds, in terms of the staff and in terms of supplies that were needed.

So even though we see that our numbers have come down, and we have fallen from 600,700, down to a little bit less than 400, we are only just now a little bit out of that red zone where we would have had high pressure on the health system. And it is not until we reach down to a level of about 150 will we be in the green zone where there is minimal disruption of health services. So we still have a considerable way to go in terms of moving from just under 400 beds occupied to 150 beds occupied for Covid. So there is still a lot of pressure there. It is while we are trending down, there is still a lot of work to do to get our numbers down to where we can safely manage within our health system.”
Dr Bisasor-McKenzie reviewed what the positivity rate is and noted that in the 2nd wave it had gone up to near 40% and had come down then to in the teens. She reminded that countries were to be below 5% consistently for a period of time before relieving restrictions.
She also reminded that an 8-10% positivity rate was regarded as an indicator of very high transmission and that during the 2nd wave our positivity rate had gone up to 38.9%.

“So we were way above the very high transmission….Right now we have not reached down to 10%. So we are still in the very, very high transmission. We need to get down below 5% to get into the green, where we can feel comfortable to relieve restrictions.”
Dr Bisasor-McKenzie pointed out that the last time we were in that green zone – the below 5% positivity zone – was in July and the beginning of August 2020, before the 1st wave. It had gone down to about 2 or 3% and that was where we needed to get back to, she said.

Just to look at this slide, you can just imagine that if we were at a 2-3% positivity rate at the start of the 1st wave and we went up as high as 25% in the peak of that wave; for the 2nd wave we started, look where we started. We started at 10% on average positivity rate and we ended up at 39.8%. Now can you imagine if we were to go into a 3rd wave starting at a 15% positivity rate? It means that our number of cases would be far more than what we would have peaked at before.
This slide highlighted some of the points made by the CMO about the positivity rate trends.

She spoke about the importance of bringing the reproductive number down to below 1, in order to reduce transmission of the virus, and the importance of strong public health measures to achieve this.

“That is what we want. No transmission. A reproductive rate that is tending towards zero. And that is why we had to have stronger measures put in place to bring down the numbers quickly because we were surpassing what our health system could manage.”

Dr Bissasor-McKenzie didn’t comment on this slide….
…or on this one.
She spoke about the impact of the interventions and the tendency once they begin to take effect to want to relax the restrictions.

“So this graph is a little bit fussy but what it shows is the effect of the measures that we had put in place and how it is that after we had imposed restrictions on public gatherings, in terms of the use of places of amusement, when the reproductive number was high, close to 2, we would have introduced those measures and you would see the blue line would have dropped down below 1. When we would have increased our curfew hours – the curfew hours are in the orange – and you would see that when we increased the curfew hours as well, the blue line is down. However, when the curfew hours are decreased, when the measures – and ususally what happens is that we see that whatever we are doing is working – the restrictions are working, the numbers start trending down and then we start to feel that we need to open up and we need to allow more movement. And as soon as we do that, we see the reproductive rate going up and then shortly after the reproductive rate starts going up, then our numbers start going up again. So it is very important that we recognize that the use of restrictions, the use of curfew has positively impacted the decrease in the number of cases and to get the epidemic under control.”

This slide emphasized some of the points Dr Bisasor-McKenzie made about curfew hours and the reproductive rate while talking about the previous slide.
This slide and the next are very significant in terms of projections about a 3rd wave. The CMO said:

And what will happen if we do not maintain our restrictions? There is the possibility of a 3rd wave. We see that several countries have gone into a 3rd wave. I mean countries like Italy, Germany, Hungary, France, Poland, Spain, India, Pakistan, Bangladesh, Indonesia, Phillipines, Brazil, Peru, Iran; they have all gone into third phases.

And why has that happened? Because as soon as there was a decrease in the number of cases, persons started to become complacent and we started to lift restrictions. More movement. Persons started to feel that they had to have the freedom to have gatherings and there were mass gatherings in many of these countries. We can see very, very clearly what has happened in countries like India, where with the release of restrictions in February, they have now gone into a 3rd wave. It can happen to us.

It can happen to us because, as Minister has said, the test results have come back; it does indicate that we have quite a bit of the UK strain in country, which means that there is a high level of transmisssion coming up out of that strain. We have seen that the exposure in the 20-29 and the 30-39 age group is pretty high with a large number of infections. So if it is that we are not careful and do not continue to have measures that decrease exposure, then we can go into a 3rd wave.

And what will a 3rd wave look like? Our starting point is not going to be as low as it was in August last year or even in December of last year. We’re going to have higher starting points that are going to result in possibly very, very high rates…

…where we could have the possibility of as much as 10,700 cases in the peak week, compared to 4000 cases in the peak week of the 2nd wave and just over 1000 cases in the peak week of the 1st wave.

Now it means also that as the number of cases go up, then we could have deaths going up as much as 180 deaths that could occur in a week, in a peak week, where we had 59 in week 11, which was the peak week of the 2nd wave and 31 in week 41 of 2020, which was the peak week of the 1st wave. Now 180 deaths in one week is something that we would not want to see.

It means also that there is going to be a severe stress on our beds and where we went up to 716 beds at peak, we could be going up to needing as much as 1900 beds. Do we have 1900 beds? We do not. We do not and we see what is happening in other countries. Hospitals are closing their gates because they do not have oxygen, they do not have beds. It can happen to us.

And now is the time that we have to ensure that we take the precautions, that we continue to maintain our restrictions, we decrease exposure, we wear our mask, we keep physical distancing, we stay at home, avoid gatherings – social gatherings, business gatherings, any type of gatherings – we avoid those gatherings to decrease exposure, so that we can keep our reproductive rate down, keep our positivity rate down, keep our hospitalizations down. Thank you, Minister.

Dr Bisasor-McKenzie laid out some of the indicators of what a 3rd wave could look like; she laid them out back at the end of April, 4 months ago. As many as 10,700 cases in a peak week, 180 deaths one week after a peak week and 1900 beds needed 2 weeks after a peak week.

Last week Thursday (August 26, 2021), National Epidemiologist Dr Karen Webster-Kerr said in an interview on Nationwide News Network that we were about 2 weeks away from the peak of this 3rd wave that we are now in. She said that in the coming week we could have as many as 140-150 deaths and a number 10-20 deaths higher the week after that.

And what are our numbers currently? Using the figures given in the daily MOHW Clinical Management Summary reports for Sunday, August 21 – Saturday, August 28, 2021, last week we had:

  • Total new cases: 4830 (This has exceeded the peak week of the 2nd wave, which had 4082 new cases; Saturday’s number of 929 is the highest single day total since the start of the pandemic.)
  • Positivity rate: Ranged from a low of 41.3% to a high of 50.7%, the first time it has gone above 50%. (The high in 2nd wave was 39.8%)
  • Hospitalisations: Went as high as 739 (This is confirmed cases only; the number in slide presentations combines confirmed and suspected cases, so would be higher than this.)
  • Deaths: 116 (This is the number of deaths REPORTED during the week; it includes some deaths which ocurred earlier than last week but were only reported last week. Also some deaths that occured last week have not yet been reported.)
  • All these indicators are going in the wrong direction.

It is clear that the scenario now playing out during this 3rd wave was certainly contemplated as being possible for Jamaica. Our Chief Medical Officer described what could happen during a 3rd wave, what could lead to a 3rd wave and what needed to be done to reduce the chances of a 3rd wave. At the time, the variant she spoke about was the UK or Alpha variant, which caused our 2nd wave. Within short order, it became clear that the more transmissible Delta variant (which originated in India and caused their devastating 3rd wave) was likely to be carried to Jamaica, probably from the US or the UK. The CMO, the National Epidemiologist, the public health professionals at the MOHW certainly would have forseen what would come with our 3rd wave.

Others in the society also warned about what could result from relaxing the restrictions too early, too fast and too far. It is possible to debate the reasons for the relaxation of the measures, the competing arguments around the decision. But let us not pretend that it is only with hindsight that one could say that the decisions made were wrong.

LINK BELOW

PBCJ Recording of MOHW Press Briefing on April 29, 2021, at which CMO Dr Bisasor-Mckenzie made this presentation. Her presentation begins approx 13 minutes into the recording.

MOHW Press Release re Shortage of Oxygen


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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…


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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: 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


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“…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.