Right Steps & Poui Trees


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.

Advertisement


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.


1 Comment

350 Words or Less: No Need for Covid Conversations Anymore?

One of the communication tools the Ministry of Health and Wellness (MOHW) has used during the pandemic to share information with the public is the press conferences dubbed Covid Conversations. For some periods, these Conversations took place routinely on Thursday evenings and included an epidemiological update on the Covid situation in Jamaica, with slides, presented by the Chief Medical Officer or the National Epidemiologist. Aspects of policy and administration would be dealt with and current issues that had recently arisen. Importantly, it was also an opportunity for members of the media to ask questions of MOHW representatives, including the Minister and Permanent Secretary, and have them answered on the record. And the PBCJ recordings of these events have provided a very useful archive for tracking aspects of the pandemic and the MOHW’s approach.

In more recent months, however, these Covid Conversations have been held less frequently, as I and fellow blogger Emma Lewis have commented on on Twitter:

It isn’t that the Minister or the CMO or the Director of Family Health Services are not accessible to the media. They certainly do interviews on various radio programmes. However, these are not archived in the way that the PBCJ recordings are and quickly become inaccessible to the public and they certainly won’t be available via Access to Information requests. And when the Minister speaks in Parliament, members of the media don’t get to ask him questions there.

The last Covid Conversation was held on the morning of Tuesday, October 26, 2021, an unusual day and time, as the Minister himself commented. That’s 4 weeks ago today. There has been no Covid Conversation in November. Why not? Has MOHW decided that these convos are no longer useful? If so, what is the strategy being used to replace them or to provide other means for the sharing of the information they provided and the regular opportunity to have questions asked and answered? Or is it that there’s nothing new to share or to answer questions about? Covid’s over?

Maybe this Thursday we’ll have another Covid Conversation…or maybe not…


2 Comments

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