Right Steps & Poui Trees


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Cases Reported of a Possible Exposure to Covid-19 in Schools?

During his statement in Parliament on Tuesday (Nov 16, 2021), while announcing changes to the Covid-19 measures, PM Andrew Holness briefly mentioned cases of children with possible exposure to Covid-19 and how this was dealt with by schools.

Speaking about the country as a whole, he said:

“We are being very cautious in reopening and, just to be clear, we are not going to shut down again.”

He then went on to say:

“So, Madam Speaker, we have reopened our schools. We have seen cases reported of a possible exposure to Covid-19. We haven’t shut them when they have opened. We tell them to sanitise, clean up, isolate the child, keep them at home. But we are not going to close the schools again.”

These cases referred to by the Prime Minister – of possible Covid exposure in children in schools – haven’t been reported in the media nor to general public by the Ministry of Education, Youth and Information (MOEYI) or by the Ministry of Health and Wellness (MOHW). In his statement, PM Holness gave no other information about these cases…what schools or parishes they occurred in, when they occurred or how many children or schools were affected, for example.

Other questions needing answers include:

  • Has information about these cases been reported to the parents, guardians or families in the schools where these cases occurred?
  • Were the children who were possibly exposed to Covid-19 tested to see if they actually had Covid-19?
  • Were the other children and teachers in their class or in the school also tested?
  • Was any contact tracing done?

And a more general question needs to be asked about what exactly the protocol is when schools have a child in attendance who was possibly exposed to Covid-19, beyond what PM Holness mentioned…”We tell them to sanitize, clean up, isolate the child, keep them at home.”

There is very little specific information in the MOEYI’s Manual for the Reopening of Educational Institutions – Version 3, August 2021 on how suspected/confirmed cases of Covid-19 in students or staff are to be dealt with. And there is no mention of testing. Perhaps it is set out in detail elsewhere. It would be good to know.

PBCJ recording of the sitting of the House of Representatives on November 16, 2021


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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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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


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: Children and this third wave

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

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

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

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

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

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

Slide from MOHW press briefing August 12, 2021

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

Slide from MOHW press briefing August 12, 2021

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

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

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

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

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

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


“…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