Right Steps & Poui Trees


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Disaster Risk Management Order No. 11 Amendment – Dated November 18, 2021

The current Disaster Risk Management Order has now been posted on the Ministry of Justice website, which has a new look for the arrangement of its archive of these gazetted Orders. Perhaps the transition to this new arrangement was what was causing some glitches to the page over the past couple of days. Neither Order No. 11 nor this Amendment is posted on the OPM website yet.

Here is a copy of this gazetted Order, Disaster Risk Management (Enforcement Measures) (No. 11)(Amendment) Order, 2021:


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Disaster Risk Management Order No. 11, 2021 – Dated October 29, 2021

This is a copy of Disaster Risk Management Order No. 11, 2021, dated October 29, 2021. It is not the most recent Order, as Prime Minister Holness announced changes to the measures in Parliament last Tuesday (November 16, 2021). The new Order or Amendment to this Order has not yet been posted on either the OPM or Ministry of Justice website.

A copy of this gazetted Order is posted on the Ministry of Justice website but is not yet posted on the OPM website.


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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.


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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Gazetted Amendment to Jamaica’s #COVID19 Order No. 4: April 28, 2020

An amendment to The Disaster Risk Management (Enforcement Measures) (No. 4) Order, 2020 – April 21, 2020 has been gazetted. It is dated April 28, 2020 and a copy of it can be found below.

Disaster Risk Management amendment to gazetted order 4 - April 28 blog pic

Disaster Risk Management (Enforcement Measures) (No. 4) (Amendment) Order, 2020

It was posted on the Office of the Prime Minister’s website yesterday and can be found at this link below.

 

Previous Orders & Amendments can be found in earlier blog posts.


Jamaica’s Gazetted #COVID19 Order No. 4: April 21, 2020

A new Disaster Risk Management Order setting out measures to deal with Covid-19 in Jamaica has been gazetted. I have posted a copy here:

 

gazetted covid-19 Order No. 4 21-4-2020 blog pic

The Disaster Risk Management (Enforcement Measures) (No. 4) Order, 2020 – April 21, 2020

The Gazetted Order is available online on the Office of the Prime Minister’s website.

The OPM website Covid19 Order No 4 blog pic

The Prime Minister announced the measures at a press briefing on Monday evening (April 20, 2020). The draft order was the subject of discussion in Parliament late into the night on Tuesday (April 21, 2020) and was subsequently gazetted. The gazetted order is dated April 21, which does raise the question of whether it was gazetted that night before midnight, or whether it was actually gazetted the following day (April 22) and back-dated. And whether that matters or not…

This is a link to the Public Broadcasting Corporation of Jamaica’s (PBCJ) recording of that sitting of Parliament. Prime Minister Holness’ statement regarding Order No. 4 begins at about 4:16:30 in the video.