No New Covid-19 Numbers From Ministry of Health in Nearly 4 Weeks, Despite “Weekly” Bulletins

When asked about the absence of new Covid-19 numbers since October 1, 2022, when the daily updates ended, the Ministry of Health & Wellness (MOHW) keeps saying that the information is being posted weekly on their website.

It isn’t.

The only two copies of the Weekly Epidemiological Bulletin posted on the MOHW website since the daily updates ended are the bulletins for the Week ending September 24, 2022 (posted on October 7) and for the Week ending October 1, 2022 (posted today, Oct 27).

This is not posting weekly and it means that for nearly 4 weeks – October 2 – 27, 2022, the MOHW has published no new Covid-19 numbers. We have no data on what has been happening with Covid-19 in Jamaica for the month of October. Not the number of confirmed cases, not the number of tests administered, not the positivity rate, not the number of people hospitalized, not the number of deaths reported. Nothing. We don’t know if the numbers are showing an upward trend, a downward trend or have remained pretty much the same.

And even if the MOHW posts the next Weekly Epidemiological Bulletin a week from today (November 3, 2022), it will presumably be the bulletin for the week ending October 8, 2022. Which means the information will already be nearly a month old by the time it is published. Not much use to anyone hoping to use such information to help assess the current risk, in order to adjust the precautions they take to protect themselves.

The government tells us to take personal responsibility, while reducing the information it shares that helps us to do just that.

Weekly Epidemiological Bulletin EW39 – for Week Ending October 1, 2022

And now a few comments about Bulletin EW39 itself.

• For Bulletin EW 38 & EW 39, the MOHW has changed the format in which it now posts the Weekly Bulletin. It used to be possible to download a copy easily, with one click. That is no longer possible. Now you would have to save each of the 8 or 9 pages separately. Less easy access is not progress.

• I am glad to see that the Bulletin now includes a full page dedicated to Covid-19 (p. 6). This is in addition to the cumulative number given on the page dealing with Class One Notifiable Events (p. 5).

• The Covid Surveillance Update includes the number of confirmed cases for the week, as well as the totals to date. It indicates the sex and age range for these cases.

• A chart indicating the occurence of cases over the course of the pandemic is included.

• The list of outcomes includes the number of deaths for the Epidemiological Week (EW 39). However, it is not clear if that death actually occured during that week or if it was reported during that week but may have occured at an earlier date.

• A chart is included showing the vaccination status of the people who have died – whether they were fully vaccinated, partially vaccinated or unvaccinated. This chart relates to deaths occuring since the vaccination programme began in March 2021.

• The parish distribution of confirmed cases is given for the Epidemiological Week, as well as the total for each parish since the start of the pandemic.

• The number of tests administered, which used to be given in the daily updates, is no longer being given. This is a gap in public information, as it doesn’t allow for tracking the adequacy of testing in the country. It also means that you have no idea what percentage of the tests administered has returned a positive result.

• And, despite all the problems with it as an accurate indicator, no positivity rate is given.

• Another number that is no longer being given is the number of people hospitalized. This is a significant gap in the public information, as over time it has proven to be one of the most reliable figures for tracking the ups and downs in the pandemic. It is also that number that has warned us when the hospital system is being overwhelmed.

• It is interesting to note that the research paper referred to on p. 9 is related to the Covid-19 pandemic.

I have created a copy of Bulletin EW 39 2022, if you wish to download it with one click. I hope that MOHW will change the format on their website to allow for this once again.

Weekly Epidemiology Bulletin Ew 39 2022Download

The Covid-19 pandemic is not over. It is ongoing. The MOHW is now giving us Covid data that is already a month old by the time it is published. This is not good enough. While it may suffice for recording purposes, it is not good enough during an ongoing pandemic. The MOHW publishes a weekly update giving the data for the previous week for monkeypox. It should do the same for Covid-19.

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Ministry of Health & Wellness Ends Daily Covid-19 Updates: A Few Comments & Concerns

Last week Wednesday (September 28, 2022), the Ministry of Health & Wellness (MOHW) announced that it would be discontinuing its daily Covid-19 updates:

The release was a brief one and didn’t give any reasons for the discontinuation, simply saying that it would take effect on Saturday, October 1, 2022, and that “[t]he updated numbers will instead be published in the Ministry’s Surveillance Bulletin, published weekly on the Ministry’s website at moh.gov.jm.”

Although the MOHW website hasn’t posted any more of the daily updates since the announcement on Wednesday, the Ministry’s Twitter account did post one on Saturday, which is presumably the last of the long series of daily updates.

I do want to comment more at another time about the fact that for most of the past two and a half years, the MOHW has been providing daily Covid-19 updates in one format or another and the value that this has had, despite gaps in or problems with the updates. Christmas Day, New Year’s Day, public holidays, weekends…the update was posted daily, almost without fail. Someone or some team needs to be acknowledged for that. And I also want to say more about other aspects of the updates themselves.

But in this post I want to raise some concerns that I have about the discontinuation of the daily updates or Clinical Management Summaries, as they are officially called, and the proposed method for sharing the Covid-19 numbers in the future.

The MOHW release said that the Covid numbers will be published in the MOHW Surveillance Bulletin, which is published weekly on the MOHW website, at the bottom right hand corner.

The Weekly Epidemiology Bulletin is published by the National Epidemiology Unit of the MOHW and is a useful record of information for each epidemiological week of the year. It provides information about Class One Notifiable Events (e.g. accidental poisonings, maternal deaths, cases of tuberculosis, tetanus & zika), gives an influenza report and has a report on dengue, among other things.

Weekly Epidemiological Bulletin for EW36, posted on MOHW website

One concern that I have is regarding how much of the information that is currently provided in the daily Covid-19 updates will be provided in the weekly bulletin. The bulletin already provides a year-to-date total of confirmed cases, which is given for both the current year and the previous year, as seen on the page below:

Epidemiological Bulletin for Week ending Sept 10, 2022, p. 5

But will more information than that be provided, as with the page dedicated to dengue in the Bulletin?

Epidemiological Bulletin for Week ending Sept 10, 2022 p. 7

The current daily Covid summaries provide quite detailed breakdowns – confirmed cases, female and male numbers, age range, number and types of tests, positivity rate, parish distribution, hospitalization data, information about deaths and recoveries. How much of that will be included in the weekly bulletins?

The answer to all of that will be seen when the first of the weekly bulletins containing the Covid update is published.

Another concern I have is about the timeliness of the reporting in the future. The MOHW press release says the Surveillance Bulletin is posted on the MOHW website weekly, which may give the impression that each week the Bulletin for the previous week is published. This isn’t so. The Bulletin is produced for each Epidemiological Week of the year but it takes a while for the Bulletin to be produced and posted on the MOHW website.

So, for example, the most recent Bulletin currently posted on the website is for Epidemiological Week 36, which is the week ending September 10, 2022. It was posted on the website on September 26, 2022, sixteen days after the ending of that week.

And this is the pattern, as the chart below shows. There is a time lag of about 2 to 3 weeks between the ending of the Epidemiological Week and the date on which the Bulletin for that week is published on the MOHW website.

You can see it here again for an earlier period in the year:

If this continues to be the pattern, it means that by the time the Covid-19 updates are published on the MOHW website, the information in them will already be 2 to 3 weeks old. And whereas this isn’t a problem from a record-keeping perspective, it is a problem for anyone who is trying to assess what the current trends are in the pandemic…which has not yet ended, despite what many would want to believe.

We are in a period when we have been told it is our personal responsibility to assess our individual risk and to follow the protective protocols based on our assessments…as individuals, families, institutions, businesses. Whether we wear a mask at all or in particular spaces. Whether we avoid crowded spaces indoors or outdoors or at all. Whether having a meal at a restaurant is a reasonable risk to take. Or going to a particular government office or waiting room at a business place. Or whether it is advisable to attend an in-person event/meeting or to select a virtual option, if one is provided, or not to attend, if a virtual option isn’t available. Etc. Risks which may be reasonable when there are low numbers may not be as reasonable when there is an upward trend in numbers.

To have less information or information which is already 2 or 3 weeks old by the time you see it reduces your ability to make real time assessments of the risks. The situation would already be 2 or 3 weeks further on, by the time an increase in cases or an increase in hospitalizations or an increase in deaths is seen in the published bulletin.

I was not surprised by the MOHW’s announced decision to end daily Covid reports. It is in keeping with the trend in many countries. In our region, Barbados also announced on Wednesday that it would be ending its daily Covid updates, as of September 30, 2022. In fact, I wonder if this issue came up for discussion at the recently held Annual General Meeting of the Regional Health Communication Network.

It would be good to hear from the Ministry its reasons for this decision and what it sees as the purpose of the Covid-19 updates going forward. I would also be interested in hearing if a weekly update along the lines of the current weekly monkeypox updates isn’t a viable option.

When dealing with public health issues, as a general principle, greater access to information is better than less access. When dealing with most public issues, in fact.

Jamaica: #Zika, Guillain-Barre Syndrome & Information

On Tuesday evening (June 21), Nationwide News Network carried a report of a speech given that day by Minister of Health Christopher Tufton, in which  he gave current figures for cases of Guillain-Barre Syndrome (GBS) in Jamaica.  Minister Tufton stated that 30 confirmed cases of GBS have now been identified in Jamaica (this year?) and that the majority of the current cases are Zika-related. (Nationwide’s report is available online & contains audio clips of the Minister.)

This is a significant increase in the number of cases of GBS over the figures given by Minister Tufton during his press conference 3 weeks ago, at which time he also said that none of the GBS cases identified had yet been linked to zika infection. (In an earlier blog post, I dealt with that press conference: Jamaica: Ministry of Health #Zika Virus Update – June 2, 2016.)

Minister Tufton also referred to the cost of treating GBS and the pressure being put on the public health system by the increasing number of cases of GBS.

“A confirmed case of Guillain-Barre costs or is costing in the public health system to treat 1.5 million Jamaican dollars. If we have had 30 cases confirmed to date – do the math – 1.5 million…you are talking about 45 million or so.” – Minister Tufton

I checked the Ministry of Health (MOH) website to see if anything has been posted there about these increased numbers or a copy of the Minister’s speech, but unsurprisingly there is nothing (yet). And Jamaica Information Service’s (JIS) article about the speech focuses entirely on the launch of the Agro-Grace products (which look interesting), saying nothing about the increased numbers of GBS.

 

So I am grateful to Nationwide for covering the story.

 

Nationwide News’ GBS Discussion

In their discussion about GBS that evening, Nationwide had two guests – Mr Reid Buckley and Dr Karen Webster. Mr Buckley shared his experience with GBS, which he developed in October 2014, following bouts of flu and chikungunya. He detailed being hospitalized with what was initially thought to be a stroke, but because the paralysis affected both sides of his body, the doctor treating him suspected GBS, did an MRI and, with the symptoms getting progressively worse, transferred Mr Buckley to the University Hospital, where he was admitted to the Intensive Care Unit (ICU). Mr Buckley said that the immunoglobulin needed for his treatment was not readily available in the island at the time and when tracked down at one supplier,  his family was faced with the cost of J$1.6 million for 5 days of treatment.

Mr Buckley spoke about losing his ability to speak, stand, sit, swallow or eat and described the pain he experienced as severe. He said that he immediately began to feel better once the treatment started, but that it took a long time to recover, and that he needed a lot of physiotherapy during that time. He says that he is now 99% recovered, but still occasionally feels some tingling in his toe.

Dr Karen Webster, National Epidemiologist at MOH, said that there is a spectrum of GBS and Mr Buckley seems to have had a severe form of this rare condition. She said that many viral infections can have GBS as a complication; it wasn’t particularly described as being associated with chikungunya, but it has been so described for zika. She noted that with the current outbreak of zika, it is estimated that Jamaica may eventually have between 350- 400 zika-related cases of GBS.

Because of this association, from 2015 the MOH has acted to procure adequate supplies of immunoglobulin needed for treatment of GBS and to increase the numbers of functioning ventilators, which are needed when GBS affects breathing. Dr Webster said that there are adequate supplies of immunoglobulin and the aim is to have 80 treatments in stock at any one time; more would not be kept, as the immunoglobulin has a short shelf life. She said that it is expected that there would be no more than 5 cases of GBS in the peak week of the outbreak. She also said that most of the people who have had GBS this year have responded very well to the immunoglobulin treatment and have recovered quickly. In response to host Cliff Hughes’ question about cost, and whether people who couldn’t afford the expensive treatment would simply have to die, she indicated that the treatment can be accessed without cost, once GBS has been diagnosed.

Concerns have been expressed since the beginning of the year about the capacity of our health facilities to deal with any significant increase in the number of GBS cases that might result from the zika outbreak. As recently as last week, I heard such concerns being expressed again.

Weekly Epidemiology Bulletin Posted on MOH Website

When I was trying to find out if  the information about the increase in GBS cases was posted on the MOH website, I noticed that the Weekly Epidemiology Bulletin produced by the Epidemiology Unit of the MOH is again being posted on the website. On June 16, most of the bulletins for 2016 were posted; none for May or June had been posted as of today. The posting of such material as this, already being produced by the MOH, makes a great deal of sense, and I hope to see more of this kind of routine proactive posting of information.

It was interesting to note that the first two bulletins for 2016 acknowledged the likely outbreak of Zika in Jamaica, with the first bulletin highlighting microcephaly and the second highlighting GBS.

I remain concerned that it is not easy to access some types of information about public health situations on a real time basis  in some central online space. I know that there are problems associated with doing this, but every effort must be made to provide such information in a timely, permanent, accessible format. Access to Information Act timelines are not sufficient in a time of an active outbreak or other developing public health situation. Provision of data 30, 60 or 90 days later may have an impact on people’s ability to make fully informed decisions for themselves, their families or communities.

I again acknowledge the availability of MOH representatives to the media and their willingness to share the up-to-date information they have. Public health information is also being communicated via broadcasts and publication in the press. However, continuing efforts must be made to deal with the gaps where they exist.

More Information About GBS

• Here is a link to the US National Institute of Neurological Disorders & Stroke Information Page about GBS, which provides some basic information. Note that there is a feature that will read the article aloud, if you wish.

• The MOH has circulated to doctors this document about The Management of Guillain-Barre Syndrome, if you are interested in more detailed medical information. MOH – Zika Virus MANAGEMENT OF GUILLAIN-BARRÉ SYNDROME