On March 10, 2020, as I heard the news that Jamaica had its first COVID-19 positive patient I felt a knot of fear in my gut. Memories of the chik-V epidemic, and the Ebola threat made me wonder if we could cope with this new threat. With the first press briefing that followed the announcement of the first cases, I was very reassured by the focused data-driven, science-backed approach to this health crisis. The clear communication of credible information did much to calm my fears. The regular scheduled press briefings complete with charts and graphs, and promptness of action when the situation demanded it, helped to untie that knot.
The concepts of flattening the curve, quarantine, and contact tracing were brought to life in these press briefings. The importance of personal responsibility of every Jamaican following the infection prevention protocols was driven home. Nobody wanted to be a weak fence. Much was sacrificed by many as the country went into a version of lock down with schools closing, work from home, and closing of borders to international travellers. There were curfews and an end to social gatherings. The Alorica outbreak had the potential to “unflatten” the curve as our case count went from 73 to 105 in 24 hours. Swift and decisive action by the government to quarantine the entire parish of St Catherine allowed us eventually to resume our flattening of the curve, and to keep our numbers within the coping capacity of the health care system. The Minister of Health and Wellness and the Chief Medical Officer (CMO) were trusted to prioritise public health and they did not let us down.
Then with declining new cases, the decision was made to reopen the borders, first to Jamaicans returning home, and later to tourists and other travellers. Again, although I personally felt this was a bad decision, because of transparent communication I could appreciate the steps the government had taken to mitigate the risks and their proposed plan to review the numbers and adjust accordingly was reassuring. Our new normal of living with COVID now meant that you did not leave your house without a mask, and you entered any establishment with hands outstretched for sanitising. We looked for ways to maintain social connection while keeping physical distance. I think most of us mentally prepared for community quarantine and “lock-down” that would be triggered by a surge in cases because we saw that those measures were effective in flattening the curve when appropriately used. This is what I came to see as living with COVID.
In the past week however, that knot in my gut has reappeared with near strangling intensity. Based on the data posted on the Ministry of Health and Wellness (MOHW) website, I make the following observations :
- Over the past 8 days (August 20-27, 2020) we have had 668 new cases. Just for perspective, it took us more than 3 months to get to 600 cases after our first case in March.
- On August 20, 2020 there was record high of 88 new cases (not including the 10 from testing backlog). Again for perspective, when the case count increased by 32 between April 12-13, 2020, the parish of St Catherine went into a lock-down that began April 15, 2020
- On August 23, 2020 we had 116 new cases and we topped that number 2 days later with 120 cases on August 25, 2020
- On August 14, 2020, there were 241 active cases, and by August 21 this had almost doubled to 471, and by August 27 this number had again almost doubled to 933. This does not resemble a flattened curve.
- Over the past 7 days, the number of new cases in Kingston and St Andrew have been consistently over 20 per day, with highest so far being 51 new cases on August 23.
- On August 26, 2020, the press release posted on the MOHW website indicated that University Hospital of the West Indies (UHWI) and Princess Margaret Hospital were at capacity for COVID patients.
Add to the above facts, the letter from the internal medicine residents at UHWI shared on public media on August 27, 2020 detailing the high levels of staff fatigue and burnout at that hospital, and reports of more health care workers testing positive for COVID. Top all of that with the images of large social gatherings disregarding masks and physical distancing, which are widely circulating on social and other media. Then we hear reports that attendees at these events are returning positive tests for COVID. These attendees are not the so-called illiterate, indisciplined masses but leaders and public figures who are now very effectively demonstrating what weak fences look like. I think my knot of fear is justified.
So it was with great eagerness that I tuned in to the COVID Conversations yesterday evening hoping for reassuring answers from the MOHW leadership . Alas, instead of reassurance, I was left with only big unanswered questions :
- What specific measures are being taken to halt community spread in the areas of Kingston and St Andrew that are showing high numbers of active cases (as indicated on the CMO’s colour coded map of Jamaica)?
- The events of the past 6 months have shown that decisive strict quarantine measures have been effective in bringing the spread under control. The entire parish of St Catherine was quarantined when the first 31 cases were identified in the Alorica outbreak, and contact tracing suggested high numbers. This successfully quelled that surge in numbers. Further evidence that restricting movement is effective is seen in the pale pink (indicating only few active cases) of the “resilient corridor” where tourists are “confined to hotel property”. There have been 203 new cases in Kingston and St Andrew over the past week. There is video documentation of several big social gatherings where mask wearing and physical distancing were not observed. This is potentially a St Andrew equivalent to the Alorica event in St Catherine. Why are there no quarantine measures being implemented in Kingston and St Andrew, either in specific communities or the entire parish?
- Given that two hospitals have reached capacity for COVID patients, and there seems to be no slowing down of the surge of new cases, what is the plan for flattening the curve?
- The number of cases in a week is greater than the total in the first 3 months of the pandemic in Jamaica, and there is video evidence of influential people and leaders breaking the rules regarding physical distancing. Are the rule breakers being made to bear the consequences of their actions?
- As we learn to live with COVID, what is the plan for dealing with surges like the one we are experiencing now, while ensuring our health care services (both the human and material resources) are not overwhelmed, and also providing the public with scheduled information based updates?
The current situation in Jamaica poses some very big challenges to keeping calm and carrying on in the face of this pandemic. Living with COVID means more than just repeating the phrase like a mantra, highlighting recoveries, and hoping to recover after the election. It requires a return to the transparent, data and science-driven, proactive, citizen engaging approach and exemplary leadership that we had at the beginning of this pandemic.