In the practice of medicine, when we gather information it is with the goal of identifying problems and finding solutions to these problems. A good doctor rarely gathers information simply for the sake of recording it. When we gather numerical data like temperature readings, or numbers of people diagnosed with an infectious disease, often we are looking for patterns and trends so that we can activate appropriate interventions. For example if there is a sudden spike in temperature we may look for an underlying infection that could be causing a fever. If we see a sudden increase in the number of patients with dengue fever in a particular area, the health department may initiate fogging for mosquitoes. Similarly a major reason for tracking COVID-19 numbers in Jamaica is to identify trends and patterns that will guide interventions and actions to be implemented. The way the numbers are presented can make a pattern clear, and the appropriate action obvious. A mass of numbers on a page, or read out by an individual to an audience is not the best way to effectively convey the pattern to a large number of people. For example hearing that we had 90 active COVID-19 cases on August 2, 2020 may not mean much unless you also knew that on August 1, 2020 we had 82 cases, and that on August 6, 2020 we had 149 cases. Perhaps if we saw all three of those figures strung together on a graph, we may have decided not to be part of large celebratory social gatherings. To paraphrase the Minister of Health and Wellness, information has to be communicated in a way that brings about the desired change in behaviour.
At the beginning of our COVID-19 journey, our government leaders used graphs and charts very effectively to show us how the infection could spread (doubling curves), and how our capacity to cope with the number of sick people could be exceeded if we did not “flatten the curve”. Enough of us were convinced of the need to flatten the curve that we supported the measures to reduce the spread: hand hygiene, physical distance, avoiding crowds, and later the wearing of masks. We saw how the Alorica outbreak threatened to shift the curves in the wrong direction, and we understood the need for quarantine even as we complained about its disruption to our lifestyles. We managed to overcome that spike in our numbers and continued on a path that successfully flattened the curve. We all breathed a collective sigh of relief as our numbers of new cases went down in response to the measures instituted to address the undesirable pattern reflected in the numbers. The use of those graphs allowed the general public to see these patterns and appreciate the need for the interventions when disturbing trends (spikes) surfaced. They also helped us to see the effectiveness of the interventions, as the doubling curves shifted in the desired direction and our numbers went down.
Now that we are in the phase of living with COVID-19, the practice of watching these “curves” or graphs needs to become a regular practice, for the foreseeable future, for the general public. Watching the curves can motivate all of us to adjust our behaviours in order to maintain our COVID-19 cases at manageable levels. All the numbers are readily available on the Ministry of Health and Wellness (MOHW) website but are not presented in a way that allows us to appreciate the gravity of the situation we are now faced with because the trends and patterns are not obvious. The data in the daily COVID-19 updates is like a 200 piece jigsaw puzzle that has not yet been assembled to display a clear picture of the chilling crisis we are faced with. The MOHW has done the hard work of collecting and reporting the data. It is not an insurmountable challenge for the media to take those numbers and generate graphs that form part of the daily television newscasts.
Like many of my fellow Jamaicans, the numbers I have been hearing for the past few days have me near paralysed with fear and a sense of helplessness and despair. As a family doctor, I am terrified for the many elderly patients I look after. I am scared for myself as an individual at higher risk because I look after sick people. I am afraid for my fellow doctors working in hospitals that are now being reported to be “bursting at the seams”. In moments of panic I am challenged to find gratitude for the resources that I have which many others in this country do not. So in an attempt to calm the gut-wrenching fear, and regain some sense of control, I decided to try and lay out the jigsaw puzzle of data pieces in the MOHW COVID-19 updates, and see if I could assemble a picture that could spur us all into action to do our part to once again flatten the curve. I chose to focus on the number of active cases because this represents all the people with COVID-19 in the country on a given day who will put a drain on our health services. The graph below is the picture that emerged.
The graph illustrates the total number of active cases per day from July 3, 2020 to August 31, 2020, and shows clearly the rapid increase in the number of COVID patients needing health care services, in that second half of the month. But it is also clear that the numbers began increasing from the beginning of the month. Remember that once infected with COVID-19, people can take up to 2 weeks to become sick. So if the rise in cases began in early August, we need to look at what events occurred in mid July. The CXC examinations come to mind immediately, and perhaps other events like funerals.
The current peak is thought by many to be due to the various non-COVID compliant celebrations that occurred over the “emancipendence week”, and a look at the graph certainly confirms that trend. Now if the public were being shown the numbers in the form of a graph on a daily or even weekly basis, the disturbing increase in cases might have been apparent to more of us, and many may have voluntarily chosen to flatten the curve by staying at home. Alas that horse left the stable weeks ago. If we do nothing at this point, the consequences of non compliance during nomination day activities will cause that curve to keep rising. Up to August 31, 2020 we had a total 1476 active cases. At this rate we will exceed our health care system’s capacity to cope perhaps even before the ballots are counted.
We cannot wait for the government to pull us back from the brink. Each of us needs to appreciate that we have a finite number of hospital beds and a finite number of healthcare workers who are exhausted from looking after not only COVID patients but also patients with other illnesses. They have been toiling through “emancipendence” tracing contacts, monitoring sick patients, taking samples and doing tests. Each of us needs to look at what we can do to flatten the curve. My graphic was created by my 18 year old daughter with the use of general Information Technology (IT) and mathematical knowledge. As a doctor, I chose the bits of information to be represented, and her dad who is a computer science professor advised her on how to efficiently extract the data from the MOHW website. This is a feat that could be easily replicated by our journalists and media houses to raise public awareness about the patterns of infection spread. As we don our masks, sanitise our hands, and prepare to cast our votes on Thursday, let us all be also thinking hard about what individual and group resources we have that can be contributed to “mashing the brakes” on this runaway bus that COVID-19 is becoming in Jamaica. Instead of adding to the numbers with our behaviours, let us find ways to become part of the solution.