COVID-19 in Jamaica: Wary of a Third Wave

The Ministry of Health and Wellness held one of their regular press briefings on April 29. It was not hard to detect a change of tone – and it was quite disturbing. There was hardly a glimmer of a smile, and at one point both Minister Tufton and the Chief Medical Officer (CMO) actually looked distressed. The body language spoke loudly.

There was no major self-congratulation over the number of new cases, which has declined quite a bit. There was no complacency, although our hospitals are under rather less pressure than they were a few weeks ago and there was a sense of relief that our beleaguered health care workers are getting some respite. As of yesterday (April 30) there were 199 new cases – the highest number being in the northern parish of St. Ann – and the positivity rate was an unimpressive 21.2 percent (our average positivity rate since the pandemic began has been 16.2 percent, which is way higher than the five percent threshold suggested by the World Health Organization (WHO). There was only one death on April 30, while six are under investigation.

This is critical. We are still well and truly in the “very high transmission” level as far as positivity is concerned, and we need to get down to the green. The WHO has recommended that countries with positivity rates over five percent should not ease COVID-19 restrictions. Our rate has been consistently “very high” since last summer before the first wave, but we have regularly eased restrictions. Why?

The hospitalizations have gone down to 204, with 15 moderately ill and 22 critically ill. To date, we have had a total of 779 deaths. Several well-known Jamaicans have died, and many have lost loved ones. We are all tired of sending condolences and sad emojis on social media. It has become all too common!

It seems quite clear that the recent “lockdowns” – curfews for the past three weekends, starting at 4 pm on Saturdays and 2 pm on Sundays – plus our ongoing 8 pm curfew on weekdays, have been making a difference. Perhaps also, people are becoming more obedient – and the Jamaica Constabulary Force has found itself more empowered with changes in the regulations so that it can take action on illegal parties. So, we have made progress and we can breathe a little easier.

Well, have we reached the “plateau” that the Chief Medical Officer was talking about recently? Or are we at some other juncture now? Are we teetering on the edge of a cliff on a windy day, trying to stop ourselves from getting blown off and to pull ourselves back from the brink? Because, it seems it’s up to us. If we don’t continue to follow protocols, we will undoubtedly be in trouble.

There have been two “surges” as Minister Chris Tufton prefers to call them. Whether it’s a “wave” or a “surge,” we don’t want it to swamp us. We don’t want to drown. The first wave was last summer (around August/September, 2020) and we are starting to come out of the second wave, when we had many more deaths.

The “peak week” in the second wave was four times more serious than the first wave. What does this mean? Our numbers had not come down far enough, so we were starting at a higher point. If we have a third wave, we would, again, be starting at an even higher number.

“There is a threat, a growing threat,” said Minister Tufton. He also pointed out that seven out of ten samples sent for genetic sequencing at the Caribbean Public Health Agency (CARPHA) were found to have the UK variant, while three others had mutations that are being investigated, but are not considered to be of concern. Well, we already knew the “UK variant” was here – and it could possibly explain the rapid rise of the second wave. We do need to have our own capability that CARPHA has – and the Minister said that acquiring the needed equipment is “in motion as we speak.” It seems to take a very long time to get samples back from Trinidad; there have been many delays. We need to do it ourselves.

Now, the mention of the UK variant, coupled with the news that Jamaica has opened its borders to the UK as of today, May 1, has sent tremors among some Jamaicans. There are rather bitter memories of the very first case of COVID-19, which was brought here by a woman from the UK who was attending a funeral. There are also subsequent memories of a plane load of UK passengers, who apparently brought the UK variant, and who very rudely declared that they didn’t want to go into quarantine on arrival in Jamaica.

My take on this? The old “balancing lives and livelihoods” catch phrase came up more than once, and I get a sense that the balance has just tipped back in favor of “livelihoods” with the lifting of restrictions on the UK and a push to open up to tourism beyond that. Minister Tufton said that there would be ruminations and discussions among Ministers over the weekend, and when Cabinet meets on Monday (May 3) decisions would be made and divulged to the public. No wonder the CMO and the Minister have stressed that a third wave is more than possible.

So, perhaps Jamaicans can be forgiven for their nerves over visitors from the UK. Having said that, the situation there has considerably improved (take a look at this graph from Johns Hopkins University) and vaccinations have been going well. So, perhaps that should not worry us too much. What should worry us is…a third wave.

Why should we worry about a third wave? We just need to look at our own experience and that of other countries. The CMO gave us quite a long list of countries that are in their third wave currently.

The CMO showed us some slides – some of those we are used to. This is our situation: those in their twenties and thirties are by far the largest age groups in terms of new cases. They are moving around, gathering during curfew hours. Hospitals have seen a number of young people coming in for treatment “after events.” These age groups (which may not have major symptoms, or any at all) are putting the rest of the population at risk. My question is though, are we testing enough?

Taking care of your general health is so important: building your immunity, exercising, eating right, taking your meds, and managing your stress. Almost all deaths have been among people with co-morbidities (a word I have learned since COVID arrived) and being aged over sixty remains the highest risk factor. After that, heart disease and hypertension (what Jamaicans call “pressure”) has been a major factor, followed by diabetes (“sugar”).

When the CMO provided details of the pressure on the health system and the number of beds (augmented by the field hospital that was moved to the Spanish Town Hospital) I noticed her voice became increasingly emphatic. We are only just out of the “very high pressure” zone in terms of the impact on the system, she stressed: “There is still a lot of work to do.”

As soon as we allow more movement, our reproductive rate goes up, said the CMO. Simple. If we do not maintain our restrictions, there is the possibility of a third wave, she said. Once restrictions are lifted and people become complacent, mass gatherings take place (as in many of the countries she cited) and “it can happen to us.” The only answer is to stay home, avoid gatherings, decrease our exposure.

This slide is frightening to contemplate – projections for what a possible third wave would look like. The CMO made it very clear that our hospitals would not be able to cope.

Meanwhile, during May some 39,000 people will become eligible for a second dose of the AstraZeneca vaccine. 140,000 have received their first dose, so far. Priority groups (over 60s) are currently still getting their first dose (although reports are that the response has been low, so far; if you are, or know someone in that age group appointments can be made online or by phone).

Prevention is key. Let me repeat that: Prevention is key! Restrictions must be maintained, said the CMO, her voice rising when she described the recent intense pressure on our health system. (But, will that be the final Cabinet decision on Monday?)

In the words of the CMO, “We have seen larger health systems than ours collapse because of COVID.” Indeed. We do not have the capacity to cope with a third wave, she repeated.

Minister Tufton doesn’t want us to “panic.” However, perhaps he and his colleagues could just let us know when we need to, at least, get extremely nervous.

Take the utmost care, everyone. Stay safe.

Minister Tufton actually appeared calm – but suppressing anxiety at times, as did the Chief Medical Officer. He did try to end on a positive note, however.

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