Chris Tufton | Empathy, partnership, data: fighting dengue frontally
Since declaring the dengue outbreak on January 3, I have interacted with hundreds of Jamaicans, all of whom are anxious over the disease while being bombarded with news of an increasing number of cases, including the deaths of some of our children. I understand and empathise with that anxiety and am, in fact, not immune to it myself.
It is against this background that I wish to assure all Jamaicans that the Ministry of Health is doing all that is within its power to usher the country through this outbreak, even as we urge your cooperation and support in our efforts.
Public health crisis situations such as we are currently experiencing are difficult to handle, requiring measured and deliberate decision-making to ensure timely interventions that work. The success of those interventions is, however, determined, in large part, by the public response.
In line with the 2016 Integrated Management Strategy for Dengue Prevention and Control in the Americas, developed by the Pan American Health Organization (PAHO) in collaboration with member countries, including Jamaica, the ministry has been tackling the disease through six components: laboratory, social communication, epidemiology, integrated vector management, environmental, as well as patient care.
For many months now, the ministry has acted out of an abundance of caution, following the guidelines - in the wake of the Caribbean Public Health Agency's (CARPHA) warning for the region to brace for a likely dengue outbreak - while tracking the cases.
- May 2018: Launched the annual Vector Control Programme, including the training of existing and new personnel to undertake public education at the community level and destroy mosquito-breeding sites, ahead of the rainy season in June.
- June 2018: Commenced the Enhanced Vector Control programme, including the start of recruitment of 1,000 temporary workers, boosting public education at the community level and destroying mosquito-breeding sites.
- July 2018: Fully rolled out Enhanced Vector Control programme, including increased fogging and treatment of mosquito-breeding sites; and extension of MOH-USAID ZAP programme to July 2019.
- August 2018: Started ad campaign for vector control.
- September 2018: Quarterly press briefing.
- December 2018: Hosted press conference on dengue.
- December 2018: Announced extended hours at several health centres.
On January 3 (2019), we declared a dengue outbreak when the numbers of suspected cases passed the epidemic threshold. Also on January 3, the International Health Regulations Unit of the PAHO-World Health Organization and the chair of the National Disaster Council were notified and there was full activation of the Health Emergency Operations Centre to coordinate and report on activities in response to increasing dengue cases.
In keeping with the outbreak response, there is further enhancement of surveillance through the integrated surveillance programme (sentinel sites, laboratory, vector-breeding hotspots) and the ministry has continued efforts to bolster triage and management at the primary and secondary care levels, with:
- Clinical staff resensitised to the management of dengue.
- Emergency departments at hospitals supported by increased clinical and administrative staff.
- Sensitisation of all doctors private and public.
This is especially important since, despite its complexity as a disease, dengue can be relatively easy to treat and with little expense. However, as the PAHO guidelines tell us, "the key is early detection and a clear understanding of the clinical problems that may arise during the different phases of the disease".
The ministry has since early December been increasing available hospital beds by providing the support to open unused wards at St Joseph's and National Chest hospitals, in addition to the extended opening hours at various health facilities.
Blood inventory at the National Blood Transfusion Service is being monitored daily and laboratory testing is provided through support from CARPHA and the University Hospital of the West Indies. Further, the Pan American Health Organization is developing the capacity at the National Public Health Laboratory to carry out testing. The ministry is also finalising framework agreements to enhance laboratory capacity.
Still, much has been made of the length of time it took to declare the outbreak and I feel the need to bring some clarity to the issue. An outbreak is an increase in incidence above what is usual at that time. All reports for a specific time period take up to two weeks after the time to come in.
On January 3 (2019), we were still receiving reports for December, and this was the first time for 2018 that the numbers of cases went above the epidemic threshold for a month. In the management of an outbreak, verification and investigation are carried out at the same time as prevention and control measures.
In Jamaica, the Public Health Act gives the minister extraordinary powers once a significant public health threat is detected and reported to him/her. During a public health crisis, the minister is empowered to take such actions as may prove uncomfortable and/or inconvenient to a variety of stakeholders and have potentially far-reaching implications for critical sectors, including tourism.
Section 16(1) of the Public Health Act tells us that in such an event, "the minister may, by order, direct the enforcement of any measures recommended by the Central Health Committee or by a local board, as the case may be, or any other measures that he thinks expedient for removing or otherwise guarding against any such condition and the probable consequences thereof, or for preventing or mitigating as far as possible, any such disease".
- The ministry welcomes feedback from all stakeholders and is open to new ideas on how to better serve the public health interest. If we work together, I have no doubt that despite the challenges, we can overcome. Dr Christopher Tufton is the minister of health. Email feedback to firstname.lastname@example.org.