Sunday, September 14, 2014

Mosquitoes, Ineptitude, The PNP, Ineptitude and the Iceberg Phenomenon

There are a million-gazillion people in Jamaica presenting with symptoms that 'suggest' Chikungunya. We know it is Chikungunya but can't or should not say it is - all the signs point to it, Chikungunya sweeping the Caribbean, Jamaica being lax when it comes to Disease Surveillance at out ports of entry, poor border protection, the PNP being in power etc. Many of the cases seen recently do present with the symptoms Chikungunya and any old fool could tell you that yes it is. But the PNP has one thing going for it - the fact that confirmation has to be done by Laboratory analysis. The Learned Minister of Health, Dr. Fenton Ferguson maintains that Jamaica is in fact 'controlling' the Chikungunya outbreak and to date only 24 cases (0.2% of the total confirmed for the region) have been confirmed in Jamaica of the 9000 confirmed in the Caribbean Region, such statistics would suggest Jamaica is doing exceptionally well in containing the outbreak - right? Well, read this article first then we can decide.

Jamaica has 7% of the Caribbean's population but well below 7% of the confirmed cases of the disease. Yet, day after day we hear of (and see) people with symptoms suggesting Chikungunya. We have never had a Leptospirosis outbreak to the extent where people are showing up with it to the extent we see people with these symptoms and if this happens to be Leptospirosis, as the Minister is suggesting then that is very very bad. Could it be due to the rising prices and rapid devaluation of the dollar that Jamaicans have also been forced to suffer a drastic reduction in Sanitation and Hygiene? Life is hard but not hard enough (yet) to result in regression of our development resulting in sanitation conditions akin to those seen 16th Century London before Pasteur and Koch. Leptospirosis in many cases is not detected too early and often results in liver failure in many patients which manifests itself by Jaundice and I am sure not one of these cases have presented with such signs as yet. So, Leptospirosis is out of the question Minister, come again.

"Well, there is Dengue" he is saying, "well, no there is not," I am saying! How come not even one of these cases are Dengue Hemorrhagic Fever which almost always shows up in a Dengue Fever outbreak or better yet, how come not even one of these cases present the classic symptom of retro-orbital pain (pain in the back of the eyes)? Another lame excuse is, 'it could be Influenza' - a full  two months early? Mr. Minister, come on man, stop taking us for fools! The drought has officially ended so naturally we will see a rise in mosquitoes, so this disease has to or is more likely to be something mosquito-related (further ruling out Influenza and Leptospirosis). Why would we even consider any of the aforementioned when Chikungunya is island-hopping and claiming many casualties on its little trek across the Caribbean?

How fortuitous for the present Government, the PNP that Dengue presents similar symptoms and also Leptospirosis to a lesser extent? So, it is OK for them to say "well the gazillion cases could be Dengue or Leptospirosis" which should underline the PNP's ineptitude just as much (if not more because these are all diseases we are familiar with and should by now be able to get under control). The exoticism and novelty of Chikungunya is what makes it so fearsome and would make the perception of an outbreak worse than the outbreak of Dengue or Leptospirosis when such outbreaks are just as bad if not worse.

In Disease Outbreak Investigation there are various bits of evidence that make laboratory confirmation a moot point such as patient history and behaviour. If, for example a person was exposed to rodents and farm animals and never exposed to mosquitoes then we can rule Chikungunya and/or Dengue out, and if a patient travelled to a country that is experiencing an outbreak of Chikungunya then we can conclude with some certainty that it is in fact Chikungunya as long as they present with the symptoms and further our Caribbean neighbours are being ravaged by the disease then why should the Minister suggest that the cases are mostly if not all Dengue and/or Leptospirosis? All the factors point to this outbreak being Chikungunya. One classic symptom of Dengue that makes lab confirmation unnecessary is the retro-orbital pain, Dengue is the only disease (as far as I know) with such symptoms. But lucky for the Learned Doc and his handlers in the PNP the lab confirmation is the only Technically and Legally acceptable determination.

As far as statistics go, The Ministry of Health can send only the 24 confirmed samples to be tested and technically we only have 24 'confirmed' cases, when a million-zillion suspected samples were not sent to be tested, that keeps figures (statistics) down and everybody happy - especially 'the tourists' and the Ministry of Health did its part in contributing to a phenomenon in Epidemiology we know as the "Iceberg Effect/Phenomenon," (more of a Sunken Rock or Swept Under the Rug Effect).

But guess what, we know better, don't we?