Doctors want review of ministry protocol

The Medical Association of Jamaica (MAJ) is calling for a review of a Ministry of Health and Wellness (MOHW) protocol that requires health-care workers (HCWs) to continue working if they test positive for the novel coronavirus but show no symptoms.

According to MAJ President Dr Brian James, the quarantine and isolation protocol is what will assist the country in terms of having people available when the current surge of COVID-19-positive cases hits a peak.

The protocol, outlined in a document titled 'Health Workers Exposure Management in the Context of COVID-19 Version 4', dated January 6, 2022, states the infection prevention and control (IPC) measures of the MOHW and the management of health-care exposure to COVID-19.

It advises that asymptomatic HCWs must complete the MOHW reporting form, but will not be required to miss any time at work. The document further states that HCWs must adhere strictly to IPC measures and always wear N95 masks for at least 14 days, plus self-monitor for 14 days, and follow the protocol for those symptomatic if they develop symptoms during this period.

Self-monitoring, according to the document, involves the taking of one's temperature twice a day and remaining on alert for respiratory symptoms such as cough, shortness of breath, and sore throat. The document says anyone on self-monitoring should contact the IPC committee lead if they develop fever or respiratory symptoms during the self-monitoring period to determine whether medical evaluation is needed.

The protocol for HCWs showing symptoms suggestive of COVID-19 include completing the reporting form; testing for COVID-19; filling out a MOHW case investigation for COVID-19 form; and isolation, which will end after three days without symptoms and earliest 10 days after the onset of symptoms. The document said the discharge protocol from isolation is none test based.

The document went on to highlight that if the COVID-19 test is negative, then the health-care worker will be referred to their private physician for review and assessment and a sick leave may be generated by the private doctor based on clinical diagnosis.

One doctor who spoke to the Jamaica Observer on the condition of anonymity said, following the document, they were told if they show symptoms and are positive they will get a quarantine or isolation letter. If they show symptoms but are negative they will get sick leave, and if they are showing no symptoms, regardless of testing positive or negative for COVID-19, they are required to continue working.

Another doctor said the protocols were amended and now say asymptomatic workers are required to do a PCR test after seven days and if negative they return to work. But, if positive, they return after day 10. However, they say the amendment is not yet officially documented or circulated.

Meanwhile, the MAJ's Dr James said it is likely that there will be some tweaking to the document in circulation as the MOHW is in the process of looking through all of the data to make sure that whatever is being done is consistent with what is safe.

“There are other jurisdictions that have a very similar kind of arrangement. In the UK they have that arrangement. They continue working and masking, but they do home-testing as part of their protocol. I think the ministry is actually looking through all the various considerations involved and then come up with a final protocol on the matter. I don't think the communication out there is likely to be the final one. There will be some tweaking, I believe, with that one,” Dr James said.

He added: “The science is telling us you do not transmit after a particular number of days, and if you are asymptomatic and you wear a mask and you do all of your normal precautions, then you are very unlikely to transmit it to anyone. [But] I'm a bit concerned about the trajectory of this wave. It's moving very, very steeply on the upward trend. I am hoping that it will go up and come down very quickly, but it's not pretty at all.”

BY KIMBERLEY HIBBERT Associate editor — News/Health hibbertk@jamaicaobserver.com

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