#TurksandCaicos, May 23, 2022 – The Ministry of Health and Human Services has been carefully monitoring reports of monkeypox which have been increasing and are being reported in multiple countries across Europe (Spain, Portugal, Germany, Belgium, France, the Netherlands, Italy and Sweden), the US, Canada and Australia. 12 countries which are not endemic for monkeypox, so far have reported at least 92 confirmed cases with 28 pending investigations. More cases are likely to be reported as surveillance expands.
Monkeypox is a viral illness and is found in a number of countries in Central and West Africa. The more recent news of spread to countries without known endemic disease is unusual. Cases may occur in persons who have travelled from Nigeria or who have been in contact with persons with the confirmed illness. Cases which have been reported since May 14 2022, have largely had no history of travel.
The UK Health Security Agency (UKHSA) has announced that the total number of monkeypox cases confirmed in England since 6 May is 20. The UKHSA initially identified one case of monkeypox on 7th May 2022 in an individual with a history of recent travel to Nigeria. Subsequently, additional infections have been identified, some of which have been linked and others which have been unrelated. This spread as well as the occurrence of cases in Europe and other countries has suggested the possibility of community spread. Active investigations are ongoing in countries which have identified cases including contact tracing, testing isolation etc. in order to prevent further spread.
The World Health Organization (WHO), held an emergency meeting on Friday 20th May 2022 to discuss the monkeypox outbreak. WHO is working with affected countries in order to expand disease surveillance to find and support people who may be affected, and to provide guidance on how to manage the disease.
It is expected that more cases will be identified through surveillance with the possibility of additional countries being affected.
TCI residents returning from, or going to, countries where cases have been identified, are urged to be aware of the signs of infection and to seek medical help if they think they may be at risk.
How the virus spreads
Monkeypox does not spread easily between people. The virus spreads through close contact with an infected animal (rodents are believed to be the primary animal reservoir for transmission to humans), humans, or materials contaminated with the virus. Human-to-human transmission occurs through large respiratory droplets and by direct contact with body fluids or lesion material. Respiratory droplets generally cannot travel more than a few feet, so prolonged face-to-face contact is required.
The virus enters the body through broken skin (even if not visible), the respiratory tract, or the mucous membranes (eyes, nose, or mouth).
Person-to-person spread is uncommon, but may occur through:
- contact with clothing or linens (such as bedding or towels) used by an infected person
- direct contact with monkeypox skin lesions or scabs
- coughing or sneezing of an individual with a monkeypox rash
Animal-to-human transmission may occur through a bite or scratch, preparation of wild game (in areas where the virus is present in animals such as Central and West Africa), and direct or indirect contact with body fluids or lesion material.
Individuals, particularly those who are gay, bisexual or MSM, are urged to be alert to any unusual rashes or lesions on any part of their body, especially their genitalia, and to contact a health services if they have concerns.
Monkeypox has not previously been described as a sexually transmitted infection, though it can be passed on by direct contact during sex. It can also be passed on through other close contact with a person who has monkeypox or contact with clothing or linens used by a person who has monkeypox.
The incubation period is the duration/time between contact with the infected person and the time that the first symptoms appear. The incubation period for monkeypox is between 5 and 21 days.
Within 1 to 2 days a rash can develop, often beginning on the face, then spreading to other parts of the body including the genitals.
The rash changes and goes through different stages – it can look like chickenpox or syphilis, before finally forming a scab which later falls off.
The illness tends to be mild and self-limiting within 2-4 weeks, however it can in some cases be severe particularly in persons with weakened immune systems and children. In some cases, affected persons may die.
Treatment for monkeypox is mainly supportive. The illness is usually mild and most of those infected will recover within a few weeks without treatment.
There is no specific vaccine for monkeypox, however, vaccines used against smallpox can be used for both pre and post exposure and is up to 85% effective in preventing monkeypox. People vaccinated against smallpox in childhood may experience a milder disease.
Anyone with unusual rashes or lesions on any part of their body, especially their genitalia, is advised to visit their health care provider, particularly anyone who; 1) traveled to countries where monkeypox cases have been reported 2) reports contact with a person who has a similar rash or received a diagnosis of confirmed or suspected monkeypox, or 3) is a man who has had close or intimate in-person contact with other men in the past month.
As the virus does not usually spread easily between people and the risk to the general public is expected to be low, however the public is advised to monitor the situation as it develops and obtain information from credible sources. The MOH should be notified of any suspected cases.
The Ministry of Health will continue to monitor developments and provide updates accordingly.
Monkeypox confirmed in St Lucia, everyone exposed is quarantined
By Shanieka Smith
#StLucia, June 30, 2022 – St Lucia has increased surveillance for Monkeypox after a crewmember on a flight to the island has tested positive for the virus.
Officials said the crewmember did not disembark the aircraft when it arrived.
Regardless, the Ministry said in a press release that the significant increase in the number of cases of Monkeypox confirmed globally in recent weeks has pushed St Lucia to strengthen its capacity to manage individuals who are either suspected or confirmed cases.
The protocols set for COVID-19 have been modified to manage Monkeypox.
The stated also said: “As obtained with infectious diseases, the required contact tracing process is currently being undertaken by the contact tracing team within the Ministry of Health. All identified contacts of the case shall be contacted by the Ministry of Health and placed in quarantine and monitored over a 21-day period.”
People exposed to Monkeypox will be placed in quarantine and monitored by the Home Monitoring Team of clinicians. Also, since the Caribbean Public Health Agency (CARPHA) has the capacity for testing for the Monkeypox virus, samples will be taken from anyone who shows symptoms in quarantine.
The Victoria Hospital has assigned a ward for the care and management Monkeypox positive individuals.
Another Tragedy for Texas, Truck load of migrants die from the heat after being trapped in a truck
By Dana Malcolm
#Texas, USA, June 30, 2022 – At least 62 people, including children, crossed the US-Mexico border in a truck on Monday, probably hoping for a better life, and while they made it into the country 46 of them died before the truck’s doors could open and five more died at hospital. Local media are describing it as the deadliest human smuggling case in modern US history.
US authorities say it was heatstroke and dehydration, the people were in what was supposed to be a refrigerated truck not unlike the ones used to ferry fresh food to supermarkets, only there was no working air conditioning in the truck and when firefighters arrived on the scene they say there was no sign of water either.
San Antonio Firefighters were called when one person stumbled out of the truck and collapsed by the road. Fire Chief Charles Hood described in a press conference what they found when the doors opened.
“The San Antonio Fire Department responded to a report of a dead person and found the trailer — with a body outside and several that they could visibly see inside once the doors were open. We’re not supposed to open up a truck and see stacks of bodies in there. None of us come to work imagining that.” he lamented.
Temperatures in San Antonio where the truck was discovered were as high as 37 degrees (Celcius). When temperatures reach between 32° and 40° heat cramps and a little heat exhaustion starts to appear, between 40° and 50° heat exhaustion is apparent once the temperature goes past 54° then deadly heat strokes are likely. Temperatures in cars can rise exponentially on hot days, dwarfing the temperatures outside.
A study from Arizona State University found that cars can reach 71° in summer. A surface that hot will give human third degree burns. The study found that cars can hit that mark in under an hour. This usually only refers to parked cars since moving vehicles either have the windows down or the air conditioning on. The truck carrying the migrants had neither.
Miraculously 16 survived initially, four of them being children, unfortunately later the public would learn, five of the survivors passed away at hospital.
“The patients that we saw were hot to the touch, they were suffering from heatstroke and heat exhaustion, no sign of water either,” said Hood.
The nationalities of several of the dead have been confirmed to be Honduran, Mexican and Guatemalan.
Three people are said to be in custody.
TAP Medical Care Network not ‘subpar’ says Health Minister
By Dana Malcolm
#TurksandCaicos, June 30, 2022 – Jamell Robinson, TCI Health Minister is urging residents not to be deterred by their perception of the country to which they are sent for medical care through the Treatment Abroad Program (TAP). Robinson explained that the TAP works in a specific way, and the goal is to deliver medical services which improves lives.
A person must be referred for overseas care by a local doctor, private or public. Once they are referred to a facility overseas, a Joint Referral Committee comprising members of the TCI Hospital and the National Health Insurance Board reviews the referral. With the overseas trip confirmed, there is communication within the regional network of doctors and hospitals to see if the case can be accommodated. If it can’t be accommodated in the Caribbean that case then goes outside the region to Columbia, any failure there results in TCI employing the extended network which includes the United States.
“Generally speaking the NHIB provides great flexibility on the location within the primary network.” He said, “So if they select the Dominican Republic and would prefer to go to Jamaica, no big deal they’ll send you to Jamaica.”
Robinson explained that while the TAP was very flexible for contributors who wanted to go to a specific place, he reminded that the Ministry of Health and the National Health Insurance Board would not send patients to subpar institutions anywhere in the world.
“Remember we are not sending you to a country. We’re sending you to a specific facility. Unfortunately, when we get into the ‘choice thing’ that we do accommodate, most times, it isn’t because of the healthcare that is provided at the specific facility. It’s usually because of the view of a person has of that country. If [the hospital] is in the Amazon Rainforest and it has the healthcare you need, if it was a part of the network that’s just the best location.”
Robinson said people in the TCI usually want to use the advanced network especially in the United States but he explained that the process to choose all the hospitals was extremely thorough and NHIP contributors would always get the best care despite the cost.
“With the way facilities are reviewed and graded so to speak within the network you have at least three options for pretty much every particular procedure that can be done within the network. So if it’s heart surgery then a particular institution would be the number one choice. That doesn’t mean other institutions can’t do that same procedure.”
Currently the NHIB covers all costs for international procedures including airfare for the patient; sometimes there is financial support to an accompanying loved one with the patient and funds are made available to cover partial costs of accommodations.
“At no point will anyone not have access to the healthcare that they need and that’s a very important thing to know,” Minister Robinson maintained.
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