 A pleasant good morning everyone and welcome to the press conference on Dengue. As we all know, we are in outbreak mode for Dengue fever. And with us today, the panel, we have Dr. Michelle Faswa, who is the National Epidemiologist. We have Dr. Glensford Joseph, Medical Officer of Health and also Mr. Parker Ragnan and Chief Environmental Health Officer. First we will have Dr. Michelle Faswa, who will give us a brief overview as it relates to epidemiology. As many of you know, Dengue fever is caused by a virus. It is spread through the bites of a mosquito, the Aedes aegypti. Dengue fever has been with us for decades and it is considered endemic to St. Lucia, which means that we have recorded cases throughout the year with certain peaks during certain periods which coincide with our rainy season. There are four distinct types of Dengue, four serotypes of Dengue virus, they are type one, two, three and four. When you get one type of Dengue, you automatically get immunity for life to that particular serotype. However, you have short-term immunity to the other serotypes. If you get Dengue fever a second time, you are more predisposed to what is called severe Dengue, which is a more severe form of the Dengue itself, which my colleague will go into shortly. In Epi Week 29, which corresponds to mid-July, the epidemiology unit noticed increases in the reported cases of persons presented with fever. This coincided also with the number of Dengue cases which started to increase. What we did, we issued alerts to the public as well as to the medical fraternity in an effort to address these increases. In August of 2020, the Ministry of Health officially declared an outbreak of Dengue fever in St. Lucia. As of September, there have been 503 confirmed cases of Dengue fever. These are persons who have been tested at a lab and have come back positive for Dengue fever. This by no means represents a total number of cases, because as we have seen in previous outbreaks, Dengue, Chikungunya, and even Zika, not everybody chooses to seek medical attention and not everybody gets tested. In addition, almost three-quarter of the cases of Dengue fever are asymptomatic or they present with a very, very mild clinical picture, so not everybody goes in and would be recorded. 49% of the confirmed cases have occurred during the month of August, with the highest numbers being recorded during the last week of that month. The mean age of the confirmed cases is 19 years, however, the ages have ranged from three weeks to 84 years. The age group 5 to 14 has accounted for approximately 39% of the cases, followed by the age group 5 to 24 years. So we see our younger persons are being infected and, of course, that is something that we have concerns about. The hospitalization among cases has been recorded at 25%. So 25% of these confirmed cases have been hospitalized either at our private or our public hospitals. Although both serotypes 3 and 2 have been recorded in St. Lucia, serotype 3 has accounted for the majority of cases. And the fact that we have two serotypes in circulation is also of concern because, as I indicated, during an outbreak, an individual can get dengue twice and having been infected with one type, you are more predisposed to other severe form. So we are quite worried and monitoring our cases of severe dengue and what is happening on the ground. While all health regions have reported cases of dengue fever, the highest number of cases continue to occur in the northern part of the island. Castries, grocery and babo, babo no sorry. View photos accounted for 13% of the cases followed by dengery, 10% and Miku, 6%. To date, there has been one dengue related death. The case is a male adult 65 in the age group 65 plus who resided in the north of the island. The gentleman also, he came in with signs and symptoms of dengue. However, he had several underlying medical illnesses which predisposed him to a more severe form. So as we note with many other infectious diseases, the very young, the extremes, the very young and the older age groups are more predisposed to a more severe form as well as individuals with underlying medical illnesses. So this gentleman having presented with his age and underlying medical illnesses was more predisposed to develop a more severe form of the illness. The Ministry of Health however remains very alert. We continue to work with the public in an effort to address the dengue situation and my colleagues here will speak about the measures that we have put in place and what we have been doing on the ground to address the dengue situation in St. Lucia. Dr. Glensford Joseph, who will give us some information as well. Good morning. Thank you, Ms. Neptune. Thank you, Dr. Fossoir, for the situation update. As pointed out, 75% of persons infected with dengue virus do not show symptoms. That is, they are asymptomatic. And of this, 25% have mild to severe form of the disease. In one class, which we call the dengue without warning signs, patients have fever, which lasts about two to seven days, and two or more of the following. They may have nausea, vomiting, or a rash, headache, what we call retroorbital eye pain, that is pain to the back of the eyes, muscle, and joint pain among other symptoms. In another group, dengue with warning signs, patients develop intense abdominal pain, tenderness, as well as persistent vomiting. They have fluid retention, mucosal bleed, that is, in places in the eyes, the lining of the mouth, and in the gut, you can have bleeding. They tend to become restless, and fall in their blood pressure, as well as liver enlargement, and progressive increase in something called hematocrit, or the thickening of the blood, because of a loss of fluid. We do have the third group, severe dengue, where the patient experience significant fluid loss, a significant fall in their blood pressure, which we call shock. They tend to develop respiratory distress, and severe bleeding with severe organ involvement, that is, multiple organ failure. Infected persons have, overall, a 1% chance of dying from dengue. However, with the severe form of the disease, this increases to 2% to 5%, and if left untreated, severe dengue can result in a 50% chance of dying. All are at risk for the development of dengue. As pointed out, while each and every one are at risk, we find that persons in the lower age group, children, those over 65, persons who have underlying conditions like diabetes, cancers, respiratory illnesses, among others, pregnant women are at higher risk for the development of complication of dengue. As pointed out, we have currently type 2 and 3 circulating, and if you have had infection with one serotype of dengue, and subsequently develop infection with a second type, you are at greater risk for the severe form of dengue. Over the years, we have had all four strains circulating in synclutia, but as pointed out, currently, we have identified serotype 2 and 3. So it is important that if you think you have signs and symptoms consistent with dengue, is that you see your health care provider who will evaluate you to determine whether you have dengue and whether you are a candidate or a person who could be managed at home with follow-up care or you need hospitalization. Persons with symptoms tend to attempt to manage their symptoms, for instance, the fever or the pain. And from the Ministry of Health and Wellness, we encourage persons that if you are going to take medication to manage your fever and pain, to use a paracetamol and to avoid the use of medication like ibuprofen, aspirin, and other drugs within this class, what we call non-steroidal anti-inflammatory agents, because these medications tend to cause bleeding or can worsen bleeding in a person with dengue. The Ministry of Health and Wellness would have developed and continue to implement several strategies to control and prevent the spread of dengue. The Vector Control Committee will continue to update its response in the context of COVID-19. The Ministry launched its 2020 Vector Awareness Week in July the 31st under the theme, our actions, our community, our health, to promote greater community mobilization and participation in reducing and eliminating mosquito breeding. Through the Bureau of Health Education and Promotion and the Communication Unit, the Ministry will continue to use available communication channels to provide the general public with the relevant information. That is, we are going to use the mass media, social media, print media along with community engagement. The Ministry will also continue to collaborate with national stakeholders along with regional and international agencies to ensure that we continue to manage the dengue situation. Through the surveillance unit, the Ministry continues to work with private and public health care providers and the laboratories to collect, analyze, and provide us with the information necessary to guide our intervention. Human can transmit and we do transmit the virus to the mosquitoes. And this can occur two days before the onset of symptoms, during symptoms, especially with the fever, or two days after the fever would have subsided. In addition, infected persons who do not have symptoms are also and can transmit the virus to mosquitoes. The Ministry encourages all to take protective measures to limit the risk of mosquito bites. Such measures include the use of long clothing, insect repellent, among other interventions which will be highlighted. At this point, I yield to the Chief Environmental Health Officer for his intervention. Thank you. Now we will have Mr. Parker Ragnon who will talk about the measures that the Ministry of Health is actually putting in place. Thank you again to all and thanks for having me here this morning. We've heard about dengue fever and the prime culprit in the transmission of dengue fever is the mosquito. Now there are several species of mosquitoes that are prevalent in St. Lucia. However, there is one specific species, the Edis Egypti mosquito. And that is the mosquito that is responsible for transmitting the dengue virus. This mosquito is a mosquito that most if not all of us here have seen at some point. It is that mosquito that has the stripes, the white stripes on the wings and on the legs. When you try to catch them, they are a little faster than the others. This is the Edis Egypti mosquito. So we want to make it very clear it's not all the mosquitoes on the island that transmit dengue virus. It is restricted to the Edis Egypti mosquito. This mosquito is deemed to be a domesticated mosquito. That means it lives very close to human habitat. It also likes to breed in fresh stagnated water. So it's not the mosquito you're going to find in the dirty pools generally. But it enjoys the fresh, clean, stagnated water. That is why it lives around human habitat. We as human beings have a tendency to store water for various purposes. We understand that in many parts of the island there are intermittent supply of the water in distribution. And as a result, the auxiliary water that is stored on premises, either using buckets, drums, or barrels. And if these containers are not kept covered, then the adult mosquito has access to that water. And that is where it would lay the eggs. So there are some things to understand about the mosquito. Firstly, it is only the female Edis Egypti mosquito that bites. The reason why it bites is because it needs a blood mill in order to reproduce. And therefore, that is why we get bitten by this female adult mosquito who gets a blood mill and then would get into any water source, whether it's a water drum, a flower vase, a tire, a coconut shell, even a bottle cap that is left and water collects there. In places like our roof gut rings, that's not free flowing. And if they get into the septic tank, so they are a host of areas that we need to look for in and around our surroundings because they are potential breeding sites for the Edis Egypti mosquito. Once they get access to the water, that is where they would lay the eggs. The eggs are laid just above the waterline, not directly on top of the water. So the cycle of the mosquito really begins with an adult mosquito laying eggs. After a couple of days, the eggs mold into the lava. And the lava is the little worm-like thing we see wriggling in the water. That is the lava. And then about two days after, the lava changes further and becomes a pupa. And the pupa is really a big head you see with a little tail in the drum, a big black head. This is called a pupa. So it's getting closer to becoming an adult. And the final stage in the development of that cycle is the pupa becomes an adult. The whole process takes between five and seven days, depending on the condition. So we start with an egg, and in seven days we have a live mosquito. In order for us to be able to deal with a prevention or control of mosquito breeding, we must intervene at any one point of the life cycle. And that is why it's so important for us to understand the concept of integrated vector management. Because the application of chemicals alone is not enough to control the proliferation of mosquitoes. Throughout the years, we have tried using chemicals, whether it is on a national level where forking operations have taken place. And you would have seen the forking activities, particularly in the evening towards the early night. Why is that so? Because the Edis Egypti mosquito, they come out to feed at dawn and at dusk. They are not the mosquitoes at midnight that sings in your ears, musical tunes. But rather they come out at about 5, 6, and early in the morning at the same time. And that is why when you do forging, it has to be a targeted time. You cannot go forging at 10 o'clock in the morning. These mosquitoes are in hiding. And so when you are doing a forging operation, it's really targeted only at the adults. So forging only targets the adult mosquito, not the eggs, not the larva, not the pupa. So we can continue to forg the island of St. Lucia. But what would happen is after two or three days of forging, the pupa that is in the drum would become an adult. And therefore what you have is the cycle continues. And you are finding it very challenging to continuously knock down the adult population. And hence the reason why we're speaking about an integrated approach. So the integrated approach means that every single householder in this country must learn to do a proper examination of the yard. What are we examining for? We are inspecting to see whether there are containers that are holding water to allow for mosquito breeding. And the simple things that can be done, for example, in areas where there is indiscriminate dumping of garbage, there are times we have all appliances that we keep outside. They're not working, but instead of discarding them, we keep them somewhere in the corner. Sometimes you have a spare tire that you're keeping there and water is collected in it. The inspection of the household should look for potential breeding areas for the Edis-Egypti mosquito. So we're spoken about the drums, the flower vases, and we encourage our people to please replace water in your flower vases. Use sand, use soil, use something else. Because water standing there for two days or three days would allow for the mosquito to come in and lay their eggs in there. So we have to do a thorough inspection of our premises to determine whether there are potential sources for breeding for mosquitoes to breed. And when we find these sources, we need to be able to either control them or remove them. What we mean by control? So we won't ask you to take away your water drum, but we are asking you to put a wire mesh over that drum to prevent mosquitoes from accessing into that water supply. There may be other containers, bottles and coconut shells, empty cans that you would have to collect and remove and put in the garbage. There may be little environmental modification you have to do, for example, turn in over a container. So this is all part of the control activities that one has to do. And therefore, we recognize in order to break the cycle, every single solution must play their part. It's not just about the ministry doing the fogging activities, or you have the inspectors coming to your home. And we do that very regularly. We come and we apply a lavish side. A lavish side is really a chemical that is put in the water, targeted at killing the lover. Because what science has taught us is that two prime stages for dealing with the mosquito and killing them is at the level stage and at the adult stage. So you would find that the health officer would come and they would be put in chemical in a drum, in a container to kill the little riglers, the lovers in there. But that too is not sustainable. Because in periods where we have high rainfall, as we have had in the earlier part of this week, date last week, what you find happening is that when the drum would overflow because of the high rainfall and the water comes out of the gut ring, the chemical would also wash out. So it's a difficult task administering chemicals to control mosquitoes. There must be the entire environmental modification. And that is looking for breeding sites and removing them. And every single one of us must play our part. Mosquitoes has a fairly long flight range. It can go beyond a mile. So think of a community. And think of you taking responsibility for your own yard, your own premises. And your neighbors does the same. But 10 houses away from you, somebody's negligent and is not doing it. What is happening is my yard is taken care of, it's clean. But the person's yard, a few houses away from me where mosquito is breeding would also allow the mosquitoes to get to my house. And so it must be a sustained, integrated community effort that is needed. We all must have our hands on board. We all have our part to play. It's important because mosquitoes has a fairly long flight range. The other thing about it is Egypt in mosquito. And Dr. Joseph spoke about the mosquito and how it gets infected. A mosquito is not infected. Once it bites somebody who has dengue fever, it becomes infected. The scientific term that is used, it becomes infective. That means it is now harboring the virus in its system, the dengue virus. And one of that mosquito, if it bites 10 people in one house, all 10 people will come down with a dengue fever. So one mosquito can transmit the disease to more than one person. So hence the reason why it is important for us to understand the mosquito, the cycle of the mosquito, and what it is that we must do to be able to control the breeding and the proliferation of the Aedesis-Egypti mosquito. As a Ministry of Health, there are a number of initiatives that we have undertaken. And we continue and will continue to undertake. We've done extensive fogging operations throughout St. Lucia. At different times, the majority of the schools on the islands have been fogged. But fogging is a very taxing activity because you have a short window to fog. It's between five and eight. And then it makes no sense to fog after. The other thing about fogging is that the individuals, when they see the officers are doing fogging, they close the windows on the doors. And so they're not allowing the chemical to work. And so there are limitations with fogging. And I must say that any chemical you use would have impact on the environment. But we continue to do fogging operations. And more and more, there is an appeal to fog. And the Ministry will continue its best in doing fogging throughout St. Lucia. We continue to do our premises inspections, do what is known as the entomological surveillance. That is to go out and to meet with householders, to examine water containers, to see whether there is breeding on a premise, and to give basic information as to how to deal with the breeding, and also administer treatment for the breeding. We respond to complaints. Mosquito related complaints. We have targeted hotspots for breeding. For example, tire shops and the storage of used tires, because we know tires readily collect water. And that mosquito likes a little back place. So the tire creates that nice ambient environment for them. So we target the tire shops. We continue to work with other government and non-governmental agencies. Again, that brings us to the point of the integrated approach that must be taken. And so we've worked with the St. Lucia Solid Waste Management Authority. We've worked with local government through Ministry of Social Transformation. We've had discussions with the Department of Infrastructure. And there are a number of community groups and organizations that we have worked with. There have been some community cleanup activities that have been taking place at different locations on the island. And this is an area where we are looking at stepping up the efforts. Having community work together in terms of doing cleanup and removing bulk waste and waste that would allow for storage of water on premises. It requires a community effort. And so we've started doing our source reduction cleanup campaigns with the communities. We've gone to a number of the schools as part of our education process and a number of community organizations giving information. We've developed PSAs that are now on some media houses. And all of that is in a quest to empower the householder to employ the citizen of this country, to empower the citizen of this country in understanding the mosquito and the things that can be done to control mosquito breathing. We continue to work with agencies in terms of looking at some modification that can be done. And right now we are exploring additional possibilities as to other means that we can employ in St. Lucia to be able to control mosquitoes and the Adiz-Egypti mosquito specifically. But there is so much that a ministry, a department can do. The question now is, what can you do? What can every St. Lucia do? And so we've spoken about the protective measures that you can take. I've already mentioned about playing your part, removing breathing sites for mosquitoes. But we also need to be responsible. And that responsibility means that we must take personal responsibility for our health and our well-being and that of our family. Knowing the times of the day that the mosquito come out, we need to be vigilant that at these hours, if you are going to apply a repellent, do so. Wear long-sleeve clothing. What you're doing is reducing the chances of getting bitten by a mosquito. You need to do that. So if you have to wear socks and wear long pants, do that. We also encourage the use of bed nets. Some people find it difficult to sleep in a enclosed environment, but the nets have proven to be quite effective in keeping the mosquitoes at bay. We continue to encourage persons to get involved. That's the only way we can stem the spread of dengue fever by every sentlusion getting involved. It's a matter that we must take seriously. We've heard already that the mosquito can transmit dengue fever, and dengue fever can be fatal, deadly. And therefore, it's not a matter that we need to treat lightly. It's something that is serious. The outbreak that is before us is an unprecedented outbreak. And therefore, all of us as sentlosions must put our heads together in order to break that transmission and to reduce the spread of dengue fever. Thank you. Thank you very much, Mr. Ragnanan. Right now, we will take a few questions from the media. We're asking that persons raise their hands before asking the question and also state your name and your organization. DBS Television, it's a two-part question. One is, what is the ministry doing in terms of working with organizations such as the Castries Constituencies Council in cutting down on the stagnant water in the city that can give rise to the breeding of mosquitoes? And also, when it comes to the use of chemicals, isn't it a vicious cycle where you have chemicals being sprayed in the home and then you're inhaling those chemicals? Isn't that another type of health hazard that you're creating there? I did say that we are working with local government. And that would include the councils. As a matter of fact, we have done extensive training for a number of officers at the different councils from Rhode Island. And therefore, we are looking at strengthening our partnership with them in working together to looking at how they can assist, not just in looking at stagnated water, but other measures that can be implemented to reduce the spread of mosquitoes. The second question you ask, it's a nice question. When you have outbreaks, you need to look at the mediums that are at your disposal that is available to you that you can use. Throughout the world, we recognize that chemicals, they have adverse effects on humans as well as all the flora and fauna in the environment. However, you need to do what is called a cost-benefit analysis. If you decide you're not going to use chemicals at all, then you need to be prepared to deal with the outcome of the spread of a disease. So many times, you're very challenged in terms of what you can use to be able to tackle the situation. And hence the reason why we have to use chemicals, but it has to be used in a very sustainable way. And any overuse of chemical, one would cause resistance. And we've seen that at the household level and in many communities. Because many times, you had a complaint that I'm using this chemical at home, this insecticide, and it's not effective. It causes this cockroach or this mosquito to become dizzy using it on the floor. And then after a while, it gets back to full strength. One of the things that has happened is using a prolonged type of insecticide can cause resistance. And so we have been doing resistant testing in many parts of St. Lucia for the mosquitoes. And we know what chemicals they have developed resistant to some level. That is why ever so often, we would change the type of chemical that is used, especially in forging for the adult mosquitoes because of resistance that they have developed. But I agree with you that we have to be very careful in the application and the administration of chemicals because it can cause harm. And therefore, that is why it must be used in a very responsible and sustainable manner. Sheffield Gillard looks in Lucia News. Piggy marking on the question, one of the questions, don't ask. Recently, the president of the Medical and Mental Association expressed concern that the forging is hazardous to human beings. Can you all clarify whether that is the case? And also, is this the first death caused by dengue? And if not, what is the numbers to date over the last five years? Or so if you allow those figures. And at what point did the Ministry of Health decided that, OK, we have a dengue outbreak in St. Lucia? OK, thank you for that multiple questions. I will address the force component of it as it relates to the impact on health. As pointed out, for every chemical that is being used, there is always a potential for some adverse effect on life, including human. With the material being used or chemical being used for forging, and this can be striking from the expertise from the environmental health, is that the concentration and the duration of exposure with intermittent use has not been proven to be hazardous to human. This being said, we do acknowledge that there are persons who have certain respiratory illnesses like asthma, chronic obstructive A-ray disease, among others, in whom with exposure to such chemicals can trigger a crisis, an asthmatic crisis. And as such, measures are being put in place when there is time for the application of such agent to notify the community so that these persons can take the necessary steps if it includes removing themselves from the area to allow for the intervention. As pointed out, yes, we acknowledge the limited impact, especially for persons with certain underlying illnesses. But when you look at the cost-benefit ratio of using these substances when needed, let's say here in the midst of an outbreak and not using them at all, the impact on life, the economic loss would be significant much more than we are experiencing. And for this reason, Foggin, while it's one of the measures we have in place to address the adult mosquito is not the primary measure to control the mosquito's population. And for this reason, it is important that each one of us play our part in reducing the mosquito breeding site. And if we can do justice, whereby we inspect our environment regularly, as pointed out by the Chief Environmental Health Officer, empty standing water, try to avoid having standing water for a long time. Because as pointed out, the span from having the eggs to the adult is just about seven days. So if we can play our part, it would reduce the need for the authorities to use these chemicals. And I think that is how best at this point such could be answered. As it relates to the other components, I yield to the national epidemiologists to provide some answers. Thank you for your question. What we do at the epidemiology unit is monitor trends. So one of the things that we monitor every single week from the public and private sector is what we call undifferentiated fever. So a person presenting to any health care facility with fever plus headache or fever plus eye pain or whatever it is, we monitor that. And we have developed our trend so that we know at certain points of the year, it normally goes up. And that, as I said, normally coincides with our dengue numbers or in previous years with our chicken gunia or Zika at the time. What we noticed through the beginning of the year, the numbers were exactly where we expected them to be within normal range. However, in July, we noticed that the undifferentiated fever started to go up. And when we looked at our dengue cases, we noticed that it coincided with that as is usually the case. So it started to go up in about July. Now, we knew previously that our regional, our neighbors were experiencing outbreaks. We know, although there was not open borders and we didn't have the level of travel that we had previously due to COVID, but there was still movement from one island to the other. So that, of course, in itself, if our neighboring islands have something, then more than likely we tend to get it. So it was in July that we noticed the increases. We continued monitoring. We issued alerts so that persons would be aware of what was happening and put the measures that Mr. Ragnanan and Dr. Joseph spoke about, measures in place to restrict breeding of mosquitoes in and around the homes. We declared the outbreak in August after we noticed that the numbers had surpassed what we expected for that time and period. And we confirmed our first dengue death. That has been the only death to date. I cannot give you off the top of my head for the past five years. I know definitely there were no deaths last year either, but today we have only recorded one dengue-related death. And it was, as I said, an elderly, well, not elderly, but an older gentleman with underlying medical illnesses which predisposed him to the more severe form of dengue. As you know, NBC Prime, the evidence and data, if you will, is there in terms of when these mosquitoes breed and the information you have already confirmed to know when the peak times are for breeding for these mosquitoes. So is it a case that the ministry or the officials don't have the capacity to deal with the breeding? And what would you attribute the prevalence of this mosquito to given the fact that you know the evidence, you know when the peak times are, why are we at an outbreak level today? You'll take part in it, Parker. Well, as I indicated, we monitor it. And I think Dr. Joseph also alluded to it at a certain period, we start mobilizing, we start sensitization to the general public of ways and means of reducing breeding in and around the home. So it was not something that we reacted after the fact, it is something that we do on an annual basis. We have had for this year several interruptions in our water supply. And while we understand the need of persons to store, what we have noticed is that we had a lot more storage due to these interruptions this particular year. In addition, as I pointed out, St. Lucia is not the only island experiencing an outbreak, but what happens in one island usually influences what happens in the other islands because of travel. So it's not a matter of not preparing adequately. The preparations are done yearly, but it is more of a collaborative effort. And that is what we have been trying to communicate to the public that the Ministry of Health and Wellness, while we do go out and we do the fogging and we do the lavish siding and we do the necessary, persons need to exercise their responsibility as citizens in and around their homes to monitor what is happening, monitor the breeding sites and eliminate these breeding sites in order for us to manage this dengue situation. If we do not have a mosquito, we do not have transmission of dengue and that is a fact. So if we can eliminate these breeding sites, it will go a long way, but it is not the Ministry of Health alone who can do this. One follow-up and it's in relation to the sensitization efforts, Bureau of Health, Ministry of Health, every week we have, every year we have Vector Awareness Week and we have PR campaigns, yet still we are here with an outbreak. Is it a case where the messaging from the Health Ministry is not as effective? Or what would you attribute where we are today in terms of your messaging? Thank you for such an interesting question. And as you rightfully pointed out that the Ministry would have had Vector Awareness Week and also with several activities to raise or heighten awareness to vector breeding. And here we are talking about the mosquito. This year, the Ministry of Health and Wellness would have launched its 2020 Vector Awareness Week on July the 31st. And that are those activities were heightened during the third to the 8th of August. Even prior to launching the Vector Awareness Week, the Ministry in collaboration with other agencies would have had media appearances trying to alert the general public of the need to strengthen their activities in and around their homes, dwelling places, business places in an attempt to limit the mosquito prevalence. And that was even before the Vector Awareness. During that time, we have had and I must say, continue to have several media appearances to not only share the information as it relates to the denger situation, but also to get persons to understand the need for a change of behavior, to mobilize the community so that they can become actively involved in reducing the vector breeding. So yes, we have been doing a lot as it relates to the media. One of the things we need to understand, and even though that's not the focus of our discussion at this time, is just to highlight that while we have had challenges with water supply through the tap with persons, storing water and that could be one of the factors contributing to the increase in the mosquito indices is that we all know this whole concept of physical distancing in the new era of COVID-19. And as such, while the environmental health officers are going out there to conduct inspection, one of the challenge is that some persons would have some reluctance in persons entering their, what they call, private space, even though, yes, they would have been successful in doing so on many occasions. But also, when you think about the community engagement, we've had to make modification toward intervention. So while we address the garbage and the community cleanup, which have started, it's to really limit the number of persons you want to congregate in close proximity. So all those factors, that can be responsible for this current outbreak. That being said, the ministry is doing all in its power to ensure that we work with other government agencies, the private sector, and more importantly, the family and individual, because you recognize is that while you apply the various chemicals, while you get to the communities to assist with the cleanup in the open spaces, a lot of the breading takes place in the house and around the homes, around dwelling places. And if we can get persons to really take on this fight in and around their homes collectively through our theme, our actions, our community, our health, we'll be able to turn the tide of this day and day outbreak. Thank you. For the odd, I don't think the issue so much is with the message that goes out. What we are seeing is really how serious are we taking that message? It would seem to us that a mosquito is generally deemed to be harmless. You know, you get bites, you know, it prevents you from sleeping and that's it. But we've seen consistently over the years that it is that same mosquito species that is responsible for transmitting so many diseases. So the same Edis-Egypti mosquito transmits, was responsible for transmitting chicken gunia. It was the same Edis-Egypti mosquito that was responsible for transmitting Zika that we had in 2016. It is the same Edis-Egypti mosquito responsible for transmitting dengue virus. And the messages have been going out year by year consistently. This is what we need to do to reduce breeding spaces and breeding grounds and so forth. But are we adhering to these messages? Are we taking them seriously? Unfortunately, now we have a death. And so the question is, would now seen that one of owners died, would we take that message seriously? We need to be able to understand the situation we're dealing with is a serious situation. And so we've spoken about the outbreak. Dengue is endemic to St. Lucia. So every year we get cases. This year there is an outbreak, an unusual number of cases. And we've seen, not making excuses, but there are several other sistering countries, north and south of us, who are similar situations. What we saw is we had a water emergency for many months. And that led to persons storing water because many places for days on no water. Then we had a sudden onset of the rainy season. Remember, we had a long dry spell. All of a sudden we had an onset of the rainy season. And these containers continue to remain. The mosquitoes began to proliferate. And that is why we started seeing the increase towards the end of July. And that is just one analysis. We have not been able to conduct a thorough analysis as to exactly what is responsible for the transmission. But again, there are several things we can draw from. So hence the reason why we need to take this outbreak very seriously and to do our part because we cannot sit back and continue to ask for fogging. When are they coming to fog my area? That is just one little intervention. Am I going to sit back and wait for fogging to happen? Then three days after fogging mosquitoes start back again because the breeding grounds are there at my home in my yard. So the adults are killed and then the pupil becomes adult into two, three days, more mosquitoes again. We need to take these things seriously and to do our part and put in our intervention measures in place. And every single inclusion has to take that responsibility. Because this dengue outbreak is a serious outbreak. It is not restricted to any one location. From what we are seeing from the data, it's throughout the island. There are some areas that have a higher number of cases, but it is spread throughout the island and every one of us must get on board and play our part. Jaffa Wooding, Hot7 News. How strenuous has it been on the health sector dealing with a pandemic and an outbreak at the same time? Not only just on the health sector, but in terms of getting members of the public to not only adhere to COVID-19 protocols, but then also take steps to help mitigate the dengue situation. And also, are there any concerns, given that in the onset of both diseases, they have similar symptoms? So members of the public might self-diagnose and just go take some paracetamol when they should be going out and getting tested for COVID. The first component of your question, how strenuous it is on the health sector, it is clear that St. Lucia and not just the health sector is managing the COVID-19 pandemic, which is unprecedented. We have seen the impact in terms of the economic, the psychological, and the overall toll on human life. The health sector is no different. However, within the Ministry of Health and Wellness, we are prepared and we'll always be ready, irrespective of the circumstances, to manage these situations, because that's what the Ministry of Health and Wellness is there for, to ensure the health and safety of the nation. So when you think about the strenuous nature, yes, because of a limited human resource, among other things, but we are prepared to manage. Well, as pointed out, while we work from this level to manage the pandemic, the COVID-19 pandemic, the dengue outbreak, and all other health issues, it is important that the community, the individual, get on board, play their part, and this will, no doubt, reduce the need for the application of chemicals, for the human resource to be more out in the field. Yes, they're going to continue with their inspection and everything else, but you would be able to redeploy your human services for other activities. So the community is very important in playing their part. The other question as it relates to the coexistence of COVID-19 and dengue, even though as we make a comparison, as you pointed out, there is some similarity, but yet differences in the two diseases. First, the mode of transmission is different. Dengue, by the mosquitoes, the infected, female, ADs, Egypti, while COVID, it's respiratory airborne. So you find that your mechanism of protection would be different. While they both may present with fever, the fever patterns are different. You find that dengue presents with, as pointed out, 75% of the cases or infected persons do not have symptoms. 25%, yes, they do. And within those, many do not go to a health facility because it's mild. So while we see the numbers out there and we are concerned, it is important to know that that's just the iceberg. And for this reason, we need to act as individuals. Dengue, you have headaches, eye pain, especially with movement of the eyes. I'm not going to likely to find out with COVID. You're going to have more muscle aches, joint aches, even though the pattern of muscle pain and joint pain are going to be different. And here you have the clinical, personnel, the physicians, the nurses, and other health care professionals, sorry, who are going to be able to separate those two. And as such, because you may not be aware as to which one you have, it is important that you present yourself to a health care personnel to assist you with such assessment and also to wear your mask because you are not sure which one you're having. And after assessment, then the health care professional would determine which way to go in terms of your management. So I just heard HDS. I have two questions. The first one is, we saw an incredible amount of resources being pumped into the control and the prevention of COVID-19 in St. Lucia, where no deaths were recorded. How would the ministry respond to the criticism that the ball was dropped in the fight against Dengue, given that we have recorded one death? We must admit that every disease has its own presentation. As pointed out for and well-established Dengue, there is a 1% case fatality overall. However, for those who may have progressed through the severe form of the illness, have a 2% to 5% case fatality rate that is likely of dying. And if you wait too late to present for medical evaluation or you do not present at all, then the chances of you dying increases as far as 50%. That being said, and one of the things I'm going to take this opportunity to do is that we have seen country-wide aggressive adherence to the many protocols the Ministry of Health and Wellness would have implemented to reduce and prevent the spread of COVID-19. We know COVID-19 is a new disease. We have seen how easily and really it can transcend across borders. And this disease is still evolving. We do not know all about it. And hence, probably this is one of the reason why the general public would have adhered to many of the policies, programs, protocols implemented, hence reducing the risk of transmission and also deaths. However, we have seen mosquitoes being around for ages. Globally, they were turning in the 1960s, having control. However, since in the early 1970s, mosquito population continues to grow. The rate of dengue continues to increase when you look at the data globally within the tropics and subtropics. And one of the reasons is it's mode of transmission and human behavior. Organization, people living in close proximity, not having the appropriate environment to limit the spread or proliferation of the disease. And as such, we need to turn the tide in terms of our behavior because dengue control really resides in reducing that factor that is responsible for the spread. And it's a mosquito. So if we can turn the tide with our behavior in our homes, in our communities, our business places, collectively, we'll be able to reduce the mosquito population, reduce dengue, and the chances of dengue deaths. Thank you. Specific what type of the ADZG climate mosquito is attracted to or is that a myth? There has been a lot said about type AB that persons with type AB tend to, there has been a lot said about the type AB. I don't think there has been anything concrete that has come out saying that this specific group, the mosquitoes, are more prone to it. But there has been a lot said about the blood group types, but nothing concrete. Mr. Ragnanen, given that castries, Babuno and Grossly are the hot pockets area of the dengue outbreak, is there any immediate plans for concentrated preventative measures in these areas? Well, we have already began to work with these areas. We have done a number of interventions, including fogging operations. We continue to do the entomological surveillance and go into the household and doing the labisiding. We have worked with community groups. And unfortunately, last Saturday, for example, we were supposed to have a cleanup campaign with one community. But because of the inclement weather, it didn't come through. So we are looking at rescheduling for that. However, I want to assure you that we have been working with these communities. And we continue to work with them. We have gone to every school within these areas because we've seen the need to target the schools especially because what we are seeing from the data is that our children, the age range between 5 and 15, are the highest infected age group. And so we continue to work with all the schools. And having said so, we have also done a number of sensitization programs, especially with the schools and with community organizations in these areas. But not just these areas alone. We have done extensive work throughout the length and breadth of St. Lucia because we recognize that we have concerns in Danry, in Maycud, in Viewfort as well in terms of the spread. I think we have no more questions. So with that being said, we have come to the end of the press conference. I want to thank you so much for taking part. Thank you.