From Cayman Islands Ministry of Health & Wellness

Grand Cayman, Monday, 16 January 2023: The Public Health Department published its third monthly Public Health Spotlight on Communicable and Non-Communicable Diseases (NCDs) since the announced changed on August 31, 2022.

From the Desk of Sabrina Turner
The year is in full swing, and for many January 1st offered a much needed fresh start to take on the challenges- new and old- of the new year.
It is important to give ourselves permission to start over and reset, as well as to identify the things that no longer serve us and which we wish to change.  However, that permission should not be something that we allow ourselves only once per year, as many people do when setting their New Year’s resolutions.
Thus, this month’s spotlight focuses on putting mental wellness at the forefront of the reset, including in goal setting, and provides local resources in the form of a mental health service providers list.
Food safety is also highlighted as a key component of overall wellness that warrants more attention.  Our efforts to improve the quality of the foods that we eat should be supported by the appropriate handling, preparing and storing of our food.
I am also pleased to be able to share some information on the work that the Ministry of Health and Wellness has been undertaking when it comes to public health gains in the area of tobacco control.  The FCTC is an important framework that will strengthen health and wellness for decades to come.
And, as always, our epidemiology corner provides us with our monthly COVID-19 update.  In light of queries from the public, our team has included additional information on SARS-CoV-2 genomic sequencing to provide local context to the questions of dominant strains within our community.
My team at the Ministry of Health and Wellness and I remain committed to achieving our nation’s health and wellness goals for 2023 and beyond.

At your service.
New Year’s Resolutions and Mental Wellness
“New Year, new ME!”  That is often the resounding call on January 1st every year as individuals identify goals and changes for the upcoming year.  New Year’s resolutions have been around for as long as any of us can remember, and for many people resolutions tend to focus on things like fitness and health.  Weight loss, ability to complete a physically demanding task (such as running a marathon), and gaining flexibility and mobility are all among goals which individuals set for themselves.
Studies in this area tend to vary, but some suggest that as many as 23% of people who make resolutions quit within the first week, and as little as 9% of persons who make resolutions are actually successful.
There are several key barriers that are identified with hindering the success of New Year’s resolutions:
1- An “all or nothing” approach which focuses on competition and punishment, thus making it more difficult for people to ‘get back on the right path’ if they stray.
2- Not setting a realistic goal.
3- Not creating a timeline and setting progress markers and rewards.
4- Not having systems of accountability and support.
5- Being inflexible.
In fact, the inability to adhere to a New Year’s resolution can become a source of stress for one’s mental health, and even self harm for  those who are already struggling with mental ill health.

The focus on mental health over the past few years, especially in light of the impact of the pandemic, has made its way to this year’s resolutions as Forbes Health/One Poll reports as many as 45% of respondents putting improvement in mental health as their top resolution for 2023.
In fact, 50% of 18-25 year olds and 49% of 26-41 year olds who answered the survey put said mental health improvement as their top priority, highlighting the importance that Generations Z, millennials and Generation X have placed on mental wellness.

Whatever one’s resolutions and goals may be, behavioural health experts recommend the following steps to ensuring greater success in achieving them:

1- Choose a specific and realistic goal: Specific goals should be measurable, so whether you are deciding to ‘lose 10 pounds’ or ‘attend counselling sessions twice a month’, ensuring that you can measure your goal will help put you in the right path.

2- Create a plan: Your plan should include things like a timeline, progress markers, as well as potential barriers and suggested solutions for said barriers.

3- Set rewards to motivate yourself: The final reward shouldn’t really be the only reward.  Change takes time and is part of a process, and as such rewarding yourself for making progress is a great way to remain engaged and committed.

4- Find your people: Whether you find like minded people locally or get your support online, get some support.  Support can come from those who are sharing a similar journey, or from those persons who love and care for you who are cheerleading you through yours.

5- Accept failure and forgive yourself:  Be flexible.  Change is a process, and as mentioned above the ‘all or nothing’ mindset can do more harm than good.  You may slip up, you may fail, but that too is part of the journey.  Use those words of encouragement that you would have for a friend for yourself.  If needed go back to your goal and reassess.  You are learning as you’re going along, so you may find that you may need to change and adapt things during your journey.

Food Safety: A Key Component of Health & Wellness
Any New Year’s resolution that involves health and wellness will no doubt include goals relating to food and nutrition.

While it makes sense to look at eating “healthier” or “better”, one often forgotten aspect of wellness is food safety.

Food safety refers to the handling, preparing and storing of food in a way to best reduce the risk of individuals becoming sick from food borne illnesses.

Food safety is normally understood within the context of inspections of restaurants and eateries by health officials who work to ensure that the food safety standards are being met.
However, food safety principles are equally as important in our homes in the privacy of our own kitchens.

Food safety is achieved through various actions, including but not limited to:

 *   Properly cleaning and sanitising all surfaces, equipment and utensils
 *   Ensuring a high level of personal hygiene is maintained in general, but especially in the kitchen with a focus on hand-washing
 *   Storing, chilling and heating foods correctly.  This means taking into account the temperature of the food, the environment, as well as the equipment.
 *   Ensuring that pest control measures are in place to prevent against pest-related contamination
 *   Being aware of and understanding how to handle food allergies and intolerances
 *   Being aware of and understanding food poisoning
The impact of food poisoning varies from symptoms like diarrhoea, vomiting, abdominal cramps, nausea, fever, aches and fatigue.  In the United States, 1 in 6 Americans (or 48 million people) get sick due to food borne illnesses.  Of those an estimated 128,000 are hospitalised and 3,000 die from said food borne illnesses.

Here in the Cayman, the Department of Environmental Health’s (DEH) Food Safety team holds the responsibility for ensuring foods sold (or offered to the public) in the Cayman Islands comply with health requirements and are not likely to cause harm to the health or safety of the population.

It is also the responsibility of the department to inspect food establishments to ensure that food is stored, prepared and handled safely by food handlers employed to food establishments.

The appropriate level of knowledge, supervision and training of food handlers is a vital factor in assuring the safe preparation, handling and serving of food. DEH provides training of food handlers to minimise the risk of food poisoning and contamination of foods. This training is a food safety requirement for all food handlers who serve or offer food for sale to the public.

In 2022, following the lifting of COVID-19 restrictions on public gatherings, the DEH resumed the Basic Food Handlers’ training as part of its Food Safety and Surveillance Programme. A total of 50 sessions were conducted providing training to 1,165 participants.

As the year begins, the DEH is resuming its training courses for personnel in the food industry on January 18, 2023. Registration is now open.

The Basic Food Handlers’ training equips participants with sufficient knowledge to prevent food-borne illness caused by food-borne pathogens and other contaminants.

Offered every Wednesday from 9:00 a.m. to 3:00 p.m. at the Red Cross building, this training applies to all new personnel working in the food industry and anyone wishing to continue as food handlers after expiry must renew their certification which is valid for three years.

Business owners and Food Business Operators are encouraged to act now and register all their food handling personnel for these important workshops, as DEH requires all personnel handling food to be trained.

Members of the public who are interested in enhancing their food safety knowledge are also encouraged to participate.

Registration is KYD$15, and can be completed by phone on 949-6696 or email on [email protected]<mailto:[email protected]>

The World Health Organisation (WHO)’s Framework Convention on Tobacco Control (FCTC)
The WHO Framework Convention on Tobacco Control, or FCTC, is the first global public health treaty that was adopted by the World Health Assembly in May 2003 and entered into force by February 2005.

The FCTC is an evidence-based treaty that reaffirms the right of all people to the highest standard of health by tackling some of the causes and consequences of today’s biggest killer: the global tobacco epidemic.

According to the World Health Organisation, tobacco kills more than 8 million people each year. Seven (7) out of those 8 million deaths are attributed to direct tobacco consumption, while as many as 1.2 million are the result of non-smokers being exposed to second hand smoke.

Tobacco use is also the only common risk factor for three main non-communicable diseases which account for nearly 80% of all deaths within the Caribbean region: cardiovascular diseases, cancer and diabetes.   Here at home, the top two causes of death on our shores are cardiovascular diseases and malignant neoplasms, both illnesses which are inextricably linked to smoking.

The FCTC’s overall aim of promoting public health and responding to the globalisation of the tobacco epidemic aligns perfectly with the Ministry of Health and Wellness’ focus on strengthening public health nationally.

The FCTC aims to tackle complex factors with cross border effects, such as direct foreign investments, tobacco advertising, promotion and sponsorship beyond national borders, and illicit trade in tobacco products all in an effort to help those nations that are a party to this Convention optimise their tobacco control efforts.

The United Kingdom, which has been a world leader in tobacco control and has complied with many of the FCTC provisions, has been keen to support the Overseas Territories in strengthening their resilience against the tobacco epidemic, and the Cayman Islands has been working hard to get to this point.
In order to have the FCTC extended to Cayman, we first had to ensure that Articles 8, 11 and 13 of the Convention were satisfied.

Article 8- “Protection from exposure to tobacco smoke” requires that parties to the Convention shall adopt and implement laws that protect citizens from tobacco smoke in indoor workplaces, public transport, and other public places.

Article 11- “Packaging and labelling of tobacco products” requires that parties to the Convention ensure that tobacco packaging and labelling do not promote tobacco products by false, misleading, and/or deceptive means or in any way that may create an erroneous impression of the health hazards of any tobacco product, and stipulates that health warning messages must be present for each unit packet and package of tobacco products.

Lastly, Article 13- “Tobacco advertising, promotion and sponsorship” requires that parties to the Convention undertake a comprehensive ban on tobacco advertising, promotion and sponsorship in an effort to reduce the consumption of such products.

In August 2022, the Cayman Islands Government formally asked for the FCTC to be extended to the Cayman Islands, making it the first United Kingdom Overseas Territory (UKOT) to reach this milestone.

This legal framework will allow policy makers to develop and expand a more comprehensive approach to tobacco control that will pay dividends in strengthening the health and wellness of our population, present and future.

Epidemiology Corner
Mpox Update
The Multi-country mpox outbreak, formerly referred to as monkeypox, has continued to show signs of improving. Data up until 2 January reported by the WHO indicates that of the 110 countries, territories or states who have reported mpox cases, 79 have not reported any new cases for at least 21 days which is the maximum incubation period[i]. The majority of new cases over the past week were reported in the America’s, however the trend in cases there is relatively stable. Over the past month ten mpox deaths have been reported; eight in Peru, one is Chile and one in Cameroonviii.
There have been no mpox cases detected in the Cayman Islands.

COVID-19 surveillance data
December 2022 (data as of 3 January 2023)

Internationally:
The People’s Republic of China (PRC) has focused efforts on a COVID-Zero policy during the pandemic, including stringent non-pharmaceutical interventions to control outbreaks[ii]. During December 2022, these measures were removed and the borders re-opened. Concurrently, the media reported a significant increase in COVID-19 infections, which alongside limited data reporting from China particularly on circulating variants, has led to international concern on the current scale of cases and deaths[iii]. The World Health Organization requested real-time data from China, and recent updates of genomic data suggest most of the variants circulating in China are BA.5 sub-lineages[iv]. Several countries have introduced pre-departure or post-arrival testing of passengers travelling from China including the US, UK, France, Italy and Australia. No travel requirements have been introduced for passengers arriving in the Cayman Islands.
XBB and XBB.1.5 are both sub-lineages of the Omicron variant. Samples were first identified in September and October 2022 respectively, and more recently an increase particularly in XBB.1.5 has been reported in Europe and the United States of America[v],[vi]. XBB.1.5 has a growth advantage over other Omicron sub-variants, meaning that it can rapidly replace them[vii]. XBB.1.5 has been detected in 29 countries globally, but not yet in the Cayman Islands, whilst XBB has been detected locally[viii]. Currently there is no evidence to suggest that these variants produce more severe illness, or are more resistant to protection from vaccines, and strongly recommend that everyone in the Cayman Islands should make sure that they have received a dose of COVID-19 booster vaccine during the last 6-months’.

Locally:
In the Cayman Islands COVID-19 data presents a similar picture in December as over the autumn months. There were 16 COVID-19 hospital admissions in December compared to 17 hospital admissions in November, although there was a slightly higher number of admissions in the last week of December. There were no COVID-19 patients admitted to the ICU or any who required ventilation. One COVID-19 death was reported in December.
Uptake of the Autumn Booster has continued at a similar rate in December to the previous month, with the highest uptake in 50-69 year olds.
Genomic sequencing of COVID-19 samples from October-November 2022 shows that the Omicron variant continues to be the dominant strain, specifically BA.5 lineages. XBB has been detected in the Cayman Islands, however is not a commonly detected sub-variant.

SARS-CoV-2 Genomic Sequencing
Genomic sequencing of over 300 SARS-CoV-2 samples from October-November 2022 shows that the Omicron variant continues to be the dominant strain in the Cayman Islands. Within this, the majority of samples were BA.5 lineages.
There are a number of sub-variants within Omicron which are circulating, and during October-November the most commonly detected sub-variants were CN.1 which attributed 21% of the samples sequenced, BA 4.6 (17%) and BQ.1 (14%). XBB has been detected in the Cayman Islands, with the earliest sample identified late October, however available data does not indicate it to be a commonly detected sub-variant.

–ends–

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[i] World Health Organization, 2023. Mutli-country outbreak of mpox, External situation report #13 – 5 January, 2023. Available online: Multi-country outbreak of mpox, External situation report #13 – 5 January 2023 (who.int)<https://www.who.int/publications/m/item/multi-country-outbreak-of-mpox–external-situation-report–13—5-january-2023>

[ii] China Center Disease Control, 2022. China CDC Weekly, Perspectives: The Dynamic COVID-Zero Strategy in China. Available online: https://weekly.chinacdc.cn/en/article/doi/10.46234/ccdcw2022.015

[iii] British Medical Journal, 2023. News, Covid-19: China stops counting cases as models predict a million or more deaths. Available online: https://www.bmj.com/content/380/bmj.p2

[iv] United Nations News, 2023. WHO continues to urge China to share more dada amid COVID-19 surge. 4 January 2023. Available online: https://news.un.org/en/story/2023/01/1132167

[v] European Centre for Disease Prevention and Control, 2023. Update on SARS-CoV-2 variants: ECDC assessment of the XBB.1.5 sub-lineage. 9 January 2023. Available online: https://www.ecdc.europa.eu/en/news-events/update-sars-cov-2-variants-ecdc-assessment-xbb15-sub-lineage

[vi] Centres for Disease Control and Prevention. 2023. COVID Data Tracker: Variant Proportions. Data reported up to 7 January 2023. Available online: https://covid.cdc.gov/covid-data-tracker/#variant-proportions

[vii] UK Health Security Agency, 2023. Investigations of SARS-CoV-2 variants: technical briefings. Updated 11 January 2023. Available online: https://www.gov.uk/government/publications/investigation-of-sars-cov-2-variants-technical-briefings

[viii] World Health Organization, 2023. Virtual Press conference on global health issues transcript – 4 January 2023. Available online: https://www.who.int/publications/m/item/virtual-press-conference-on-global-health-issues-transcript—4-january-2023