The Covid-19 pandemic is gathering momentum at an alarming rate. There has been a steep rise of deaths and cases specially after the Delta strain became widespread not only due to the more rapid spread but also the increased severity of the Delta strain. But efforts are being made to downplay this danger.

The Government report of July 29 states that up to then the total confirmed cases was 304,202, and that 26,448 active cases were in hospitals. On that day, there were 2,329 new cases and 66 deaths. The total deaths recorded up to then was 4,324.

Even the daily figures up to then showed an increasing trend of both deaths and new cases. But as everyone knows many more people are falling ill and dying at home, without going to hospital. One can speculate that the real number is two or three times more than the official figures. It is also estimated that about 80% of those who are infected are asymptomatic (that is they do not show any illness), but they too are infectious. Thus, the situation is explosive, but our society is functioning near normal, and people are collecting in large groups at parties, weddings, meetings, and public transport like buses are overloaded. This is mainly in towns, specially in Colombo and the Colombo district.

In the last 10 days, the tendency for people to gather in groups of 10 or more has also increased. If this is allowed to continue, there will be an explosive pandemic with many thousands of deaths.

Suitable Plan for Sri Lanka – The situation will get out of hand unless the whole Sri Lankan community and the Government act with vigour strictly according to a precise plan. Everyone will have to fall in line with this plan. Given below are some highlights of a suitable plan.

(a)

Make everyone aware that the virus is in the whole community and that each person can be infected by any other person. Therefore, each person is in danger and must protect him/herself. To get this across, an intensive program of health education must be carried out by every available communication channel.

(b)

To achieve this objective every person must avoid crowds. (10 people or more)

(c)

Social distancing – ensure that the distance between any two people exceeds one meter (preferably two meters).

(d)

Ensure that everyone wears a proper mask whenever he/she leaves their home. Even at home, if there is a visitor the mask should be worn.

(e)

Any article touched by another person may have live virus. Anyone else who touches that article should promptly wash his/her hands applying soap for at least 20 seconds.

(f)

To ensure that the above objectives are observed, Covid Committees should be set up in all villages, groups of slum dwellings, offices and work places.

(g)

The above Covid Committees should also spot any sick persons who might be having Covid symptoms and promptly dispatch them to a doctor or hospital. They must obtain the PCR report as soon as it is ready and if it is positive ensure that all contacts are quarantined in the house.

(h)

The Covid Committee must carry out intensive health education among all the people. This should be supported by colorful easily understood messages about the virus and its behavior and how to safeguard oneself illustrated by cartoons.

Vaccines

– If an effective safe vaccine becomes available, it should be used widely and selectively. Unfortunately, this has not yet been achieved because, on an average, it takes 5-7 years of research to produce an effective and safe vaccine.

(a)

As there was a big demand for vaccines, many have been put into the market within a short period of less than one year without adequate safety and efficacy testing.

(b)

Vaccines like AstraZenica, Covishield and Sputnik-V use a proven vaccine technology based on the Adeno virus as a vector, and should be safe and have reasonably high efficacy.

(c)

The Chinese vaccines are based on use of killed virus or attenuated virus like Sinopharm, which use the whole virus but without there being alive or able to cause infection. These are safe but the efficacy may be lower. This is also a well tried technique in vaccine production.

(d)

The Pfizer and Moderna vaccines produced in the USA are mRNA vaccines. This is a new technology which has not been used before in vaccine production and also transfers viable genetic material. These have been shown to give good protection. But their safety is questionable. The introduction of genetic material through the vaccine may lead to and have an effect on our genes, even several generations later, that can be harmful. I am not in favor of their use.

4. Vaccine schedule for Sri Lanka- if Sri Lanka was a rich country, it could have given two doses of any of the above recommended vaccines. However, we have limited resources. The WHO gave us sufficient recommended vaccines as a gift to immunize 20% of our population. It would be best to give these vaccines to the vulnerable groups (that is the groups that are liable to develop severe disease and even die). The vulnerable groups are,

(a)

Frontline workers – such as doctors, nurses, attendants, ambulance drivers etc. (b) Those over 60 years of age. (c) Those with comorbidities (severe chronic lung & heart diseases, diabetes etc.)

There may be those over 60 years, over 30 years, under 30 years or children in that order according to availability of vaccine. (The above vulnerable group of three categories must be given the vaccine even if it is necessary to be bought from the manufacturers).

5. Non-vulnerable group – All the others need not be vaccinated at state expense. Those who can afford could get vaccinated. But for children under 12 years vaccination is not indicated.

Prof. Tissa Vitarana