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A science-based strategy to control the current covid-19 situation

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by Malik Peiris

Chair/Professor of Virology, School of Public Health, University of Hong Kong, Faculty of Medicine, Hong Kong and

Kamini Mendis

Professor Emeritus, University of Colombo, Public Health and Malaria Expert formerly at the World Health Organisation.

I. The current covid-19 situation in the country

There is a high intensity of transmission of covid-19 in the country just now. Although it became apparent with cases increasing in the last week of April, the increase in transmission began about 4 weeks before that. The incubation period of the virus (3-14 days) together with testing / reporting delays mean that the cases detected and reported now were the result of transmission that took place 1-2 weeks ago. Since deaths follow with a lag period of a further two weeks, the deaths occurring now were the result or transmission that took place around one month ago. The mortality impact of the increase in cases is only just starting to be felt now.

The B.1.1.7 variant of the virus spreading now is more transmissible, and possibly more virulent, than in previous “waves”. An even more concerning variant B.1.617 (first detected in India) has also been detected in Sri Lanka and it remains to be seen how widespread it will become. WHO has designated it a “variant of concern,” it is now spreading in the UK and is the cause of some of the recent case clusters in Singapore.

There was an exponential increase of cases from mid-April to date. Although case numbers appear to plateau in recent days, it is likely that this is a result of limitation in testing capacity. Testing numbers have remained flat, in spite of high positive rates (exceeding 10% in most laboratories), raising concerns of whether the epi-curve we now see reflects reality. ICU admissions and deaths continue to increase, as will be inevitable, from infections that have already occurred.

As a result, the capacity of the health system to manage covid-19 patients has already been exceeded, the inevitable consequences being more avoidable deaths. With increasing cases, even the implementation of the public health measures that were being implemented– i.e. testing, isolating, contact tracing and quarantining, have exceeded the capacity of the health sector. In addition, health staff in the curative and preventive sectors is becoming victims of covid-19 themselves, which makes the situation grave.

The vaccination programme, currently getting under way within the constraints of limited vaccine supply, even if targeted to those at highest risk of death, i.e. the elderly and those with co-morbidities (a policy that has NOT been consistently followed in Sri Lanka so far), will take many months to translate into an impact on mortality. Vaccines, which require two doses at least a month apart, take optimal effect >2 weeks after the second vaccine dose. As of now, only 1% of the population have received both doses of vaccine and 6% received at least one dose, that too, mainly in one province of the country. Even under the most optimistic scenarios, it will be over 6 months before most of the high-risk population receives protection from vaccine across the country.

The only available option in the short-medium term to arrest this impending catastrophe is to significantly curtail transmission through social and public health interventions.

Although a few public health interventions have been implemented in the past week, we explain below why these recent measures of small-area isolations, prohibiting inter-provincial travel, intermittent and short period lockdowns, as the one during 14 – 17 May, together with mild restrictions on human movement such as those based on identity card numbers, will not arrest this wave of the epidemic.

We explain why a nation-wide lockdown of at least 14 days (defined below) is absolutely necessary, if increasing ICU admissions and deaths from this wave are to be contained. We also comment on the likely economic impact of these different approaches.

II. Why small-area isolation, preventing inter-provincial travel, short and intermittent lockdowns and mild restraints on human movement will not work

 

1. The testing is not sufficient to make small area isolation have an impact.

Small area lockdowns are based on obtaining information of a cluster(s) of cases from a particular location. The detection of these clusters are based on testing a population in an area in response to detecting a few cases from that location – i.e. reactive case detection rather than proactive surveillance. Thus, by the time the cluster has been detected, multiple weeks have lapsed since the initiation of each cluster and therefore the people in that cluster would have already spread the virus through their movement, to many other areas, adjacent and distant. In other words, isolating that small area will not have much effect on the spread of the virus to other areas, because it has already happened. If small-area isolation is to work, then an extensive amount of active surveillance and testing in the population (as opposed to being based on contact tracing) is necessary, but this is currently not feasible given the laboratory system being already overloaded. Initiating these small-area lockdowns are sucking up a huge lab testing capacity at the moment, which will be more productively deployed elsewhere.

2. Since all provinces have ongoing high transmission already, stopping travel between provinces will have little effect.

By the end of April, all provinces had ongoing high transmission of the virus and therefore stopping inter-Provincial travel will be of no avail at this stage. It may have had a role in early or mid-April, soon after the B.1.1.7 variant was detected in the Western Province. But not any more, with the virus entrenched in every province.

3. Countrywide lockdowns of 3 days will not block even a single cycle of virus transmission or cover the period of infectiousness of an individual.

Intermittent countrywide lockdowns (such as the one from 14 – 17 may or the proposed one from 21 – 25 May) will only have effect during those three days. Three days is far shorter than the incubation period of the virus, i.e. from infection to manifestation of illness and transmission, which is around 5 days (range 3- 14 days). It is even shorter that the infectious period of one infected individual, which is around 8 days. For example, if an infected individual begins to be infectious on day one of a 3-day lock down, he/she will remain infectious at the end of the lockdown, at which time the person will be again moving in the community. In order to even partially interrupt transmission, one needs to cover at least two cycles of transmission, i.e. 10-14 days of intervention. That will allow an exponentially higher probability of chains of transmission being interrupted. Therefore, the minimum period of lockdown should be countrywide and at least 2 weeks in duration. The impact of 5 successive intermittent lockdowns of 3 days each (i. e. 15 days in aggregate) will therefore, be much less than that of one continuous 14 day period of lockdown. Furthermore, the former strategy will be spread out over a much longer period, when we do not have the luxury of time any more.

4. Partial restriction of human movement using ID card digits will not have much impact on virus transmission.

Limiting the movement of people and crowd-gathering through means such as restricting them to alternate days based on identity card numbers is not sufficient to prevent the congregation of people because up to half the population could be out of home at any given time. This is not sufficient for transmission is to be halted.

5. Standard preventive measures are not having optimal impact because of overcrowded living conditions

Even the strict enforcement of social distancing and mask wearing will not have its optimal impact because they are not ideally implementable under overcrowded living conditions in urban areas.

6. People working in enclosed environments e.g., office spaces will enhance virus transmission

Offices such as banks, and industrial working places such as garment factories require people to be in enclosed and confined spaces with insufficient ventilation for the entire working day. These are extremely and highly conducive to the spread of the virus.

Thus, these recent measures have impeded economic activity and sucked up huge resources and effort from the security forces for a marginal public health gain, at best. Moreover, repeated, intermittent short-duration restrictions also carry significant economic costs. The uncertainty associated with the introduction of these measures/future measures create an unstable environment for most economic activities. Most daily wage earners are not given work by employers because they travel daily from unknown risk situations at home. Most industries and offices are working within a context of uncertainty and are unable to plan even for the medium-term. This is not conducive to economic growth.

A rational, determined and convincing strategy is needed, both to get control of an impending public health disaster and also to restore economic confidence.

 

III. A countrywide lockdown for at least 14 continuous days is immediately necessary for the following reasons:

 

1. Only a degree of restriction of human movement enabled by a total countrywide lockdown of 14 days will lead to interrupting at least one (preferably two) cycles of virus transmission in the community. Such an intervention would give an opportunity for the health sector, currently at or beyond breaking point, to catch its collective breath, to face the future. Otherwise, exponential increase in the number of cases (and deaths) will lead to health staff succumbing and the consequent collapse of the health system.

2. Such an intervention can be signaled >5 days in advance so that the community, traders and businesses can make adequate preparations. It will give some level of certainty for planning and instill confidence in the population, the business community and the health sector.

3. The daily wage earners will need to be given an allowance to tide over this period. But this investment will be amply repaid by the opportunity to get faster control of an epidemic that is rapidly spiraling out of control.

4. Access to essential commodities – food, fuel, medicines, health care will not be compromised because the necessary logistical arrangements can be made. The experience of the March-April 2020 lockdown will be an asset in planning and implementing the distribution of essential goods to the people.

We recommend the following:

All persons to remain in their homes at all times for a period of at least 14 days continuously, and all schools, industries, commercial enterprises and places of worship to remain closed, with the exceptions listed below. These exempted places will be subject to social distancing, capacity restriction, wearing of face-masks, hand sanitizing and operating under conditions of optimal ventilation.

1. All essential services to be functional.

2. A minimum number of grocery stores, pharmacies, and fuel stations to remain open in every district. A limited number of vegetable, fruit and fish/meat, bakery and other food delivery vehicles permitted to operate on the basis of permits.

3. Restaurants able to prepare food for delivery on order, but not allow in-house dining.

4. Government departments deemed essential, to keep an office open for a few hours a day and function with a skeleton staff on a roster basis.

5. Any organization or enterprise may allow its employees to work from home.

6. A person can leave home only for a health need (including vaccination), any other emergency, or to purchase food supplies, but only one person can leave home at any one time for these purposes.

7. Gatherings of more than 4 people to be prohibited.

8. Outdoors agricultural work permitted to continue.

We request, in addition, that all ongoing preventive measures be enforced rigorously, including increasing vaccination coverage, and that case management and treatment interventions are greatly strengthened in the country.

 



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Features

Talent Networking Group doing the right thing

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The pandemic has certainly taken its toll of the showbiz scene, especially in our region.

Our entertainers are feeling the heat very badly and so are their counterparts in India, and in the Maldives, as well.

There is absolutely nothing that any of us can do to make showbiz some kind of a happening scene.

All we can do now is…yes, just watch and wait!

In the meanwhile, there are still opportunities for artistes to showcase their talents, so that music lovers would know that their favourites are still very much active, and haven’t disappeared from the music scene…altogether.

What is gaining popularity now are social media platforms where artistes are given the opportunity to entertain music lovers.

The Talent Networking Group is one such setup that has impressed me, and has featured quite a few very talented artistes, especially from India – the Anglo-Indian sector.

I’ve also seen some of our artistes doing their thing, on this platform, via TNGlive.

What makes this TNG group extra special is that the people involved are innovative and are coming up with new ideas, on a regular basis.

Yes, they are expanding in order to give other talented folks the opportunity to come on the scene and display their culinary skills, dancing, etc., in addition to singing.

This is the new weekly setup, as indicated, on social media, by those responsible for the Talent Networking Group.

Says Derek J. Wheeler, one of TNG’s liverwires…

“It’s been an eventful year for all of us and, boy, what a ride it has been at TNG! But, time to shake things up a little and inject some new life, as we look at another long lockdown ahead.

“We are spicing up the weekends at TNG – throwing it open to the whole family to rock the joint, with your singing, your instrumental gigs, cooking, baking – whatever rocks your weekends at home. Time to share it with the rest of the family!

“And, this is the new scene:

“TNG Throwback Thursday

– Sing us some old songs, cook us a memory or just go old school on us in whatever way you like.

“TNG FriYAY

– We are just happy it’s a Friday. TGIF and all! So just come on out and do your thing. We are there to support you.

“TNG Saturday Swag

– The spotlight closure to our hip weekends. Calling all you rock stars to close it out with a bang for us all.”

Last Thursday, the spotlight was on Vrinda and Lynette throwing it back with some golden oldies – both in Hindi and English – while on Friday it was Shania, in the limelight, with an exclusive country and western set.

And, on Saturday, the inimitable singing chef Nigel Galway took centre stage, with his extremely talented and pretty daughter Leanne. It was certainly a rocking session!

Remember, TNGlive is not confined to India only. Sri Lankans, too, can show the world that we have got it all and are only waiting for the pandemic to slow down to boom into action…live on stage.

Melantha Perera would provide you with all the details as to how you could be a part of TNGlive. And, it’s all so simple – you do it from home, singing live, of course, to pre-recorded tracks. Yes, it’s as easy as that.

All you need to do now is give a shout to Melantha on 0773958888

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Everyday violence and exclusion at university

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By Ramya Kumar

This week’s Kuppi Talk takes off from an earlier piece on ragging that drew attention to the anti-democratic culture that breeds violence within the university system. Shamala Kumar linked this violence to the lack of democracy within universities, and society more broadly.

When we talk about violence within our universities, the conversation invariably turns to ragging. Some of us also talk about other forms of violence, such as the arbitrary sacking of a vice chancellor or an academic who does not toe the line. But the classed, gendered, and ethnicized forms of everyday violence we experience within the university system remain invisible. Here, I draw on discussions with students and teachers at various state universities to illustrate how gender violence pervades our everyday, and perpetuates exclusion and injustice.

Hierarchical systems

Our education system, whether primary, secondary, or tertiary, coaches students to conform and to not question authority. Non-conformers are penalized, and alternative ways of thinking discouraged within an exam-oriented system that measures performance by grades. On top of that, school curricula reinforce social hierarchies and difference by using myths or tropes like the ancient Sinhala king, the sari-clad virtuous mother, or the meat-loving Muslim.

When they enter the university, students are already saddled with various stereotypes and prejudice conveyed as authoritative knowledge through this system. Many would not have interacted with people outside their frame of thinking/knowing. Ignorance, misinformation (conveyed through the ragging apparatus) and the unfamiliar environment of the university creates conditions for further polarization. An undergraduate talked about the oppressive environment she encountered in her first week at university:

“The seniors harassed the boys [in our batch] if we did something “wrong” like dress “indecently” or behave “incorrectly.” The male seniors had discussions with our boys about how we dress and what was wrong with us….[they were told] the girls were their responsibility… “See, we have our girls in the palm of our hands, they listen to everything we say, yours also should be like that” they said. So ultimately the way we dressed, where and when we went out, and everything we did were to be dictated by a group of boys who were our age, who were strangers … we knew better, but it was very stressful and confusing.”

University authorities have not been able to address ragging because the university itself is built on systems of hierarchy. In fact, our universities are complicit in such acts of violence. For instance, a Muslim undergraduate who wears hijab talked about feeling marginalized after the Easter Sunday bombings when security personnel singled her out to check her backpack, commenting that she looked like “Zahran’s sister,” while letting others pass through.

From second class students…

Students internalize gender and other “norms” with few opportunities or forums to question them. Their activities are often divided along gender lines, albeit varying in different settings. When organizing an event, women tend to take on clerical and accounts work and tasks like serving tea. In some faculties, women attend lectures, dutifully taking notes for men, who are coerced into less mundane engagements by unions (and others) during lectures. Those who fail to conform to this “subculture” are branded as selfish, anti-social, or elitist.

At many universities, women (students) are not considered for leadership positions, such as president of a student union or association, even in faculties where women far outnumber men. “The mental picture of a leader is always male…it is the norm,” said an undergraduate. This “norm” is often justified on the grounds that women cannot travel back home/to their hostels after meetings, a strange notion for the many women who travel on their own. Most elections do not involve voting as decisions are made “unanimously” before elections. When women find themselves in leadership roles, they are often spoken over and not heard.

Women’s attire is strictly under surveillance. A Muslim undergraduate spoke of being banned from the prayer room at her faculty because her skirt did not reach her toes. A Tamil undergraduate who studied in the south described how her (Tamil) friends in another faculty had to wear Salwar, a single plait, pottu and vibhuti to maintain their “culture” in the dominant (Sinhala) environment. Similarly, women Sinhala students in the North are warned by their male counterparts not to transgress so-called Tamil norms by wearing short skirts, or tight clothes, in the name of safety and security.

Gender norms are also reinforced by university teachers and others in positions of authority. A medical undergraduate felt discouraged when a clinician advised the women in her group to think carefully before embarking on postgraduate studies: “[The doctor] said we would get late to marry, that we may not find a husband, and that our studies would interfere with our duties as a wife and mother.” Another student spoke of a clinician who referred to female students, including herself, by body shape and size, making her feel humiliated. Women encounter these forms of violence on a daily basis, making them feel little and unimportant, even as some confront the system head on, struggling to redraw boundaries and trouble the status quo.

… to second class academics

The university hierarchy places temporary and probationary lecturers at the very bottom. A professor described the ways in which younger lecturers, especially women, are silenced at meetings in her Faculty: “They are just not taken seriously … their contributions are ignored or they are simply spoken over.” A temporary lecturer talked about being harassed by a member of the support staff when she commenced work. He was known for treating women disrespectfully, but her complaints fell on deaf ears. A system that favours internal recruitment sustains hierarchy, obliging junior staff to take on additional (uncredited) work and even forego first authorship in publication, to support their seniors in the race to professorship.

As academics, women are frequently excluded from decision-making processes, which usually take place at informal meetings among an “in group” of (predominantly) men, who flock around (and bow down to) the administration. This culture of decision-making prevails at all levels of the university, and, by virtue of its character, excludes women and minorities, who cannot participate in the “machan” talk and camaraderie, for different reasons. Those who speak up or ask questions are delegitimized as fussy, irrational, or troublemakers. “Men throwing a tantrum is totally acceptable, but when a woman does that, she is being emotional,” a senior lecture pointed out. A professor spoke of feeling stifled during Senate meetings where questions and discussion were generally discouraged: “When I pointed to a breach in procedure, the VC asked me to stop raising trivial issues.”

The gender hierarchy is more visible at higher echelons of the university. The UGC and university councils are dominated by men. Although women do hold positions of authority within universities, as deans and, less frequently, vice chancellors, the gendering of academic work continues. In various committees, women tend to take on a lot of coordinating and paperwork, but their contributions remain uncredited as they rarely share the limelight. In fact, many women are faulted for their “family commitments,” and any negative traits attributed to their gender. Yet, the (widespread) mediocrity of men is never attributed to gender.

At the root of all this is pervasive sexism that objectifies and sexualizes women. It is commonplace for women academics to receive comments on their hair do or attire. A professor commented, “There is no understanding of what is appropriate here.” Even when there are serious breaches of conduct, like sexual harassment, there is nowhere to go. “Using established university procedures to address sexual harassment comes with risks that most women are not willing to take,” she continued. Overall, there seems to be very little trust in the system, and, in all likelihood, any incidents, along with their inquiry reports, may be brushed under the carpet.

Consequences

What does this situation ultimately mean for universities and society? Most immediately, it allows university administrators to function in the service of power. Second, rather than pushing the boundaries of knowledge and public discourse, central to their role, our universities reinforce social hierarchies, with accompanying exclusions and marginalisations. Third, by discouraging critical dialogue, the system sustains a disengaged university community that remains paralysed in the face of injustice, and supports producing graduates who easily comply with authority. The consequences are far-reaching, as we see in the unfolding COVID-19 mess.

Clearing up this mess must start from within our institutions. Building on the egalitarian principle of Free Education, we need to create inclusive spaces for students and teachers to come together to dialogue on the trajectory of higher education, and demand justice at this critical juncture.

Kuppi is a politics and pedagogy happening on the margins of the lecture hall that parodies, subverts, and simultaneously reaffirms social hierarchies. 

(The writer is attached to the Department of Community and Family Medicine, Faculty of Medicine, University of Jaffna)

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Lockdowns, travel restrictions and basics for control of Covid-19 third wave

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Vehicles moving towards Colombo, along the Negombo Road, during lockdowns

 

By Dr. Pradeep Kariyawasam
Former Chief Medical Officer
Chairman, Standing Committee on Health/CMC

The 14-day ‘Lockdown’ or so called ‘Travel Restrictions’ to prevent the further spread of the Covid-19 virus which later became a 21-day event ended on Monday (21).

The inevitable happened in April this year after we were lax in taking the timely decisions. In January this year I warned through your newspaper about the possibility of the UK variant B 1.1.7. (now called Alpha) arriving in the country. Many who came over from the UK were in protective bubbles or in quarantine centres, before they were allowed out in the community and that included the English Cricket team. There could have been others infected with the virus that arrived from the UK. Considering that the PCR tests show only 70 % of infected persons as being positive for the disease, so many others could escape being detected with Covid-19 and be symptomless carriers.

It is interesting that the virus has spread to a lot of areas before it was found but details are sketchy. We don’t know whether there were unconnected cases in the community. So, maybe it was here for a few months before the existence was confirmed in April this year. What happened to our surveillance system operated by the Epidemiology Unit? The lowering of the number of PCR or antigen tests may be the reason why this was not detected earlier, and lower infection rates that were shown since February this year were not factually correct. Then, when the first notification of the possibility of the arrival of the virus was made on the 8th of April 2021, the immediate reaction should have been to order a total Lockdown at least in the Western Province. Timeliness is the most important factor in controlling epidemics. But then it was important to have the New Year festivities and here we are. We now have to take urgent informed action to control the present outbreak post Lockdown. Otherwise, it would be catastrophic for the country.

Looking at the present situation, the six strains of Covid-19 virus in the country at present are detectable now, and the areas where each is located are mapped at least by the district. When patients were found mainly Grama Niladhari Divisions were brought under lockdown to control the spread. Some were opened after a few days or weeks. This was hardly enough to stop this epidemic spreading. There seems to have been no coordinated efforts by the stakeholders. While politicians have to listen to the people’s social and economic woes, the health authorities have to impose conditions laid out in the Quarantine and Prevention of Diseases Ordinance. The Mayor or the Medical Officer of Health is the Authority to implement the conditions in this Ordinance at local level and therefore it is seen that the Municipal Councils or Town Councils have a role to play during this period, too. But this did not take place and while some politicians had a field day others got into confrontations.

 

Spreading like wildfire

While local lockdowns may have worked in the peripheral areas in the short term, such small lockdowns could have been ineffective, useless and dangerous in areas where large crowds live. These are towns and cities, where a large number of slum and shanty areas and middle-class Housing complexes are situated side-by-side allowing the disease to spread like wildfire. The solution for such areas was vaccination of all people at least over the age of 30. But it did not take place as that was not a priority, and then there was a vaccine shortage. The rich had an unfair share of the vaccines which is happening even today. I hope they will realize that by vaccinating the people in the poorer areas we could stop the spread into their areas. These people live in small poorly ventilated slums or rooms, sometimes 5-6 in a room, that create ideal situations for virus transmission unlike in richer areas. Although mutations take place all over the world creating new variants, and will continue until Covid-19 goes away, most of the vaccines seem to be holding well against them. The infected people plus vaccinated persons will create herd immunity but only vaccinations can prevent massive infections and mutations quickly so that there isn’t much of a damage to the society. The toll of this traumatic experience for many cannot be measured individually or as a society. Families have suffered socially, economically and some have already lost their beloved ones. The deaths of pregnant women and infants show how traumatic the experience could be not only to the family but also to the health staff.

Lockdowns themselves will not stop the spread among the people unless they are properly policed. This is what happened in the recent days where 60-70 thousand vehicles entered the city every day. That is nearly 100,000 entering the city! In poorer settlements life is continuing like on any other normal day with people roaming around within their area. But then they cannot engage in work! So, lockdowns seem to be for the poor and “travel restriction” are for the rich. Scientists have identified that the virus stays alive in the body only for 6-7 days, so a quarantine period or a proper lockdown of 21 days would suffice to clear an area of the virus. We need 21 days as the incubation period could be up to 10-14 days and after getting infected, the virus will be dead by 6 to 7 days. Of course, there are outliers to this range.These days the number of new patients found daily are around 2200-2400 which shows that an upward trend has been checked and that is good news.

 

Achieving good results

To achieve good results the law enforcement agents and field staff of the Health Departments should build positive relationships with their community, respect civil rights and not impose unnecessary hard and fast rules which may be counter-productive. With the threat looming due to the UK’s Alpha and other new variants, we have to prevent the disease spreading but at the same time see that socially and economically people are not that affected, as for more than a year they have undergone immense hardships. This is so, especially with the farmers and middle level traders, who are unable to trade or sell their crops due to sudden closures and lockdowns.

‘Live with the virus’ should be the slogan for the next few months. TV footages showed vendors with perishable items such as vegetables and fruits told all of a sudden to pack up and go from road side, fairs or economic centres. I understand the police have been given orders but then these people should have been handled more humanely. Perhaps they also should be allowed to sell the products while maintaining health conditions. Consumers should be told that only one person is allowed near a street vendor at a time and they should stand in queues with a two-metre social distance between them waiting for their turn. Small scale shops should be allowed to open and only one person per four square metres should be allowed inside the shops, and others should stay outside waiting for their turn so that there won’t be a rush to buy food stuff and other items. This is much better than getting vendors in mobile vehicles from other areas. The government should order that paying leasing charges or rents for vehicles, shops should be postponed or halved for this period and allow the dues to be gradually paid after the lockdown.

 

Communication breakdown

Unfortunately, the communication between the government agencies and the people at large have broken down. There is no direct communication with the poor people, the most vulnerable sections of our society, and they are not organized although civil societies exist. The people are apprehensive about the actions of the law enforcement officers and the Public Health Inspectors. Usually, in Colombo Health Educators and Instructors communicated well with the people, spreading out the health messages in an appropriate manner. We had at least 300 active Community Development Councils in the city before 2015. Today we don’t have that system anymore. The result is disorganized communities in the cities especially in the urban slums and marginalized apartment complexes. During the second wave around 100 people died in their homes in Colombo without medical help. Prevention and control of disease spread therefore has become impossible as there is no community participation. More informal health education actions should be carried out visiting the probable high-risk areas and action should be taken to look into various needs of the people in locked down areas whether it is the rice, fruits and vegetables, dry rations, curry powder, cooking oil, gas or whatever basic things they need, or simply help them to sell their wares.

 

Need for proper data

So, what should be done to rein in the virus and stop this menace? First, in future we have to take quick, strong and timely action to stop the transmission of the disease. For that we need proper data and maps before taking decisions. The government should not allow any organisation impose their will by coming out with various unproductive and social destructive proposals. Years ago, there were so many Epidemiologists who were highly trained, mainly abroad, but I just don’t see the Epidemiology Unit in the fore-front of Covid-19 control now. I think the government should bring back those who have retired and put each province under one of them. The data provided now is not worth to take informed decisions. There should be enough young medical officers with IT knowledge who can bring out great analyzed data and maps who can be put to work at the main Unit. The prevention and control should involve the following actions for outbreak response: surveillance of patients and contact tracing, laboratory testing, case management at home and hospital level, infection prevention and control, travel restrictions, lockdowns, epidemiological and outbreak analytics, dissemination of information to relevant officials and most importantly to the general public, logistics, risk communication and community engagement. Lockdowns are may be a short-term strategy but not desirable in the long-term as a strategy and what should be done is to place systems in place and building up capacities not only of the health staff but also of the general public for short and swift actions to prevent the spread of the virus.

 

How to stop transmission

With regard to travel restrictions the strategy should be based on the notion that when people stop moving the virus also stops moving and if it stops moving then it dies away. Data has shown that 8 out of 10 people should stay at home for the corona virus to be controlled. This is an important message as sometimes even the vaccinated get ill. So, what can be done? What can be suggested is that at any time or any day both the Public and the Private Sectors should have only 20% of their office staff at work at least until the end of September this year. All government departments, businesses or institutions should have their own Covid-19 prevention Standard Operating Procedures (SOPs) and health protocols in place catering to the specific needs of such places. This is important especially for government institutions. Inter district travel should be only for the essential staff. The manufacturing industry can have all their staff in bubbles by providing the staff with lodgings. The factories should have 50% of the staff but with longer working hours having weekly rotations. The same goes for the building industry. They can have night shifts. The staff can be allowed home once a fortnight after being checked by a physician whether they have the symptoms. They should also be given a place in the priority list for vaccinations. In any case if they have the disease the others also will get ill by that time and then the whole group could be quarantined together. Private transport for the staff is important and that goes for the government workers also. Similarly, others also can make arrangements after obtaining medical opinion by those who are involved in Covid-19 prevention. Those drivers and conductors in the transport services also should be vaccinated as a priority.

The Covid-19 Prevention Task Force should work in smaller sub-committees: Disease Control; Security; Logistics, Vaccine procurement and delivery; Hospital Management; Economics, Manufacturing, Agriculture and Trade; Ambulance Service, etc., and meet the Task Force with their own decisions which should be conveyed at the meetings with the Head of the Government. That meeting should be for only the key officials from these sub-committees or those who are invited specially to hear their opinions. Those who come with different opinions should be given a chance to voice their concerns at each level. Public Health staff should engage with local communities in the MOH areas to build trust for evidence-based actions to detect possible cases and encourage local leaders to support outbreak control response measures. Strategic decisions with regard to control measures should be taken at central level by an Expert Panel comprising of Epidemiologists, Virologists, Public Health and Hospital administrators. Keep out the ‘Wannabe Epidemiologists’ stupid ideas such as vaccinate people in ‘Virgin Areas’. They do more harm than good as too many cooks spoil the soup. A true Epidemiologist with years of experience gets a gut feeling of what should be done next. Ambulance Services should be combined and coordinated by one sub-committee. All vacancies for health staff should be filled at least temporarily especially, those in the public health workforce. Border control should be strict especially in the northern seas to prevent delta virus not entering the country. Fishermen should be told not to mix with Indian fishermen. All decisions should be based on guidelines, policies and decisions of the Task Force or Presidential directives based on worked out strategies, the analyzed information, maps, risk assessments, and the epidemiological situation. The basic messages to the general public should be to wear a mask, wash the hands, keep social distance, get vaccinated, go for self-isolation and get medical help if they suspect they have the disease, home quarantine if required etc.

 

Equitable treatment 

On the side of the authorities, they must ensure equitable treatment of all people, free equitable access to diagnostic tests, therapy, and vaccines, which should be allocated according to worked out criteria and needs. The Local NGOs and INGOs should be roped in to help whatever way without getting involved in decision making and politicians should be involved only for organizing the people for PCR testing or for vaccination programmes.

It is a must to have proper communications with people in the area and the health staff comprising of the field officers are the best to do this. Secondly, in future lockdowns must cover larger land areas than at present. For example, if patients are found in a certain Grama Sevaka (GS) Division then lock down the surrounding GS areas too as obviously people don’t contain themselves to their own areas but would have gone into other close-by areas also even before the virus was detected by PCR or antigen testing. If there is a cluster of GS divisions affected then the MOH areas or even Districts should be locked down. However, the essential health staff should be allowed to go to work and trading of essential items should be allowed. Every household should be issued with a card where only one person at a time is allowed outside to go to buy needed items. If these measures still don’t work out then curfew should be declared in such areas again for at least two weeks and see the progress. What has been mentioned above are the basics that should be attended to stop the third wave but not an exhaustive one.

 

Natural decline or vaccination

What will finally stop this epidemic is natural decline or vaccination of the population as Israel did for their citizens. The latter should be our priority. People should as early as possible get their doses of the Covid-19 vaccine, whether it is the AstraZeneca, Sputnik V, Sinopharm or Pfizer vaccine that is available in their area. If we want to stop large scale deaths as in India this should be done immediately. We don’t want this to happen especially in cities such as Colombo, Kandy or Jaffna. Vaccine mis-use, pilferage, selling, and only the privileged getting the injections should be stopped forthwith. Now that the health and armed forces staff are given the vaccines the next priority should be various field staff, staff members of private and public institutions who are in direct contact with customers, traders, shopkeepers, and people in high population density areas where the disease affected large numbers and decisions should not be based on their connections, power or money. Hope we will stick to basics of epidemiology and control this third wave, and see that all are safe in this country.

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