The Covid-19 pandemic continues to spread at an alarming rate in Sri Lanka and in most countries world-wide. This is mainly due to the lack of a people-based campaign with proper leadership. In Sri Lanka the corona virus was introduced into the country by identified individuals coming from abroad. By identifying each case and the contacts who formed a cluster and isolating each cluster for the required period, the spread to the community was prevented.

This was done effectively by Sri Lanka’s good Public Health Service well supported by the Armed Forces. But with a high percentage of those infected not showing any symptoms (maybe as much as 80%), the virus began to spread among the community.

But that stage is well passed and today there is extensive spread among the community island- wide. Community spread began in the Western province with Colombo as the focus. Had there been early recognition of this change, a campaign to create awareness among the public and effective action to perform effective crowd control measures, the spread could have been controlled to a considerable extent. For some strange reason, this was not publicly accepted, as if a natural epidemiological effect was a sign of failure, and the campaign was continued on the basis of the cluster concept.

The Health Service backed by the Police and Armed Services is bearing the brunt of the present campaign. Fever cases are being tested with the PCR and RAT and positives are being hospitalized. Due to shortage of hospital beds, some milder patients are being isolated in their homes. Other public health measures are being implemented. But the epidemic is spreading fast. This is not surprising with the large number of asymptomatic infections in the community. This calls for a community based approach which is carried out nationally. We have a multicultural society and the practices of each community should be accommodated in the campaign.

My first suggestion was that all political leaders be brought into a Covid control committee so that it becomes a National Campaign. This Committee should interact with the Minister of Health both within and outside Parliament in a supportive manner. The most important step is to ensure that the whole community, every household is involved and made fully aware. Intense health education using all media would achieve this in a week or two, from children right up to the elderly. The core message should be that one has to presume that everyone in society is infected, and that for one’s own protection, the three health practices must be carried out: wearing a face mask properly at all times, especially when one goes outside the home, and even at home when any outsiders come in, practice social distancing (two meters is better), and frequent hand washing, especially when touching any object that someone else may have touched.

Avoid crowd gathering. This should be practiced by everyone, with political and social leaders setting the example. The reaction of people in the country should be that if anyone is seen to break the rules, others should point this out to him at once. This practice should prevail in town and village, at home and workplace. Sharing of towels, handkerchiefs, pillows, sheets etc. should stop. Everyone should carry one’s own small hand towel in the pocket or handbag.

A Covid Committee should be established in every village, at street level in every town, and in all workplaces. Besides its preventive role, it must help the family of an infected person, e.g. supply food and other needs, and give moral support. The Committee must ensure that the contacts do not infect anyone else. If any person develops any possible symptoms, the patient should be shown to a doctor at once. The Covid Committee should have a health official like a PHI or Midwife to be in contact.

The Committee should ensure that people do not crowd together. All social and political meetings should not be allowed. Essential meetings should be confined to the smallest number of essential people, who must observe the health guidelines. At the entry and exit to all public places, soap and water with washing facilities must be provided and their use made compulsory. If possible hand washing facilities with 80% alcohol sprays could be provided.

All Government officials, especially the Police, should prevent people crowding together e.g. at shops, bus stands and buses etc.. They should ensure that the three health practices are observed. Stern action should be taken against violators.

The Covid 19 virus is new to the world and there is no herd immunity. We have much through research to learn about it so that we can better control its spread and treat it. The Coronavirus that causes Covid-19 is fairly large (80 to 160mm) and generally multiplies in the human respiratory tract cells. As other coronaviruses can enter our body through the mouth and then multiply in the bowel, this is a theoretical possibility, but any indications to that occurring have not been established to my knowledge. It is generally transferred from an infected person to another person from the nose, mouth and possibly from the eyes through sneezing (nasal secretions) coughing (saliva and respiratory secretions) and tears.

Recent mention has been made of a new variant that can be airborne i.e. be carried by air (currents) just as virus particles. If true, this means that the masks should be able to block the small virus particles, and the social distance rule needs to be further lengthened. But as a single or a few virus particle are unlikely to transfer the infection, we can let events justify the need to take these extreme steps.

As is well known viruses multiply and grow only in specific living cells, in this case those of our respiratory tract. If they fall elsewhere, in a matter of hours they die. Therefore, let us focus on practicing our health rules. But everyone must do this as a habit. In this way, we can protect ourselves and at the same time, protect everyone else. If everybody does this the virus will die out.

Much effort and money is being spent on obtaining vaccines to protect our people. But it usually takes several years, about seven years on an average, before the ideal vaccine that is safe and effective, is developed. What is being offered may or may not work, or be safe considering the short period.

The duration of protection is unknown. It may need to be repeated in a year or two. Even the best vaccine only protects that particular individual (as this is not a live virus). To protect everybody, it must be given to each and every one. Then only will transmission stops. With luck, it may stop with about 80% coverage. Vaccinating those who run the risk of dying (vulnerable people) like the elderly and those with heart and lung disease or debilitating conditions like diabetes, is to be recommended. Those who are exposed to repeated infection like doctors and nurses should be covered. Taking our financial situation as a country and the outcomes, limiting vaccination to vulnerable groups is more sensible.

Prof. Tissa Vitarana