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Reopening now will paralyse the healthcare system – SLMC

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Sri Lanka Medical Council (SLMC) yesterday said that it was too early to see a visible impact of the lockdown on the healthcare system and opening the country at this juncture would invariably facilitate the spread of the infection leading to increasing number of cases that in turn would cause a complete paralysis of the healthcare system.

In a letetr to President Gotabaya Rajapaksa, the SLMC has added that it is of the opinion that the vaccination strategy as implemented at present is flawed and needs a composite review urgently. In a setting particularly troubled by a continuous short supply of vaccines, SLMA emphasized the need for an efficient vaccination strategy, which targeting high-risk groups to achieve maximum control which would avoid the necessity for repeated lockdowns.

Given below is SLMC’s letter to the President:

“The SLMA is ever grateful to Your Excellency and the Government of Sri Lanka for declaring a “lockdown” (restriction of movement throughout the country) at the most crucial hour, which essentially salvaged Sri Lanka from getting into the abyss of a major catastrophe; a breakdown of the healthcare system of the country which in turn would have led to a breakdown of all systems.

“I, along with the SLMA Committee to advice on matters related to COVID 19, wish to bring to your kind attention the following important facts with regard to controlling of COVID-19 epidemic in Sri Lanka. In addition to the SLMA Council members and the members of the Intercollegiate Committee, Professor Neelika Malavige, Professor Malik Peiris and Professor Kamini Mendis, Contributed to the discussion.

“I. Recommendation with regard to the continuation of the lockdown

“We gathered information from consultants working in clinical settings and laboratories to find out the current usage of the capacity of the health care system

“a. Physicians indicated that the brunt of the outbreak is now concentrated in the main hospitals and all wards are well over their full capacity with symptomatic patients. There are many COVID patients as floor-patients in medical wards.

“b. Information from the ICUs indicated that other than the dedicated 82 ICU beds, another lot of about 70 more patients are treated in ordinary ICUs at the time of discussion. This situation compromises the care given for patients with Non-COVID issues. There are about 500 more patients on oxygen therapy, treated in High Dependency Units.

“c. Consultants from laboratories indicated the same or higher rates of PCR positivity despite overall PCR positive numbers remain same, when compared to previous weeks.

“This information confirms that hospitals are overwhelmed with cases. As expected, it is too early to see a visible impact of the lockdown on the healthcare system. Opening the country at this juncture would invariably facilitate the spread of the infection leading to increasing number of cases that in turn would cause a complete paralysis of the healthcare system. As such. while we are convinced of the benefits of the lockdown to the healthcare system. we are compelled to recommend a further extension of the lockdown by at least another week. Keeping grocery shops opened may facilitate compliance by the public with a longer lockdown.

“2. The need to review the vaccination programme

“We are appreciative of the decision taken by the Government of Sri Lanka to vaccinate healthcare officials and other frontline workers Such as the police. the tri-forces etc. initially with the highest priority.

However, we are of the opinion that the vaccination strategy as implemented at present is flawed and needs a composite review urgently. In a setting particularly troubled by a continuous short supply of vaccines, we emphasize the need for an efficient vaccination strategy, which targeting high-risk groups to achieve maximum control which would avoid the necessity for repeated lockdowns.

“In cognizance with the data available from the rest of the world, the death analysis of patients front the MoH, Sri Lanka, indicates that 73% of deaths occur in people over 60 years of age and 83% of deaths were in people with co-morbidities. Research findings have clearly demonstrated that vaccination reduces deaths and complications in patients infected with COVID-19. Research evidence does riot support benefits of vaccination to reduce transmission of infection unless a large majority of the population is vaccinated. As such, there is clear and compelling evidence to support prioritisation of vaccination of older adults more than 60 years, followed by people with comorbidities in the age group of 30 – 60 years. However, there is no appreciable benefit in vaccinating people with the highest mobility in so-called hotspots, as is currently carried out in the Sri Lankan setting.

“Furthermore, we emphasize the need of a definitive roadmap providing priority of vaccination in certain geographical locations. Presence of a roadmap would help in gaining the confidence of our people on the vaccination programme. Selection of Grama Niladhari divisions of high-risk locations for vaccination cannot be recommended as the infection would have already spread and the majority would have developed immunity by the time the vaccination programme is carried out. The opinion of experts with regard to selecting the geographical location is to select high-risk provinces or districts and to vaccinate high risk people in crowded areas such as main cities in those selected provinces or districts. An equal amount of vaccines could also be given to hospitals to immunize high-risk people with comorbidities. Along with vaccinating high-risk persons. people working in higher numbers in enclosed areas with longer essential congregate shifts in economic hubs and other essential congregate settings also could be prioritized.

“We urge the Government of Sri Lanka to provide a solution to the 600,000 people awaiting the second dose of the Covishield vaccine as early as possible. We see that offering them the first dose of Sputnik V following a quick clinical trial of the efficacy of such a manoeuvre as a reasonable option to solve the issue. Monitoring antibody levels 2 weeks following vaccination with Sputnik V in about 100 people who have had the 1st dose of Covishield vaccine may provide a reasonable answer to this question. The importance of documenting the adverse effects during such a clinical trial also needs to be emphasized.

“Further, we wish to highlight the need in future to reserve the second dose in instances where a second dose is in the schedule.

“3. Reporting meaningful data

“We understand that the primary role of the Epidemiology Unit of the Ministry of Health is surveillance and reporting the data in a meaningful manner to facilitate the decision – making process aimed at mitigating the outbreak.

“We would like to inquire from the Epidemiology Unit of the Ministry of Health as to whether they have data regarding PCR positivity rates in factories that are kept open, in case a necessity arises to advise the Government in this regard?

“There had been a significant reduction of the number of PCR tests carried out over the last two weeks. We understand that the majority of reported PCRs are exit-PCBs that do not measure the extent of transmission in the community. Unless PCRs are carried out proactively. it is likely that the usefulness of the results of analysis of samples with a majority of exit-PCRs will remain low despite the disease spreading rapidly. Similarly, unless the disaggregated test results based on context categories and geographical locations are analysed, the inference made by all PCRs together is likely to be most erroneous.

“We are informed by one or our experts, Professor Kamini Mendis that they are in the process of compiling a document giving important surveillance indicators. We urge the Epidemiology Unit of the Ministry of Health to pay more attention to the surveillance indicators and present the data of relevant indicators to arrive at meaningful decisions.”



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People to get fuel price shock soon

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The Cabinet sub-committee on the cost of living had decided to increase fuel prices, Energy Minister Udaya Gammanpila told the media yesterday (11) in Colombo. He said that the date of the price hikes  would be revealed soon.

The Minister said that if they announced the date, it would lead to long lines at filling stations and it would have disastrous consequences during the pandemic.

“We know that things are hard for everyone, that is why we didn’t increase fuel prices for 21 months. But the government can no longer bear the losses. The oil prices in the world market have been increasing. By the end of 2020, the Ceylon Petroleum Corporation (CPC) had accumulated a loss of RS. 331 billion. Each year we spend three billion dollars to import oil,” he said.

Gammanpila said that the main sources of income for the country had been affected due to the pandemic and foreign investments and tourism had stopped and a large number of Lankans working abroad had returned, decreasing remittances.

Prime Minister Mahinda Rajapaksa’s Office on May 20 said that a ministerial subcommittee discussed the sharp increase in crude oil prices compared to 2019 and 2020.

The PM chaired the meeting in the Committee Room 8 in Parliament. The Cabinet subcommittee discussed ways and means of addressing the problems caused by the crude price hike.

The PM’s Office said that ministers had discussed how to sustain public relief in the wake of further increase in expenditure. The subcommittee discussed the financial problems of the Ceylon Petroleum Corporation (CPC) and the Ceylon Electricity Board (CEB), among other things. The PM’s Office said that ministers had discussed how to sustain public relief in the wake of further increase in expenditure. The subcommittee discussed the financial problems of the Ceylon Petroleum Corporation (CPC) and the Ceylon Electricity Board (CEB), among other things. (RK)

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HRC asks IGP to explain how he intended to stop deaths of suspects in police custody

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Report called by June 13

By Shamindra Ferdinando

The Human Rights Commission has sought an explanation from IGP C.D. Wickremaratne as regards continuing deaths in police custody.

In a letter dated June 8, 2021, HRC Chairman Dr. Jagath Balasuriya has raised the recent deaths in police custody with the focus on two incidents involving Panadura and Batticaloa police.

HRC Acting Director Research and Monitoring Nihal Chandrasiri told The Island that the June 8 dated letter was the latest missive addressed to the IGP regarding this particular issue since the formation of the new HRC following the last general election in August 2020.

Chandrasiri made available to The Island, a copy of Dr. Balasuriya’s letter addressed to IGP Wickremaratne.

President Gotabaya Rajapaksa in late Dec 2020 named former lawmaker Balasuriya as the Chairman of the HRC comprising· Dr. M.H. Nimal Karunasiri, Dr. Vijitha Nanayakkara, Ms. Anusuya Shanmuganathan and H.K. Navaratne Weraduwa.

Chandrasiri said that the HRC first took up deaths in police custody in the wake of the killing of Dinithi Melan alias Uru Juwa, who had been arrested by the Nawagamuwa police, and Dharmakeerthi Tharaka Perera Wijesekara alias Kosgoda Tharaka in the second week of May 2021.

Civil society activist attorney-at-law Senaka Perera told The Island that continuing deaths in police custody should be examined against the backdrop of a landmark judgment, the Supreme Court of Sri Lanka delivered that the extra-judicial killing of a suspect in police custody violated the right to life, in spite of the absence of an explicit right to life clause  in the Constitution of Sri Lanka.

According to Dr. Balasuriya’s letter, reportage of the deaths of Chandana Vidushan and Ali Khan in the custody of the Batticaloa police and Panadura (North) police, respectively, prompted the HRC to take up the matter with the IGP. Declaring that the HRC has initiated an inquiry in terms of Section 14 of the Human Rights Commission of Sri Lanka Act, No.21 of 1996, Dr. Balasuriya said that inquiries revealed both victims suffered cruel and inhuman treatment in the hands of the police, leading to their deaths?.

Expressing serious concern over what he called the absence of safety and security of those in police custody, Dr. Balasuriya has pointed out to the IGP relevant sections of the Constitution, in addition to Supreme Court rulings in respect of such matters and two letters dated Oct 21, 2020 and  March 17, 2021 that dealt with the issue at hand.

Asserting that continuing deaths in police custody resulted in deterioration of public confidence in law and order, such incidents underscored the threat to what he called public freedom. Having reminded the IGP that the HRC intervened in terms of the Human Rights Commission of Sri Lanka Act, No.21 of 1996, Dr. Balasuriya has requested the IGP to submit a report to him of measures he intended to introduce to prevent deaths in police custody by or before June 13.

In the wake of several killings in police custody, Romesh de Silva, PC, recently moved the Court of Appeal on behalf of convicted heroin dealer Gampola Vidanalage Samantha Kumara alias Wele Suda held at maximum security Boossa prison. President’s Counsel successfully argued against the police taking Wele Suda into their custody.  

President of the Bar Association of Sri Lanka (BASL) President’s Counsel Saliya Pieris has appeared in the Court of Appeal on behalf of Janith Madushankar alias Podi Lassi. Having brought to the notice of justices, Sobitha Rajakaruna and Dhammika Ranepola, the most recent killings in police custody of ‘Uru Juwa’ and ‘Kosgoda Tharaka,’ Peiris sought the court’s intervention to ensure his client’s safety and security.

The lawyer has requested that the court direct the IGP to transfer his client from the custody of the CID to another unit.

 

 

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Health trade union alliance claims their strike a success

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By Rathindra Kuruwita

Senior health officials including doctors benefited from the current health crisis, Health Services Trade Union Alliance (HSTUA) President Saman Rathnapriya said yesterday commenting on the trade union action resorted to by a number of health sector unions, excluding the GMOA.

Rathnapriya maintained that the strike was a success and non-health sector unions  too had supported them because what he called unfair increases in allowances received by doctors affected the entire state sector. The allowance given to doctors had been increased by 78%, from Rs. 41,220 to Rs. 78,120, however other categories had not received any increase in their allowances, he said.

“Our union action was a success, but we are not happy we had to do this. Nurses and other staffers have not received any increase in their allowances although they too are contributing greatly in the fight against COVID-19. The Health Ministry is unnecessarily creating issues by giving a colossal allowance increase to the doctors,” Rathnapriya said.

College of Medical Laboratory Science (CMLS) President Ravi Kumudesh said that the doctors held top positions in the Health Ministry and for many years they had been ignoring the salaries and allowances of other employees.

“They not only mistreat us but create new issues, testing our patience. Throughout this pandemic you can see this. They get all the perks and have even their family members vaccinated. They are taking advantage of the fact that we are exercising patience in view of the pandemic,” Kumudesh said.

Kumudesh added that the union action had not affected the anti-COVID-19 programme, cancer, maternity and paediatric hospitals, etc.

“We are not doing this to inconvenience the people. We are trying to ensure that the Health Ministry does not create additional problems,” he said

President of All Ceylon Management Service Officer’s Union, Udeni Dissanayake said that they too supported the trade union action because the actions of the GMOA would have an adverse impact on the entire state sector.

Doctors had received certain perks in recent years, and they had contributed to salary anomalies and inequality of remuneration across the board, he said.

“Doctors were treated with great respect in our culture, and this is being eroded by the actions of the GMOA. They have been receiving allowances increased and after a while those of similar standing in other sectors, too, ensure that they get hikes, but those in the lower grades do not see any increase. Although we are not a health sector union, we fully support this action for two reasons. One is that the cause is just and the other is that the impact of the allowance hike given solely  to the doctors will soon be felt by us,” Dissanayake said.

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