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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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Haiti police riot after crime gangs kill 14 officers

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Protesters attempted to break into the Haitian prime minister's residence (picture BBC)

BBC reported that Rebel police officers rioted in Haiti’s capital Port-au-Prince on Thursday following the killing of more than a dozen colleagues by criminal gangs.

The rioting officers blame the government for not taking action.

More than 100 demonstrators blocked streets, burned tyres, broke security cameras and damaged vehicles.

Local media said several officers broke through the gates of the prime minister’s residence and attempted to enter Haiti’s international airport.

Fourteen officers are thought to have died since the start of the year in various gang attacks on police stations.

Seven officers were killed in shootout on Wednesday alone, according to Haiti’s National Police.

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Gold-covered mummy among latest discoveries in Egyptian tomb

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One of four newly discovered tombs at the Saqqara archaeological site south of Cairo (picture BBC)

BBC reported that archaeologists say they have found a gold leaf-covered mummy sealed inside a sarcophagus that had not been opened for 4,300 years.

The mummy, the remains of a man named Hekashepes, is thought to be one of the oldest and most complete non-royal corpses ever found in Egypt.

It was discovered down a 15m (50ft) shaft at a burial site south of Cairo, Saqqara, where three other tombs were found.

One tomb belonged to a “secret keeper”.

The largest of the mummies that were unearthed at the ancient necropolis is said to belong to a man called Khnumdjedef – a priest, inspector and supervisor of nobles.

Another belonged to a man called Meri, who was a senior palace official given the title of “secret keeper”, which allowed him to perform special religious rituals.

A judge and writer named Fetek is thought to have been laid to rest in the other tomb, where a collection of what are thought to be the largest statues ever found in the area had been discovered.

Several other items, including pottery, have also been found among the tombs.

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Health crisis: GMOA calls for WHO intervention

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Alleging the government has failed to address the developing crisis caused by grave shortage of pharmaceutical drugs, the Government Medical Officers’ Association (GMOA) has called for WHO’s intervention.In a letter dated January 26, 2023, addressed to WHO Director General Dr. Tedros Adhanom Ghebreyesus, GMOA Secretary Dr. Haritha Aluthge has raised concerns about shortage of pharmaceutical drugs, escalating prices of medicines and allegations of malpractices and corruption in procurement procedures.

The GMOA has released its letter to the media along with what it called a 10 fold plan formulated by an expert committee set up by the GMOA.

The following are the GMOA’s proposals:

1. To appoint a high-level coordinating committee within the Ministry of Health to ensure effective communications and coordination between following institutions, identified as responsible for the whole exercise. (a) Ministry of Health focal points (b) Medical Supplies Division (MSD) (c) State Pharmaceuticals Corporation (SPC) d. State Pharmaceutical Manufacturing Corporation (SPMC) e. National Medicines Regulatory Authority (NMRA) Monthly progress review meetings of aforementioned committees are to be ensured, with Chairmanship of Secretary, Ministry of Health or his representative. Quarterly review with Minister of Health to facilitate arriving at essential policy decisions.

2. To ensure Transparent Procurement Procedures, where every interested citizen should be entitled to know the true facts.

3. To upgrade the available computer software programme to match the current needs and to ensure more efficiency in procurement procedures.

4. To appoint a technical committee to study Auditor General Reports with regard to procurement Procedures of last 5 years and actions to be declared with specific time frame to implement recommendations of the Auditor General.

5. Review the recent Presidential Investigation Commission reports and initiate urgent actions to file legal action against the respondents. Remove all those officials who are accused through these reports of malpractices, from their current posts, until the verdicts are delivered.

6. To minimise emergency purchases of Medicinal drugs and ensure the transparency of that process through progress reports on emergency purchases, which is to be published on a monthly basis.

7. To identify alternative modes for distribution of pharmaceutical drugs to peripheral stations (e.g.: Public Transport services with identified modifications)

8. To open an “Information Desk” at the Ministry of Health to effectively communicate with and guide the donors of pharmaceutical items.

9. To fill the existing vacancies at National Medicines Regulatory Authority (NMRA), following stipulated acceptable pathways and activating all the sub committees within NMRA.

10. To declare a relief package to reduce the prices of essential medicinal drugs, through the upcoming interim budget.

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