The following article is based on a TV interview of Health Services Director General Dr. Asela Gunawardena and consultant physician Dr. Ananda Wijewickrema at the National Institute of Infectious Diseases (formerly IDH), Angoda.
Sri Lanka is currently at a crucial phase. We have been confirmed the current outbreak and the spike in the Covid-19 daily infection curve is due to the UK variant .
We are at a high risk phase. And everyone needs to understand the seriousness of the situation.
Sri Lanka recorded the first Covid-19 patient in January 2020, it was a Chinese tourist. Later in March 2020, we found the first Sri Lankan patient.
By June the same year we managed to contain the first wave of the pandemic.
From July till October 2020, no new cases were reported. Then came the second wave with new clusters reported from the Brandix factory in Minuwangoda and the Peliyagoda fish market. That was also contained with strict regulations imposed by the Health Ministry.
Dedication
Following the Christmas and January celebrations, again the daily count shot up to 1000.
However, due to the dedication of the frontline workers and the government, before Sinhala and Tamil New year 2021, the daily count of new Covid- 19 patients had dropped to 150.
Again, today we see a dangerous trend with over 1,500 patients being reported daily. It has been confirmed that the new strain is the highly transmissible UK variant B.1.1.7
From late March we warned people to stay home and celebrate Avurudu with their family members only. This is contagious, when people gather the virus spreads. We lived with this for over a year now and people are aware of the risks.
Most heeded our advice but the few who did not take it seriously, contributed to this current situation.
The second wave did not completely die down, so we can assume that this is an extension of the second wave, not a third wave, but there is a new variant which is the disturbing fact. We must realise the situation in the country is dire. The public must strictly pay attention to health advice and cooperate, if not we will end up like India. All sectors, including the hospitals as well as the country’s economy will suffer as a result.
Realise
I don’t think the country is in a more serious situation than India, but we must realise that this new variant is more dangerous than the previous one. This infects more young people, more people show symptoms and develop complications. Hence number of deaths could rise too. We need to be prepared.
We knew the virus was mutating and Sri Lanka can get new and dangerous variants. It happened elsewhere including in the UK. We reiterated that the numbers of positive cases were declining but the virus is very much out there therefore people must cooperate and stick to health guidelines.
We got an official confirmation about the new UK variant in Sri Lanka last week. There is an accusation that people were not informed of a new variant in circulation. But I think this new variant is not the main reason for the current outbreak, and why we are reporting more positive cases.
The people disregarded the advice to maintain social distancing. Blatantly neglected health guidelines and celebrated Avurudu, went shopping and the flood gates were opened.
Immediately before the Avurudu, there was a major outbreak in Jaffna. We did tests and learnt that it was not a new variant, it was the less harmful variant spreading in the country. Tests confirmed that it was not related to the Indian variant also.
Variant
Then on April 8 we got to know that the Sri Jayewardenapura University was testing on a suspected new variant but the official confirmation that it was the UK’s B.1.1.7 variant came after the Sinhala and Tamil New year.
The virus that was circulating in Sri Lanka was relatively harmless. More than 90 percent of the patients were asymptomatic and a very few developed complications leading to death. So people lost fear, stopped being cautious and concluded that contracting Covid-19 was not that serious. Some started behaving recklessly which is the closest reason for the current spike in the numbers.
We reduced the numbers with a lot of effort and we wanted to pass on the benefit to people and said to celebrate New Year in April but within the parameters. We reminded to adhere to social distancing and maintain hand hygiene while face mask law was a must.
I do not agree that the number of PCRs were reduced to artificially show low daily detections before New Year celebrations. There is a procedure on how you conduct PCR tests. One category eligible for PCRs is the first contacts of the patients, then we do random tests on ordinary patients visiting hospital OPDs.
Procedure
Then every single patient who comes for surgeries will be subject to PCR or Raid Antigen Tests. In addition, we will carry out random tests in public places such as economic centres, fish markets. That is the usual procedure.
The Ministry reduced the number of random tests and increased targeted testing during the past few days with the rapid rise in numbers reported. The daily average of tests is about 18,000 now, out of this about 14,000 are conducted by the government and the rest is by private institutions.
We must emphasise that self-discipline is a must to contain any pandemic. A person who had done a PCR test must stay indoors until the results come. His family members must also self quarantine. If we strictly follow self discipline rules until end of May, we can successfully contain this latest outbreak of Covid -19 pandemic.
We are not sure about the virus being airborne, further tests need to be done to prove it. But a test carried out in a restaurant showed that the virus had been present in a place away from where the infected person was seated.
So initially there was a conclusion that it might be airborne since droplets of saliva will travel only about one metre. Therefore, when in an enclosed place like an air conditioned room, we advise people not to remove the face masks at all.
The UK strain is highly contagious, stays in the air for a longer period, the virus can infect more people than the other strains found in the country before.
During the first wave of the pandemic, the country was locked down entirely. During the second wave, travel restrictions were imposed in areas where patients were reported.
That will be our strategy during this outbreak also. We have not decided to go for a complete lockdown. But in the coming days we might have to restrict travel between provinces and districts. The objective is to continue to function economically viable places and rely on ‘test, trace and isolate’ strategy to prevent transmission.
Exclusively
The country has 685 ICU beds and an additional 37 beds at Kothalawala Defence Hospital will be acquired to treat the Covid-19 infected. We have opened ICU units at the IDH, Mulleriyawa Base Hospital, Anuradhapura Methisiri Sevana and hospitals at Welikanda, Theldeniya, Iranawila and Kilinochchi exclusively for Covid-19 patients. So there will be 110 plus 37 ICU beds for Covid-19 patients. Currently 57 critically ill Covid-19 patients are in ICUs.
It is a proven fact that patients don’t die without symptoms, there will be Covid -19 symptoms for a few days before death.
Sri Lanka received 1,264,000 vaccines from India. We vaccinated over 900,000 people including the frontline workers at the initial rollout. We have about 300,000 vaccines left, and the administration of the second dose began recently.
At least 600,000 doses of vaccine is needed to complete the second dose for those who have already received the first dose. There is a tragic situation in India, thus the Serum Institute has not indicated a possible date the required vaccine doses would arrive here.
The World Health Organisation’s COVAX program, where they provide free vaccines to developing countries, has also been badly affected as a result. There are other countries who have excess stocks of Astrazeneca since they are rolling out other vaccine brands under their domestic vaccination drives.
The State Pharmaceutical Corporation is in dialogue with these countries to acquire part of these excess stocks.
Those who received the first dose will be saved from Covid -19 complications. Only one person who had the first dose died due to complications so far. He was a chain smoker with lung issues.
The first dose will give you immunity, some countries have decided to continue with only the first dose since it gives complete immunity for about four months. The booster shot will only extend the immunity period.
England and some other countries are testing if Sputnik V and Pfizer can be given as the second dose. When we give the first dose complete immunity is received, but after the booster shot, the period of immunity will be extended.
This fact was confirmed by Prof. Neelika Malavige and her team at the Sri Jayewardenapura university. Full immunity will be there for four months after the first dose.
But unfortunately vaccination of 1.2 million of the population will not prevent the transmission of deadly Covid-19. The WHO says the people who got vaccinated will not develop Covid -19 complications 100 percent and also the death rate is reduced to almost zero. There is an opinion that the Astrazeneca is ineffective against the South African strain of the virus but this is not clinically proven. However, it provides immunity against the UK strain which is spreading in Sri Lanka now.