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Zonal classification & daily reviews vital when easing lockdown
This strategic framework for action for the four weeks commencing from April 20 has been put forward by senior malariologist Prof. Kamini Mendis. We produce some extracts of the framework.
The next four weeks of Sri Lanka’s strategy should be to ease restrictions gradually while safeguarding the achievements thus far; a less cautious approach than given here is likely to lead to a resurgence of the epidemic with catastrophic consequences.
The aims are to sustain the districts which are free of COVID-19 at zero transmission and in all other districts, where transmission is ongoing, control the spread.
The zonal classification of districts should be reviewed daily and revised on the basis of the previous day’s reported COVID-19 incidence; a district may move up or down the scale at any point in time.
The framework for action
Country Level:
maintain closure of ports of entry for incoming passenger ships and flights, except for cargo and persons arriving under exceptional circumstances to be quarantined for 14 days, followed by a further self-quarantine for a week and cleared for COVID-19 by
PCR testing at the end of the quarantine period.
District Level
In all districts:
n Prohibit inter-district travel except for those engaged in essential services;
n Sustain and strictly implement social distancing policy and standard preventive practices (wearing masks, hand washing) at all times;
n Maintain strict surveillance to prevent community gatherings of any sort.
n Centres of entertainment such as liquor bars, pubs, cinemas and theatres to remain closed.
n Maintain services to equitably distribute food and provide access to fuel and banking services and to IT based education, to the extent possible.
n Ensure the functionality of
food produces.
n Maintain supply chain for basic consumer goods and medical services.
n Educational institutions
to remain closed.
Stratify the districts into four zones on the basis of COVID-19 incidence:
n Zone 0 Districts – No COVID-19 cases ever reported since the beginning of the epidemic despite a reasonable degree of testing. Remove curfew to restore normalcy of activity with the exception of restrictions under ‘all districts’. Allow travel within the province if all the districts are in Zone 0 and encourage only people from Zones 0 within the province to get back to work. Public and private sector transport to be allowed under strict guidance e.g. 50%
n Zone 1 Districts – Zero incidence of COVID-19 in at least the past 3 weeks. Remove curfew and replace with stay-at-home policy, stringently implemented and monitored. Issue every household with one pass, which has to be carried by any person leaving the home. This will ensure that only one person per household will be out of the house at any point in time, those going to work being the exception, but conditional on possessing work-related identities.
n Zone 2 Districts – Zero incidence of COVID-19 during the past 2 weeks. Maintain curfew, but lift it for 6 hours every day (except Sundays), while sustaining all current measures in place when curfew is lifted. Stay-at-home policy to be rigorously implemented. All shops, pharmacies, and fuel stations to be kept open when curfew is lifted. Provide ready access to people to test for COVID-19 by PCR and continue rigorous contact tracing and quarantine measures as at present.
Prohibit travel into or out of the district except for those engaged in essential services.
n Zone 3 Districts – Ongoing transmission – cases reported during the past week. Maintain curfew as at present as long as the district remains in this zone. Testing by PCR to be significantly expanded to beyond those with symptoms to include all quarantined persons before they leave quarantine, samples from the larger community of infected persons, random samples from other communities.
The districts in the Western Province and the districts of Kandy and Jaffna
As these districts are in Zone 3, they should be under continued curfew for at least two weeks without new cases being detected when these can be re-categorized under Zone 2.
However, because these districts are industrial and commercial hubs, there is scope for further relaxation of restrictions without risking increased transmission of COVID-19. This may be possible because transmission even in these districts is still fairly confined to demarcated spatial areas (foci) and there is no evidence of significant community transmission.
An Exit Strategy Assessment and Monitoring Committee should be set up by the Presidential Task Force to ensure compliance and for regular review in these three districts.
As districts graduate towards Zone 0 over time, restrictions to be relaxed as specified above. The strategy should be reviewed after two weeks to evaluate and modify as necessary.