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Too early to predict whether community spread is on – GMOA
View(s):It is too early to predict whether community spread of COVID-19 has begun because for such transmission to be established, unrelated clusters need to be reported, said Dr. Haritha Aluthge of the Government Medical Officers’ Association (GMOA).
This vocal representative of the GMOA said that according to the World Health Organization (WHO) there are four levels in a pandemic – ‘no cases’, ‘sporadic cases’, ‘clusters’ and ‘community transmission’.
“In Sri Lanka, most of the cases we have encountered, we were able to find the exposure point. As such, we don’t see open or free community transmission. But if the current trend goes on as in the Kandakadu incident, where we have several persons who were exposed and tested positive in several parts of the country, there could be some risk. It has not started yet and contact tracing of all visitors has been done effectively. The problem though is that some instructors and soldiers had used public transport. They don’t have the history of the vehicles, such as numbers, they travelled in and this is worrying,” he said in a wide-ranging interview with the Sunday Times.
The risk of community transmission cannot be excluded yet as it would depend on the incubation period of the virus, cautioned Dr. Aluthge, explaining that the tracing of the first ring of the first contacts has been done. If they are positive, transmission could happen in the contacts of the first ring. Going by what the WHO states that if 90% of contacts can be traced, the possibility of Sri Lanka’s success is heavier than failure. However, a prediction cannot be made when this cluster would end.
Conceding that “we still can’t say 100%” how the Kandakadu cluster started, he emphasized that “we should learn from the past”. The navy cluster was not studied. At least the Kandakadu cluster should be investigated thoroughly on how the infection started. RT-PCR tests have been done on those at the Kandakadu and Senapura centres, now antibody testing should be initiated to see how many have had exposure to the virus.
“We have recommended that in centres such as Kandakadu, people should be compartmentalised into smaller groups to prevent what happened in the navy camp,” he said.
Referring to some instances where there had been issues with RT-PCR testing, he said that the GMOA has requested the Director-General of Health Services to accredit and standardize all laboratories which are doing these tests. At that time, the DG had indicated that there are some practical barriers in achieving this but promised to arrange an accreditation process with support from Prof. Malik Peiris based in Hong Kong and the WHO. Unfortunately that has not happened.
The GMOA is also of the view that there should be aggressive testing as an attack mode to identify patients, while performing repeat testing to get any case which may have been missed.
“What we have suggested is that once you open up the country, you have to assess the risk in each and every part of the country whether province, district or region through random surveillance. Unfortunately, the Health Ministry is only carrying out community surveillance in high-risk groups. For the country to be declared safe, you need to test as many as possible,” he said.
The present capacity is 2,500 tests daily. The ministry is not utilising the maximum capacity on some days but does only about 500 tests. If the ministry has a problem with resources or manpower, they should tell the government these problems for a solution to be found, said Dr. Aluthge.
With regard to preventing a second wave of COVID-19 engulfing the country, the GMOA was proposing the ‘hammer-and-dance’ strategy. Under ‘hammer’ comes cutting virus growth; understanding true cases; recruiting personnel; improving treatment; releasing healthcare system pressure; learning; and building healthcare capacity. Under ‘dance’ comes keeping infected numbers under a certain amount; conducting proper testing, contact-tracing, quarantining and isolating; educating the public on hygiene and social distancing; banning large gatherings; removing most restrictions; tightening up when needed; and applying cost-benefit social distancing measures. Currently Sri Lanka is experiencing the dance phase of the first wave. Then if a cluster is identified, small lockdowns should be implemented such as in Grama Niladhari areas.
| Some issues sorted out | |
| Many contentions of the GMOA have been sorted out. The GMOA’s protest over the Technical Committee not meeting in a month has been rectified. The committee headed by the Director-General of Health Services to deal with this public health emergency which used to meet daily had not done so since the country opened up. However, on the urging of the GMOA, a meeting was held on July 11, said Dr. Haritha Aluthge, underscoring that “now is the time you need such a committee because once you open the country, the risk is more”. When asked why the extensive guidelines set out by the Health Ministry to prevent COVID-19 from spreading have not been gazetted, he disclosed that it would happen this weekend, after discussions with President Gotabaya Rajapaksa on Tuesday attended by all stakeholders. “There are guidelines for different settings and situations drawn up with input from many including the GMOA. The problem is that they are not considered law. When we requested that they be gazetted immediately, the President agreed and ordered that it should be done. There had been issues such as translation errors but now they have been dealt with,” he said. Meanwhile, at a meeting the same afternoon at the Health Ministry, a concern that had been brought up was whether these powers could be misused. However, this would not happen if the proper chain of command and supervision is followed, Dr. Aluthge added.
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