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SL needs strict mobility restrictions – allow only major economic activity and essential services
The urgent need to bring about strict mobility restrictions while maintaining major economic activities and essential services, has been strongly stressed by an expert group convened by the Sri Lanka Office of the World Health Organization (WHO).
The Independent Expert Group Meeting which had discussed ‘Optimizing the health sector response to the current COVID-19 surge in Sri Lanka’ extensively on May 8, has given some key messages to policy-makers this week.
The two “urgent” actions, the experts representing diverse specialities, have recommended to save lives are – stop new infections as effectively as possible and prepare for the predictable increase in severe cases and deaths.
They have specifically stated:
Globally, evidence shows that strict and immediate measures to restrict mobility are the only measures that quickly and drastically reduce cases. Sri Lanka will also benefit from strict mobility restrictions whilst maintaining major economic activities and essential services.
There is a need to stop inter-district travel and introduce severe restrictions on non-essential human mobilities and the congregation of people. High transmission areas must be shut down for 2-3 weeks to stop or limit transmission. There should be a national mobilization effort to accelerate vaccination.
Reconsider the management of asymptomatic cases and revise clinical management protocol to include home management. Increase focus on intermediate care centres to detect cases early, properly monitor patients and appropriately manage cases, thereby minimizing the need for more intensive care. Prepare for an increase in hospitalization and the need for adequate HDU and ICU care.
Pointing out that “the greatest danger in times of turbulence is not the turbulence, it is to act with yesterday’s logic”, the experts have laid down the following crucial factors they considered:
The COVID-19 situation in Sri Lanka is very likely to get worse over the next few weeks. The decisions we take NOW will affect the lives of millions of Sri Lankans. Therefore, the next 3-4 weeks are critical in controlling transmission and saving lives.
The epidemiological trend of the past weeks shows a rapid exponential increase in the number of cases. This trend is likely to continue for some time if no effective interventions are made.
There is a lag of 1-2 weeks between infection and case detection and a further lag of an additional 2-3 weeks between an increase of reported cases and an increase in reported ICU admissions and deaths. Thus, the deaths and ICU admissions we are seeing now are the consequence of infections that took place at the early stage of this third wave (3-4 weeks ago).
The public sector health system is stretched to the limit, making it difficult to manage COVID-19 cases as well as other essential services. More health professionals and preventive staff (e.g. PHIs) are getting infected and HR policies need to be geared to meet the urgency. There is a “tipping point” beyond which the system can rapidly go out of control.
The more transmissible and severe variants detected in India and other variants have already been detected in the country, these can spread faster and may even circumvent vaccine-induced immunity.
Vaccines will be crucial to controlling the epidemic in the medium-term but will not address the immediate crisis we now face. Some vaccines are only effective after the second dose. Therefore, it will take a minimum of 6-8 weeks to see the effects of vaccination in the number of new cases.
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| SLMA seeks strict movement control Having explained the ground reality to President Gotabaya Rajapaksa, a high-level group of medical specialists on Monday requested very stringent implementation of the Extraordinary Government Gazette notification on controlling COVID-19, with selected “lockdown processes” of certain areas such as districts and even provinces. These lockdown processes should be based only on scientific evidence of the density of caseloads, together with restriction of inter-district and inter-provincial movement of people, the specialists from the Sri Lanka Medical Association (SLMA) and the SLMA Intercollegiate Committee have said. “COVID deaths may reach unprecedented levels and a grave national catastrophe is a real potential threat in the near future, unless something that offers rapid results is implemented. Achieving rapid control would save many lives, ease the burden on hospitals, lay the background for vaccination and be economically beneficial in the longer-term,” they have said. The specialists had also stressed that the facilities for non-COVID medical problems are also being curtailed through necessity and their management is getting neglected, leading to an unavoidable increase in the deaths of those patients. The specialists were SLMA’s President Dr. Padma Gunaratne, Past President Prof. Jennifer Perera and Vice President Dr. Manilka Sumanatilleke; College of Internal Medicine President Dr. Harsha Sathischandra; College of Anaesthesiologists President Prof. Thamasi Makuloluwa; and Kalutara National Institute of Health Sciences, Consultant Community Physician (Planning), Dr Ruwan Ferdinando. | |