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To beat the pandemic – need to do it all, says WHO Rep
The WHO Representative to Sri Lanka, Dr. Alaka Singh, who took up this post in May, said that compliance with public health and social measures is the individual responsibility of each one of us.
“We must continue to protect ourselves, our families and our communities with or without quarantine curfew,” she told the Sunday Times in an email interview, adding: “This is the new normal.”
Mobile vaccination in progress in Wellawatte this week. Pic by Indika Handuwala
Pointing out that “we must take care of those who care for us”, she also focused on health workers who have been battling the pandemic.
She says: “It’s been almost two years since this pandemic that has left no one untouched. 2021 is the International Year of Health and Care Workers. WHO Sri Lanka salutes the incredible health workforce who have worked tirelessly during this very challenging time. COVID-19 has underlined the importance of health worker security for health policy and strategy, including mental well-being.”
Here is the wide-ranging interview the Sunday Times (ST) had with Dr. Singh:
n ST: How do you think Sri Lanka should move forward in the short and long term?
Dr. Singh: Fortunately, there has been a reduction in both cases and deaths in the last two-three weeks. Given the correlation between these COVID-19 indicators and quarantine curfew, we may expect to see further reductions with the extension of restrictions until October 1.
Sri Lanka’s vaccination drive continues to be critical to the pandemic response. We have reached the milestone of over 10 million fully protected – vaccinating 50% of the population with two doses is a huge achievement.
Going forward, we must continue to prioritize those with comorbidities for vaccination. However, vaccines alone are not enough. To quote the WHO Director General, Dr. Tedros Adhanom Ghebreyesus, we must do it all: get vaccinated, wear masks, disinfect and observe social distancing.
What is critical both for the short and long term is behaviour change to keep safe. Compliance with public health and social measures is the individual responsibility of each one of us and, with or without quarantine curfew, we must continue to protect ourselves, our families and our communities. This is the new normal.
The WHO’s situation report for Sri Lanka clearly shows the impact of vaccination and public health and social measures (PHSM) on cases and deaths (available on the WHO Sri Lanka website).
n ST: Is the number of COVID-19 cases reducing because the number of tests being done has reduced?
Dr. Singh: The testing strategy in Sri Lanka was revised on June 9, 2021 to include the use of Rapid Antigen Tests (RATs) more widely in different settings. As a result, more RATs are being conducted in the field setting and also in the outpatient department, emergency care and routine admissions instead of RT-PCR. If we consider both PCR and RAT, testing has not declined.
Data from hospitals indicate a decline in positivity rates which confirms the declining trend. And, the decline in the admission rates in both the government and private sector hospitals also reinforces that the numbers are declining.
However, the infection rate is still high, compared to the first two waves and this needs to be controlled by vaccination and PHSM.
nST: Is there full-blown community transmission of COVID-19 in Sri Lanka, as it would be impossible to trace the origins of the infection now?
Dr. Singh: Transmission levels change during the pandemic and the WHO has provided guidance on the control measures to be used at different levels of transmission. Sri Lanka has a well-established disease surveillance system through the primary healthcare network. This system is being enforced as numbers become more manageable to implement comprehensive testing, contact tracing and quarantining those exposed.
· Balancing lives & livelihoods
n ST: How should countries like Sri Lanka balance between critical health issues and equally critical economic issues? What is the choice between lives and livelihoods?
Dr. Singh: We must not consider this as a choice or trade-off. It is far more complex than ‘either or’. Moreover, we are in an unprecedented and prolonged global downturn. Economies dependent on external markets and tourism have been most impacted and cannot resolve the crisis alone. The lessons from the pandemic have indeed been harsh for both health and growth.
COVID-19 has left us in no doubt about the correlation between health and growth. The quicker the population is protected through vaccination and sustained PHSM, the quicker the economy can start recovering.
COVID-19 has shown that, in all development contexts, stringency measures may be used to enforce PHSM and restrict mobility. This gives the health system the necessary time to cope with increasing cases while transmission is reduced, especially when resources are stretched – both human and supplies.
Notably, Sri Lanka has successfully eased the pressure on hospitals during the current wave through the new home care management programme. The WHO is supporting this as a key surge response that brings together an augmented workforce via supervised pre-interns and information technology for effective service delivery.
Going forward, we need to consider best practices on maintaining health as well as food and income security so in the future we are better prepared to balance lives and livelihoods.
The Regional Director for South-East Asia, Dr. Poonam Khetrapal Singh has supported a Regional Knowledge Hub to be established in Sri Lanka to share experiences, support capacity development and build evidence for policy to strengthen resilient health systems in the new normal. Dr Singh’s Regional Flagships have brought focus to key programmatic and systems areas to advance universal health coverage and lay the ground for the Regional Knowledge Hub to support countries in the WHO SEA (South-East Asia) Region.
n ST: What of virus mutations – are we and also the world to expect more and more virulent variants?
Dr. Singh: This is a difficult question as we simply do not know enough at this point. What we can say with certainty is that this is not the last pandemic we are witnessing. WHO has been tracking mutations and variants since the start of the COVID-19 outbreak. Our global SARS-CoV-2 laboratory network includes a dedicated Virus Evolution Working Group, which aims to detect new changes quickly and assess their possible impact. As you are aware, the Delta variant is now predominant globally and sub-lineages never seen before are being detected regularly.
According to the latest sequencing report in Sri Lanka, 98% (82 of 84 samples) were the Delta variant. The good news is that, thus far, WHO approved vaccines appear to protect against all variants. Also, worth noting here is that these were the fastest vaccines ever developed. If we combine vaccinations with PHSM we can control transmission as well as mutations to a significant extent.
· Sense of oneness
n ST: In such a scenario, with all indications pointing to the reality that we will have to “live with the virus”, how can we arm ourselves to do so? Would we have to move away from the global village concept to closed borders and entry-points?
Dr. Singh: Our interdependence would make retreating from the ‘global village’ an improbability and an impossibility. While this may have created problems, it has also helped us find solutions together.
There is already evidence-based easing of travel as we can see in the decision from the United Kingdom this week (applicable for England). Sri Lanka, having now reversed the trend in COVID-19 related indicators and protected 50% of the population with full vaccination, is no longer a ‘red’ country for travel.
Again, rather than closing borders, WHO emphasizes that the key is change needed in health-related behaviour – combining enforcement of appropriate rules and regulations with individual responsibility and compliance to keep safe.
While there has been much debate about closing borders, we must acknowledge critical support has been extended across borders – Sri Lanka has received important assistance on vaccines and urgent medical supplies both via COVAX and bilaterally; and flexible funding via
WHO that has allowed us to be responsive to local needs [procurement of oxygen, PPE (personal protective equipment), support to home care management (HCM) etc.].
In fact, the pandemic has impacted global health and governance in a fundamental way and we need to consolidate and sustain the positive aspects. Perhaps, as the Dalai Lama has said, what we really need is a sense of oneness among 7 billion human beings. This could be one of the positive outcomes of the coronavirus crisis.
(Next: Dr. Alaka Singh on
vaccination)