“I wish to reiterate that people must at all times ensure that they follow health guidelines, wear a mask properly, sanitize, restrict their movement, maintain a social distance,” Director General of Health Services, Dr Asela Gunawardena said in an interview with Lanka Courier. Following are the excerpts;
Q. Give us an overview of this challenge that you are facing? We have been through so many challenges before but this is unlike any other.
A. This is a challenge not only for our country but the whole world. No one knows what is going to happen next, that is the nature of this pandemic.
The virus first came to Sri Lanka around the end of March which led to the first wave from April 2020. It went on up to July and there was a two month lull before the second wave started in October.
During the first wave, most of us did not know how the virus was behaving or the disease pattern. We knew it was contagious but not how fast it could spread. We depended on international figures and tried to apply it here. What we have seen is that the scenario differs from country to country. It was later identified that there were several mutations of the virus and we began to study the pattern of the disease.
The first strategy was to lockdown, which is to prevent the movement of people. This led to the closure of all services except hospitals. The case load went down to a zero naturally. We had a two month gap of zero new cases. The Brandix cluster from Minuwangoda began in a small way but went up to huge numbers. The Fish market was affected in the process. Previously we locked down the whole country but during the second wave we locked down only certain places as there were serious economic repercussions arising from a total lockdown.
The government was tasked with ensuring the smooth running of the country while battling a pandemic of which we knew very little about. It is a predicament for every country and we pursued a zero COVID strategy where we singled out specific places and locked it down.
We also changed the treatment methodology. During the first wave, we took the first contacts to the quarantine centres but we did not do so for the second wave and allowed the first contact to seek self-isolation at home. As we are removing the COVID positive patient from the situation we are lessening the extent it would spread. We also kept in mind that keeping the patient at home meant risking the elderly population.
Sri Lanka is the only country in the world where we take them to the quarantine centre, treat them and send them home. Even those coming from abroad we quarantined them for 14 days before sending them home. All of this is run on state expense.
The sad part is that people don’t realize how much is spent on these operations. We are doing nearly 15000 PCR tests per day. In the private sector you are charged Rs.6000 to Rs.8000. If you multiply it by the 15000 you get a substantial amount which we are spending on our own.
Similarly we are maintaining care centres and even treating asymptomatic patients for 14 days. In between these two there are several administrative, logistic, transport costs involved which are not visible or known. But people are picking up only shortcomings so they have to be mindful of this matter. So much of an effort is being put to contain the pandemic. It is because of this management that we have been ranked 10th globally.
People also have a moral responsibility to practice health guidelines. To wear a face mask properly, maintain a 1 meter distance, sanitizing your hands with sanitizers or soap and to minimize travel. If you must travel to a funeral or wedding, make sure you don’t linger for long and when returning home to immediately wash the clothes you wore and have a wash before you come into contact with anyone else.
Majority of people we see are adhering to this but it is those who are not adhering who are contributing to the spread. At a wedding hall, if there is one positive patient, it risks the entire 150 at the hall. They may be wearing the mask throughout the day but at the wedding you may take it off and we are cautioning people against it as much as possible.
People should give the government the fullest support. The police, tri-forces, health sector alone cannot do this. We need the support of the general public. All countries that have done this well have had the support of the general public. We have begun vaccinations as well while so many other countries are yet to even start.
Q. As the technical head, what are the strengths and shortcomings as well?
A. As the Department of Health, we have nearly 160 000 health sector workers. It is inclusive of the curative and preventive health staff. At present, we have a competent staff which is why it is being reflected in the number of deaths.
This is despite the fact that we have 70 000 cases, we have only 400 odd deaths where the mortality rate is less than .4 percent. That itself demonstrates the competency of the health staff. Even the preventative staff, they initiate contact tracing and ensure quarantine is done swiftly. On the other side, we have introduced a novel concept called intermediate care centres, which is where most of the positive cases who do not show any symptoms are kept. There are identified in hospitals such as IDH, Mulleriyawa, Teldeniya, Welikanda, Iranawila, Kilinochchi, Methsiri sevana in Anuradhapura which also serve as intermediate centres.
The IC are also manned by doctors and nurses and we speak to them over the phone. Patients are well looked after the consultant and other staff. This is the manner in which the health sector is working. We can work with this staff strength. Logistically we have the necessary vehicles for patient management.
Q. If the number of cases go up, are we able to handle it?
A. There is a limit for everything. At the moment we have buffer beds, but if the case load goes up by 1000-2000 per day, then we have a problem. We will have to change the strategy and improvise. As of now we have no issue as we are managing fine. If we can control the case we can maintain the bed numbers.
Q. What do you make of our research capacity?
A. There are researches going on but in Sri Lanka we have very limited research capacity where much of it is done in the university. As the virus is too young it is not right to seek a conclusion right now. Yesterday’s facts are being disputed today. We adhere to the WHO strategy in all these grey areas.
Q. Tell me about this vaccination process, why we need to wait after the first dose, how long it will take to vaccinate the population?
A. Any vaccine we produce is meant to prevent getting the disease. We have a good national vaccination programme in the country targeting infants and children. We give them the vaccine to prevent them from getting these viruses. Globally there are many vaccines being produced, some are given the emergency user licenses are given by WHO including AstraZeneca, Pfizer, Moderna. The viru which is given in Sri Lanka is produced by COVISHIELD in India but it is AstraZeneca. We give this vaccine to prevent deaths happening in old age and vulnerable populations as there are contributory conditions such as lung disease, kidney disease and so on.
The other reason is to reduce the transmissibility. Even if you get the virus your capacity to give it to another person is greatly reduced. Which is why we still ask those who are vaccinated to continue following the health guidelines.
With this, in Sri Lanka what we have seen is that the disease affects the 30-60 year ago group, which is the productive age bracket. If we immunize them, they will lend more productive days to the economy. Because if they fall ill, they will be kept for 14-21 days at treatment centres. You and the economy lose out on so many days.
So when the first donation came from India, we made sure to give the frontline health workers, airports, ports, tri-forces etc. According to the plan we are rolling out the vaccination programme starting with 60 and above, where priority will be given to those with contributing disease and then the 30 – 60 age group. It all depends on the orders. We have placed more orders with Covishield, but they too are inundated with many requests. We are expecting 1.5 million vaccines which however won’t come in single stock but in batches. WHO has pledged to give 20 percent of our population, and the first COVAX will arrive by the end of February. We have COVID task force headed by the President who reiterated that it will be given on government expense and sector.
I wish to reiterate that people must at all times ensure that they follow health guidelines, wear a mask properly, sanitize, restrict their movement, maintain a social distance. Even if they have to go to a supermarket, one member from one family must go. There will be holidays coming up and if they must travel to ensure that they only mingle with their relations and not outsiders. We cannot however risk reopening schools as yet