Community action can end the Covid-19 pandemic

With the global spread of the Covid-19 pandemic, especially in the developed countries like the USA, the international economic and political crisis has deepened. The economically less developed countries like Sri Lanka are also badly affected. However countries like China, Vietnam and Australia have acted firmly and effectively to control the pandemic through community action and brought it under control with minimal damage to their economies.

The USA, UK and other European countries that have not done this have seen an alarming increase in Covid-19 (e.g. one million new Covid-19 cases in the USA within the 10 days up to November 11). Sri Lanka did well by effectively identifying and isolating clusters, but now the epidemic is gaining ground. A recent random PCR study in Colombo by the CMOH detected 30% as being positive. This suggests that there is considerable spread in the community, outside the known clusters.

In Sri Lanka, the number of cases reported daily has increased and is now in their hundreds, even exceeding 400 at times, and the total number of deaths has risen to more than 40. This is because the earlier orderly spread of the virus on the basis of clusters, has now been replaced by uncontrolled community spread.

The earlier control measures based on defining each cluster by good contact tracing gave favourable results and should continue, but there is the need to do more random PCR testing. From a control angle, there should be more active community participation as well. Health education of school children and of the people down to village and urban slum levels needs to be intensified. With a large number (over 80%) of infections being without symptoms (asymptomatic) and the tendency for the new Covid strains to spread rapidly, informed cooperation of the entire community is essential.

The development of a vaccine by Pfizer in the USA, with a German partner firm, has raised hopes that this could be the answer. WHO has promised to supply sufficient vaccine to protect 20% of our population, and the Health Minister is reported, by the media, to have set up a committee to decide on a priority list of the potential recipients. But unfortunately, this is unlikely to materialize in the near future. The vaccine is of a new type (RNA). More research needs to be done on optimal dosage, duration of immunity, the frequency of administration etc. Further, the vaccine is costly (Rs. 1,500 to Rs. 4,500 per dose), and at least two doses have to be given to get protection, but it appears that this may only last one or two years, so that yearly vaccination is necessary.

The rich countries have already placed orders for their needs. It will be a long time before we get our requirement. A further problem is that the vaccine is unstable and has to be stored at a very low temperature (minus 80C), which requires expensive special ultra-cool refrigerators. To break the chain of transmission in a population, at least 80% of the population must be vaccinated, which means that we have to purchase the remaining 60%. I am afraid that at present achieving control by the vaccine appears to be a distant dream.

The better option is to ensure that the people understand and practice the three simple health rules – the wearing of a mask, observing the distance rule of at least one meter between two persons, and frequent washing of the hands with soap and water, specially after touching any object that another person may have touched. This has worked in countries like China, Taiwan, Vietnam and Korea. Sri Lankans are educated. If they properly understand that by observing these health rules each person is protecting him/herself, as well as other persons and the whole community, I am convinced that the epidemic could be controlled.

Here are some basic facts about the Covid- 19 virus to justify this course of action: The Covid-19 virus, like all viruses, is unable to multiply on its own. On present knowledge, the virus survives by multiplying in the cells of the respiratory system (from nose to the lungs) of human beings alone. The virus spreads from an infected person to a non-infected person through respiratory secretions (phlegm, snut, saliva), when coughing, sneezing, or even talking. If these infected secretions fall on any object and a person touches it, and then touches his own nose, lips, mouth or eyes, or even the face, virus could infect that person.

Death is usually a result of pneumonia, but other organs like the heart could also be affected. In Sri Lanka, the death rate has been low, less than 1%. In USA and UK, it reaches 3 to 5%. If the virus falls onto the ground or any other object, it dies in a matter of several hours. Therefore, if every person prevents the Covid-19 virus from entering his respiratory tract, the virus will die out. In that way the epidemic in Sri Lanka can be ended. Therefore, the solution is in our hands.

Through observing the above preventive actions, even if any asymptomatic person has the virus, it will not be transmitted to any other person. The virus cannot leave the infected persons respiratory tract because of the mask. If the virus gets onto his hands and then onto other objects, any other person who happens to get the virus onto his hands can contact and spread the virus.

The practice of regular hand washing will remove the virus. These preventive measures should be practiced by every person all the time in every home or residence, shop, office, workplace, in public transport and in dealing with any other person so that it becomes a habit. When in the past, diarrhea was the main cause of death among children, the decision that we took in the Diarrhoea Control Committee to include two health rules in the school curriculum helped to solve the problem. That is to wash one’s hands after using the toilet and before eating any food. A similar approach is indicated here.

Sri Lanka has a very good Public Health Service. Guidance is given by a very competent Epidemiology Unit headed by Dr. Samaraweera and Dr. Hasitha Tissera. The armed services have already shown their ability and commitment, specially in the tracing and isolation of contacts. If a good example is set from the top (no large gatherings etc.) and the people follow the health guidelines, the country can get rid of the Covid-19 scourge.

– Prof. Tissa Vitarana