Covid-19 control: The spread of missing links

Much has been talked and written about how to control the present Covid-19 epidemic in the recent past. The most valuable contributions recently made were from Prof. Malik Peiris and Dr. Kamini Mendis. I too had mentioned some of the concerns they had, with regard to lockdowns covering Grama Sewa Divisions only, and not in larger areas encompassing at least the adjacent Grama Sewa Divisions. People may not move within one area before identification as a Covid positive patient, and they could have travelled to at least the nearby areas while being infected. Then comes the length of the lockdowns. We have to have a minimum of a 14-day lockdown if we want to avoid large graveyards in the country, whether we like it or not, if we want to shorten this third wave.

The third wave happened because we did not close down the country during the April holidays. The ideal time would have been from 10th to the 24th April this year. Usually, many institutions are practically closed down, and there is less economic activity anyway during this period. I am mentioning it because next year we should not say this again, with hindsight that we should have done this, after not doing so. This is a lesson that we learnt the hard way.

Even now we have problems in controlling this epidemic. One thing that is missing is teamwork. Many have ideas but do not come forward with them at the correct forum. There are many at these meetings who do not have an iota of an idea of epidemic control or experience in controlling one. What is in the books do not apply in these situations. I believe that the Task Force should be pruned down, so that only a few people attend it from relevant fields, who will have to come armed with the relevant proposals; as then it is easy to have a proper discussion and make decisions and agree on policies. With regard to other supportive services, there could be a separate meeting to discuss logistics, manpower, funds, etc.

The information about the situation should be simple, so that even a layman could understand, and maps should be available to indicate hotspots, high risk areas, etc., so that timely action could be taken. Information given late, or PCR test results given 2-3 days later, do not help the control teams; as by the time they receive the information to take action, more patients join the queue as they infect more people with time. With regard to information and maps, we should use the services of any competent person if the Epidemiology Unit cannot handle it alone. The GMOA has taken some positive steps in this regard, they have enough resources among their membership, and they should be allowed to work with the Epidemiology Unit to carry out this work. We need more automated PCR systems in the country, because we cannot wait for days to get to know whether a patient is positive or not. Although the initial cost will be high, in the end it will save a lot of money for the country, by lessening the number of patients with Covid-19 in the long run.

There is a debate about whether the disease has spread beyond our control. In epidemiology there is a saying that only 10% of the patients down with a communicable disease are found. In the case of Covid-19, with all these PCR and Antigen tests being done, contact tracing, quarantines in place, I believe we are still missing at least 30-40 % patients. Around 80% patients do not show any symptoms, but they could infect others, but with the present Covid-19 variant it could be less. However, the numbers could be high and they may be never identified unless antibody tests are done. At present, antibody tests are done but only using the patients who come for vaccinations. Manpower is an issue, as the same PHIs, Nurses and Midwives are used for PCR testing and Immunizations. Colombo was shown as being less prone to the present third wave, but yesterday it was found that the Narahenpita area had more than 100 people in a day, perhaps due to PCR testing in that area. I do not know from which areas within that ward they are found, and such information is important for the general public. Similarly, infected areas could be found in Borella, Wanathamulla, Dematagoda, Grandpass, Modera, Mattakkuliya, etc., where population densities are high. Priority in future vaccination programmes should be given to these areas. Similarly, in other cities and townships, such areas should be identified to carry out vaccinations. We need proper planning in place to carry out these actions, and to identify the hotspots. We need the services of personnel who have the necessary knowledge to obtain, collate, analyze and disseminate information not only district-wise, but within major cities too. Unless we do that and provide information to the Task Force or decision-makers, we will not win this battle soon. We do not have a proper people- centered awareness programme for high population density areas, where they might not get the information through radios or TV. Unless we do that, the health messages on the need for wearing a mask, keeping social distance and handwashing will not sink in. Let’s hope some action will be taken to implement the above actions.

Dr. PRADEEP KARIYAWASAM

Former Chief Medical Officer of Health

Chairman, Standing Committee on Health/CMC