Is Colombo ready to face new Covid-19 strain from UK?

By Dr. Pradeep Kariyawasam

It is inevitable that the new Covid-19 strain VUI 202012/01 now spreading like wildfire in the southern parts of the UK will arrive in the country sooner than later. We are still battling with the mutant European strain in the so-called second wave of the pandemic at the moment. What would happen if a new outbreak takes place in the country before we control the present one? That would be catastrophic in the most vulnerable place in the country, the city of Colombo.

Published literature states that there are at least 17-20 mutations in the new strain. Two of them are in the spike protein through which the virus gets attached to the cells of humans. One mutation helps bind better with the cells and the other one is the deletion mutation; it makes the virus a little more resistant to anti-bodies which attack the spike. The mutations make it 70% more transmissible than the original virus. This will be dangerous in areas where large crowds gather like shopping malls, hospitals, slum and shanty areas, apartment complexes in the North and Central Colombo and Borella areas. The mutations take place all over the world and there may be other strains that will arrive here once the airports are opened. The mutations might allow the virus to evade the vaccines if enough changes occur in the spike protein as the vaccines target the spike protein. Vaccines generate neutralising anti-bodies that attack the virus but if there are a lot of changes in the spike protein’s structure then the antibodies cannot identify the virus or its structures which should be attacked. The infected people or vaccinated persons will create herd immunity but only vaccinations can prevent massive infections and mutations quickly so that there isn’t much of damage to the society.

Lockdowns themselves will not stop the spread among the people unless they are properly organised. In poorer settlements people had to face 60-day lockdowns, which are not acceptable. This is so as now the scientists have identified that the virus stays alive in the body only for 6-7 days and if so then a quarantine period with a proper lockdown of 14 days would be sufficient to clear an area of the virus. With the threat looming due to the UK variant what should be done? We have to identify those vulnerable and vaccinate them, do mass PCR tests and hospitalisations and home quarantines or lock down areas properly in an organised way as soon as the mutant virus enters the city so that the virus dies away within those specific communities.

Unfortunately, the CMC has failed to support the people in this endeavour. So, we have had 83 deaths at home without receiving proper healthcare and this is in the capital city in the country! Ours is a country which boasts a free primary healthcare system (PHC) which is second to none other in the world. In fact, when I lectured abroad, they were very impressed as most of the developed countries don’t have such systems anymore as everything has to be paid for there. The Colombo city used to have one of the best heathcare systems. There isn’t a single Health Education Officer at CMC to carry out health education programmes, which are a major element of the PHC system, and there have been hardly any Health Instructors with the people in the poorer settlements, informing the public of methods of preventing disease spread and control during the past four decades. No nutritional programmes are held unlike in the past. The organisation of communities and the forming of Community Development Councils are not done anymore. In fact, this issue was raised at the budget meeting of the CMC this year. Usually, health educators and instructors do this. The result is disorganised communities in the city, especially in the urban slums and marginalized apartment complexes. The prevention and control of disease spread therefore have become impossible as there is no community participation. This is an institution that boasted state-of-the-art prevention programmes in the past when it came to prevention and control of cholera, dengue fever or polio. The fact that the CMC comes under the provincial council system also has not helped as it is impossible to get the province to recruit technical staff for the Council. The lethargy and indifference of the top officials in the province as well as the local authority have also contributed to this situation. The post of Deputy Chief Medical Officer-Epidemiologist remained vacant for three years and CMC is functioning without an epidemiologist during the Covid-19 period. The child and maternity work has suffered with the closure of maternity homes and laboratory system is not supported; these services mainly benefit the urban poor. Now, the nurses are taking PCR samples as they have no other work. What the CMC should do is get all the departments involved in the work and assign officers to perform various tasks if an area is locked down. But all should be adequately protected to carry out this work and simply giving two masks a week is not enough.

What the authorities should realise is that if there is another outbreak again due to the VUI 202012/01 mutant from the UK then it will enter the city of Colombo first. This has been the case with other diseases too.

Claims such as the one that the second wave is under control and the virus infection line is flat will give a false sense of security to the people and they will lower their guard. Information about the areas where the disease is spreading should be shown on maps, indicating where it might spread will help the public take informed decisions on how they should act.

More health education programmes should be carried out and action taken to look into the various needs of the people in locked down areas.

Some may need even loans once the savings dry out. All this will create harmony in the locked down areas and people will participate willingly in the control measures. During my time I got the support of the private sector in such endeavours and I think it is time they also contributed to the efforts of the government to prevent the further spread of the disease. This will help them run their businesses without having to face closures. Electronic media can contribute a lot to such a programme by flashing health messages for a few seconds every hour rather than allowing a few officials use them as a media circus. The officials who work hard trying to control the disease never receive media attention as only others are easily accessible.

When one considers the number of Public Health Inspectors of the CMC who got infected due to lack of Personal Protection Equipment (PPEs) we realise that they and the nurses are doing a thankless job. The CMC and the health authorities should recognise their efforts and look after their needs.

We have to live with the threat of Covod-19; life has to go on and our economy has to be healthy. It is very difficult for those daily wage earners to survive. The Rs 5000 and the dry ration packages are hardly enough for them to survive. Perhaps, the government should give them an allowance every week to the families in lockdown areas to buy essentials. The tourism industry is being revived at last.

Now comes the news that some tourists have been found PCR positive although they underwent PCR tests before emplaning. The rate of false negatives could be around 20%. The false positive rate should be close to zero.

The negative results as regards the tourists could have been due to samples being taken early or other issues. The PCR test should be done using a nasal swab because it will have fewer false negative results than samples from throat swabs or saliva. The alternative is to take Rapid Antigen tests and this test identifies protein structures (antigens) from the virus. So, it is recommended that repeated antigen testing should be carried out as a way out. The same principles should be adopted even in the lockdown areas and the surrounding areas and testing should be used to prevent leakages from infected areas. If we do all the above, we will win this war against Covid-19 in Colombo and the country.