WHO brainstorming meeting among public health experts: Observations and recommendations

Covid-19 surge in Sri Lanka

Public health experts representing diverse specialties held a brainstorming meeting convened by the World Health Organisation (WHO) Sri Lanka to discuss the current spike in cases in Sri Lanka recently, according to a media statement issued by the WHO Colombo Office. The key observations and recommendations to policy and decision-makers indicated below are documented based on proceedings and the consensus achieved at the meeting. The views expressed on the situation are those of the experts and do not necessarily reflect those of WHO.

The following crucial factors were considered:

The COVID-19 situation in Sri Lanka is very likely to get worse over the next few weeks. The decisions we take NOW will affect the lives of millions of Sri Lankans. Therefore, the next 3-4 weeks are critical in controlling transmission and saving lives.

The epidemiological trend of the past weeks shows a rapid exponential increase in the number of cases, this trend is likely to continue for some time if no effective interventions are made.

There is a lag of 1-2 weeks between infection and case detection and a further lag of an additional 2-3 weeks between an increase of reported cases and an increase in reported ICU admissions and deaths. Thus, the deaths and ICU admissions we are seeing now are the consequence of infections that took place at the early stage of this third wave (3-4 weeks ago).

The public sector health system is stretched to the limit, making it difficult to manage COVID-19 cases as well as other essential services. More health professionals and preventive staff (e.g. PHIs) are getting infected and HR policies need to be geared to meet the urgency. There is a “tipping point” beyond which the system can rapidly go out of control. 

The more transmissible and severe variants detected in India and other variants have already been detected in the country, these can spread faster and may even circumvent vaccine-induced immunity.

Vaccines will be crucial to controlling the epidemic in the medium-term but will not address the immediate crisis we now face. Some vaccines are only effective after the second dose. Therefore, it will take a minimum of 6-8 weeks to see the effects of vaccination in the number of new cases.

In the context of the above, there are two URGENT actions we can take to save lives – stop new infections as effectively as possible and prepare for the predictable increase in severe cases and deaths.

1.

Globally, evidence shows that strict and immediate measures to restrict mobility are the only measures that quickly and drastically reduce cases. Sri Lanka will also benefit from strict mobility restrictions whilst maintaining major economic activities and essential services. There is a need to stop inter-district travel and introduce severe restrictions on non-essential human mobilities and the congregation of people. Universal adherence to ‘precautions’ such as appropriate masking, physical distancing, hand hygiene, and avoiding the 3Cs – crowds, confined and enclosed spaces, and close-contact settings is a must. High transmission areas must be shut down for 2-3 weeks to stop or limit transmission. There should be a national mobilization effort to accelerate vaccination.

2.

Reconsider the management of asymptomatic cases, revise clinical management protocol to include home management.  Increase focus on intermediate care centres to detect cases early, properly monitor patients, and appropriately manage cases, thereby minimizing the need for more intensive care. Prepare for an increase in hospitalization and the need for adequate HDU and ICU care.

Participants

Dr. Palitha Abeykoon, WHO Consultant and WHO Director-General’s Special Envoy For COVID-19 Preparedness and Response for SEAR 

Prof. Malik Peiris, Chair/Professor – School of Public Health, The University of Hong Kong, Faculty of Medicine, Hong Kong

Dr. Ananda Wijewickrama, Consultant Physician and Past President of the College of Physicians

Prof. Neelika Malavige, Professor and Head, Department of Immunology and Molecular Medicine, Sri Jayewardenepura University

Dr. Vinya Ariyaratne  

Public Health Specialist,  President- Sarvodaya (CSO)

Dr. Padma Gunaratne, Consultant Neuro Physician and President, Sri Lanka Medical Association

Prof.  Indika Karunathilake, Prof. in Medical Education, Department of Medical Education, Faculty of Medicine and Former President – SLMA

Prof. Asita de Silva, Senior Professor of Pharmacology, University of Kelaniya and President, Sri Lanka Association of Clinical Pharmacology & Therapeutics

Prof. Manuj Weerasinghe , Professor in Community Medicine, Faculty of Medicine, Colombo 

Dr. LakKumar Fernando, Consultant Pediatrician and President, Association of Medical Specialists

Dr. Nihal Abeysinghe, Consultant in Community Medicine and Former Chief Epidemiologist in Sri Lanka and President of the College of Community Physicians in Sri Lanka

Prof. Saroj Jayasinghe, Consultant Physician and former Prof. of Medicine, Faculty of Medicine, Colombo 

Prof. Kamini Mendis , Professor Emeritus, University of Colombo; Public Health Expert and former WHO Malaria expert  

Dr. Olivia Nieveras, Officer In-Charge, WHO Sri Lanka 

Dr. Sapumal Dhanapala, WHO Sri Lanka

Dr. Padmal de Silva, WHO Sri Lanka

Prof. Nalika Gunawardena, WHO Sri Lanka

Mr. T  Suveendran, WHO Sri Lanka

Dr. Preshila Samaraweera, WHO Sri Lanka

Ms. Sahani Chandraratna, WHO Sri Lanka

Dr. Mizaya Cader, WHO Sri Lanka

Ms. Sadhani Rajapakse, WHO Sri Lanka

Dr. Anjalee De Silva, WHO Sri Lanka

Dr. Roshan Sampath , WHO Sri Lanka

Dr. Shreenika De Silva, WHO Sri Lanka