Photo courtesy of France 24

Sri Lanka is facing a resurgence of COVID-19 due to the Delta variant that mirrors the devastating surge in India in April. In the last 24 hours government sources have reported 3,435 cases and 161 deaths bringing the total death count to 6,096. There are also serious concerns about the validity of government data especially related to undercounting of cases. As cases have increased, and deaths being a lagging outcome, it is logical to assume that there might be an increase of deaths in the coming weeks although we hope for a different outcome.

At this stage, where our communities buckle under the pressure of the pandemic fatigue, the challenges and helplessness that comes with an outbreak ripping through our community, I thought that we could use an important reminder: we still have considerable power in controlling this pandemic via vaccines and public health measures – in that we can place our faith and hope. It is equally important to recognize that the government and every person with governance and information platforms need to invest in adequate solutions if we are to overcome this resurgence.

Why we should have hope

Even in these challenging times we can focus on meaningful efforts of reducing the burden of this pandemic, stay updated with useful information and use it to guide us.

Vaccines: One of the major and effective efforts in Sri Lanka is the vaccination drive. All vaccine brands that are being provided are efficacious and have been certified safe via large clinical trials in multiple countries. The vaccine brands include Pfizer, Moderna, Astra Zeneca, Sinopharm and Sputnik with the first four also being approved by World Health Organization (WHO) for emergency use. One crucial factor to manage COVID-19 is our efforts in getting vaccinated with any vaccine that is available to us; by doing so you might very well be saving at least one life. You will also be contributing to saving healthcare resources (e.g. oxygen, hospital beds, ICU space and other essential medicines) and minimizing the risk to healthcare workers. As researchers indicate, vaccines are highly effective in reducing severe symptoms of this disease, reducing hospitalization and deaths, especially for those above 65. So be responsible and give hope to others by getting vaccinated. Take both doses as soon as you are able.

Community solidarity: Our community is resilient. We care for each other. This is a valuable strength to have at a time when we need the help of the other. For example, the recent informative twitter space discussion on vaccine myths and other health related questions by a group of physicians convened by Dr. Arshath Zameek with panelists including Drs. Kaushila, Dinu Guruge, Muhammad Sabith and Ruminda Gunaratne is a great resource for those who want to learn more on how to face the pandemic or to simply reduce your anxiety. There are also guides such as the tri-lingual versions of the homecare guide originally produced by India COVID SOS contextualized to Sri Lankan settings. While advice in public forums should not replace official medical guidance, it is helpful in ensuring that you and your loved ones remain safe.

Healthcare workers: Majority of our healthcare workers and scientists are dedicated, informed and care for the health of our population. This has been evident during every surge of COVID-19, testing drives, vaccination drives and by lives saved. It is crucial that we support the healthcare workers by keeping ourselves safe and getting an available vaccine as soon as you can. In the absence of high vaccination coverage the chances of our healthcare workers, in whom we have placed our hope, getting infected is high. We should eliminate that risk as much as possible.

Why we should not tolerate inadequate policies

The current COVD-19 resurgence with limited vaccination coverage and resurgence of novel variants is an evolving threat affecting all countries. However, the government repeating its policy mistakes of undermining the impact of public health measures has had significant consequences on the rate of infection spread. The government has been very slow to act similar to post-April resurgence that was caused by the Alpha variant. Alpha variant also remains in our community.

There is a clear urgent need to move away from ad-hoc, token and delayed public health measures and focus on meaningful efforts. Token public health measures are those that do not provide adequate impact such as gradually decreasing number of those who can attend indoor gatherings without canceling these events temporarily and rapid night time curfews that mirror a war time effort rather than a public health measure. Delayed measures in responding to an infectious disease crisis gives a false sense of security to the public. This is, in fact, a policy failure that mirrors previous mistakes indicating that our leadership have not learned from their mistakes.

In country medical experts, independent experts convened by the WHO Sri Lanka (Panel 1), have sounded strong alarms on the rising number of cases and inadequate measures by the government. We need to implement clear, widespread restrictions for at least three weeks, provide designated times to access essential services and provide public targets (e.g. case numbers per capita) so that the public can also invest in the efforts in controlling this outbreak. Sri Lanka is yet to declare community spread, which is a simple informative measure that can increase the levels of awareness and vigilance among the public.

Panel 1: Detailed recommendation for the government by WHO Sri Lanka independent expert panel:

  • Strictly enforce movement restrictions, including inter-district travel except for essential services. The effective implementation of these measures may require the enforcement of a curfew for a short period, in large geographic areas or nationally.
  • Restrict /cancel all public events for 3 weeks.
  • Provide care and protect the health workers and augment staffing in hospitals to minimize disruption of essential health services.
  • Develop and implement an effective communication plan to engage the public and to update them on the control measures.
  • Accurate reporting of both cases and deaths to get a better picture of the ground situation.  May also use proxy indicators such as observed Test Positivity Rate (TPR), trends measured using weekly moving averages and time series analysis, mobility data, etc.
  • Prioritize to vaccinate all those over 60 years old and those with co-morbidities, preferably with Pfizer, Moderna or Astra Zeneca because even a single dose of these vaccines provides some degree of protection until the second dose is given.

Source: WHO Sri Lanka

Inadequate policies need to be clearly highlighted by the media and experts for their lack of scientific rationale to ensure some level of accountability. For example, the current assertion by the Cabinet spokesperson that we will just vaccinate and leave the rest to god or that we will impose a lockdown when medical experts tell us to do so as asserted by a State minister, are very worrying trends that are misleading and reveal a lack of a comprehensive plan; vaccination alone cannot control the pandemic and medical experts have already called for countrywide public health restrictions. We need strong public health leadership at the helm of this response and advice of those who have the pulse of the pandemic. COVID-19 response should not be alternative efforts of investing in testing, vaccinating, quarantining or lockdowns one at a time but a process that incorporates all these efforts to a central plan with time bound targets.

We have a very challenging period ahead of us. We also have ample reason to be hopeful because we have tools at our disposal to address this recent resurgence. Yet, without a sense of responsibility shown at a personal level by us as a community and by the government as leaders we will not be able to overcome this. Estimates suggest that we may lose an estimated 18,000 additional lives by the end of this year if we do not act now. The current crisis demands accountability and refocusing of political and policy priorities. The government owes it to their stated assurances of creating a safer Sri Lanka and we owe it to our loved ones and to the larger community.

Let’s not lose hope but demand accountability from ourselves and from our leaders.

The author was a Policy Associate at the Center for Policy Impact at the Duke Global Health Institute and is currently a doctoral candidate focusing on global health policy at McGill University. He tweets at @ShashikaLB