BEING SWIFT AND DECISIVE KEY TO LANKA’S ANTI-COVID-19 DRIVE | Daily News


 

BEING SWIFT AND DECISIVE KEY TO LANKA’S ANTI-COVID-19 DRIVE

The country has adopted a whole-of-society approach under the strong leadership of President Gotabaya Rajapaksa - WHO Regional Director for South-East Asia, Dr. Poonam Khetrapal Singh

“Sri Lanka’s response to the COVID-19 pandemic has been swift, decisive and coordinated. The country has adopted a whole-of-society approach under the strong leadership of the President, with technical guidance from the Ministry of Health and Indigenous Medical Services, and effective partnership with all stakeholders,” said WHO Regional Director for South-East Asia Dr Poonam Khetrapal Singh in an interview with the Daily News.

Countries that are now witnessing plateauing of cases or a downward trend, have achieved this with aggressive implementation of core public health measures - detect, isolate, trace contacts and treat cases – complemented by protective measures like physical distancing, covering coughs and sneezes, and frequent handwashing.

“We need to continue with the core public health and physical distancing measures. If we don’t stay vigilant and protect ourselves and others, COVID-19 cases may go up. Our fight against COVID19 is far from over,” Dr. Singh emphasized.

Excerpts

Q:   Countries where coronavirus infections are declining could still face an “immediate second peak” if they let up too soon on measures to halt the outbreak”, the World Health Organization (WHO) warned recently. How should we tackle this situation?

A: The world is still on a big wave of the COVID-19 pandemic. All countries, including those which are seeing fewer cases and are easing restrictions, must continue to detect and test suspected cases, isolate and treat confirmed cases, and trace all their contacts; promote safe hygiene practices and respiratory etiquette; protect health workers; and increase their health system capacity.

We cannot assume that the downward trend in the disease has occurred naturally. This happened thanks to the tough public health measures put in place by the countries to break chains of transmission in communities.

The cornerstone of the response in every country must be to find, isolate, test and care, and to trace and quarantine every contact. That is every country’s best defense against COVID-19.

Q: Can you elaborate on WHO’s strategic preparedness for the South East Asia region to combat the virus?

A: In early January, even before the first case of COVID-19 was reported by any Member country in the Region, WHO initiated critical activities to strengthen readiness and response capacity in South-East Asia.

A readiness assessment was completed with all Member States by January end for a rapid and comprehensive situational analysis, specific to COVID-19, to accordingly plan and implement response activities in the Region. Through a number of key activities, by the end of January, WHO had prepared a solid platform in the Region to scale up COVID-19 response operations.

The Regional Strategic Preparedness and Response Plan developed in February, in line with the global plan, has been guiding WHO’s outbreak response in the Region. Based on this framework, WHO has been supporting the COVID-19 response in the Region.

As the COVID-19 pandemic spreads, WHO is supporting countries in the Region in their containment and mitigation efforts by providing technical guidance, laboratory capacity strengthening for testing, equipment for hospitals and health-care workers, as well as creating awareness and addressing misinformation.

All Member States in the Region have taken extensive measures to strengthen the response and have set up multi stakeholder platforms to coordinate the response at the highest level. Action plans have been developed and are being implemented. Surveillance has been strengthened at national and subnational levels to ensure effective case detection and to successfully trace contacts. Case management has been scaled up and patient management and referral mechanisms activated.

All countries now have in place the laboratory capacity to test in-country.  WHO is supporting countries to tailor their response strategies and mount an adequate response depending on the stage of transmission. WHO has transmission classifications with practical guidance for each phase. For each scenario, whole-of-government and whole-of-society strategic actions can be adapted according to specific national and subnational situations and capacities, including for countries preparing for a phased transition to a steady state of low-level or no transmission.

The overarching goal is for all countries to control the pandemic by slowing down the transmission and reducing mortality associated with COVID-19.

WHO stands committed to work with countries in their efforts to overcome the pandemic.

Q: How would you explain the New Normal - post covid 19 era? Curfew has been lifted in many countries and people are back at work. Schools too will reopen shortly. Do you think the regional preparedness is sufficient to prevent a second peak? What guidelines are offered by WHO to mitigate the risk?

A: Human viruses can evolve, becoming less or more pathogenic, but the COVID-19 virus is a killer virus. Our analysis must remain driven by facts and based on the current evidence, transmissibility and severity of COVID-19 haven’t changed. We are constantly observing these two factors in our efforts to better understand the virus.

The reproduction number of COVID-19 (which measures the transmissibility) is naturally above 2, which means it has an epidemic potential to take off if we allow it to. And this feature remains true so far across countries. Severity remains also consistent. We know that the virus causes a range of illnesses, with a majority of people having experienced mild symptoms and 20% a more severe disease.

What is important is that countries can reduce both the transmissibility and severity of the virus by putting in place public health measures in a whole-of-society approach. Countries need to maintain their efforts to reduce the number, frequency and intensity of exposure to suppress transmission.

As countries ease lockdowns and work towards finding the right balance to save lives as well as livelihood, they need to focus on local epidemiology to adjust and implement public health and social measures. A national risk assessment should be supported and implemented through subnational or even community level risk assessment, as the transmission of COVID-19 is not typically homogenous within a country.

The risk assessment should be based on epidemiological factors, healthcare capacities, public health capacities and availability of effective pharmaceutical interventions. Currently there are no COVID-19 specific therapeutics or vaccines.

Guiding principles when considering the adjusting of public health and social measures should be based on a number of considerations such as - adjusting of measures should not be undertaken all at once; measures should be lifted in a controlled, slow, and step-wise manner; in the absence of scientific evidence on the relative and independent efficacy of each single measure, and as a general principle, measures with the highest level of acceptability and feasibility and the fewest negative consequences could be introduced first and removed last. Most importantly, protection of vulnerable populations should be central in the decision to maintain or lift a measure.

The adjusting of public health and social measures, including large-scale movement restrictions, needs to minimize the risk of a resurgence in COVID-19 cases.

As I said earlier, countries that are now witnessing plateauing of cases or a downward trend, have achieved this with aggressive implementation of core public health measures - detect, isolate, trace contacts and treat cases – complemented by protective measures like physical distancing, covering coughs and sneezes, and frequent handwashing.

This is the ‘new normal’. We need to continue with the core public health and physical distancing measures. If we don’t stay vigilant and protect ourselves and others, COVID-19 cases may go up. Our fight against COVID19 is far from over.

Q: Sri Lanka, and its President Gotabaya Rajapaksa have been ranked 9th in the Global Response to Infectious Diseases (GRID) index. 

i) As WHO South East Asia Regional Director, how do you analyse Sri Lanka’s approach?

ii) What more needs to be done as a country to combat the deadly Coronavirus altogether?

A: Sri Lanka’s response to the COVID-19 pandemic has been swift, decisive and coordinated. The country has adopted a whole-of-society approach under the strong leadership of the President, with technical guidance from the Ministry of Health and Indigenous Medical Services, and effective partnership with all stakeholders.

Sri Lanka’s response is built around the fundamental public health approach of universal public health and social measures; case isolation and management; close contact quarantine; suspension of public gatherings; and movement restrictions.

The country has been implementing early detection, reporting, isolation, treatment. It has a strong public health system with an effective network of providers that provide free services at point of care.

Sri Lanka identified five COVID-19 facilities right after the first imported case. Currently there are nine treating hospitals with good surge capacity, to handle cases of the new coronavirus. Surge for bed capacity and human resources is being closely monitored and adjusted. Adequate PPEs are being provided to health workers.

Testing capacity has been rapidly scaled up. Laboratory facilities have been expanded from one to 17, including private and university laboratories.

Effective community engagement interventions have been implemented. The country is rightly adopting a calibrated approach for easing lockdowns through risk assessment of districts. These measures are being complemented with a social marketing campaign on the new normal across the country.

Going forward, as the country transitions into a new normal, sustained whole-of-government and whole-of-society approach, close monitoring of the situation and the response would be important to calibrate measures.

Ensuring all essential health services, particularly to vulnerable and at-risk populations, would be critical.

Use of digital solutions such as telemedicine and e-learning platforms should now be part of the ‘new normal’.

As Sri Lanka nationals continue to return home from abroad, testing protocols, quarantine measures and case management needs to be further strengthened to prevent and control COVID-19 transmission.

Continuous efforts would be needed to ensure laboratory capacities and surveillance systems across the country can test and detect cases to prevent community transmission.

The country must also gear up for the rainy season and its associated health risks such as dengue.

Q: The GRID  index report further stated;  “The reason Sri Lanka responded so well is because Sri Lanka has a public health system which is free for all citizens. Going hand in hand, Sri Lanka has had a free education system until graduate school for the last 60 years; thanks to which it has trained thousands of well-qualified healthcare professionals and paramedical workforce for many decades through well-regulated state.” Your view?

A: Building health systems resilient to public health emergencies is key to minimize deaths and diseases. Sri Lanka’s investment in health, education and overall strengthening of health systems over the years has hugely contributed to its numerous public health achievements and its effective response to natural as well as man made disasters in recent years.

Q: Is  WHO satisfied with the steps/strategies undertaken by the region to mitigate COVID-19 spread in the South Asian Region? What are high-risk areas in the region?

A: The risk of COVID-19 pandemic is high across the world, including our Region.

The responses across many countries in our Region are being led by the highest political leadership facilitating whole-of-government and whole-of-society approach.

However, we are also cognizant of the challenges – high population density, especially some urban pockets; socio-economic conditions which impact acceptability/ compliance of social measures; varying response capacities of countries and varying capacities within countries at national and sub-national levels.

WHO continues to work with governments and partners to further build capacities, share updated knowledge and guidelines, provide and support procurement of medicines and medical equipment.

The Region has not seen an exponential rise in COVID-19 cases but there is always a risk in view of the challenges and the nature of this virus.

Q: What are the different types of Covid 19 tests?  PCR and antibody testing are the two major ways used for testing people for Covid 19.  Which out of the two is most appropriate?

A: The PCR-based tests are better for telling whether you’re infected or not and the serology test or the blood test is better to detect whether you’ve been infected recently or in the past.

 Governments need to focus on PCR-based testing or any form of testing that detects active infection but serologic tests are extremely important for determining how many people have been infected in the population and those data are important to tell us where we’re going in this epidemic.

Q:  What are the best ways to boost one’s Immune System to fight the coronavirus?  Are there Immunity boosting foods? What foods should be consumed and what should be avoided? What is your nutrition advice for the public?

A: Eating healthy and undertaking any form of physical exercise, permissible as per the national government’s physical distancing guidelines, is important to  keep yourself  healthy.

However, currently the only protection against COVID19 is to take preventive measures such hand wash, and physical distancing.

Q: The question now on everyone’s lips is “ When will a coronavirus vaccine be ready? According to  WHO, “ three vaccine candidates are in the clinical testing phase, while 67 potentials are in the preclinical phase.” How long will the world have to wait for a Coronavirus vaccine?

A: Even with an accelerated process, development of a vaccine for COVID-19 will take time. WHO is working with partners all over the world to accelerate research and development of a safe and effective vaccine and ensure equitable access for the billions of people who will need it.

The first vaccine trial began just 60 days after the genetic sequence of the virus was shared by China. This is an incredible achievement.

Together with global health actors and partners, WHO launched the Access To COVID-19 Tools (ACT) Accelerator, a global collaboration to accelerate the development, production and equitable access to new COVID-19 diagnostics, therapeutics and vaccines. On 3 June, the United Nations and the International Red Cross and Red Crescent Movement called for unity to scale up efforts on vaccines.

A Solidarity trial for vaccine development has been launched, in addition to the one for therapeutics. This large, international, multi-site, individually randomized controlled clinical trial will enable the concurrent evaluation of the benefits and risks of each promising candidate vaccine within 3-6 months of it being made available for the trial.

Q: So far 11 deaths have been reported from Sri Lanka. More than 1800 people have been tested positive for the coronavirus. Of late more than half of the new cases are being reported from Sri Lankan migrants who arrived in the island from the Middle East.  Many Navy personnel too have been infected. What piece of health advice do you have to offer with regard to this situation?

A: Sri Lanka , with its all-of-government and all-of-society approach, has been able to keep COVID-19 transmission levels to clusters of cases. Its response mechanism is able to rapidly detect new cases, isolate them, trace their contacts and care for the affected. This needs to continue till Sri Lanka is able to break COVID-19 transmission, and even beyond, till we have a safe and effective vaccine against this virus.

Q: The importance of traditional herbs and healing practices have been in much discussion since the start of the coronavirus outbreak. The demand for Venivel Gata (Calumba Wood) ginger , coriander  has increased. Steam inhaling using plant leaves such as lemon, Beli and Ada Thoda has been recommended by authorized Ayurvedic practitioners. All these precautionary measures are practised in many Asian homes in addition to social distancing methods to protect themselves from the coronavirus? What is your view on the importance of traditional healing practices to curb the spread of the virus?

A: There is no evidence yet on the effectiveness of these measures against COVID-19. Your best guard is personal protection – hand hygiene, cough etiquette and social distancing.


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