ECONOMYNEXT – As deaths and daily cases surge in Sri Lanka, an independent expert group convened by World Health Organisation (WHO) Sri Lanka on the island nation’s COVID-19 situation has called for swift and stringent mobility restrictions to save some 18,000 lives by January 2022.
A report of key observations and recommendations made by the group at a meeting held on Tuesday (10) said that, at current levels of mobility restrictions, the daily caseload would increase up to 6,000 a day by mid-September.
Daily deaths, at current levels of stringency, is expected to peak around 220 deaths a day by early October, while intensive care unit (ICU) admissions will peak around 275 around the same time.
If stricter restrictions aren’t imposed, Sri Lanka will see some 30,000 cumulative deaths by January 2022, according to the group of experts.
“But note that since we have not yet achieved the vaccine coverage assumed in the model, the projections are an under-estimate,” the group said.
At increased levels of stringency in restrictions that would be comparable to the month-long lockdown-in-all-but-name from May 21 to June 21, the experts said quoting projections by the Monash University, Australia, in collaboration with WHO SEAR and the Sri Lanka County Office that daily cases would drop to around 1,000 a day from the current ¬3,000 a day. Deaths and ICU admissions would be fewer than 25 a day each by October. Stricter restrictions similar to May-June would also avert 18,000 deaths by January next year, the group said.
(The projections assumed that 50% will be fully vaccinated by end of August 2021).
“We need to act NOW,” said the experts, among who was Prof Malik Peiris, Chair/Professor of the School of Public Health, University of Hong Kong.
“Our urgent priority is to SAVE LIVES,” they added.
COVID-19 deaths continue to spike in Sri Lanka, with 156 deaths confirmed by the Director General of Health Services for Wednesday (11), the seventh consecutive day the daily death toll reached a record high.
The government also confirmed 3,039 new infections on Thursday (12), the highest daily total in nearly three months. Active cases in the country as of Thursday evening are 37,043. Total cases since last March are 345,118.
Many areas of the country show a high PCR test positivity rate of over 20%, as noted by the group of experts. By July 31, over 60% of sequenced samples belonged to the fast-spreading delta variant of SARS-CoV-2, the virus that causes COVID-19.
As the caseload grows, ICU beds have reached 90% capacity and bed capacity at other levels of care have also reached over 85%, while patients needing oxygen had increased from 528 to 646 in a matter of days leading to growing concerns of an oxygen shortage.
These numbers come amid worries expressed over the accuracy of government data. According to one regional health officer, there may be a significant discrepancy between daily COVID-19 cases confirmed by health authorities and the number of people that actually test positive on a given day.
Eastern Province Health Services Provincial Director Dr R M Thaufeeque told reporters on Wednesday (11) that 837 cases found in the Eastern province on Tuesday (10) did not tally with the 194 cases reported by the health ministry’s epidemiology unit.
Related: Sri Lanka health official points to significant discrepancy in daily COVID-19 numbers
Sri Lanka has seen an alarming surge in COVID-19 deaths since mid-July, with daily infections also on the rise. Health authorities suspect the delta variant of SARS-CoV-2, the virus that causes COVID-19 is behind the rapid spread.
Despite rising cases – and repeated calls from the medical community for a lockdwon – the government has opted not to impose stricter restrictions, choosing instead to limit crowds at indoor events such as weddings.
A meeting is to be held today chaired by President Gotabaya Rajapaksa on the future course of action.
Calling for immediate mobility restrictions, the independent expert group said, a four-week lockdown would provide the time needed to accelerate Sri Lanka’s vaccine rollout (only 15% of the population is fully vaccinated at the time of writing) and to achieve the level of protection following the second dose.
Four weeks of stringent restrictions would also give Sri Lanka’s overworked and exhausted health workers some much needed recovery time from the overwhelming case load, the group said.
“A significant number of health workers are getting infected with a consequent pressure for curtailment and closure of services. All indications are that staff are exhausted and struggling,” they said.
According to the experts, the May-June lockdown saw “very effective” restrictions at 85% of the Oxford Stringency Index. The index records the strictness of ‘lockdown style’ measures of a country and is calculated using nine response indicators including workplace and school closures.
In July, Sri Lanka’s score on the Oxford Stringency Index, the experts said, was at 49% and has since fallen to a “dangerously low” 29% as of August 5.
With the decrease of the stringency from 84% (during 21 May – 21 June) to 29% by August 5 and 32% from August 6, cases and deaths have demonstrated a significant rise from around 1,500 (early July) to near 3,000 as of August 9, the group noted. With relaxation of stringency, the mobility patterns have also shifted to pre-COVID levels, they said.
“Immediate actions are crucial and critical because it takes a few weeks before measures show a positive impact on the number of infections and hospital admissions. Any delay in implementation will lead to increase in deaths and will require even more stringent measures with longer duration to regain control,” the experts said.
More detailed recommendations from the experts are as follows:
- 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.
Meanwhile, Health Services Deputy Director Dr Hemantha Herath said the situation in Sri Lanka has not yet gone out of control.
“If it has, then the virus would be spreading much faster than this. If it was spreading fast, then the number we recorded a few days ago would’ve doubled by now,” Herath said on Friday (13).
“But we are in a very dangerous situation without a doubt,” he conceded. (Colombo/Aug13/2021)