College of Community Physicians recommends staggered exit strategy for COVID-19-struck Sri Lanka
ECONOMYNEXT – In a comprehensive exit strategy formulated for Sri Lanka from the ongoing COVID-19 lockdown, the College of Community Physicians Sri Lanka (CCPSL) has recommended that normalcy is restored in a staggered manner, taking into consideration the evolving dynamics of the epidemic.
“In the context of COVID-19, an exit strategy should be considered as a contingency plan that needs to be executed by the ‘whole-of-government and whole-of-society’ approach, once the stipulated objectives of containing the epidemic has been partly/fully achieved, which could maximise benefit and/or minimise damage,” the CCPL said in a report released yesterday.
“It is equally important to prepare the mindset of the general public with a well-executed immediate communication plan. It should reinforce the continuous need for hand-washing, respiratory etiquette and physical distancing and inform that a revert is likely in the event of epidemiological evidence of community spread, if the public do not comply,” it added.
Outlining the exit strategy, the CCPSL said the objectives of such a strategy should be threefold: maintaining the caseload well below the country’s health system capacity, returning to near normal public life, and economic recovery.
A careful analysis of the interventions already adopted should be made, the report suggested, adding that which of these need to be removed or gradually scaled down should also be determined.
This should be executed under the strict guidance, coordination and supervision of the National Operation Centre for Prevention of COVID-19 Outbreak, the collective of physicians said.
An in-depth understanding of the epidemic behaviour, the report said, is required for decision making on the timelines and exact strategies that need to be deployed. This will be facilitated by conducting escalated strategic RT-PCR testing.
In addition to passive, active and sentinel surveillance, the CCPSL recommends antibody testing among those providing frontline essential services and those negative for RT-PCR 2 weeks after recovery.
This, it said, will provide guidance to determine the stage of the epidemic in the country and help categorize the geographical areas based on risk as well as determine the pattern of infectivity by aggressive continuous contact tracing.
Warning that ending the curfew too soon could lead to a second outbreak, the CCPSL said that, on the other hand, enforcing it for too long could further cripple the economy and public morale.
“When to end the current phase must be decided at national level by an expert panel comprising health and non-health authorities with vigilant monitoring of the area-specific caseloads, as premature relaxation of the lockdown in any part of the country could affect the spread in the rest of the areas. If Sri Lanka can maintain the low numbers of new COVID-19 cases at national level along with no solid evidence of community transmission (i.e. no known epidemiological link for the transmission), moving to more and more relaxed phases can be considered with time,” it said.
Since every geographical area would not pose a similar threat for COVID-19, a blanket exit strategy is not applicable across the board to the entire country. Instead, said the CCPSL, targeted strategies need to be worked out at area level – at the district level. In the initial stage, each district in the country should be categorized according to the caseload prevailing in each area.
With further understanding of the behaviour of the epidemic/ people in each district, relevant authorities may shift the focus to clusters of divisional secretariats (DS) areas or to individual DS areas within a district, the report said. However, it added, in all situations, more stringent criteria should continue to be applied for areas under strict quarantine.
“It should be reiterated that such decisions on relaxing or maintaining lockdown should be facilitated by a multi-disciplinary expert panel at national level with adequate representation from the index localities. In the absence of defined case-wise cut-offs or strict timelines, the decision makings throughout this process must be reflective and done using a frequently revisited process.”
Within each of the identified risk areas, the withdrawal of curfew implemented measures/restrictions needs to be carried out in phases in a staggered manner, while ensuring the continuity of interventions carried out so far to contain the epidemic, the CCPSL said.
The report also went onto outline country-level measures to be taken in the event of an exit from the current lockdown, with recommendations for future challenges.