COVID-19 B.1.1.7 (UK) strain: What’s in store for Sri Lanka?

Dr Ravi Rannan-Eliya (l), Prof Neelika Malavige (r)

ECONOMYNEXT – With the highly contagious B.1.1.7 strain of COVID-19 now confirmed in Sri Lanka, experts have called for tightened borders, restrictions on gatherings and other stringent measures to prevent an outbreak that could prove disastrous. Others, however, contend cautiously that it’s still early days and premature panic may be unwarranted.

Neelika Malavige, Professor in Microbiology at the Department of Immunology and Molecular Medicine, Faculty of Medicine, University of Sri Jayewardenepura, told EconomyNext that the fast-spreading UK strain was observed in the community toward end January this year. A team of researchers at her university sequenced 92 samples collected in different parts of the island including a number of quarantine centres. The new strain was detected in samples from Colombo, Avissawella, Biyagama and Vavuniya and some of the quarantine facilities. The university told this website yesterday that it is possible that Sri Lanka’s existing B.1.411 strain could’ve undergone de novo mutation owing to its wide and rapid spread in the country. However, Prof Malavige said today that the source is most likely a returnee from overseas.

“[The strain] possibly leaked into the community due to some failure in the quarantine process,” Prof Malavige said.

Defending Sri Lanka’s quarantine efforts, she said: “This is natural. Nothing is perfect. We have one of the toughest and longest quarantine processes in the world for our returnees. But, of course, nothing is fool-proof.”

Malavige attributed the recent spike in COVID-19 cases in Sri Lanka to the presence and possible spreading of the new strain which she said is 50% more transmissible than earlier variants.

“We need to quickly assess the situation and take action accordingly,” she added.

She noted, however, that only three individuals from the community tested positive for B.1.1.7, the rest being identified in Sri Lanka’s military-run quarantine centres.

“Since we identified the variant in the community very early, we might be able to contain it,” she said.

Institute for Health Policy (IHP) Executive Director Dr Ravindra Rannan-Eliya is less optimistic. He told EconomyNext that the new strain could cost Sri Lanka billions if it wasn’t contained.

“We need to tighten our borders immediately, and stop the tourism project. If planes arrive in the next 24 hours, I would impose 14-day quarantine on them or give them the choice of going home. There are many more dangerous variants now spreading globally and we cannot afford this getting even worse,” he said.

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The discovery of the B.1.1.7 in Sri Lanka, he further said, is an indictment of the government.

Claiming that there have been quarantine leaks since December, Rannan-Eliya said Sri Lanka will have to step up its pandemic prevention measures without delay. This includes ramping up PCR testing which recently saw a significant drop in numbers – down to some 12,000 to 14,400 a day, prompting a government lab technologists’ collective to accuse officials of “giving up” on PCR testing altogether. Testing has since gone back up to over 15,000, but according to Dr Rannan-Eliya this is a far cry from the targets that Sri Lanka needs to hit in order to contain the spread, particularly with the arrival of the new strain.

“We need massive increase in testing, up to 60,000 a day or more. This needs drastic actions and I don’t think the Ministry of Health (MoH) can be trusted to do this. The president needs to take over,” he said.

“We will need a change in strategy. I despair because I don’t think this can come from inside the MoH,” he added.

Rannan-Eliya believes B.1.1.7 will likely become the dominant variant in Sri Lanka within two to three months, after which he warns it will not be possible to achieve herd immunity with the India-manufactured Covishield-Oxford-AstraZeneca vaccine, Sri Lanka’s vaccine of choice at present.

“Only Pfizer, Moderna and Sputnik are good enough. Even then vaccination will need to cover 80% of the population, which means 100% of all adults. That will be very difficult,” he said.

Prof Malavige, however, is more cautious in her projections. She told EconomyNext that all leading vaccines, including Covishield, have proven to be effective against the new strain.

“Things are likely to get worse with the introduction of B.1.1.7, but since the situation has not escalated to a bad one in India after the arrival of this variant in that country, it might not be as bad in Sri Lanka as what has been observed in the UK,” she said.

However, Malavige did stress on the need to take all possible measures to curb an outbreak until a sufficient number of people have been immunised to prevent further transmission.

“Fortunately all the leading vaccines (Pfizer, Asatrazenaca/Covishiled) are effective against this variant. What is needed is to take all necessary steps to reduce transmission by limiting gathering or stopping them altogether. This is the most important thing. Maybe we have to reconsider keeping our borders open. If the South African or Brazilian variant also enters Sri Lanka, that would be bad news,” she warned.

Dr Rannan-Eliya is of the opinion that since Sri Lanka is not purchasing other vaccines besides Covishield in quantity, the country will not return to normality this year.

“The UK and the US have all come to the same conclusion. Welcome to the club which didn’t try to eliminate the virus. The only option for us to return to normality now is to eliminate the virus locally, like Australia, New Zealand and others,” he said.

Asked to elaborate on his remark that the fight against the pandemic ought to be handed over to the president’s office, Rannan-Eliya said that, as has been the case in Japan, Sri Lanka has a strong medical officialdom that is somewhat conservative on COVID policy, particularly with regard to testing.

“This is becoming more ideology than science. I can’t see this changing by replacing one person in the MoH. Even if policy is changed, it will not be implemented well and reasons will be given for not doing so. I can also see that at many levels it is becoming harder to change because that would require an implicit admission that the earlier policy was mistaken. You also see this globally. There is some element of denial in this, so there needs to be much higher level pressure,” he said.

Rannan-Eliya’s call comes against widespread criticism that Sri Lanka’s political leadership has not done enough to curb the outbreak. Criticism has also been levelled against the government over its ill-advised Ukrainian tourism pilot project. Asked to comment on this, the IHP director called into question the advice offered to the president by the ministry.

“My understanding is that the president has been told several times by outside experts, including me, that policy, especially testing, needs to change. What I understand is that each time he listened and then consulted with the MoH which told him otherwise. His mistake, I think, was to listen too much to the MoH. I know there is a belief that he and the military make these decisions, but what my understanding is that the MoH has never really supported a change in policy or offered him a real alternative. At some point, the president needs to decide whether he keeps on following what they advise, or seek a different strategy,” he said.

The Ukrainian policy, he said, is a side-effect and the project happened at a time when the MoH was failing to prevent or control the current outbreak – a failure that he said made it that much harder for MoH officials to push back on the policy.

“This is a vicious cycle. In countries which succeeded like us in initial elimination and which, unlike us, maintained that status through good policies, there is much more political support for government to maintain tight borders. People understand why. Think about Thailand and Vietnam which usually get millions more tourists than we do. Our failure to control the outbreak means there is much less support for a tough border policy. So we are paying the price for partial success or partial failure,” he said.

Rannan-Eliya added, however, that the president doesn’t need to run things.

“He can’t. But he needs to find a way of putting some people in to specifically set and steer COVID health strategy, and then ensure the MoH implements it. In a democracy this is entirely appropriate. Civil servants can advise but ultimately must implement what the policymakers – the politicians – decide. If you think about New Zealand, the strategy came from outside their MoH, but [the ministry] has implemented it,” he said.

Prof Malavige contests the accusation that the current spread of COVID-19 is a total failure on the part of the authorities. She said the criticism levelled by parties not directly involved in the process is unfair and uncalled for.

“Of course our authorities are not perfect. No authority in the world is. We are a lower middle income country, having daily struggles. I know for a fact how hard the authorities have been working to get things under control. I think it’s very unfair and wrong to criticise the efforts of our authorities and frontline workers just like that. This is a very contagious virus. It’s very difficult to stop transmission,” she said.

“One important thing I would like to ask the individuals who criticise on social media is what have you done to make things better for the country?” she added.

Malavige further said that her team of scientists managed to sequence a large number of samples because they were provided adequate funds.

“Whether we like to accept it or not we are a poor country with very limited resources. Despite that, we have managed to keep our mortality rates from COVID to the lowest. I think that is a huge achievement, compared to any developed country. What we need to stop is people getting severe disease and dying. I think we have been very successful in doing that. Of course our cases are rising. Then the strategy has to change to keep mortality and severe disease down,” she said.

Though she agreed that things will likely get worse with the arrival of the UK strain, the professor said that, given the encouraging situation in India vis-à-vis the new variant as well as Sri Lanka’s climate getting warmer in the coming months, it is hard to say whether things will escalate.

According to Malavige, B.1.1.7 is present in over 80 countries at the moment,  but there has been no increase in case loads or deaths. She anticipates a similar situation in Sri Lanka, though it’s hard to be certain at present. Following health guidelines, she said, will prove vital.

“The B.1.1.7 variant is currently present in India, Singapore, Thailand, South Korea and many other Asian countries. Despite this, they haven’t seen a disproportionate surge of cases and seem to have things very much under control. Our outbreak patterns and mortality rates have been very similar to what has been observed in Asian countries and not European countries. So while we obviously need to be very concerned, we don’t need to panic,” she said.

Reported by Himal Kotelawala (Colombo/Feb13/2021)

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