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Sunday September 19th, 2021

Doctors and health officials disagree on imminent fourth wave of COVID-19 in Sri Lanka

ECONOMYNEXT – Government officials and a national professional association of doctors seem to disagree on a the likelihood of an imminent fourth wave of COVID-19 in Sri Lanka.

Though the possibility of a new wave always exists, Sri Lanka is not looking at a fourth wave of the epidemic at the moment, according to Health Promotion Bureau (HPB) Director Dr Ranjith Bathuwanthuduwa.

Pointing to a slight drop in daily cases, the official said Sri Lanka is still in the third wave that began in April 2021 and recent wave does not portend a fourth wave.

According to Bathuwanthuduwa, a wave can be identified in three different ways from an epidemiological point of view.

“First is a chronological wave; meaning over some months or weeks, the case numbers are volatile – increasing and decreasing. The second is based on variants. In this current wave, we find more patients of the Alpha variant. If a different variant becomes dominant then we can identify it as a wave due to this different variant. Other waves can occur due to human behavious,” he said.

The ongoing third wave, according to Bathuwanthuduwa, is of the third category: triggered by human behaviour.

“We know what happened as a result of the behaviour of the public in April,” he said.

However, the government’s official position on the cause of the third wave has been criticsed as an attempt to shift the blame to the public, as repeated calls for a lockdown was ignored amid an inexplicable drop in PCR testing at the time.

“There is potential for a fourth wave. We won’t deny that,” he said.

Thirty-six cases of the highly infectious Delta variant of SARS-CoV-2, the virus that causes COVID-19, have been detected in the community in Sri Lanka. If this variant is not contained, Bathuwanthuduwa said, a fourth wave can occur.

“Only a few cases of the Delta variant have been detected so far. Some cases are being monitored and followed up on. Measures have been taken to keep the situation under control,” he said.

“When I say ‘only if we lose that control’, people start to panic because they don’t see the ‘if’,” he added.

Whatever the variant may be, Bathuwanthuduwa, people should continue to follow health guidelines and avoid infection.

Bathuwanthuduwa’s position on a possible fourth wave as a government official contradicts that of the Sri Lanka Medical Association (SLMA), who warned on Tuesday (20) that a fourth wave may, in fact, be on the cards.

SLMA President Dr Padma Gunaratne told reporters on Wednesday (21) that given the increasing number of patients in the national hospital and other COVID-19 treatment centres, Sri Lanka appears to be losing any gains made during the May-June lockdown.

“It’s important that people are aware of the situation, if people carry the myth that the vaccine [alone] will protect us,” she said.

Noting that vaccination is the most important response to the pandemic, Gunaratne said it may not provide adequate protection over the next two months.

“Only about eight percent in Sri Lanka have received both doses of a vaccine. Even if you’re vaccinated, it takes about six weeks to develop immunity,” she said.

Gunaratne said there are instances of vaccinated people contracting the disease as it does not provide 100 percent protection.

“High-risk people should take precautions so they don’t become victims of the fourth wave that has yet to come,” she said.

Gunaratne called for increased capacity in state hospitals and a system to manage asymptomatic patients at home.

With 3,218 deaths and 187,076 cases in the span of just three months, the third wave has been devastating to say the least. Uuntil its arrival, Sri Lanka’s COVID-19 death toll stood at 609.

Dr Bathuwanthuduwa said about 80 percent of Sri Lanka’s COVID-19 deaths were of patients with comorbidities such as heart condition, kidney transplant, cancer, and diabetes.

Comorbodities weaken the immune system and when a patient is at an old age, immune system does not operates on an optimum level, he said.

“That is why more deaths occur in old age categories. Young adults or children don’t die owing to a strong immune system,” he said.

There were 10 deaths of children at the Lady Ridgeway Children’s Hospital in Colombo due to COVID-19. According to Bathuwanthuduwa, those children too had suffered from comorbidities.

Some COVID-19 deaths have occurred due to delayed medical treatment, he said.

“These people had neglected the symptoms and upon being severely ill they come to the hospitals and death occurs on admission or within 24 hours,” he said.

With 930 being discharged on July 21, the number of recovered patients in Sri Lanka has increased to 263,757.

“We have a fatality rate of 1.35 percent compare to other countries and have a recovery rate of 91.43 percent,” said Bathuwanthuduwa.

“People should seek hospital treatment as soon as possible, because they can recover from this virus,” he added.

Meanwhile, the World Health Organisation (WHO)’s weekly report on COVID-19 said, globally, cases of the Alpha variant have been reported in 180 countries, territories or areas, while 130 countries have reported cases of the Beta variant; 78 countries have reported cases of the Gamma variant; and 124 countries have reported cases of the Delta variant.

“Growing evidence supports the increased transmissibility of the Delta variant as compared to non-VOCs. However, the exact mechanism for the increase in transmissibility remains unclear. A recent study from China during an outbreak of the Delta variant examined the time interval from the exposure of a quarantined population to the first positive PCR result and found that the interval may be shorter for the Delta variant when compared to non-VOCs [4 (IQR 3.00-5.00) days compared to 6 (IQR 5.00 to 8.00) days, respectively],” WHO said.

“Moreover, the viral load of the first positive test of Delta infection was over 1200 times higher than non-VOCs, suggesting that this VOC may be able to replicate faster and be more infectious during the early stages of infection”.

WHO said, a study from Canada analysing data from over 200 000 COVID-19 cases showed an increase in virulence of the Delta variant when compared to non-VOCs. Among the COVID-19 cases, the risk of hospitalization, ICU admission and death associated with the Delta variant compared to non-VOCs increased by 120 percent (93-153percent), 287 percent (198-399percent) and 137 percent (50-230percent), respectively. Increased disease severity was also identified for Alpha, Beta and Gamma variants combined when compared to non-VOCs: 59percent (49-69percent) for hospitalization, 105percent (82-134percent) for ICU admission and 61percent (40-87percent) for death. (Colombo/Jul 22/2021)


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