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Surveillance mechanism continuously strengthened: Dr. Jayaruwan Bandara

08 Nov 2020

  • People have to take responsibility over their health 
  • Section of stakeholders failed to adhere to guidelines  
  • Inquiries ongoing over institutional heads failing with preventive measures
[caption id="attachment_100882" align="alignleft" width="270"] Ministry of Health Media Spokesperson Dr. Jayawuan Bandara[/caption] By Sarah Hannan The number of Covid-19 cases and the deaths that were a result of complications caused by the virus, spiked over the month of October and seemed to escalate the world over. Meanwhile, Sri Lanka too is witnessing more clusters/subclusters over the past few days following the second wave that originated in early October.  As the vaccination for the virus is yet to reach countries that have to wait for donor countries to purchase the vaccinations on their behalf, Sri Lanka too will have to wait on its donor. During such time, the health authorities, Government, and experts in the fields of virology and epidemiology are suggesting that the public should learn to live with the virus whilst exercising caution when going about their daily routines.  Ministry of Health Spokesperson Dr. Jayaruwan Bandara joined in conversation with The Sunday Morning to respond to our queries over the present situation and the level of preparedness on part of the healthcare authorities in handling the mounting caseloads this time.  Excerpt below: 

The re-emergence of Covid-19 escalated at a fast pace. Were the authorities caught off guard this time? 

We were not caught off guard, but were in the process of strengthening the health system to continuously adapt to the challenges that were posed by this pandemic. Since the pandemic was declared, we were heeding the instructions issued by the World Health Organisation (WHO), and our healthcare system too was adjusting to the rising healthcare needs that were presented since the first patient was recorded in Sri Lanka.  By now, we have understood that this virus is not going to go away in a matter of weeks or months and therefore, we have taken measures to deal with this on-the-go. It is apparent that now, not only Sri Lanka but the entire world will have to adapt and live with the virus for years to come, until a vaccination is made available.  Unfortunately, the news of a successful vaccination has not been made public. There are close to 100 types of vaccines that are being developed, but these vaccinations will have to go through clinical trials and improvements before being made available to the population at large. 

What were the monitoring mechanisms that the health authorities had in place after the country opened up after the lockdown earlier this year? 

A community surveillance mechanism by the Ministry of Health’s Epidemiology Unit was always in place, which is why we were able to respond promptly when the clusters started in early October. There were parameters in place, such as the requirement to report on patients who were admitted to hospitals with respiratory disease symptoms, and, if the clinician suspects that the patient was infected with Covid-19, they were to further investigate the patient’s health records and conduct a preliminary stage contact tracing by asking further questions.  A circular was also sent to the Medical Officers of Health (MOHs) across the country requesting them to obtain 10 nasopharyngeal swab samples from the patients who were being admitted and who showed Covid-19-related symptoms, at the main hospitals in their area and to submit the same to the Epidemiology Unit and the Medical Research Institute (MRI) for PCR testing and surveillance purposes.  For instance, when we detected the first patient of the second wave, we had to conduct several samplings to confirm the virulence of the present strain. At least three rounds of testing were conducted at the MRI, during which it was confirmed that the viral load was high and that the behaviour of the strain was more aggressive than the one that was present in the period from March-May. Even the symptoms that were displayed by the patient were a little different from the previous symptoms that were communicated.  It was the surveillance mechanism that we had in place that assisted us in taking prompt action, thereby helping us take control of the second wave that we are still experiencing. 

Was there a lapse in the surveillance mechanisms in the past few months which resulted in the re-emergence of Covid-19? 

I don’t agree that we had a lapse in the surveillance mechanism which resulted in the re-emergence of Covid-19; rather the failure of a section of stakeholders in upholding the responsibility of adhering to the guidelines that were issued by the Ministry of Health, led to the re-emergence.  Had the guidelines and circulars that we continuously issued and painstakingly collated been followed, the impact that we are facing at present could have been far less. It was visible that certain institutions – both state and private – failed to implement and adhere to the guidelines in the past four months, and that led to the present situation.  There were units appointed to supervise as to whether the guidelines were followed, and these units were directed by the MOHs and PHIs (public health inspectors) and were overseen by the Epidemiology Unit of the Ministry of Health. These officials work as a network in which there is continuous communication, which helps in maintaining the surveillance mechanism.  This team works like an army where the chain of command finally reports to the Chief Epidemiologist, who is then responsible for reporting all the surveillance findings to the Director General of Health Services.  Moreover, all steps were communicated through circulars and were readily available on the Ministry of Health website for public access, and were also communicated through various media channels; also on how the health authorities are containing the spread of the virus; and if the public was aware of any mishandlings, they were encouraged to report such incidents to their MOHs or area PHIs.  Part of the responsibility also lies with institutional heads, and there are ongoing inquiries over these institutional heads who failed to implement the necessary preventive measures and skipped on timely reports to the surveillance teams on possible outbreaks in their administrative regions.  A separate inquiry is being conducted on the delay in the respective MOH failing to report the record number of flu patients reported from the Minuwangoda area where the second wave originated as well.  There are weak links in the mechanism and we are working on strengthening them at present, to ensure that we have a robust surveillance mechanism in place.

When the public seemed to let their guard down and started to disregard the health regulations, why didn't the health authorities step in and take stern action against violators? 

Actually, when we talk about the responsible way of behaviour, that sense of responsibility towards one’s own health should come from within. This is why, rather than enforcing laws over the public, we decided to first issue guidelines and improve awareness among the public before resorting to strict regulations and law enforcement as stipulated in the Quarantine (and Prevention of Diseases) Act.  We placed our trust in the people at the time and presumed that educating them and continuously asking them to follow the guidelines would instil in them good healthcare habits and thereby prevent the virus from spreading.  If you take Singapore for example, from day one, they imposed strict laws. For instance, there was an incident where a couple was fined for not wearing masks when they were outdoors – the fine amounted to Rs. 1.4 million in local currency.  Imposing laws in Sri Lanka is not practical, as not many will have the ability to pay such a steep fine; in fact, some even struggle to purchase face masks.  This is why even the issuance of the gazette notification imposing the penalties against the people was delayed. But finally, Health Minister Pavithra Wanniarachchi decided that the maximum fine for not wearing a mask when in public should be limited to Rs. 10,000.  Again, I would reiterate that there are practical difficulties that the people face on a day-to-day basis, and people will not be able to pay such a fine if they are booked. People need to remember that Covid-19 does not kill more people than other diseases, if we are to look at the past 10-month history. Even if you take the world, in certain countries where there is a larger ageing population, the number of deaths are very high. Immunity and other factors also matter.  But I would like to remind people that we need to continuously adopt safety etiquettes and practise the good health habits that have been communicated in the wake of this present pandemic.  People should be forthcoming about their illness rather than trying to conceal it; the surveillance teams and the Covid-19 taskforce have started to roundup infected persons who are escaping the quarantine facilities and not giving proper information about their travel histories.  A law should not be enforced to keep the people’s behaviour in check, as they should by now have come to the realisation that if they are not taking the necessary precautions, they will get infected with the virus. Once infected and if your immunity is not good, it could cost you your life. 

With the number of Covid-19-positive cases seeing a drastic increase, does the country's health sector have sufficient medical equipment to treat the patients? 

From the outset of the pandemic, we have been suggesting that it is advisable to have fully automated lab equipment to conduct PCR tests. We are still managing in most labs with manual or semi-automated work benches, which is causing delays in issuing the reports as well.  We have now employed our maximum workforce to conduct these diagnostics and in the past four days, we conducted diagnostics on over 12,000 samples, which is our maximum capacity.  If the process is automated, the results can be issued faster and in a more efficient manner, thereby reducing the risk of exposing Covid-19-positive patients to more people, and referring them for medical attention or isolation immediately. 

Have the health authorities managed to fulfil all its medical requirements – from ICU and hospital beds to PCR test machines and test kits – to address the current situation in the country? 

We provided approval for the implementation of a PCR laboratory at the Colombo General Hospital three months ago and we also collaborated with Gateway International School Colombo in donating a PCR machine. Meanwhile, several regional and rural hospitals too are being upgraded and refurbished to ensure that there are sufficient beds and treatment facilities in every MOH region of the country. We are also once again using the facilities that are available in universities to conduct diagnostics, as there is a record number of samples getting collected.  Meanwhile, the Medical Supplies Division (MSD) will receive rapid antigen test kits, which they will release to all hospitals from Monday (tomorrow) onwards.   

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