Public complacency will worsen situation: Dr. Sudarshini Fernandopulle

By Sarah Hannan 

Renewed fears and speculation of countrywide lockdowns have raised concerns among the public once again, after the detection of the highly virulent UK Lineage B.1.1.7 variant of Covid-19 within the country.

Meanwhile, with the rollout of the Covid-19 vaccine programme last week, the rest of the country is eager to get inoculated.

This week, The Sunday Morning took these concerns to State Minister for Primary Health Services, Epidemic Control, and Covid-19 Prevention Dr. Sudarshini Fernandopulle, to seek clarity on the present situation, and what the future outlook would be as we continue to live with the pandemic.  

Following are excerpts of the interview: 

With the new Covid-19 variant being detected, are we going to follow any additional health guidelines to prevent the spread?

All the samples that were sequenced and detected came from quarantine centres, and there are no reports of the UK Lineage B.1.1.7 variant in the community. Therefore, we will not place any additional health guidelines. However, I wish to remind the public to once again adhere to the Covid-19 preventive health guidelines that were in place since last year.

Lately, people have fallen back on these practices and have become complacent. When you are in a public space, wear your mask to cover your nose and your mouth, and do not remove it to speak to the person next to you; wash or sanitise your hands frequently when you enter and exit buildings or vehicles; maintain physical distancing when in a crowded area; reduce unnecessary travel and gatherings, and when using public transport, wait for a bus that would have adequate seating capacity; if you have any symptoms, immediately consult a doctor or if you have chronic respiratory illnesses; and limit exposure by staying indoors. 

What is the status of further studies on the existing variants that are in circulation?

We are continuing studies and have also commenced contact tracing for persons that contracted the B.1.1.7 variant, to determine whether it was imported or whether the variant surfaced within the country itself. Further studies of other variants in circulation too are taking place at present. 

Some of the expert committee members are now making statements indicating that they have already given clearance to go ahead with burials for Covid-19 related deaths. Why is there a delay in adopting this?

Allowing burials to take place for Covid-19-related deaths was included in the recommendations. However, the final decision was to continue with cremations, as it was decided by the Director General of Health Services, and explicitly stated by the Minister of Health in Parliament. 

Recently, the acting Health Minister had given the directive to carry out Covid-19-related death rites within 24 hours. However, there are occasions where the families have to wait nearly two days to have the body released from the morgue due to the delay in getting the PCR test results. How will this be expedited?

I am aware of the delays that are taking place in certain hospitals in releasing the corpses from the morgues. The Judiciary Medical Officer and the Medical Officer of Health should actually take a call on these matters to reduce the time taken to release the bodies. For instance, the earlier protocol was that the Grama Niladhari was given the authority to issue a letter on whether or not a PCR test was required to be carried out on the dead person for Covid-19.  

If a family member had contracted Covid-19, had recovered recently and returned, and then the death took place, there is a necessity to do a PCR test on the dead person. The other instance is if the area is considered to be a high-risk zone where a large number of Covid-19 cases were detected. This delay can be easily avoided if these steps are followed.  

What do you have to say about patients that are treated in the hospitals for a longer period of time and eventually succumb to their illnesses, but their PCR test is done only after death? Should this even happen, given that there is a virus circulating?

Given the present situation, this should not take place. They should be testing the patient for Covid-19 when they are admitted to the hospital, then only if the patient has been in hospital for too long, should they be running PCR tests when they are pronounced dead. 

There are also several bodies of Covid-19-positive persons that are held at morgues, with the Kandy National Hospital revealing there were 14 such bodies still held in the morgue. What could be the reason for this?

Covid-19 bodies are disposed of for cremation only after the family has signed the release papers. If there are any unclaimed Covid-19 corpses at the morgues, we will wait a month and then dispose of them accordingly. 

There is a shortage of equipment such as ECMO machines in the country required for Covid-19 critical care. Has the Government looked at bringing these machines down?  

The ECMO machine was only required in one instance so far – to treat the demised Dr. Gayan Danthanarayana. It is a machine that is used to treat infants, and should the need arise to treat an increasing number of Covid-19 pneumonia-stage patients, the Government will consider making purchases. 

Are we looking at setting up necessary treatment facilities for Covid-19 long haul patients if required?

The necessity for such a treatment centre in Sri Lanka has not yet been determined, as we still have not received any reports of Covid-19 long haul patients that are showing symptoms beyond the standard treatment period, which is 14-21 days. 

However, if the need arises, and if there are persons with prolonged symptoms of the virus, they are required to keep the nearest hospital informed, and are required to seek further treatment for their symptoms. 

Given that there is a hold-up in bringing down the Sinopharma and Sputnik V vaccines due to the delay in the clinical trial reports and the authorisation by the World Health Organisation (WHO) for wider usage, how long will it take to bring down the next batch of vaccines to Sri Lanka? 

The National Medicine Regulatory Authority informed that the dossiers submitted to register the Sinopharma and Sputnik V vaccines were incomplete at the review stage. The institutes have been informed to resubmit them with the completed documentations.  

We have placed an order for vaccines under Covishield once again, which are scheduled to arrive in the next two weeks. 

There was an issue over the mismanagement of vaccine doses, which was brought up last week. What measures are in place to ensure no wastage takes place?  

It was not actually a case of mismanagement, but an observation that was shared by the nursing staff. A vial holds 6 ml of the vaccine, and if they are careful enough, they should be able to draw 11 shots from the vial. We have instruments that allow us to draw the exact amount of solution without wastage. 

The public are eager to know as to how and when they would be given access to the vaccine. When will the other provinces get the vaccine?  

Our initial timeline to commence vaccination was in the beginning of March; however, the vaccines arrived earlier and we have already commenced the rollout. We prioritised the frontline workers from both the state and private sectors, which was then followed by the rest on the priority list.  

The decision was taken to roll out the vaccine first to the Western Province, as there is a high number of cases reported in the area, and we want to arrest that situation by vaccinating the people in this Province first. In due course, the rest of the country will receive their vaccinations, and as soon as the vaccines are available, the area MOH will inform the people. 

So far, 16 centres are issuing vaccines for the people from the Western Province. Once the vaccine drive rolls out to the entire country, we will have 4,000 centres that will be issuing the vaccination, with the target of inoculating up to 600,000 persons per day at maximum capacity throughout the country.

We have ordered 18 million vaccine doses to inoculate nine million of the population in the first phase. 

Private hospital frontline staff said that some of the institutions have denied access to the vaccine doses that were issued. Is there such an issue? 

The vaccines were issued to be given for free to all consultants, doctors, nurses, support staff, and even minor staff. If any of the staff affiliated to private hospitals are being denied access to the vaccination, they can contact our Ministry with all the details, so we could look at conducting an inquiry through the Director General of Health Services. 

What steps will you take to ensure that the vaccines, which are issued for free at the moment, will not get stockpiled to be sold to persons willing to pay for them?  

The general public should be aware that at the moment, the vaccines are issued for free to everyone. We will strictly monitor this, and it is our firm decision that the vaccine will not be sold to anyone. The vaccines that we issued to the private hospitals were to be administered to their medical, support, and minor staff free of charge as well.  

Should there be any incidents where the public or the staff is asked to pay for the Covid-19 vaccine, we request the public to notify us immediately, and inquiries will be conducted to ensure such incidents would be prevented. 

Can we expect a timeframe as to when the country would return to normal? 

It all depends on the public being responsible. What they should understand is that even after getting inoculated, they can still contract the virus and they can still spread the virus to others that are not inoculated.

Therefore, we will have to continue to follow the health guidelines and prevent Covid-19 from spreading. Wearing masks, sanitising/washing hands, maintaining physical distance when in crowded areas, and adhering to respiratory etiquette should by now be routinely done by everyone.

Complacency will only make this situation worse, therefore act responsibly.