05th May, 2021
Sri Lanka is facing an unprecedented rise in the number of cases, with the highly infectious B.1.1.7 strain spreading rapidly across the country. The lack of concerted and urgent efforts to contain the virus will result in overburdening the health system, an increased risk for healthcare workers and an increased number of deaths. Sri Lanka is recording the highest number of daily cases reported each day with 1860 cases reported on May 4th, 2021. The number of active cases have more than doubled since November 2020.The absence of immediate proactive measures will endanger the health and well-being of the citizens of Sri Lanka, while causing damage to our livelihoods and economy. A failure to act decisively now will cost Sri Lankan lives.
Therefore, as citizens of Sri Lanka, we call on the Government of Sri Lanka to implement better border control, increase testing both within the country and at ports of entry, and implement proactive, effective measures to control the COVID-19 pandemic that is tearing through the country in full force. Professionals and scientists in the fields of public health and epidemiology have repeatedly warned about variants of concern of SARS-CoV2 being detected, and called for better public health measures from the Government to control its spread. Among these, have been calls for increased testing, active tracing and discouraging opening of the borders for tourism purposes.
The Government has not taken heed of these warnings, and instead created haphazard ‘Travel Bubbles’ with high risk countries, most recently with India, where current reports indicate an average of over 390,000 people test positive daily, and 20 million people having been infected to date. Whilst we feel deeply for the pain and suffering our Indian neighbours are enduring, the Government of Sri Lanka must prioritise the health and wellbeing of its own people, rather than gamble on short-sighted and counter-productive initiatives such as promoting tourism from high risk countries.
While we welcome the recent public health measures from the government and the post New Year press conference on COVID-19, government efforts evidently remain inadequate to address the current situation. Ineffective border control measures, and increasing capacity challenges to manage testing at ports of entry and within the country, puts the country at increased risk, with limited infrastructure capacity to manage a surge in COVID-19 cases. We are already experiencing infrastructure capacity challenges in Sri Lanka’s healthcare system, which will only worsen as the number of cases increase, posing a very real threat of a healthcare system collapse.
Therefore, while public responsibility and collaboration is vital to combat COVID-19, without effective, proactive, clear public health measures, we are risking the importing of COVID-19 variants, and allowing it to spread unmitigated within Sri Lanka. Currently, government measures have largely been reactive measures with incoherent policies that led to a decrease in testing, and the relaxing of COVID-19 restrictions during the New Year season. The responsibility of learning from past mistakes and providing better public health measures to minimize the importing of COVID-19 variants, and reducing the spread of COVID-19 virus, lies with the government.
Therefore, we call on the government to:
1) Immediately halt tourism activities to limit the cross border spread of COVID-19 into Sri Lanka, by temporarily closing the border for tourism related activities, and shutting down the ‘Tourist Travel Bubbles’, which continue to endanger the lives of Sri Lankans, while running the risk of overburdening our limited healthcare services and resources. Even one patient with a novel strain, and one leak can cause irreparable damage, as we have seen in Sri Lanka and in other countries. This should not however impede the return of Sri Lankan workers and others (including diaspora), wanting to return home, and the government has a responsibility to prioritize and provide proper quarantine measures to returning citizens. Prioritising the wellbeing of the people over that of the economy, was proven by countries such as Vietnam, which has been quite successful in facing this crisis, while having a comparable economy to Sri Lanka.
2) Establish transparent and accountable mechanisms to consult with relevant local and international experts, and implement COVID-19 prevention measures on the basis of their recommendations. Data, analysis and rationales that inform these measures must be placed in the public domain and reported on.
3) Increase island-wide testing for COVID-19 infections and provide resources for citizens to get tested free of charge. Low testing yielding a low number of positive cases, in the past has given people a false sense of security, and could result in people being less inclined to follow health and safety guidelines, contributing to an escalation in positive cases. Currently, options for on-demand COVID-19 testing in private hospitals are unaffordable for the majority of the public.
4) Provide public health measures and improve communication focused on attaining zero-COVID target, with a medium to long term phased plan that is proactive and clearly communicated to the public, including on the current three-tier system, and explaining the revisions made to the system. Current public health measures are largely reactive and have led to confusion and misinformation due to the ad-hoc nature of the measures and lack of communication. A clear, long term, phased public health measure plan, integrating restrictions of public gatherings, mobility, work-place and public transport guidance, that is clearly communicated with frequent periodic reminders, is required to effectively minimize COVID-19 infection spread. Improve public health messaging in relation to stigma, following guidance, impact of variants and increase the visibility of credible independent public health experts to minimize misinformation and counter non-credible sources. This is achievable, as best practices from other countries with similar economic, cultural settings indicate (e.g. Vietnam).
5) Hold at least bi-weekly press conferences that include government officials from the public health sector, including public health inspectors, operations leaders from the Department of Health, military operations leaders who handle logistics and other operations, scientists who are analyzing the current COVID-19 situation in Sri Lanka, and other relevant stakeholders. Consistent, detailed and coherent communication from the government on the pandemic response is vital to re-establishing public confidence and compliance with public health measures.
6) Ensure that the enforcement of COVID-19 measures (and penalties for violations of COVID-19 guidelines), are applied equitably; without discrimination against those who are disadvantaged or marginalised, and without preferential treatment for those with influence or status. Government ministers, officials and their associates must be seen to abide by the regulations at all times, and not to violate COVID-19 guidelines. Failure to do this in the past has significantly contributed to mixed messages and seriously undermined public confidence in the pandemic response.
7) Provide and implement a transparent and clear vaccination plan, with priority groups clearly delineated on the basis of the established principles of a) minimizing death and serious disease (of high risk groups), b) preserving functioning of society, c) reducing the extra burden COVID-19 has on people already facing disparities, and the general public to be notified of this plan via multiple channels such as, online platforms, mainstream media, SMS, local announcements and public posters. As we have currently vaccinated most of our healthcare workers, priority should be given to the most vulnerable in our population in terms of age and relevant underlying health conditions, and those whose living and working conditions place them at greatest risk. This could include frontline service providers with high public interaction levels (for example in sectors like public transport, law enforcement, retail, and cleaning), workers who are required to work in close proximity to each other, or live in shared accommodation, and people residing in, or detained in facilities such as care homes or prisons.
8) Improve and provide transparent avenues for supporting the most economically vulnerable groups in Sri Lanka. The pandemic has impacted the lower income quintiles of the country the most. Therefore, the government should act to raise funds and dedicate funding to support the most vulnerable and provide transparent avenues to gain such support without political exploitation or interference. Improving welfare programmes and distribution mechanisms to ensure that resilience and recovery of all communities to and from the COVID-19 crisis is equitable.
9) Allow the COVID-19 response to be led by healthcare professionals with an established point of contact for media from the department of health. While the military can provide logistical and human resource support, as this is a public health security challenge, we need a more visible and empowered leadership role from the public health sector of Sri Lanka. The actions of the military and law enforcement must be guided by the public health leadership.
The nine evidence-based action points listed above are necessary for us to face the threat of this pandemic, avoid the collapse of the health system in Sri Lanka, and keep the public safe and secure. At this point, the government should prioritize the health and well-being of its citizens above all else. Failure to take immediate meaningful action will result in the unnecessary loss of lives, lasting damage to our healthcare system, and dire consequences for the country overall. This is not a legacy that any Government of Sri Lanka would wish for, nor one that its citizens should have to bear.