Are we ready for another bout of Covid?

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With festering wounds inflicted by an economy struggling to get back on its knees, Sri Lanka is on the edge of being overwhelmed by a bitter dose of infectious diseases. 

The number of dengue cases has topped 46,400 with over 35 deaths in 30 weeks. But a more formidable foe has been fortifying itself on the sidelines in the form of the coronavirus which reached three digit numbers and claimed a comparatively higher number of victims this week when the number of Covid cases mounted to 108 and the deaths toll to seven on one single day. 

Covid comeback

Till about late June, the cases of Covid were inconsequential despite the large numbers being recorded in the outside world. Several countries including China have reported a large number of Covid cases infected with the particular subvariant of omicron.  The cases being detected in the island too have been increasing since of late.

Rolling out the second booster 

The country rolled out its second booster dose in May 2022. However, with the collapse of the economy and the unstable political situation, majority Sri Lankans had too many burdens on their minds to pay close attention to any possibilities of a Covid outbreak as well. 

But repeated calls have been made since June this year for the public to take the second booster dose of the Pfizer-BioNTech vaccine against the viral infection. The Director General Health Services (DGHS), amidst serious criticism, extended the vaccines shelf life (date of expiry) from 31 July 2022 to 31 October 2022 while urging the public to obtain the second booster shot in order to prevent an outbreak of the Covid pandemic. 

As of 3 August 2022, a total 43,536 had taken the second booster dose of the Covid vaccine. 

Disease surveillance

With a noticeable drop in disease surveillance, currently patients who come to hospital with Covid-like disease symptoms are tested for the infection. “However, during the past two years, the health service and the Health Ministry have taken great pains to hound the patients and thier contacts to  control  and prevent disease spread».

Concerns have been raised with regard to monitoring the current situation of the infection with the closure of the Covid Operations Room on 16 June 2022. In addition other monitoring stations like the Covid Prevention Action  Committee (CPAC)  were disbanded owing to conflicts of interests amongst certain sections in the Health Ministry.  

Therefore, Medical Offices of Health (MOHs)  have been tasked with a large portion of the burden. Sources revealed large scale outbreaks of the  Covid infection in a section of the Colombo Port as well as at one of the island’s foremost power plants should be added to the current numbers of Covid cases being recorded. With meagre surveillance the possibility of there being a greater number of patients with the infection was even higher, sources noted. 

Serious Concerns 

Doctors have voiced serious concern as to whether Sri Lanka can afford to go into another lockdown, should there be a fifth Covid-19 wave.

The Government Medical Officers’ Association (GMOA), warned that Sri Lanka would not be able to face another lockdown if the Covid-19 situation spiralled out of control with the present economic crisis. There was also a question as to whether the health service too would be able to bear the strain in such an event.

“Health services would also be affected by the coronavirus. Therefore, there is a serious question as to how far the health service would be able to sustain the weight of a disease burden,” the Media Committee Member of the GMOA, Dr. Chamil Wijesinghe cautioned.   The Union member called for the Health Ministry to create public awareness with regard to the real situation of Covid-19 in the country.

He said there had been a question as to whether the citizens had been aware of the coronavirus situation in Sri Lanka during the four waves of the infection experienced during the past two years.

“There were large-scale discussions, speculations and accusations regarding data collection, statistics of the number of infected patients, and the daily deaths. If the public had been aware of the real situation in the country, they may have been more careful about maintaining good health practices.”

The Health Ministry should take action at least now to communicate the true situation with regard to the infection to gain public support in controlling it.

Dr. Wijesinghe said measures should also be taken to get the required technical support needed to control and prevent a disease spread. Specialist advice should be sought from those in the related field. Advice should be called from persons in epidemiology, disease control, with regard to the coronavirus infection. “Necessary policy and technical decisions should be taken through a specific consultative process and implemented as soon as possible,” Dr. Wijesinghe said appealing to the public to do their bit in preventing a virus speared by taking the first and second booster doses. 

Lurking in the background

Amidst the chaotic situation, looming over  the country is yet another disease threat in the form of Monkeypox. India confirmed its first death caused by monkeypox in the southern state of Kerala. A 22-year-old, who had recently travelled to the State from the United Arab Emirates, died on Saturday (29 July).  According to foreign media reports since January 2022, cases of monkeypox have been reported to WHO from 85 Member States across all six World Health Organisation (WHO) regions. As of 3 August 2022,  a total of 25,054 laboratory confirmed cases and 122 probable cases, including 11 deaths, had been reported to the WHO. Since 13 May 2022, a high proportion of these cases have been reported from countries without previously documented monkeypox transmission. 

“WHO assesses the global risk as Moderate. Regionally, WHO assesses the risk in the European Region as High and as Moderate in the African Region, Region of the Americas, Eastern Mediterranean Region and the South-East Asia Region. The risk in the Western Pacific Region is assessed as Low-Moderate,” the foreign media recorded. 

Is it a Sexually Transmitted Disease?

The outbreak  largely develops in men who have sex with men; defined as homosexual or bisexual males in reporting forms) networks. However sexual orientation does not necessarily reflect who the case has had recent sexual history with nor does it imply sexual activity. Generally, severity has been low, with few reported hospitalisations and deaths.

Historically, the sexual component of transmission in the countries above has been thought to contribute less to human to human transmission of monkeypox than has been observed in the ongoing global outbreak. It should also be noted that there is limited testing capacity for monkeypox in many of these countries, which has led to under-ascertainment of monkeypox cases. 

 According to medical sources, sexually transmitted diseases (STDs)  are  spread through sexual contact,  oral, vaginal, or anal. 

“But monkeypox is transmitted through  skin-to-skin contact,  one  can get monkeypox from someone without having sex with them by merely using the towel that has been used by an infected person,” they noted. 

Does Sri Lanka have adequate surveillance? 

Medical sources said the  WHO was yet to issue instructions on how surveillance work should be carried out on the disease. Although monkeypox is a serious public health concern, there have been no established surveillance methods to monitor the situation. 

Vulnerable as Sri Lanka is owing to her close proximity to India and the number of people travelling to India and returning from that country, the existing disease surveillance systems set up at the ports of entry would enable the monitoring of a carrier of the infection entering the country.  Even foreign delegates arriving on resident visas are tested for tuberculosis, Human Immunodeficiency virus (HIV) and mosquito-borne diseases like filaria and malaria. 

Also, unlike Covid-19, the rash-like blisters that appear on the skin, makes it difficult to hide the infection, they noted.  

But the question that needs to be looked into is whether Sri Lanka could handle such a disease burden. With the shortages in medicinal drugs, the fuel crisis (which is still satisfactorily unsettled), may have to rely on the health services and the security forces to administer the vaccine against smallpox or the monkeypox vaccine in addition to the first and second booster doses against Covid-19.

By Dilanthi Jayamanne