Can the Spread of Virus be Contained?
By Sumanasiri Liyanage
President Gotabhaya Rajapaksa recently opined that only vaccination can successfully control the spread of COVID-19 pandemic. The same view was reiterated by the Minister of Health, Pavithra Wanniarachchi recently in Parliament. Sri Lanka has a long and unblemished record of universal vaccination and such programmes almost eliminated the spread of certain diseases. In spite of the fact that vaccinations developed so far in the USA, Russia, the UK and China have no 100 per cent guarantee of completely stopping the spread of the disease and that vaccinations seem not to be available to Sri Lanka in adequate quantity in the near future, there is no doubt that the vaccination of people will provide, as the President says, the best bet to contain and control the pandemic.
According to General Shavendra Silva, some kind of anti-COVID-19 vaccination may be expected to be given to every Sri Lankan by the end of 2021. Hence, vaccination will not be an answer in the short run. In such a backdrop, the containment of COVID-19 depends almost entirely on three factors, namely, (1) the capacity of the public health service and associated institutions; (2) the macro-, meso-, and micro- level policies of the Government; and (3) the behavioural pattern of the general public. The experience of a few countries that have been successful in containing the pandemic has demonstrated clearly that the workings of these three factors in synergy is critical. Having taken the degree of vaccination as a separate factor although it is dependent on the policies of the Government we may write the containment of the spread of pandemic is a function of the capacity of the public health service and associated institutions; the macro-, meso-, and micro- level policies of the Government; the behavioural pattern of the general public and the degree of vaccination.
The First Wave
We blew our own trumpet with some justification that we were able to control the pandemic in its first wave. Sri Lanka was among first ten countries together with New Zealand, Taiwan, South Korea and Vietnam. Sri Lanka has a good State-owned public health system that includes medical doctors, nurses and good supporting staff, medical technical service, MRI and faculties of medicine in the university system, public health inspectors and midwives. It has been able to almost eliminate or control certain diseases like malaria and polio. When the first COVID-19 infected Sri Lankan was identified, the entire health system was put on alert. Even while not deploying its full capacity, the system was able to contain the spread of COVID-19. The security forces, one of the most efficient mechanisms in country, gave its support to health authorities. The policies of the Government were in congruence with the decisions of the health authorities. Above all, the way in which the general public responded was a contributory factor in containing the spread of the virus. This positive public response may be attributed either to fear or to proper understanding of the nature of the new virus. As a necessary corollary of these three factors, the spread of virus was kept within the capacity of the health system.
The successful handling of the pandemic in the first wave led to three unfortunate developments that had adverse ramifications. First, Government politicians wanted to get the political capital out of this successful operation. As a result, they were not able to realise that the success was primarily due to the non-intervention of politicians in the process, notwithstanding the fact that operation was conducted under the administrative arm of the Health Ministry. Hence the politicisation of the pandemic containment. Secondly, it appeared that the successful handling of the pandemic’s first wave led to complacence of all the stakeholders including the general public. The eruption of a new cluster leading to a second wave had happened in an internationally well-known garment factory. It was a clear evidence that the health of the employees had been totally neglected by the management of the factory in spite of continuous complaints. Thirdly, the success or failure of an operation depends on the mechanisms, strategies and tactics deployed in the process of operation. It appeared that the capable leadership of Dr Anil Jasinghe was critical for the success during the first wave. His calm and quite but firm approach gave the insight that the parties should follow. However, as part of the politicisaton process, he was removed from the post with a golden handshake. In addition, some changes were introduced at Medical Research Institute. All these changes of personnel adversely affected in the second and the third wave. The recent incident in Piliyandala has shown that the decisions of the health officers were put in the back burner due to requests by local politicians.
Current Situation in Sri Lanka
Prof Suneth Agampodi of the Rajarata University has graphically portrayed the present COVID-19 situation in Sri Lanka. We can no longer boast about the way in which we dealt with COVID-19 after the eruption of the second wave in Minuwangoda. It would be pertinent to reproduce two diagrams produced by Prof Agampodi. In the first diagram he compared the Sri Lankan situation with that of India with reference to effective reproduction rate of COVID-19.
Figure 2 shows hypothetical situations in relation to the capacity of the Sri Lankan health system that was shown by a dotted straight line. It is imperative to stay below that line. Red hill shows the present situation in Sri Lanka while the blue hill shows the hypothetical situation if Sri Lanka took necessary steps proposed by larger section of the health system including their trade unions.
When Sri Lanka was able to flatten the curve at the end of the first wave, it was clear that it was still a world phenomenon. The situation in many developed countries was grim. It had been spreading fast in some developing countries. In such a context, it was not so difficult to predict sudden eruption. Hence it is imperative to think of the capacity of the health system as a straight line parallel to the x axis but an ascending line indicating a gradual increase of capacity to meet any contingencies especially in a situation the private health system is totally redundant in a health hazard of this sort.
The excuse always given by the Government may not be rejected easily. The steps taken to contain the spread of the pandemic invariably affect the economy adversely. Hence one may argue that if the economy is declining, the Government would encounter a resource problem that in turn would have undesirable mark on the capacity of the health system. Of course, the economy has to be improved. The issue is which sectors should be prioritised? It seems that the Government shared an incorrect view on this matter.