The ‘third wave’ of the COVID-19 pandemic remains a threat to Sri Lanka this week as the number of infections continues to rise exponentially, even as the Government enacted a series of measures to avoid a catastrophe of epic proportions such as the tragedy presently unfolding in neighbouring India.

At the time of writing, over 1,900 infections were being recorded in a single day and all indications are that the daily number of infections would surpass 2,000 for the first time shortly. The total of number of persons infected in Sri Lanka now stands at 114,000 with 709 persons succumbing to the virus.

This time last year, Sri Lanka was in a strict lockdown. That was after the first Coronavirus infection was detected in March last year. That lockdown helped curb the spread of infections spectacularly and the country was hailed as a model of managing the pandemic with limited resources.

The lockdown measures which were in place until late last year kept Sri Lankans safe from the coronavirus while countries with more advanced health systems such as the United Kingdom and the United States suffered thousands of deaths. However, it damaged the nation’s economy considerably.

More developed countries which enforced long term lockdowns were able to sustain their populations through benefits, subsidies and financial handouts to those who became unemployed as a result. Being a developing nation, Sri Lanka is not in a position to do so for a lengthy period of time.

That was why the Government decided that a long-term lockdown was not sustainable for a country such as Sri Lanka. President Gotabaya Rajapaksa has said that, given Sri Lanka’s economic structure and its preponderance of daily wage earners, long-term lockdowns are not viable.

With the gradual re-opening of the country, a second wave emerged, initially in two clusters at a garment factory in Minuwangoda and at the wholesale fish market in Peliyagoda. While the second wave continued for several months, it did not reach the proportions seen in the current third wave.

Challenging task

Now, with the third wave of the virus very much established, the government has to perform the delicate act of balancing economic sustainability with the health needs of its population, a difficult and challenging task. This is what it is trying to do, but public co-operation is vital in this effort.

The warnings from health experts have been unequivocal. They believe the third wave of the pandemic is due to the British variant of the virus which is known as ‘B.1.1.7’. The virulence of this particular type of the virus is much greater, resulting in a higher number of infections in a short time.

“The B.1.1.7 variant spreads much faster, causes more severe disease, causes re-infection in those who previously had infection and can escape vaccine induced immunity. Its transmission is 50 per cent higher than other variants,” Prof. Neelika Malavige of the University of Sri Jayewardenepura said.

“Several studies have also shown that the British variant of the virus may cause illness in younger individuals as well. As a result, they can be more susceptible to this variant than the ‘original’ coronavirus,” Prof. Malavige cautioned, urging the public to practice social distancing whenever possible.

The President of the Sri Lanka Medical Association (SLMA) Dr. Padma Gunaratne echoed these thoughts. “When 1,800 plus COVID patients are detected daily, there are three to four times that number undetected in the community,” Dr. Gunaratne said, noting that the health system is under strain.

“As the number of COVID patients increases, the capacity in hospitals is gradually reduced. They have now almost reached their full capacity and consequently, some COVID-19 patients have to remain at home due to delays in taking them to hospitals,” the SLMA President observed.

Workforce to remain productive

The Government has responded with a series of measures. Although a countrywide national lockdown is not being enforced at this time, several restrictions are in place. This strategy is aimed at allowing the workforce to remain productive while at the same time minimising the spread of the pandemic.

These controls include a ban on all public functions and gatherings and restrictions imposed on selected localities such as Police divisions. Schools which were due to re-open on May 3, have been kept closed until further notice. Travel in public transport is also subject to restrictions.

The Government aims to combat the virus by enhancing its vaccination drive against the Coronavirus. Health Minister Pavithra Wanniarachchi said it is planned to vaccinate over 60 per cent of the population by the end of the year. Currently about 900,000 persons have been vaccinated (first dose).

“The Government has ordered 13 million doses of Russia’s Sputnik V vaccine of which 15,000 have already arrived. The balance will be received within this year in stages. Sri Lanka will also receive 8.4 million vaccine doses from the COVAX facility and five million Pfizer vaccine doses within this year,” the Minister said.

Minister Wanniarachchi also said the Government was in discussion with India’s Bharat Biotech (Covaxin) and Johnson & Johnson (single dose Janssen vaccine) to purchase more vaccines. China has agreed to provide Sri Lanka with more doses of Sinopharm vaccine, soon after World Health Organisation (WHO) grants its approval, the Minister said. This approval is expected as soon as next week.

Minister Wanniarachchi, who herself recovered from being infected with the coronavirus some time back, said that sufficient beds were being made available to treat COVID-19 patients islandwide. “About 13,800 beds have been allocated already and 10,000 additional beds would be allocated during the next two weeks,” she said.

The minister also dispelled fears of a shortage of oxygen for hospitals as being seen in India. “The requirement for oxygen in our hospitals is 25 tonnes. It can be increased up to 80 tonnes. The issue is the shortage of cylinders. We have ordered 7,000 more jumbo cylinders,” Minister Wanniarachchi noted.

Meanwhile, State Minister of Production, Supply and Regulations of Pharmaceuticals Prof. Channa Jayasumana has responded to speculation that pressure was being brought on the Government to use the Chinese manufactured Sinopharm vaccine in Sri Lanka. Minister Jayasumana has denied this. It has already been given to around 4,000 Chinese nationals residing in Sri Lanka, but it has not been given to Sri Lankans.

“As a responsible State Minister, I can assure you that there is no pressure from the Chinese Government to use it. It is a safe vaccine as per the data we have,” Minister Jayasumana said, noting it can be used when it is approved by the WHO for Emergency Use.

Public health experts

Minister Jayasumana also noted that none of the vaccine-related decisions was taken by politicians. “All the decisions were taken by medical experts including virologists, immunologists, physicians and public health experts. They have assessed all the available information,” the Minister said.

Minister Jayasumana also defended the decision to open Sri Lanka’s borders and the gradual lifting of the lockdown previously. “More than 30,000 people returned to Sri Lanka in April. We isolated and quarantined them. We did extensive PCR testing. We took every preventive measure,” he observed.

The Minister was also confident that a crisis such as that seen in India will not occur in Sri Lanka. “The Indian variant is double mutated and it has not been detected in Sri Lanka. There is also a difference between the two societies in terms of literacy rate and adherence to health practices,” he said.

State Minister of Primary Health Services, Pandemics and COVID Prevention, Dr. Sudarshani Fernandopulle also addressed the issues related to vaccines in Parliament. Sri Lanka was also exploring the possibility of combining different vaccines in the same person (Mix and Match option) to meet the current demand, she said.

Minister Fernandopulle acknowledged there was a shortage of 600,000 doses of the Oxford AstraZeneca Covishield vaccine to be given as a second dose. “There is nothing to hide. It is not related to the Government. The issue has arisen due to the manufacturer’s (Serum Institute of India) inability to supply stocks to other countries,” the Minister said.

“Research is in progress on the possibility of vaccinating for the second dose with another brand of vaccine for those who were vaccinated with AstraZeneca for the first dose. We cannot decide on that. However, based on the results of research, we may be able to do so,” Minister Fernandopulle noted.

Health experts agree that Sri Lanka is also likely to see a further spike in COVID-19 infections in the month of May and possibly in June when the pandemic is expected to reach its peak. This could result in a rush of hospital admissions and the distinct possibility of more fatalities in the coming few weeks.

Selective lockdowns

The Government is taking all possible measures such as increasing PCR testing to 20,000 per day, purchasing more vaccines, enhancing hospital bed numbers and enforcing selective lockdowns in a bid to curb the epidemic. However, the ultimate responsibility of adhering to these health measures lies with the general public, medical experts say.

Previously Sri Lanka has demonstrated that it is a highly health literate nation. Its free health system is a frequently cited model of care not only in South Asia but also internationally. These factors are in the country’s favour as it gears to face the full brunt of the third wave of the pandemic.

The next few weeks will be extremely critical for the health of the nation and its citizens as Sri Lanka faces arguably its greatest health crisis since the malaria epidemic in 1935 which cost some 80,000 lives (Today, the country has eliminated malaria). The country waits both in hope and in trepidation for these weeks to pass.