By Sarah Hannan The World Health Organisation (WHO) last week stated that the world will have to learn to live with Covid-19 as it would not be eliminated anytime soon. Like many other countries, Sri Lanka too seems to have understood this, having recommenced activities in 23 districts with the Colombo and Gampaha Districts still functioning under indefinite curfew. On Monday (11), state institutions and private establishments in the Colombo and Gampaha Districts were required to commence business with one-third of their staff in an attempt to ease the public into normalcy by allowing the workforce to return to work under strict regulations. Retail shops, pharmacies, and supermarkets in the Colombo and Gampaha Districts are now allowed to conduct business while requirements pertaining to limits on travel for essential services and maintenance of social distancing when outdoors are slowly disappearing. It seems that the Colombo and Gampaha Districts are well into functioning with the minimum number of staff to commence work, and are attracting the maximum number of consumers for their businesses. The Sunday Morning spoke to University of Peradeniya Department of Sociology Head Dr. W.M.S.M. Kumari Thoradeniya about the impact of a pandemic-related lockdown on society and how people would ease into an environment where life goes on while also protecting themselves from the threat of a virus. “When an unknown virus starts infecting society, we all feel unsafe. People are filled with uncertainty and to top it off, when the country is placed under curfew for a prolonged period of time, it tends to cause a bigger issue. It is also impractical to keep the country under lockdown until medical experts study the behaviour of the virus and eliminate it.” Dr. Thoradeniya, while agreeing that imposing curfew when the disease started to spread rapidly was a good move, noted that the time during curfew should have been used wisely to communicate the guidelines people should follow once the country opened up after the lockdown. “People need some time to get used to following these guidelines and even after two months, the guidelines have not been communicated to a larger portion of society. This was evident when curfew was relaxed in the 23 districts. People forgot about the need to maintain the one-metre distance; they flocked to purchase essentials as soon as curfew was relaxed.” She noted that people need to be educated on the damage the virus could cause as a result of irresponsible behaviour. She also shared that lifting curfew and allowing people to start work should be done according to a plan. While this is the responsibility of the authorities, people should also make it their personal responsibility to follow the health guidelines to protect their health and ensure their safety. Since Sri Lanka is a developing country, the prolonged closure of economic activities resulted in major implications such as people being deprived of earning their daily wages from day-to-day work. Unfortunately, the Rs. 5,000 relief that was issued to many low-income and poor families is insufficient to purchase the bare necessities needed. “Therefore, if we were to continue the lockdown until the disease is eliminated or a proper treatment is found, it would have a huge socioeconomic impact on the country. Even the most developed countries in the world have started to feel the impact on their economies and lifestyles,” Dr. Thoradeniya added. As Sri Lankans, we will have to alter our social behaviour drastically to align with the health guidelines in place. Sri Lankans are a close-knit society and would come together in times of need to help a fellow citizen. We are also very keen on hosting social gatherings that are religiously, culturally, or socially accepted, while getting acquainted with new communities and people at these gatherings. Dr. Thoradeniya observed that these behaviours or craving closeness will have to change as we as a country adapt to live with Covid-19. “People are not allowed to flock at temples or religious institutions; we are requested to limit non-essential travel and visits to our close family. This is something we will all have to get used to and practice for a considerable amount of time until a vaccination or treatment for the virus is found.” Epidemics are not new to Sri Lanka; people are used to maintaining social distancing and self-isolation during measles and chicken pox outbreaks. Dr. Thoradeniya said that Sri Lanka was already used to observing health guidelines when it comes to such communicable diseases, stating: “No outsiders are allowed to visit the house when a person from a family is having measles or chicken pox. The infected person is separated from the rest of the family and is kept in a clean environment that is regularly disinfected. This takes place on a minor scale, so it is easy to manage the situation. But with Covid-19, people found it challenging to adapt to the guidelines that were issued.” People are yet to understand the danger Covid-19 imposes, not only to their family but to the entire country and the world as well. We have faced massive setbacks in how we conducted life prior to Covid-19, and the country should use this as a learning point to improve on when returning to normalcy, Dr. Thoradeniya noted. Personal health and safety Face masks and alcohol-based hand rubs have now become must-haves when stepping out of the house, be it for work or to go to the closest boutique to buy essentials. Medical experts weigh in that not everyone will follow the health guidelines due to various practical issues, and also point out that the proper way to use a face mask has not been communicated to the majority of the public; they observe many using disposable masks for days and using latex gloves for prolonged periods of time. While wearing face masks have now been made compulsory in the health guidelines published, Sri Jayewardenepura Hospital consultant microbiologist Dr. Kushlani Jayathilake advised that people need to be educated as to when they should wear face masks and when it is not required. “When a face mask is worn, it hinders the breathing capacity of a person. It reduces the amount of oxygen that one would inhale and retains a considerable amount of carbon dioxide that is exhaled. “Face masks should be therefore worn if a person is expected to be in a crowded place, use public transport, and working in enclosed areas with a crowd. A person will not need to wear a face mask if they are in their own vehicle, working in a single cubicle, going for a jog/walk, or are exercising in an outdoor space.” Dr. Jayathilake also noted that retailers have been instructed to wear gloves, but it would not be practical as the vendor will not be able to constantly change the gloves after every transaction. She also noted that the virus tends to survive for a longer period of time on latex and rubber surfaces; if a consumer sneezes/coughs onto the grocery items that are sold and the vendor touches it, that can cause contamination. “They handle the groceries and with that they also take the money that is handed to them. There are several ways the virus could find its way to the vendor or consumer through the gloves itself. So, the best thing to do is to use hand sanitiser; then again, the affordability and the frequency with which one could use it become practical issues.” Since mid-last week, buses operating in the 23 districts curfew was lifted were allowed to take passengers to fill the seats while passengers weren’t allowed to travel standing. Prior to that, the health guidelines issued requested that only one passenger occupy a two-seater and two occupy a three-seater. However, it would seem that due to the loss of revenue experiences over the past two months, every industry is trying to earn as much as they can. “We witnessed an increase in mobility among the workforce and at the same time, we have removed the isolation restrictions that were placed for Bandaranayake Mawatha, Colombo 12 and Suduwella in Negombo on Thursday (14). While we have strictly informed them to observe a further 14-day self-quarantine period, we cannot assure that no new clusters will be created. It all depends on how well people are adjusting to life according to the health guidelines,” Health Services Director General Dr. Anil Jasinghe noted. Practice self-discipline When retail shops opened for business, people were seen flocking to purchase groceries and essentials. Not all shops however have the luxury of being able to control the number of people who enter the premises, ensure distance is maintained, that every consumer washes their hands/is given hand sanitiser, or that their temperature is checked. “People need to have some self-discipline in this sense. You need to think about your health and wellbeing as well as the health and wellbeing of your family members at home. Taking necessary precautions therefore cannot be forced upon a person by the Police, military, or security officers of an establishment. You are required to consciously change your behaviour patterns,” Epidemiology Unit Specialist Medical Epidemiologist Dr. Hasitha Tissera said. Dr. Tissera noted that the same goes for a person who has to use public transport or public spaces once the entire country is allowed to move around. One should think before boarding a crowded bus or disobeying the regulations in place for the entire country’s wellbeing. Furthermore, the guidelines that have been issued for various sectors of society will be continuously revised based on emerging needs. Timeline of Health Ministry response to Covid-19 Our Health Ministry was one of the first in the world to take steps to recognise the grave risk to Sri Lanka and mitigate the impact of Covid-19 in the country, even before the World Health Organisation (WHO) declared the disease a Public Health Emergency of International Concern (PHEIC) on 30 January. Four days earlier, on 26 January, Health Services Director General Dr. Anil Jasinghe raised the alarm in a 10-page circular to all medical and administrative staff throughout the health service, in which he outlined the seriousness of the disease and issued guidelines for the health system to brace itself for the upcoming pandemic and to identify and treat patients. On the same day, Sri Lanka’s Chief Epidemiologist Dr. Sudath Samaraweera issued a two-page press release setting out the origins and details of the disease, and telling the public about the three suspected cases (Chinese tourists) identified in the country at the time. According to the release, from this time, the Health Ministry had begun screening arrivals at the airport for fever and preparing a quarantine regimen. The public were advised to avoid crowded places, frequently clean hands with soap and water, and take other precautions. From 28 January, the Health Ministry begun issuing daily “situation reports” though the Epidemiology Unit with the local and global status of Covid-19. The day before the WHO declared the situation a PHEIC, on 29 January, the Health Ministry issued guidelines for Sri Lankans returning from abroad, urging them to self-quarantine and wear a mask if they displayed symptoms. By 6 February, the Health Ministry had grown more alarmed by the risk of the spread of the disease in Sri Lanka. Dr. Jasinghe issued a revision to his guidelines from barely a week prior, sounding the alarm that despite precautions, the disease had spread to “Thailand, Japan, Singapore, Australia, South Korea, Vietnam, Malaysia, Cambodia, the Philippines, Sri Lanka, India, the US, Canada, Finland, Germany, Italy, Russia, Spain, Sweden, the UK, UAE, and France”. Dr. Jasinghe considered a local outbreak inevitable and expanded the testing criteria and issued a national surveillance plan to identify and trace the contacts of anyone in Sri Lanka displaying symptoms. On 10 February, having failed to limit air traffic between the two countries, the Health Ministry issued urgent guidelines to all flight crews travelling between China and Sri Lanka, including insisting that all passengers wear face masks that should be discarded after the flight, and asking all passengers and flight crew to self-quarantine for 14 days after arrival in Sri Lanka. The Health Ministry also urgently contracted web design firm Arimac to produce a website for the Health Promotion Bureau (HPB) that could be used to share information about the virus’ status in Sri Lanka, with the public and international agencies and bodies co-ordinating the global response. On 24 February, the Health Ministry expanded its restrictions on passenger arrivals from China to include those entering the country from South Korea, placing them under the surveillance of regional epidemiologists. On 29 February, Dr. Jasinghe expanded the restrictions to include Italy. After the expanded travel caution on 29 February, official updates to the public from the Health Ministry paused for several weeks with the exception of the daily situation reports and statements to media. The website for the HPB was ready but remained unlaunched. The only official written communications by the Ministry were on 10 March, in which strict criteria were outlined for selecting suspected patients to be tested for Covid-19, and strongly discouraging private hospitals from conducting such tests. The same day, 10 March, the first case of Covid-19 was reported in Sri Lanka, and Dr. Jasinghe stated to the media that public gatherings would be banned if the situation took a turn for the worse. From 11 March onwards, travel restrictions were gradually rolled out for certain countries for a period of two weeks, incoming travellers were quarantined for 14 days, and subsequently the travel ban was extended to all countries from 18 March until further notice. On 16 March, Health Minister Pavithra Wanniarachchi stipulated a maximum retail price for face masks. On 19 March, the HPB website was launched and immediately became an invaluable resource for the public. The Health Ministry also released information from its contact tracing programme, detailing how the first 100 patients had been identified through returnees and quarantine centres. The next day, islandwide curfew was imposed.