- Irresponsible behaviour jeopardises health and safety of hundreds
By Sarah Hannan
The decision to relax quarantine curfew imposed in 21 districts last week, except for high-risk zones identified in certain districts, seems to have presented new challenges to the Police, tri forces, PHIs (public health inspectors), and health authorities.
Throughout last week, the citizens of these 21 districts had to adjust to the new health guidelines issued to be followed when using public transport and then ease into the “new normal” amidst Covid-19 starting to spread in community clusters.
The first challenge they faced was getting to work as there were insufficient transportation facilities made available. Although the Ministry of Health had issued clear guidelines for buses and trains to follow in transporting passengers, given the scarcity of transport vehicles, people soon started to pack into buses as usual.
The regulation for physical distancing was quickly forgotten and even the bus drivers and conductors were not in a position to control the crowd that was getting into the buses. Some of the distressed passengers took to social media to post the way they were provided transport, and the Police had had to intervene by stopping the buses to advice that one bus should only take up to 25 passengers at a time. Passengers too were not happy that they were removed from the only bus that was available to them.
“If the Government wants us to follow guidelines, then they should make more buses available. We are heading to work after an entire month. We do not have enough buses to get to work if we are to follow the health guidelines,” a passenger lamented. Another passenger returning home from work, who was asked to get off from the bus because it was crowded, said: “If we do not go in this bus, we will have to wait for about an hour or two for the next bus. What if that bus too is crowded? If the Government cannot make necessary arrangements for people to go to work after the curfew is lifted, then they might as well impose the curfew throughout.”
With the number of cases being reported increasing in cluster areas, it seems that people are not adhering to the health guidelines issued by the Ministry of Health.
Minister of Health and Indigenous Medical Services Pavithra Wanniarachchi meanwhile pointed out that observing the origins of the community cluster infection pattern, it was evident that people were not following the health guidelines issued to be followed during the quarantine curfew period.
“We kindly request the citizens of this country to take these health guidelines to heart. If you do not take necessary precautions, you are not only jeopardising your health, but also the health of the people that closely move with you.
“If you lack discipline, all these days of curfew and the mechanism that has been introduced to eliminate the spread of Covid-19 will be in vein,” Wanniarachchi said, specifically referring to the community cluster that was detected in Srimath Bandaranayake Mawatha, Colombo 12, which has accounted for 87 Covid-19 patients as of yesterday (25).
Ensuring health and safety
Sri Lanka Police yesterday announced that the currently imposed islandwide curfew will be lifted tomorrow (27) at 5 a.m. With that, the extended curfew that was in place in the Colombo, Gampaha, Kalutara, and Puttalam Districts along with police areas of Alawatugoda in the Kandy District, Warakapola in the Kegalle District, and Akkaraipattu in the Ampara District too will be lifted. Areas identified as isolated zones will remain as is. The Police also stated that entry and exit from the Colombo, Gampaha, Kalutara, and Puttalam Districts will be prohibited.
The Police Media Division revealed that when the curfew if lifted on Monday (27), all vehicles and persons using public transport will be monitored for their eligibility to exit or enter these districts once work commences.
“We have already setup barriers at entry and exit points on the main roads. With work commencing last week for some private and government institutions, other than the essential services, there was an increase in the traffic flow to the Colombo District. We have instructed our officers to check whether they are permitted to enter Colombo,” the Police Media Division informed.
Accordingly, companies that have over 50 employees will be allowed to enter and exit the Colombo, Gampaha, Kalutara, and Puttalam Districts if their companies have requested permission from the relevant law enforcement authorities. Companies with less than 50 employees will have to issue a letter attested by the area police to any employee who is to report to work.
Deputy Inspector General (DIG) Ajith Rohana, commenting on how the law would be enforced after Monday, informed: “People should observe social distancing, be it during curfew or after the curfew is lifted. We have deployed officers to monitor this, and the same will go to public and private transport vehicles. Anyone disregarding these instruction will be arrested and will not be granted bail.”
DIG Rohana too reiterated that people should strictly follow the health guidelines and once work commences, the workplaces should instruct their employees to follow good hygiene habits and adhere to the safety precautions that have been practised thus far. This will allow to prevent the virus of spreading.
Director General Health Services (DGHS) Dr. Anil Jasinghe too resonated with DIG Rohana’s statement. Commenting on the situation anticipated for Monday after curfew is lifted for all districts, Dr. Jasinghe noted: “Government and private institutions were clearly instructed on how they should commence their work once the curfew is lifted. For instance, offices located in the Colombo District should only bring in employees residing within the district for now. We are taking these steps to ensure the safety of everyone.”
Dr. Jasinghe also noted that the public should adhere to the guidelines issued by health authorities when using transport services as well as accessing services from retail stores, banks, markets, etc. Vendors too have been issued instructions on how to engage in trade, ensuring the health and safety of their customers as well as themselves.
First workplace in isolation
Meanwhile on Thursday (23) and Friday (24), a total of 65 personnel from the Sri Lanka Navy Welisara Camp tested positive for Covid-19. One of the Navy personnel had fallen ill after he went home on leave and was admitted to the Polonnaruwa District General Hospital. The PCR test confirmed that this Navy personnel had contracted the virus.
The Welisara Navy Camp was informed about this and PCR tests were then conducted to the test the rest of the personnel. Most of these Navy personnel were involved in providing security for the Suduwella area in Ja-Ela after the village was declared an isolated area earlier that week. They had also assisted in transporting the residents of Suduwella to quarantine centres.
Out of the 65 Navy personnel tested positive, five had travelled to their homes as they were permitted to take leave. These personnel too were located and subjected to PCR tests. The entire camp is now declared an isolated area, making it the first workplace to be placed on isolation. Meanwhile, the families of the Navy personnel who went on leave to their homes were also sent to quarantine centres.
“Some unrest was reported from the villages these Navy personnel had visited. We can assure that all these Navy personnel have been brought to the Welisara Navy Camp and their families have been placed in quarantine and would be undergoing PCR tests in the coming days. Therefore, we urge these people to not panic,” Lt. Gen. Shavendra Silva confirmed.
The Navy personnel were from Lankapura in Polonnaruwa, Panduwasnuwara, Rambewa in Anuradhapura, Kurunegala, and Galle. Lt. Gen. Silva also elaborated that the Navy personnel involved in monitoring and assisting in maintain the peace in the Suduwellla area were residing in two quarters and therefore, the PCR test was first conducted on these Navy personnel.
Cluster transmission anticipated
Institute for Health Policy (IHP) Executive Director and Fellow Dr. Ravi Rannan-Eliya said that it should not surprise the health authorities when the community cluster transmission was reported.
“Although Sri Lanka has attempted in maintaining minimal community transmission over the past weeks, we are increasingly dropping behind in our response. This is making it more difficult to lift the lockdowns; it will continue to frustrate the Government’s economic and political goals of restarting the economy and holding elections, and it is putting to waste the enormous sacrifices the public has made during the month of lockdown,” he noted.
To explain what is happening, Dr. Rannan-Eliya divided the world into two groups of countries: Countries where the goal is only to control the epidemic at a manageable level (or “to flatten the curve”) and countries where the goal is to keep the epidemic crushed (or something as close to “elimination” as possible). Sri Lanka fits in the second group so far, but complacency is leading us to fall behind.
The first sign of this came in early April. After stopping foreign arrivals in March, Sri Lanka did not crush the second wave as rapidly as the others. Instead, the decline in new cases was less rapid, and then it was not sustained with numbers fluctuating from day to day, he explained.
Sri Lanka failed to contain the virus to foreign arrivals and their immediate contacts. Instead, it has allowed the virus to jump to others, resulting in chains of transmission continuing into late April. This serious failure has been camouflaged by labelling the subsequent cases as imported case clusters, and saying that we do not have community transmission. This is nothing more than semantics.
“Community transmission only means that we don’t know the chain of transmission from an imported case; it does not mean that local transmission has not occurred between people living in the community and outside a quarantine camp. Local transmission is what the other countries in the group have prevented and what we need to focus on,” Dr. Rannan-Eliya elaborated.
Crowd control
Ministry of Passenger Transport Management, Power, and Energy Media Spokesperson W.M.D. Wanninayake said that drives and conductors had reported the difficulty in crowd control once the curfew was lifted.
“Last week, a very few buses were deployed to provide transport facilities for persons who were to report to work. At the start of the journey, there were police or army personnel to monitor the amount of people getting into a bus. But then the drivers and conductors had to deal with the people getting into the bus from the in-between halts. When one person got off the bus, several people got in and there was no police or army personnel to control that,” he stressed.
Wanninayaka revealed that when the drivers and conductors had kindly requested the passengers to adhere to the guidelines, irate passengers had verbally assaulted them. In this backdrop, the Ministry on Thursday (23) had requested the Police and tri-forces to look at deploying a security person for each bus from next week onwards in order to manage the crowds.
He further noted that many of the people are not even wearing masks nor following the health and safety guidelines and therefore suggested that it should be closely monitored.
“We are providing a service here and cannot be enforcing regulations on people as we need to ensure the safety of our drivers and conductors. For that, we seek the assistance of our Police and tri-forces,” Wanninayake said.
Goal to eliminate
Dr. Rannan-Eliya, after analysing all these incidents, noted: “To get back on track with the goal of elimination and to ensure the country is safe to lift the lockdown, we need to fully copy the elimination strategies of Vietnam, Hong Kong, Taiwan, Australia, New Zealand, and others. Incidentally, this also implies going beyond WHO (World Health Organisation) recommendations which are not tailored for countries that are aiming at elimination.”
He added that the Office of Medical Officers of Health needs to strengthen its testing guidelines to make testing mandatory for many patient groups where it is still discretionary. For example, all ICU (Intensive Care Unit) patients must be tested for Covid-19, and we need much more testing of patients in OPDs (outpatient department).
In addition, quarantine and self-isolation procedures need to be tightened to prevent cross-infection and include testing to identify any infected cases before release. As a remedial measure, all family members of those who arrived in late March and underwent home quarantine should be urgently tested with PCR or antibody as appropriate.
“Looking ahead, we need a better strategy for controlling transmission of the virus after the lockdown is lifted. This needs to combine much more testing than now, with stepped up social distancing, public education, and hygiene measures. It would be foolhardy and irrational to assume that no virus will be circulating in the community. At the very minimum, we would need to have 28 days with zero new cases, but the country will not tolerate this. We can now see how many people just one or two hidden cases can infect in the space of a month under curfew. Imagine what will happen during five weeks of an election campaign,” he emphasised.
In conclusion, Dr. Rannan-Eliya stated that the curfew alone is not suffice to stop community transmission. Although the enforcement of the curfew could be improved, it is not realistic to stop all interactions during curfew, especially in poor areas where families cannot sustain themselves for long periods. This suggests that stronger social distancing and hygiene measures combined with much more surveillance testing is needed to slow transmission, both during and curfew.
