CCPSL lays out detailed exit strategy for COVID-19

• Says escalated strategic RT-PCR testing would be pre-requisite in deciding on timeline to relax restrictions
• Recommends phased-out exit after categorising country into high, moderate, and low risk areas
• Says blanket exit strategy is not applicable across entire country
• Says rationale behind relaxations should be for staged resumption of normality while continuing social distancing strategy approximately at 50% or above

The College of Community Physicians of Sri Lanka (CCPSL) has laid out a detailed exit strategy for COVID-19, saying escalated strategic RT-PCR testing would be a pre-requisite in deciding on the timelines and exact strategies that need to be deployed.

The escalated strategic RT-PCR testing has been categorised by the CCPSL as “passive surveillance”, which is suspected patients fulfilling the case definition of COVID-19, “active surveillance”, which is targeted high-risk testing among all three tiers of close contacts and quarantined persons and “sentinel surveillance” which is patients in sentinel centres fulfilling the severe acute respiratory infection (SARI) and influenza like influenza (ILI) criteria.

The CCPSL said that antibody testing option should be explored among those providing frontline essential services (e.g. oncology, obstetrics, and ICU staff) and those negative for RT-PCR 2 weeks after recovery. The College, which consists of the public health specialists in the country, said that ending the curfew too soon could lead to a second outbreak, while enforcing it for too long could further cripple the economy and public morale.

“When to end the current phase must be decided at national level by an expert panel comprising health and non-health authorities with vigilant monitoring of the area specific caseloads, as premature relaxation of the lockdown in any part of the country could affect the spread in the rest of the areas. If Sri Lanka can maintain the low numbers of new COVID-19 cases at national level along with no solid evidence of community transmission (i.e. no known epidemiological link for the transmission), moving to more and more relaxed phases can be considered with time,” CCPSL said.

It added that implementation must be phased out since every geographical area would not pose a similar threat for COVID-19, a blanket exit strategy is not applicable across the entire country. The CCPSL said that the initially each district in the country should be categorised according to the caseload prevailing in each area into High risk districts, Moderate risk districts and Low risk districts.

“Relaxation must be based on a blend of influences of scientific evidences as well as socio-cultural and economic factors. Lifting the restrictions must be graded, while their timelines must depend on the area specific parameters,” it said.

CCPSL also said that even within the existing lockdown strategy, the following measures have been maintained throughout the country, and should continue irrespective of the risk level or the geographical area including key essential services such as health, water, electricity, gas, postal, petroleum, telecommunication, ports,  vehicle breakdown services, road maintenance, irrigation and essential industries (non-crowding): farming, fisheries, construction sites. “The rationale behind relaxations should be for staged resumption of normality, while continuing with the social distancing strategy approximately at 50% or above,” the College said.

It also made specific reference to economic resumption in Western Province (WP), which is the economic hub of the country. “With a high number of cases reported, WP is still considered as a high-risk area. Under the proposed strategy above, it will take longer time to exit and the economic repercussions would be many. As such, the WP will clearly need a micro-planned strategy,” it added.