The Sri Lanka Medical Association (SLMA) on Wednesday wrote to President Gotabaya Rajapaksa detailing factors of importance under three main categories in relation to the COVID-19 containment measures and vaccination strategy in Sri Lanka.
The concerns and recommendations highlighted in the letter looked at healthcare capacities and travel restrictions, vaccination strategy, and data reporting. The SLMA explained that the factors were discussed by SLMA council members as well as Prof. Neelika Malavige, Prof. Malik Peiris, Prof. Kamini Mendis, and members of the Intercollegiate Committee.
The SLMA was of the opinion that the current vaccination strategy was flawed and needed composite review urgently. They stressed the need for targeting high-risk groups to achieve maximum control, thus avoiding repeated lockdowns. The SLMA backs this with data, stating that the death analysis of patients indicates that 73% of deaths occur in people over 60 years of age and 83% of deaths were in people with comorbidities.
The SLMA also emphasised the need for a definitive roadmap providing priority of vaccination in certain geographical locations, suggesting that an equal number of vaccines could be given to hospitals to immunise high-risk people with comorbidities.
With regard to the 600,000 persons awaiting the second dose of the AstraZeneca vaccine, the SLMA stated: “We see that offering them the first dose of Sputnik V following a quick clinical trial of the efficacy of such a manoeuvre as a reasonable option to solve the issue. Monitoring antibody levels two weeks following vaccination with Sputnik V in about 100 people who have had the first dose of Covishield vaccine may provide a reasonable answer to this question.” However, they emphasised the importance of documenting the adverse effects during such a clinical trial. The SLMA recommended the continuation of lockdown for a further week, which was announced by the Government on Wednesday night.
Stating that it is too early to see a visible impact of the lockdown on the healthcare system, the SLMA wrote: “Opening the country at this juncture would invariably facilitate the spread of the infection leading to increasing number of cases that in turn would cause a complete paralysis of the healthcare system.”
The SLMA highlighted three main factors regarding the current usage of the capacity of the healthcare system. This included indications that the brunt of the outbreak was concentrated in the main hospitals and that all wards were well over their full capacity with symptomatic patients.
“There are many COVID patients as floor-patients in medical wards,” the SLMA wrote.
With regard to ICU facilities, the SLMA stated that in addition to the dedicated 82 beds, information from ICUs indicated that an additional 70 patients are being treated in ordinary ICUs, which compromises the care given for other patients. The SLMA added that there are approximately 500 patients on oxygen therapy being treated in high dependency units.
“Consultants from laboratories indicated the same or higher rates of PCR positivity despite overall PCR positive numbers remaining the same, when compared to previous weeks,” the letter reads. The SLMA also focused on the need for meaningful data, stating: “We would like to inquire from the Epidemiology Unit of the Ministry of Health as to whether they have data regarding PCR positivity rates in factories that are kept open, in case a necessity arises to advise the Government in this regard.”
The SLMA also pointed out that there had been a significant reduction in the number of PCR tests carried out over the last two weeks.