ශ්‍රී ලංකාවේ කොවිඩ්-19න් මියයන රෝගීන්ගෙන් 73%ක් වයස අවුරුදු 60ට වැඩි බව ද, 83%කට වෙනත් රෝග හෝ වෛද්‍ය තත්වයන් දෙකකට වඩා ඇති බව ද ශ්‍රී ලංකා වෛද්‍ය සංගමය පෙන්වා දෙයි. මේ බව සඳහන් වන්නේ ජනාධිපති ගෝඨාභය රාජපක්ෂ වෙත යවන ලද ලිපියකයි.
ශ්‍රී ලංකා වෛද්‍ය සංගමය විසින් එහි සභාපති වෛද්‍ය පද්මා ගුණරත්නගේ අත්සනින් යුතුව ජනාධිපතිවරයා වෙත යොමු කර තිබෙන ලිපියෙහි එහි අඩංගු කරුණු හා නිර්දේශ සාකච්ඡා කිරීමට මහාචාර්ය නීලිකා මලවිගේ, මහාචාර්ය මලික් පීරිස් හා මහාචාර්ය කාමිනී මෙන්ඩිස් සහභාගී වූ බව සඳහන් වේ.
එන්නත්කරණය මගින් ආසාදිතයන්ට සංකුලතා හා මරණ ඇතිවීම අවම වන බව පැහැදිලිව ප්‍රදර්ශනය වන නිසා එන්නත ලබාදීමේදී වයස අවුරුදු 60ට වැඩි අයට හා ඔවුන්ගෙන් අනතුරුව වයස අවුරුදු 30ත් 60ත් අතර බහුවිධ රෝග තත්වයන් ඇති අයට ප්‍රමුඛතාව දිය යුතු බව සාක්ෂි සහිතව පැහැදිලි වන බව ද එම සංගමය පෙන්වා දෙයි.
එහෙත්, ශ්‍රී ලංකාවේ දැනට කරන පරිදි කොවිඩ්-19 අවදානම වැඩිම ස්ථාන යයි කියනු ලබන තැන්වල වැඩිම සචලතාවක් සහිත පිරිස්වලට එන්නත ලබාදීමෙන් සැලකිය යුතු වාසියක් නැති බව ද ශ්‍රී ලංකා වෛද්‍ය සංගමය පෙන්වා දෙයි.
ඇතැම් ප්‍රදේශවල ප්‍රමුඛතා පදනමින් එන්නත්කරණය සම්බන්ධයෙන් මහජන විශ්වාසය දිනාගැනීම සඳහා පැහැදිලි සැලැස්මක් සකස් කළ යුතු බව ශ්‍රී ලංකා වෛද්‍ය සංගමය පෙන්වා දෙයි. අධික අවදානම් ඇති ග්‍රාම නිලධාරි වසම්වල එන්නත්කරණ නිර්දේශ කළ නොහැකි බව ද, එම ප්‍රදේශවල දැනටමත් ආසාදනය පැතිරී බහුතරයක් ජනතාව අතර ප්‍රතිශක්තිය ඇති වී තිබිය හැකි බව ද සංගමය පෙන්වා දෙයි.
යම් යම් ප්‍රදේශ තෝරාගැනීමේදී ඉහළ අවදානමක් තිබෙන පළාත් හා දිස්ත්‍රික්ක තෝරාගෙන ප්‍රධාන නගර වැනි ජනාකීර්ණ ප්‍රදේශවල අධි අවදානම් ජනතාවට එන්නත ලබාදීම විශේෂඥයන්ගේ නිර්දේශය බව ද එම ලිපියේ දැක්වේ. ඒ හා සමානම එන්නත් සංඛ්‍යාවක් බහුවිධ රෝගාබාධ ඇති අය එන්නත් කිරීම සඳහා රෝහල්වලට ලබාදිය හැකි බව ද සංගමය පවසයි. එසේම, වැඩි මිනිසුන් සංඛ්‍යාවක්, දිගු කාලයක්, සංවෘත ස්ථානයක සේවය කරන ආර්ථික කේන්ද්‍රස්ථානවල හා වෙනත් අත්‍යවශ්‍ය සේවාවල සේවකයන්ට ද එන්නත ලබාදීමේදී ප්‍රමුඛතාව ලබාදිය යුතු බව සංගමය පවසයි.
කොවිෂීල්ඩ් එන්නතෙහි දෙවෙනි මාත්‍රාව බලාපොරොත්තුවෙන් සිටින ලක්ෂ හයක් ජනතාවට හැකි ඉක්මණින් එන්නත ලාදෙන ලෙස ද, ක්ෂණික සායනික අත්හදා බැලීමකින් පසු ඔවුන්ට ස්පුට්නික් එන්නතෙහි පළමු මාත්‍රාව ලබාදීම විකල්ප විසඳුමක් බව ද සංගමය පවසයි. ඒ සඳහා, කොවිෂීල්ඩ් එන්නත ලබාගත් 100ක් දෙනාට ස්පුට්නික් එන්නත ලබාදී සති දෙකක් ඔවුන්ගේ ප්‍රතිදේහ මට්ටම පරීක්ෂා කළ යුතු බව සංගමය යෝජනා කරයි.
අනාගතයේ එන්නත ලබාදෙන විට දෙවෙනි මාත්‍රාව සුරක්ෂා කර තබන්නැයි එම සංවිධානය ඉල්ලා සිටියි.
සම්පූර්ණ ලිපියෙහි අන්තර්ගතය පහත දැක්වේ.
2nd June 2021
His Excellency Gotabaya Rajapaksa,
The President of the Democratic Socialist Republic of Sri Lanka,
Presidential Secretariat,
Colombo 01.
Your Excellency,
Mitigation of COVID 19 infection in Sri Lanka
The SLMA is ever grateful to Your Excellency and the Government of Sri Lanka for declaring a “lockdown” (restriction of movement throughout the country) at the most crucial hour, which essentially salvaged Sri Lanka from getting into the abyss of a major catastrophe; a breakdown of the healthcare system of the country which in turn would have led to a breakdown of all systems.
I, along with the SLMA Committee to advice on matters related to COVID 19, wish to bring to your kind attention the following important facts with regard to controlling of COVID-19 epidemic in Sri Lanka. In addition to the SLMA Council members and the members of the Intercollegiate Committee, Professor Neelika Malavige, Professor Malik Peiris and Professor Kamini Mendis, contributed to the discussion.
Recommendation with regard to the continuation of the lockdown
We gathered information from consultants working in clinical settings and laboratories to find out the current usage of the capacity of the health care system
a. Physicians indicated that the brunt of the outbreak is now concentrated in the main hospitals and all wards are well over their full capacity with symptomatic patients. There are many COVID patients as floor-patients in medical wards.
b. Information from the ICUs indicated that other than the dedicated 82 ICU beds, another lot of about 70 more patients are treated in ordinary ICUs at the time of discussion. This situation compromises the care given for patients with Non-COVID issues. There are about 500 more patients on oxygen therapy, treated in High Dependency Units.
c. Consultants from laboratories indicated the same or higher rates of PCR positivity despite overall PCR positive numbers remain same, when compared to previous weeks.
This information confirms that hospitals are overwhelmed with cases. As expected, it is too early to see a visible impact of the lockdown on the healthcare system. 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. As such, while we are convinced of the benefits of the lockdown to the healthcare system, we are compelled to recommend a further extension of the lockdown by at least another week. Keeping grocery shops opened may facilitate compliance by the public with a longer lockdown.
The need to review the vaccination programme
We are appreciative of the decision taken by the Government of Sri Lanka to vaccinate healthcare officials and other frontline workers such as the police, the tri-forces etc., initially with the highest priority.
However, we are of the opinion that the vaccination strategy as implemented at present is flawed and needs a composite review urgently. In a setting particularly troubled by a continuous short supply of vaccines, we emphasize the need for an efficient vaccination strategy targeting high-risk groups to achieve maximum control which would avoid the necessity for repeated lockdowns.
In cognizance with the data available from the rest of the world, the death analysis of patients from the MoH, Sri Lanka, indicates that 73% of deaths occur in people over 60 years of age and 83% of deaths were in people with co-morbidities. Research findings have clearly demonstrated that vaccination reduces deaths and complications in patients infected with COVID-19. Research evidence does not support benefits of vaccination to reduce transmission of infection unless a large majority of the population is vaccinated. As such, there is clear and compelling evidence to support prioritisation of vaccination of older adults more than 60 years, followed by people with comorbidities in the age group of 30 – 60 years. However, there is no appreciable benefit in vaccinating people with the highest mobility in so-called hotspots, as is currently carried out in the Sri Lankan setting.
Furthermore, we emphasize the need of a definitive roadmap providing priority of vaccination in certain geographical locations. Presence of a roadmap would help in gaining the confidence of our people on the vaccination programme. Selection of Grama Niladhari divisions of high-risk locations for vaccination cannot be recommended as the infection would have already spread and the majority would have developed immunity by the time the vaccination programme is carried out. The opinion of experts with regard to selecting the geographical location is to select high-risk provinces or districts and to vaccinate high risk people in crowded areas such as main cities in those selected provinces or districts. An equal amount of vaccines could also be given to hospitals to immunize high-risk people with comorbidities. Along with vaccinating high-risk persons, people working in higher numbers in enclosed areas with longer shifts in economic hubs and other essential congregate settings also could be prioritized.
We urge the Government of Sri Lanka to provide a solution to the 600,000 people awaiting the second dose of the Covishield vaccine as early as possible. 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 2 weeks following vaccination with Sputnik V in about 100 people who have had the 1st dose of Covishield vaccine may provide a reasonable answer to this question. The importance of documenting the adverse effects during such a clinical trial also needs to be emphasized.
Further, we wish to highlight the need in future to reserve the second dose in instances where a second dose is in the schedule.
3. Reporting meaningful data
We understand that the primary role of the Epidemiology Unit of the Ministry of Health is surveillance and reporting the data in a meaningful manner to facilitate the decision-making process aimed at mitigating the outbreak.
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?
There had been a significant reduction of the number of PCR tests carried out over the last two weeks. We understand that the majority of reported PCRs are exit-PCRs that do not measure the extent of transmission in the community. Unless PCRs are carried out proactively, it is likely that the usefulness of the results of analysis of samples with a majority of exit-PCRs will remain low despite the disease spreading rapidly. Similarly, unless the disaggregated test results based on context categories and geographical locations are analysed, the inference made by all PCRs together is likely to be most erroneous.
We are informed by one of our experts, Professor Kamini Mendis that they are in the process of compiling a document giving important surveillance indicators. We urge the Epidemiology Unit of the Ministry of Health to pay more attention to the surveillance indicators and present the data of relevant indicators to arrive at meaningful decisions.
We, from the SLMA Council and the Intercollegiate Committee, would be greatly indebted to you if an appointment could be kindly granted to us to discuss this issue further with your good self.
We remain committed to assist you in all your endeavours to safeguard the health of the nation.
Dr. Padma Gunaratne
President, SLMA
Copies to
Hon. Mrs. Pavithra Wanniarachchi, Minister of Health
Hon. Dr. Sudarshinie Fernandopulle, State Minister of Primary Health Care, Epidemics and COVID Disease Control
Hon. Dr Channa Jayasumana, State Minister of Production, Supply and Regulation of Pharmaceuticals
Dr. P. B. Jayasundara, Secretary to H E the President
General Shavendra Silva, WWV RWP RSP VSV USP ndc psc MPhil
Major General Dr. Sanjeewa Munasinghe, Secretary, Ministry of Health
Dr. Asela Gunawardana, Director General of Health Services, Ministry of Health
(praja.lk)
