Former Speaker Karu Jayasuriya has written to President Gotabaya Rajapaksa expressing his concern that the country could be headed for a public health disaster and economic catastrophe unless it adapts to the new ground realities as it battles the COVID-19 crisis.
In the letter titled ‘COVID- 19 Crisis: A Need to Change Direction,’ the former Speaker said while the restrictions on public movement imposed by the Government had helped to control the spread of the COVID-19 virus, and the health services, Armed Forces and Police had performed admirably in providing essential services to the people, there was the need for the country to adapt to the new ground realities. Towards this end he has made several observations and recommendations that have been placed before him by public health experts and other professionals.
Jayasuriya pointed out six areas on which the authorities would need to focus on in their coronavirus control programs. These include dealing with criminalisation and stigmatisation of victims, eradication versus containment, testing, employment, economic recovery and curfew mitigation.
Following is the full text of the letter:
While the restrictions on public movement imposed by the Government have helped to control the spread of the COVID-19 virus, and the health services, Armed Forces and Police have performed admirably in providing essential services to the people, I am increasingly concerned that a public health disaster and economic catastrophe will ensue unless the country adapts to the new ground realities.
With a view to minimising loss of life and damage to the economy, it is my duty to bring to your urgent attention the following observations and recommendations placed before me by public health experts and other professionals.
1. Criminalisation and stigmatisation of victims
The visible symptoms of COVID-19 are the same as a common flu, such as fever, sore throat, and a cold. Even in a normal time, tens of thousands of Sri Lankans usually have such symptoms from an ordinary cold and cough. But now, very few of the people who have such symptoms are coming for testing, possibly out of fear that they will be treated like criminals. Even private hospitals are turning away such cases because they are not encouraged to conduct tests.
It is very likely that hundreds, if not thousands, of COVID-19 cases are being driven ‘underground’ and inadvertently infecting other people without being detected. Unless people can present themselves without fear of being treated harshly, very few of those who are infected will do so.
The experience of other countries suggests that about half of persons infected with COVID-19 show no symptoms. Yet, they can infect others. Such infection is probably spreading through the country undetected even now because it is mistaken for a common cold and cough, and because testing has been confined to the few cases admitted to Government hospitals. As most potential cases are not being tested and identified, we cannot rule out the risk of widespread epidemic, and the sacrifice the country has made as a result of the curfew and economic shutdown will have been in vain.
The collective cost of a public fear of being identified as a patient will be monumental. I respectfully urge you to direct the relevant authorities to take urgent and effective measures to treat COVID-19 patients and at-risk persons simply as patients in need of medical care, rather than criminals to be smoked out and cast out of society. These measures will cement the people’s trust in the Government and ensure we can identify and treat all those who may be infected.
2. Eradication versus containment
Eradicating COVID-19 in Sri Lanka will not be like the eradication of malaria five years ago. The experience of other countries shows that eradication is impossible at least until a vaccine is developed.
Medical experts do not expect such a vaccine to be available for at least a year. We should expect the disease to remain prevalent in Sri Lanka to some extent, and throughout the world, for the foreseeable future. Rather than eradication, the public health focus must be to reduce the caseload by slowing the spread of the virus, so that our hospitals have enough capacity to treat those who fall seriously ill.
It appears that most people who get COVID-19 recover with no treatment, while a small percentage develop life-threatening complications that require hospitalisation. Further, it appears that about half of those who contract the virus may show no symptoms at all, and do not even know that they had been infected. Such persons must be regularly and reliably monitored and identified in order to minimise the risk to others.
The Government must convey the reality to the people, that COVID-19 will be with us for the foreseeable future. Our challenge is to adapt our country’s working practices to keep the caseload sufficiently low that our healthcare system can cope with it. Once those working practices are established, it may be possible to gradually relax the curfew.
Public health experts agree that the only way an epidemic can be averted is by frequent testing of our population on a mass scale. I am concerned that at present, PCR (saliva) testing is restricted to Government hospitals. In the event of a spike in infections, it will be difficult for government hospitals alone to manage the caseload. I strongly urge you to allow private hospitals, clinics and universities to begin PCR testing as soon as possible. PCR testing requires skilled personnel. The university departments of molecular biology have people with these skills. They together with their postgraduate students should be co-opted to join the testing effort.
Further, we should also begin mass community-level antibody (blood) testing for COVID-19. These test kits are now becoming available. They are much less expensive and easier to administer than PCR tests and will help identify those who have unknowingly had the disease and recovered. These immune persons are of great value because they run a much lower risk of re-infection and can move around freely in society without infecting others. Large-scale blood testing will also help identify areas which harbour reservoirs of COVID-19 cases, helping to isolate them.
All those who can afford it should be encouraged to get tests in the private sector. The Government should encourage the private sector to engage in manufacturing and conducting tests as soon as possible, by the NMRA. I recommend that you invite a consortium of private-sector institutions to manufacture antibody test kits in Sri Lanka. We have national capacity for this, and such tests will be so vital to our national security that we must manufacture them locally. Because the results from such tests need interpretation, however, antibody tests should be administered only by hospitals and healthcare professionals.
We must engage the private sector in mass-scale manufacturing of other items needed to stem the spread of COVID-19 during the coming years, such as face masks, hand sanitisers, gloves, spray-on surface disinfectants, disposable paper towels and tissues and protective equipment for health workers. Like test kits, these items will be in high demand worldwide, so surplus can be exported.
Once the curfew is relaxed, an important part of public testing will be to continually monitor the body temperature of everyone entering a crowded place, such as an office, supermarket or train station. This can cheaply and easily be done using hand-held remote thermometers. People with high temperature can be identified and advised to self-isolate. Such testing should become commonplace.
4. Economic recovery
Sri Lanka’s economic recovery will involve many challenges. We will have to transform the way we do things with regard to transport, working practices, shopping practices and other aspects of daily life.
We need to begin now and engage all stakeholders. The Government should also reach out to all political parties, the diplomatic community and other similarly situated countries in a broad effort to seek debt moratoria and forgiveness from lenders including the World Bank, Japan, India and China.
In the endemic stage of the disease that will likely last for the foreseeable future, only mass testing will allow us to reduce the risk to workplaces that are necessarily crowded. These include places such as police and armed forces barracks, factories, airports, tourist resorts, restaurants and public transport. It is vital that we begin implementing these testing regimens without delay.
We must think of how we can safely allow international travel and tourism to begin again, even with a small number of COVID-19 cases prevailing in our society at any given time. One way is to insist that anyone travelling to Sri Lanka must test negative for COVID-19 in the 24 hours before travel, as a condition of their authorisation to enter Sri Lanka. People leaving Sri Lanka too, should be required to undergo such tests. PCR testing technology is evolving rapidly. It should soon be possible for results to be available within a few hours. All countries are likely to require such tests as international travel begins once more, and Sri Lanka should begin planning for this eventuality.
The leading trade chambers should be invited to develop industry guidelines for the economic recovery. In the future, workplaces will have to regularly test employees and members of their households for COVID-19. If we are to reduce congestion on public transport, we will have to stagger our office hours and even workdays, so everyone works on restricted number of days of the week. It may also be necessary to limit public holidays in the coming year, allowing workers to take holidays for religious worship, for example, from their annual leave allocations. This can be a good gesture from all Sri Lankan for a limited period until economy recovers.
Workplaces will be required to adhere to sanitary guidelines, like having soap and paper towels in washrooms, and providing hand sanitiser dispensers near all surfaces used by multiple people such as doors and fingerprint readers. Changes to buildings will be necessary, such as modifying doors so they can be pushed open instead of pulled or operated by the foot rather than the hand. The rules of sick leave will also need revision, so that anyone with flu-like symptoms is tested for COVID-19 and prohibited from reporting for work. Employers may have to bear the cost of such testing.
Although most employers have paid salaries for the month of March 2020, after a whole month of zero revenue, many employers will struggle to pay salaries in April and thereafter. We must expect that the COVID-19 situation in Sri Lanka could become much worse before it can be stabilised. Therefore, it is likely that restrictions on public mobility may continue for some more months, with unavoidable and tragic economic consequences. Employers will struggle to pay their employees in such an eventuality, leading to an economic collapse that will have dire implications for social order.
I therefore suggest that you request the trade chambers to make an urgent assessment of the business sector and come up with proposals on how to minimise the risks of bankruptcy and mass unemployment.
Measures to reopen parts of the economy on a phased basis must also be considered no sooner the Government is able to introduce or facilitate large-scale and intensive testing.
6. Curfew mitigation
It is important that the Government communicates its COVID-19 containment strategy to the people. Our aim should be to keep the disease from turning into an epidemic that will swamp the capacity of our hospitals. Meanwhile, we should develop a social and economic system that can sustain our economy as we coexist with COVID-19. Based on epidemiological advice and based the example of other countries that kept their economies open such as China, South Korea, Taiwan, Hong Kong, Japan and Singapore, we should gradually relax the present curfew.
The curfew is having a serious effect on public well-being and morale. Extending it indefinitely is not practical. Since the main aim of the curfew is to avoid the mass gathering of people, measures can be adopted to allow a small portion of the population to move freely on each day, so households have an opportunity to step out for essential needs such as food, medicine and banking at least once a week.
Your Excellency, we share a love for our country and a devotion to keeping our people safe and minimising the pain and suffering our country will endure. I strongly urge you to give the matters raised in this letter your closest attention. It is incumbent upon leaders worldwide to put their political ambitions and differences aside and work together to steer our people through this crisis.