By Murali Vallipuranathan –

Dr. Murali Vallipuranathan

New Zealand appears to be the first nation successfully applied an elimination strategy to the COVID-19 pandemic and brought down the new cases though it is too early to claim victory or complete eradication (1) (2). The purpose of this article is to discuss the strategies used by the New Zealand in achieving this success and to propose strategies to Sri Lanka to achieve similar success. Present day statistics of both countries are compared above in Table 1 and distribution of daily new cases of both countries are shown in Graphs above.  

New Zealand is an island nation similar to Sri Lanka and had the advantage of easily shutting down the country borders (3). However, the estimated population of the New Zealand 4.82 million (4) is much smaller compared to Sri Lanka with an estimated population of 21.4 million (5). New Zealand was going through an increasing phase of COVID Cases in March 2020. New Zealand Prime Minister came up with an elimination strategy in March 23^rd and announced a full-scale national lock down on 26^th March 2020 (2). New Zealand government simultaneously introduced economical support package for the vulnerable population to overcome the lock down period (2). All these strategies brought New Zealand to the successful present-day figures of new Corona cases to single digit and it further seems to be possible to bring to zero levels though the threat of Corona will loom until a successful vaccine or an antiviral drug is invented (2).

Table 1 Comparison of Corona Disease situation in New Zealand and Sri Lanka as reported on 29th April 2020

Now looking back into the Sri Lankan situation our total number of COVID cases is still smaller than New Zealand despite the larger population of the country (6) (7). There is absolutely no need to give up the hopes of elimination strategy at this point of time though our daily cases had gone up and showing an increasing trend. The following steps are proposed to move our country forward in the elimination battle of Corona.

1. As Corona pandemic elimination phase requires lock down measures and social isolation the plan of having a parliamentary election on 20^th June 2020 would be seriously jeopardizing the implementation of elimination strategy (8). We have already seen how the election arrangements for the last few months delayed our success in achieving the elimination phase. While the universities and schools were closed down political parties were having their campaign meetings increasing the risk of spread. There was a case report that a Corona patient came from UK to campaign for an election candidate (9). At this crucial juncture President should act as a statemen above the party interest making the country safer to all the citizens free from Corona. At the same time the opposition parties should support and contribute to the efforts of the President to eliminate the Corona virus disease as we see the success of the Prime Minister of New Zealand was attributed to the extended support of the opposition parties in New Zealand (3). 

2. Improved lab surveillance with enhanced testing facilities for all possible suspects should be the main strategy to find out the so far undetected cases (10). Though improved attention has been paid in this direction we need to screen all those who left the quarantine centres (QC) within last 3 weeks as we now clearly know that individual isolation was not satisfactory at the QC as evidenced by the increasing cases of cross infection from QC (11). Further there should be adequate supply of Personal Protection Equipment to the health staff and armed forces involved in quarantine and treatment of suspected or confirmed Corona cases. Ventilators need to be increased in the government hospitals as our statistics shows that Sri Lanka is having one of the least ventilator population ratios. It is high time that we improve our ventilator capacity even if we could achieve our success early at the elimination phase. 

3. GMOA should stop its political gimmicks and get involved in a constructive manner in elimination of Corona as the international experience shows when a country fails to contain the Corona Pandemic next it takes a heavy toll on doctors (12) (13) (14). President of GMOA a Specialist Paediatric Neurologist and his team of committee members who are just medical officers should honestly accept that they do not have the expertise to manage Corona Pandemic and should appoint experts among the membership to advice the government and public at this crisis stage. It is so amusing to see the daily talk shows by GMOA medical officers some of them who had left patient management and involved in full time trade union and administrative work for last several years but still addressing through the media to patients and public on Corona Management. GMOA talk shows with misinformation and wrong statistics had come under severe criticism by experts and research organizations (15) (16). An exit strategy document prepared by the pseudo experts of the GMOA was condemned by Muslim leaders as the document identified Muslim population as a risk factor for COVID 19 infection without any epidemiological rationale (17) (18). The most useful step for the GMOA and other medical associations at this stage would be to impress upon the President and the Government that the scheduled election on June 20^th would be not conducive to eliminate Corona from this country. Further they should educate the political leaders that Consultant Community Physicians with epidemiological background should be at the forefront of managing Corona spread as they are the field experts trained in managing Pandemics and it is happening in other countries such as Canada where the Prime Minister openly acknowledges that he follows the advice of chief public health specialist in the management of Corona Pandemic (19).

4. Lock down and isolation measures should be enforced strictly without any political favours. New Zealand set an example by demoting the Health Minister for ignoring the lock down rules (20). Quarantine should be enforced to all immigrants including those who would be arriving from China and USA too. Similarly, district Lock down procedures also should be implemented without any partiality. 

5. The QC’s should be set up carefully ensuring individual isolation and prevention of cross infection. The current strategy of armed forces choosing the location for QC’s at heavily populated areas can be dangerous if there is a possibility of cross infection. Further locating armed forces at the schools would not be appropriate as at these places individual isolation cannot be ensured and cross infection cannot be prevented. My choice as a public health specialist would be temporary selection of star hotels where the rooms contain facilities for individual isolation and prevention of cross infection. The tourist industry should realize that resumption of their business would depend on a Corona free country. Further expatriates and other passengers returning back to Sri Lanka should be directed to the underused Mattala Airport where they can be straight away quarantined without risking outgoing passengers with cross infection. 

*Disclaimer: Author Dr. Murali Vallipuranathan is a Consultant Community Physician at the Ministry of Health and a visiting lecturer at the Universities of Jaffna and Colombo. He was trained at the Section of Epidemiology at the King’s College, London in 2006/7. In 2010 he addressed on “Pandemic Preparedness Plan “at the SLMA Auditorium anticipating a pandemic in future. Though he is presently managing the COVID 19 Crisis at the Northern Province he claims the technical opinion expressed in this article to improve the public awareness is his private opinion and in no way reflects the official position of the Ministry of Health in this issue.

References:

1. https://www.bbc.com/news/world-asia-52436658
2. https://www.theguardian.com/world/2020/apr/10/elimination-what-new-zealands-coronavirus-response-can-teach-the-world
3. https://www.washingtonpost.com/world/asia_pacific/new-zealand-isnt-just-flattening-the-curve-its-squashing-it/2020/04/07/6cab3a4a-7822-11ea-a311-adb1344719a9_story.html
4. https://www.worldometers.info/world-population/new-zealand-population/
5. https://www.worldometers.info/world-population/sri-lanka-population/
6. https://www.worldometers.info/coronavirus/country/new-zealand/
7. https://www.worldometers.info/coronavirus/country/sri-lanka/
8. https://economynext.com/parliamentary-general-election-on-june-20-67200/
9. https://www.seithy.com/breifNews.php?newsID=242667&category=TamilNews&language=tamil
10. (10)https://www.weforum.org/agenda/2020/04/there-s-only-one-option-for-a-global-coronavirus-exit-strategy/
11. https://www.newsfirst.lk/2020/04/28/206-sri-lanka-navy-sailors-tested-positive-for-covid-19-dg-health-services/
12. (12)https://www.bloomberg.com/news/articles/2020-04-09/virus-takes-heavy-toll-on-doctors-in-philippines-indonesia
13. (13)https://www.courthousenews.com/virus-takes-toll-on-russian-doctors-and-nurses/
14. (14)https://www.thelocal.it/20200409/more-than-100-doctors-have-now-died-in-italys-coronavirus-outbreak
15. (15)https://www.colombotelegraph.com/index.php/covid-19-downright-disinformation-should-be-worse-than-rumour-mongering/
16. (16)http://www.dailymirror.lk/slide-1/GMOA-on-relative-rate-of-COVID-19-case-growth-in-Sri-Lanka-mistaken-on-both-data-and-trajectory/329-186126
17. (17)https://www.asianmirror.lk/news/item/31189-hakeem-hits-out-at-gmoa-s-exit-strategy-for-racially-profiling-muslims-and-causing-stigmatization
18. (18)https://www.colombotelegraph.com/index.php/covid-19-muslim-council-questions-gmoas-racial-profiling-methodology/
19. (19)https://www.youtube.com/watch?v=NVYMfvZ-R18
20. (20)https://www.theguardian.com/world/2020/apr/07/new-zealand-health-minister-demoted-after-beach-visit-broke-lockdown-rules