Brainstorming among public health experts on optimizing the health sector response to the current surge in Sri Lanka

Public health experts representing diverse specialties held a brainstorming meeting convened by WHO Sri Lanka to discuss the current spike in cases in Sri Lanka. The key observations and recommendations to policy and decision-makers indicated below are documented based on proceedings and the consensus achieved at the meeting. The views expressed on the situation are those of the experts and do not necessarily reflect those of WHO.

The following crucial factors were considered:

• The COVID-19 situation in Sri Lanka is very likely to get worse over the next few weeks. The decisions we take NOW will affect the lives of millions of Sri Lankans. Therefore, the next 3-4 weeks are critical in controlling transmission and saving lives.
• The epidemiological trend of the past weeks shows a rapid exponential increase in the number of cases, this trend is likely to continue for some time if no effective interventions are made.
• There is a lag of 1-2 weeks between infection and case detection and a further lag of an additional 2-3 weeks between an increase of reported cases and an increase in reported ICU admissions and deaths. Thus, the deaths and ICU admissions we are seeing now are the consequence of infections that took place at the early stage of this third wave (3-4 weeks ago).
• The public sector health system is stretched to the limit, making it difficult to manage COVID-19 cases as well as other essential services. More health professionals and preventive staff (e.g. PHIs) are getting infected and HR policies need to be geared to meet the urgency. There is a “tipping point” beyond which the system can rapidly go out of control. 
• The more transmissible and severe variants detected in India and other variants have already been detected in the country, these can spread faster and may even circumvent vaccine-induced immunity.
• Vaccines will be crucial to controlling the epidemic in the medium-term but will not address the immediate crisis we now face. Some vaccines are only effective after the second dose. Therefore, it will take a minimum of 6-8 weeks to see the effects of vaccination in the number of new cases.

In the context of the above, there are two URGENT actions we can take to save lives – stop new infections as effectively as possible and prepare for the predictable increase in severe cases and deaths.

1. Globally, evidence shows that strict and immediate measures to restrict mobility are the only measures that quickly and drastically reduce cases. Sri Lanka will also benefit from strict mobility restrictions whilst maintaining major economic activities and essential services. There is a need to stop inter-district travel and introduce severe restrictions on non-essential human mobilities and the congregation of people. Universal adherence to 'precautions' such as appropriate masking, physical distancing, hand hygiene, and avoiding the 3Cs – crowds, confined and enclosed spaces, and close-contact settings is a must. High transmission areas must be shut down for 2-3 weeks to stop or limit transmission. There should be a national mobilization effort to accelerate vaccination.
2. Reconsider the management of asymptomatic cases, revise clinical management protocol to include home management.  Increase focus on intermediate care centers to detect cases early, properly monitor patients, and appropriately manage cases, thereby minimizing the need for more intensive care. Prepare for an increase in hospitalization and the need for adequate HDU and ICU care.

 “The greatest danger in times of turbulence is not the turbulence, it is to act with yesterday’s logic.” -Peter Drucker-

Participants