Inadequate PCR testing capacity and testing remains our central problem

The increasing COVID-19 deaths in the past few days is a sign that the outbreak may be larger than our current constrained PCR testing is able to track. As I and others warned six months ago, we needed to ramp up PCR testing to keep the virus at bay and prevent future outbreaks. The President and PM gave instructions to that effect, but in reality this did not happen. Why remains a mystery, but the current outbreak is the inevitable consequence.

Increasing PCR testing reduces COVID-19 transmission (Reff). In combination with contact tracing and isolation, it is the most effective intervention we have to control the virus. Better by far than lockdowns, masks, school closures and asking people to wash their hands… Other countries that were doing well back in May did continue to ramp up PCR testing, despite in some cases having no local cases. All these countries have managed to avoid a second wave.

Whatever happens, the most important gap in our current strategy and by far the most important one we need to fix remains PCR testing. It’s not ventilators, it’s not quarantine or contact tracing, and it’s not our border controls. Continue reading

At the precipice—Reaching the limits in managing the crisis

*I am reposting here with some edits and added links the article I wrote in the Daily Mirror on 29th October 2020.

As a country, we’re in a moment of great peril. More than at any time during this pandemic. Unless we shift course, single-mindedly focus on the critical issues, and make the correct decisions and implement them decisively, we face not only an out-of-control epidemic, but economic disaster. Fixating on how the Minuwangoda outbreak started or who is to blame, or whether we have community spread or not, or is utterly pointless and has become a dangerous distraction from the real challenges. Continue reading

Time to rethink our COVID-19 testing strategy

*I am reposting here with some edits and added links the article I wrote in the Daily Mirror on 7th October 2020.

The Minuwangoda incident should come as no surprise. The problems were obvious with the Kandakadu outbreak, but I remained silent in the hope that lessons would be learnt, but it seems that I was wrong.

We must recognise that as long as the global COVID-19 pandemic continues, we can never declare final victory against COVID-19 in Sri Lanka. To do so is to fool ourselves and the public. Wise leaders, like Jacinda Ardern, the New Zealand PM, warned their nations not to let their guard down, even after months of no local cases, because they understood that (a) no set of border controls can be 100% guaranteed to keep the virus out; and (b) it is impossible to know with certainty that there is no COVID-19 virus circulating unseen in
the community. Continue reading

We’ve been busy for too long…and what we feared has happened

It’s been six months since I last posted here. Far too long.

When I stopped writing here, it was to work on something else. I think we succeeded earlier in the year in helping the public and colleagues better understand the challenge we faced with COVID-19 and countering the complacency. I think we had some impact, but clearly it wasn’t enough to really change things. Continue reading

“Eliminating” … “Crushing” COVID is possible and these countries are the real Superstars

Ever since the key numbers for the Covid-19 virus became clear in mid-February, it was obvious that all countries would end up trying to control its spread. The alternative of letting the virus rampage unchecked through a country would always end up being too awful for any government, however stubborn or stupid, to accept.

Unfortunately, there is a lot of confusion about the various strategies that countries could adopt, with a whole new lexicon of terms being thrown around in the media and by experts, and often used inconsistently. Welcome to our new world of “flattening the curve”, “hammer and dance”, mitigation, elimination, suppression … and the list goes on. But ultimately, all these strategies boil down to just two – ”Mitigation” and “Elimination”, and which of these countries choose is often a matter of how much short term pain they are willing to suffer for longterm benefits. Continue reading

Interview with EconomyNext — “Blaming the public is an admission of failure”

I am posting here a link to an unplanned interview that I did with EconomyNext, since unexpectedly it has attracted a lot of interest. Continue reading

நாம் உண்மையை ஒப்புக்கொள்ள வேண்டும் – பணி முடக்கம் தோல்வியுற்றது, எமக்கு புதிய சிந்தனை தேவை

கடந்த இரண்டு வாரங்களில் கண்டறியப்பட்ட புதிய தொற்றுகள் குறித்து எங்களுக்குத் தெரிந்த விவரங்களை வைத்துப் பார்த்தால் திங்களன்று (ஏப்ரல் 27) கொழும்பில் ஊரடங்கு உத்தரவை நீக்குவது உட்பட, COVID கட்டுப்பாட்டு ஏற்பாடுகளை தளர்த்துவதை எந்த விதத்திலும் நியாயப்படுத்த இயலாது. இது மிகப்பாரிய மற்றும் முற்றிலும் தவிர்க்கப்பட்டிருக்கக்கூடிய கொள்கை தோல்வி மட்டுமன்றி மிக மோசமான தவறாகும். பொறுப்புக்கூறல் என்பதற்கு இந்த நாட்டில் அர்த்தம் ஏதேனும் இருந்தால், தற்போதைய சுகாதார செயற்பாடுகளை வடிவமைப்பதில் பங்குகொண்டவர்களுக்கு எதிராக விளைவுகள் இருந்திருக்கும். தெளிவுபடுத்திக்கூறுவதாயின், நான் இங்கு ஜனாதிபதியை குறிப்பிடவில்லை ஏனெனில் இதுவரை அவருக்கு வழங்கப்பட்ட ஆலோசனையின் மீது நம்பிக்கை வைத்தே செயல்பட்டுள்ளார். Continue reading

We must speak the truth – the lockdown failed and we need fresh thinking

Given what we know about the new cases detected in the past two weeks, it was no longer justifiable to relax COVID control measures on Monday (April 27), including lifting the curfew in Colombo. This is a monumental and totally avoidable policy failure and an unmitigated fiasco. If accountability meant anything in this country, there would have been consequences for those involved in setting the health response. And to be absolutely clear, I do not mean the President, who has so far only acted in good faith on the advice he has been given. Continue reading

The recent outbreaks reveal serious problems in our elimination strategy

The surge in cases due to spread between residents of Colombo under curfew should not surprise the health authorities – it was entirely predictable. For several weeks, we have failed to take adequate action to build on our initial success, in particular to expand testing. Whilst we remain in a select group of countries with minimal community transmission, we are increasingly dropping behind in our response. This is making it more difficult to lift the lockdowns, it will continue to frustrate the government’s economic and political goals of restarting the economy and holding elections, and it is putting to waste the enormous sacrifices that the public have made during one month of lockdown. Continue reading

First national COVID study points to challenges for community surveys in Sri Lanka and shows why herd immunity will not work

Last week (10 April), Austria released findings from the first national survey of Covid-19 infection in any major country in the world. Despite the country suffering a severe epidemic, only one in a hundred Austrians appear to have been infected. The findings demolish the idea that a strategy of going for herd immunity is a viable response to Covid-19 in any sane country. They also suggest that conducting community prevalence surveys in countries like Sri Lanka will face significant challenges. Continue reading