“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

Experts have advised for weeks that we need to do 2,000–6,000 tests a day, but why has this not happened?

We, at IHP, have consistently advocated that the COVID response must include massive testing, not only to detect patients for treatment, but more importantly to break the spread of infection by reducing the time that hidden cases spend in the community.

On 6th April, IHP produced estimates that we need to be doing 6,000 tests/day ideally, and a minimum of 2,000/day if we could not do that. We shared that report with senior MOH officials, but we also made it publicly available though this blog. Countless medical experts outside MOH, including many of the most senior doctors in the island, plus the GMOA, have made similar calls.

Later that same day (6 April), we learnt that MOH experts themselves had come to the same conclusion. 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

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

We need to start now to expand testing capacity to open our airports

We have previously explained why we will need in future to test all international arrivals for Covid-19 virus, as well as quarantining them for 14 days. 

The GMOA has called on the President to do this in a letter today. We endorse this call as the most rational option based on the scientific evidence we have right now and the experience in Sri Lanka of what happened in early March. Continue reading

New Zealand becomes the first non-Asian, Western country to adopt Elimination as the Goal

I share this in advance of a proper article on our exit paths that I haven’t had time to finish.

The most successful countries so far have been the East Asian countries which experienced SARS two decades ago. I think this has created a mental block for us in copying them. This is despite them sharing many cultural similarities, and despite the fact that one or two of them are the most similar to us in terms of how they organize their health systems.

New Zealand has now explicitly chosen the goal of Elimination over Mitigation. They are the first and only non-Asian, Western country to have done so. Continue reading

How much COVID testing do we need: (3) Who do we need to test?

We have estimated that Sri Lanka needs to be doing 2,000–6,000 RT-PCR tests a day. We have since learnt that the MOH Epidemiology Unit estimates we need to be doing 5,000 tests a day. This is essentially the same number because our estimates include testing of airport arrivals, and the airport remains closed. We provide here additional explanation of why we need to test specific groups. We will include this in a revised version of the report. In providing this, we emphasize two points.  Continue reading

How much COVID testing do we need: (2) Technical Estimates

Sri Lanka needs to increase testing of COVID from ~250 to at least 2,000 RT-PCR tests a day. There is a large backlog in testing of contacts of known COVID cases that needs to be rapidly dealt with. We also need to put in place testing capacity that will allow the country and economy to get back to some level of normality during the next 12 months. 

We report target levels for daily testing, as well as how much capacity we need overall. Our analysis does not estimate requirements for antibody (IgG/IgM) testing, as this will be additional and is not appropriate as the first line of testing in this war against COVID-19. The most urgent priority for the country is to expand RT-PCR testing. Our initial estimates and analysis are given in our report (click to download) and the key numbers are summarized below. Continue reading