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

අප දිනකට පරීක්ෂණ 2,000-6,000 පමණ කළ යුතු බවට විශේෂඥයින් උපදෙස් දී ඇතත්, එය සිදු නොවන්නේ ඇයි?

ප්‍රතිකාර සඳහා රෝගී වූවන් සොයා ගැනීමට පමණක් නොව, වඩා වැදගත් වන්නේ සැඟවුනු ආසාදිතයන් ප්‍රජාව තුළ ගත කරන කාලය අඩුකිරීමෙන් ආසාදන පැතිරීම බිඳ දැමීමේ කොවිඩ් ප්‍රතිචාරයට මහා පරිමාණයෙන් පරීක්ෂණ ඇතුලත් විය යුතු බව, සෞඛ්‍ය ප්‍රතිපත්ති ආයතනයේ අපි නිරන්තරයෙන්ම කියා සිටියෙමු.  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

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

අප සත්‍යය කතා කළ යුතුයි- අගුලු දැමීම අසාර්ථකයි-අපිට නැවුම් චින්තනයක් අවශ්‍යයි.

පසුගිය සති දෙක තුල අනාවරණය වු නව ආසාදිතයන් පිළිබඳව අප දන්නා පරිදි, ඇඳිරි නීතිය ඉවත් කිරීම ඇතුළු කොවිඩ් පාලන පියවර ලිහිල් කිරීමට කිසිදු තාර්කිත පදනමක් නොතිබුණි. මෙය බරපතලවුත්, මුළුමනින්ම මඟහැරිය හැකි වුත්, ප්‍රතිපත්තිමය අසාර්ථකත්වයක් වන අතර අනුමත කළ නොහැකි ව්‍යසනයකි.මේ රටේ වගවීම පිළිබඳව කිසියම් දෙයක් අදහස් කළේ නම්, ඊට සම්බන්ධ වූවන්ට එහි ප්‍රතිවිපාක විඳින්නට ඉඩ තිබුණි. ඇත්ත වශයෙන් පැහැදිලිව කිවහොත් මම අදහස් කළේ ජනාධිපතිවරයා නොව, ඔහු මෙතෙක් කටයුතු කර ඇත්තේ ඔහුට ලබා දී ඇති උපදෙස් මතය. 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

මැතදී ඇතිවු තත්වයන්,අපගේ වසංගතය තුරන් කිරීමේ උපාය මාර්ගයේ ඇති බරපතල ගැටළු හෙළි කරයි.

ඇදිරිනීතිය යටතේ කොළඹ පදින්චිව සිටින නිවැසියන් අතර රෝගය පැතිර යාමේ ප්‍රවණතාවය වැඩිවීම සෞඛ්‍ය බළධාරීන් පුදුමයට පත් නොකල යුතුය, මන්ද යත් එය බලාපොරොත්තු විය හැකි තත්වයක් වීමය. අපගේ ආරම්භක සාර්ථකත්වය මත, ගොඩනැගීමට ප්‍රමාණවත් පියවර ගැනීමට සති කිහිපයක් තුලම අප අසමත් වී ඇත. විශේෂයෙන්ම පරීක්ෂණ ප්‍රමාණය වැඩි කිරීමට නොහැකි වීමය. අවම ප්‍රජා සම්ප්‍රේෂණයක් සහිත තෝරාගත් රටවල් ගොන්නට අප ඇතුලත් වුවද, අපගේ ප්‍රතිචාරය පිළිබදව එන්න එන්නම පසුබාමින් සිටී. මෙමගින් අගුලු දැමීම ඉවත් කිරීම වඩාත් අපහසු වන අතර එය ආර්ථිකය නැවත ආරම්භ කිරීම සහ මැතිවරණය පැවැත්වීම යන රජයේ ආර්ථික හා දේශපාලන අරමුණු තවදුරටත් කලකිරීමට පත් කරනු ඇත. මාසයක් තුල සිදුකල අගුලු දැමීම තුල මහජනතාව සිදුකල විශාල කැපකිරීමද මේ නිසා අපතේ යනු ඇත. Continue reading