SRI LANKA MEDICAL ASSOCIATION
Established in 1887
President
Dr. Padma Gunaratne
President Elect
Professor Samath D. Dharrmaratne
Immediate Past President
Professor Indika Karunathilake
Vice Presidents
Professor Sudharshani Wasalathanthri
Dr. Manilka Sumanatilleke
Honorary Secretary
Dr. Sumithra Tissera
Honorary Assistant Secretaries
Dr. Achala Balasuriya
Dr. Hasini Banneheke
Dr. Pramil Liyanage
Dr. Shehan Silva
Honorary Treasurer
Dr. Asela Olupeliyawa
Honorary Assistant Treasurer
Dr. Sajith Edirisinghe
Public Relations Officer
Dr. Kalyani Guruge
Social Secretaries
Dr. Christo Fernando
Dr. Pramilla Senanayake
Past President Representative
Dr. Lakshman Ranasinghe
Co-Editors (CMJ)
Professor A. Pathmeswaran
Professor Senaka Rajapakse
Council Members
Dr. Chandana Atapattu
Dr. Iyanthi Abeyewickreme
Dr. Sarath Gamini De Silva
Dr. Inuka Kishara Gooneratne
Professor Sampath Gunawardena
Dr. Ruvaiz Haniffa
Dr. Kapila Jayaratne
Dr. Lucian Jayasuriya
Dr. Peethambaram Jeepara
Dr. Dushantha Madegedara
Dr. Pramitha Mahanama
Professor R. M. Mudiyanse
Dr. B. J. C. Perera
Professor Jennifer Perera
Dr. Surantha Perera
Deshamanya Vidya Jyothi Dr. J. B. Peiris
Dr. Sankha Randenikumara
Dr. Udayangani Ramadasa
Dr. Anuruddhika Rathnayake
Professor Gitanjali Sathiadas
Dr. P. K. Sashika Sandaruwani
Dr Sunil Seneviratne Epa
Dr. Chathurie Suraweera
Dr. Asitha Kosala Thannippuliarachchi
Dr. Bhanuja S. Wijayatilaka
Professor C. Nirmala Wijekoon
Dr. Dakshitha P. Wickramasinghe
Professor M. C. Weerasinghe
“Wijerama House”, No. 6, Wijerama Mawatha, Colombo 07, Sri Lanka.
2nd June 2021
His Excellency Gotabaya Rajapaksa,
The President of the Democratic Socialist Republic of Sri Lanka,
Presidential Secretariat,
Colombo 01.
Your Excellency,
Mitigation of COVID 19 infection in Sri Lanka
The SLMA is ever grateful to Your Excellency and the Government of Sri
Lanka for declaring a “lockdown” (restriction of movement throughout the
country) at the most crucial hour, which essentially salvaged Sri Lanka from
getting into the abyss of a major catastrophe; a breakdown of the healthcare
system of the country which in turn would have led to a breakdown of all
systems.
I, along with the SLMA Committee to advice on matters related to COVID 19,
wish to bring to your kind attention the following important facts with regard to
controlling of COVID-19 epidemic in Sri Lanka. In addition to the SLMA
Council members and the members of the Intercollegiate Committee, Professor
Neelika Malavige, Professor Malik Peiris and Professor Kamini Mendis,
contributed to the discussion.
1. Recommendation with regard to the continuation of the lockdown
We gathered information from consultants working in clinical settings
and laboratories to find out the current usage of the capacity of the
health care system
a. Physicians indicated that the brunt of the outbreak is now
concentrated in the main hospitals and all wards are well over their
full capacity with symptomatic patients. There are many COVID
patients as floor-patients in medical wards.
b. Information from the ICUs indicated that other than the dedicated
82 ICU beds, another lot of about 70 more patients are treated in
ordinary ICUs at the time of discussion. This situation
compromises the care given for patients with Non-COVID issues.
There are about 500 more patients on oxygen therapy, treated in
High Dependency Units.
c. Consultants from laboratories indicated the same or higher rates of
PCR positivity despite overall PCR positive numbers remain same,
when compared to previous weeks.
This information confirms that hospitals are overwhelmed with cases. As
expected, it is too early to see a visible impact of the lockdown on the
healthcare system. Opening the country at this juncture would invariably
facilitate the spread of the infection leading to increasing number of cases that
in turn would cause a complete paralysis of the healthcare system. As such,
while we are convinced of the benefits of the lockdown to the healthcare
system, we are compelled to recommend a further extension of the
lockdown by at least another week. Keeping grocery shops opened may
facilitate compliance by the public with a longer lockdown.
Tel: +94(0)11-2693324 Fax: +94(0)11-2698802
e mail: office@slma.lk website: www.slma.lk
 SRI LANKA MEDICAL ASSOCIATION
Established in 1887
“Wijerama House”, No. 6, Wijerama Mawatha, Colombo 07, Sri Lanka.

2. The need to review the vaccination programme

We are appreciative of the decision taken by the Government of Sri Lanka to vaccinate
healthcare officials and other frontline workers such as the police, the tri-forces etc., initially
with the highest priority.

However, we are of the opinion that the vaccination strategy as implemented at present is
flawed and needs a composite review urgently. In a setting particularly troubled by a
continuous short supply of vaccines, we emphasize the need for an efficient vaccination
strategy targeting high-risk groups to achieve maximum control which would avoid the
necessity for repeated lockdowns.

In cognizance with the data available from the rest of the world, the death analysis of patients
from the MoH, Sri Lanka, indicates that 73% of deaths occur in people over 60 years of age
and 83% of deaths were in people with co-morbidities. Research findings have clearly
demonstrated that vaccination reduces deaths and complications in patients infected with
COVID-19. Research evidence does not support benefits of vaccination to reduce
transmission of infection unless a large majority of the population is vaccinated. As such,
there is clear and compelling evidence to support prioritisation of vaccination of older
adults more than 60 years, followed by people with comorbidities in the age group of 30
– 60 years. However, there is no appreciable benefit in vaccinating people with the highest
mobility in so-called hotspots, as is currently carried out in the Sri Lankan setting.

Furthermore, we emphasize the need of a definitive roadmap providing priority of vaccination

in certain geographical locations. Presence of a roadmap would help in gaining the confidence
of our people on the vaccination programme. Selection of Grama Niladhari divisions of high-
risk locations for vaccination cannot be recommended as the infection would have already
spread and the majority would have developed immunity by the time the vaccination
programme is carried out. The opinion of experts with regard to selecting the geographical
location is to select high-risk provinces or districts and to vaccinate high risk people in
crowded areas such as main cities in those selected provinces or districts. An equal amount
of vaccines could also be given to hospitals to immunize high-risk people with
comorbidities. Along with vaccinating high-risk persons, people working in higher numbers
in enclosed areas with longer shifts in economic hubs and other essential congregate settings
also could be prioritized.

We urge the Government of Sri Lanka to provide a solution to the 600,000 people awaiting
the second dose of the Covishield vaccine as early as possible. We see that offering them the
first dose of Sputnik V following a quick clinical trial of the efficacy of such a manoeuvre as
a reasonable option to solve the issue. Monitoring antibody levels 2 weeks following
vaccination with Sputnik V in about 100 people who have had the 1st dose of Covishield
vaccine may provide a reasonable answer to this question. The importance of documenting
the adverse effects during such a clinical trial also needs to be emphasized.

Further, we wish to highlight the need in future to reserve the second dose in instances where
a second dose is in the schedule.

3. Reporting meaningful data

We understand that the primary role of the Epidemiology Unit of the Ministry of Health is
surveillance and reporting the data in a meaningful manner to facilitate the decision-making
process aimed at mitigating the outbreak.
 SRI LANKA MEDICAL ASSOCIATION
Established in 1887
“Wijerama House”, No. 6, Wijerama Mawatha, Colombo 07, Sri Lanka.

We would like to inquire from the Epidemiology Unit of the Ministry of Health as to whether
they have data regarding PCR positivity rates in factories that are kept open, in case a
necessity arises to advise the Government in this regard?

There had been a significant reduction of the number of PCR tests carried out over the last
two weeks. We understand that the majority of reported PCRs are exit-PCRs that do not
measure the extent of transmission in the community. Unless PCRs are carried out
proactively, it is likely that the usefulness of the results of analysis of samples with a majority
of exit-PCRs will remain low despite the disease spreading rapidly. Similarly, unless the
disaggregated test results based on context categories and geographical locations are analysed,
the inference made by all PCRs together is likely to be most erroneous.

We are informed by one of our experts, Professor Kamini Mendis that they are in the process
of compiling a document giving important surveillance indicators. We urge the
Epidemiology Unit of the Ministry of Health to pay more attention to the surveillance
indicators and present the data of relevant indicators to arrive at meaningful decisions.

We, from the SLMA Council and the Intercollegiate Committee, would be greatly indebted to you if
an appointment could be kindly granted to us to discuss this issue further with your good self.

We remain committed to assist you in all your endeavours to safeguard the health of the nation.

Dr. Padma Gunaratne

President, SLMA

Copies to
Hon. Mrs. Pavithra Wanniarachchi, Minister of Health
Hon. Dr. Sudarshinie Fernandopulle, State Minister of Primary Health Care, Epidemics and COVID
Disease Control
Hon. Dr Channa Jayasumana, State Minister of Production, Supply and Regulation of
Pharmaceuticals
Dr. P. B. Jayasundara, Secretary to H E the President
General Shavendra Silva, WWV RWP RSP VSV USP ndc psc MPhil
Major General Dr. Sanjeewa Munasinghe, Secretary, Ministry of Health
Dr. Asela Gunawardana, Director General of Health Services, Ministry of Health