Given the scary pace the pandemic is accelerating at within the country, Behaviour-Change-Communication (BCC) is vital to fight the Covid- 19 social stigma if we are to overcome the deadly disease and save the country, GMOA spokesman Dr. Haritha Aluthge told the Sunday Observer last week.
He was referring to the recent incident where a patient who tested positive for Covid-19 at a private hospital was not located because the patient had shared false information with the hospital officials. BCC is a communication strategy which encourages communities to alter their behaviour, in this case to dispel the stigma so that people will not fear reporting new Covid- 19 cases.
Head of the National Operations Centre for the Prevention of Covid-19,Army Commander, Lieutenant General Shavendra Silva told media that the patient had undergone a PCR test at the private hospital. He said that people with Covid-19 like symptoms should immediately self-isolate and remain in their home before informing health authorities in their relevant areas.
Stigma
“There is stigmatisation of the disease within the community. We (the GMOA) believe proper communication by authorities such as the Ministry of Health and the Epidemiology Unit is of utmost priority to dispel misconceptions and stigma,” Dr. Aluthge said. He also said that people should be made aware of the gravity of the situation.
He said most of the issues related to the quarantine process were settled after the Government took measures to allow home quarantine.
Home quarantine
Home quarantine for first contacts of Covid-19 patients was given the greenlight by the Government after taking into consideration the requests made by the public. They will be under strict house quarantine and not allowed to leave their homes for 14 days during which time Public Health Inspectors will strictly monitor them.
“Now the issue is with the intermediate centres. These centres are where asymptomatic patients are kept and monitored,” the GMOA official said. This is because the intermediate centres are not proper hospitals and unlike hospitals lack some necessary facilities.
“The authorities have to do a proper evaluation of the situation. They should get feedback from people who are in these intermediate centres and improve the setting. By that people will not be reluctant to got to these places,” Dr. Aluthge said.
He said that some private companies have requested to do the quarantining of their employees in charge levying hotels. But, he said, this could have practical issues such as difficulty in monitoring to see if the patient develops Covid-19 symptoms. “When they are scattered all over the country handling their cases will be hard,” he said.
Three main concerns
The GMOA has pointed out three main concerns relating to PCR testing that needs immediate intervention. One is to upgrade the PCR machines that are in about 26 laboratories owned by the Government, the private sector, universities and the Sri Lanka Army so that capacity can be increased to 15,000 a day from the current 12,000 tests.
Another concern is the provision of PCR results within 24 hours for optimum results, and improving the quality of PCR testing.
“There should be a standardisation of PCR testing so that the public will have more trust in the system. We also need a constant mapping of patients so that it will be easier for the prediction of the disease,” Dr. Althuge said. He also said that there is a needs for a GPS mapping of identified Covid-19 patients.
“The GMOA has even decided to withdraw from the Ministry of Health’s technical committees if this is not done,” he said. The process of GPS mapping has started but has not been finalised.
He warned that with the increase of the case load treatment options will have to be revisited. This is vital to ensure that in future Covid-19 patients will not fear taking relevant precautions and treatment.
There were several incidents where Covid-19 patients escaped from the hospitals. A police hunt was launched after a 26-year-old suspected Covid-19 patient escaped from the Kosgama hospital on October 23. He was later found. Another patient was found after a police hunt early last month, after he escaped from the Colombo North Teaching Hospital in Ragama where he was receiving treatment.
HRCSL
Human Rights Commission of Sri Lanka (HRCSL) early this week issued a set of guidelines for regularising quarantine processes, while it recognised the ‘need to restrict freedom of movement and the liberty of the people in the interests of public health and public order’during this time.
In a letter addressed to Minister of Health, PavithraWanniarachchi and Army Commander Lieutenant General Shavendra Silva, the HRCSL stated that it has observed that a large number of persons have been subject to quarantine processes in view of the resurgence of the fear of the spread of the Covid -19 pandemic and that it has received a variety of complaints and expressions of concern relating to the process.
“In this regard, the Commission welcomes confirmation that first contacts of Covid-19 infected patients who were earlier sent to quarantine centres, will now be home quarantined,” it said. It also said that it was in agreement that quarantining persons in their home will be the best option.
Mental health
Among the proposed guidelines are ensuring the quarantine period is considered paid or on duty leave, and ensuring financial or any other assistance to families of those in quarantine.
However, experts are saying that the pandemic is creating an equally worrying issue. According to the World Health Organization (WHO), the pandemic is triggering mental health conditions or exacerbating existing ones as a result of ‘bereavement, isolation, loss of income and fear’ caused by the current situation.
According to the WHO, people with pre-existing mental, neurological or substance use disorders are at risk of contacting the virus that could even have a fatal outcome.
“Good mental health is absolutely fundamental to overall health and well-being,” said Director-General of the WHO,Dr. Tedros Adhanom Ghebreyesus, “Covid-19 has interrupted essential mental health services around the world just when they’re needed most. World leaders must move fast and decisively to invest more in life-saving mental health programs.”
In Sri Lanka, this situation could have been made worse by media coverage of the pandemic. The media frenzy that revolved around Covid-19 victims aired what officials called ‘deeply sensitive scenes’.
Guidelines
This caused the Director-General of Information, Nalaka Kaluwewa to direct the media’s attention to guidelines issued in reporting the pandemic in a way that it does not cause pain and anguish in loved ones of the deceased patient. The guidelines also ensured that the privacy of Covid-19 patients is protected, and that he or she is not depicted as a threat of spreading the virus.
In February this year,. the WHO warned of the severe effects of the stigma surrounding the virus can have on its containment.
“How we communicate about Covid-19 is critical in supporting people to take effective action to help combat the disease and to avoid fuelling fear and stigma. An environment needs to be created in which the disease and its impact can be discussed and addressed openly, honestly and effectively,” it said.
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The Human Rights Commission of Sri Lanka issued the following set of guidelines to be considered during the quarantining process.
The Commission is of the view that the quarantine process can be regularized under the law by:
(i) Transparency in delegation of powers by the “Proper Authority”;
(ii) Vest powers of testing on designated qualified personnel;
(iii) List the places designated as quarantine centres and the designating authority.
(iv) Clarify the period of required quarantining.
(v) Create a receipt system for quarantined persons including the reason for quarantine, the place they are being taken to and the length of isolation;
(vi) External scrutiny of quarantine centres, especially by the “proper authority”;
(vii) Prohibit those handling quarantine from informing the media of the proposed quarantining efforts, exposing those being quarantined to public gaze as though they were offenders rather than unfortunate victims of a virulent virus.
The Commission is also of the view that the hardships imposed by the quarantining process can be ameliorated by:
(i) Ensuring quarantined period is considered paid/ duty leave;
(ii) Ensuring financial or any other assistance to families of those in quarantine;
(iii) The Grama Niladhari be immediately informed when a person is quarantined;
(iv) In the circumstances where the vulnerable dependents in the families are left behind due to quarantine process, the Grama Niladhari to ensure provision of all necessary support to vulnerable persons including alerting the proper authorities.