The emerging consequences of the new normal resulted from the imposition and lifting of non-pharmaceutical interventions in Sri Lanka: Are we tired of the post-COVID-19 era?
By Eng. (Prof.) Mahesh JayaweeraWhat is “a New Normal”?
Limiting the non-pharmaceutical interventions (NPIs) to the shortest possible time period is imperative because the long-term imposition of NPIs is likely to cause significant adverse psychological, social, and economic consequences (Rawaf et al., 2020). In this respect, people need to embrace ‘a new normal era’ to seek new pathways to move forward with their day-to-day activities while adhering to the measures that safeguard them against getting infected and avoiding the transmission of the COVID-19. Thus, amidst the COVID-19 outbreak, people need to adapt to a new lifestyle until the epidemic dies down, as mentioned above (Rawaf et al., 2020). In the absence of a vaccine or a medicine that is proven to be effective against COVID-19, the decisions taken by government authorities for reopening the country for day-to-day activities with the imposition and lifting of NPIs decide to what extent the people of a society healthily embrace a new normal (Figure 1). Many are prepared, though reluctantly, to enter a new normal lifestyle with the introduction of a set of NPIs, which may prevail over a short or long time. Moreover, one could surmise that the new normal conditions may affect lifestyle behavior beyond what is expected, and as a result, communities may face unanticipated crises of many kinds. Hence, behavior and functioning of future societies will appear different from what have been today (Constable, 2020).
Plausible NPIs adopted in Sri Lanka: an unavoidable circumstance for all
Rapid transmission of COVID-19 across the country has led the government authorities to introduce various strategies to prevent the spread of COVID-19. To this end, many policymakers have imposed a multitude of NPIs as effective and efficient mitigation strategies to reduce the case numbers within the susceptible population by cutting off the transmission modes. NPIs play a critical role in minimizing the transmissibility of SARS-CoV-2. Until a safe and effective vaccine is made available, NPIs will continue to be the leading public health tool against the spreading of the COVID-19 virus. The NPIs adopted in Sri Lanka include efforts on contact tracing, quarantine, social distancing & health screening, hand hygiene, wearing facemasks, lockdown & isolations, health-related supports (enhanced RT-PCR (reverse transcription-polymerase chain reaction) testing, free medical services provided, and adequate make-shift hospitals established), among others. Such NPIs are adopted in varying degrees of success individually and in combinations. However, evidence manifests that the pandemic is still in progress with a reproduction number greater than 1, indicating an alarming situation in respect of public health.
A new normal emerging loud
It is a known fact that all seven NPIs mentioned above with episodes of different scales of imposition and lifting over extended periods are essential to continue to suppress the transmission of COVID-19 in Sri Lanka. Therefore, inadvertently, we have been getting accustomed to the new normal, and the response to the exposure to something very new may differ from person to person. However, embracing a new normal seems to be a baffling dilemma, as many people show up resistant to change their normal lifestyle.
Contact tracing is one of the significant NPIs imposed in Sri Lanka, and it continues with different conventional tracing methods in public places. Moreover, the government has recently rolled out a phone app de facto (Stay Safe - ICTA) to blunt the spreading of the COVID-19 pandemic. In a new normal, people’s movements for a given day would be easily identifiable with such an app; nevertheless, there has been much opposition for its implementation. Some believe that such apps are not ethically acceptable, as they may disturb the privacy of a person to a great extent. Regarding the use of such apps, many experts highlight a number of pressing questions (who should access data? what is the legitimate role of the entity processing data? is there a possibility for pilferage of data? should use of these apps be compulsory?) that are contentious among the general public.
Sri Lankan government authorities practice quarantine efforts in isolation centers and homes once contact tracing identifies susceptible close and distance associates. Government authorities strive hard to educate people that a sense of altruism would be better than a compulsion not to oppose or evade quarantine. Better facilities provided at quarantine centers need to continue in the future to win people’s hearts. Psychological phobia for quarantine needs to be eliminated in a new normal, and everyone must be prepared to undergo such confinement at any time. Studies carried out on COVID-19 pandemic situations articulate the importance of the longitudinal studies on psychological impacts, quarantine-related stresses such as long duration of quarantine, fears of infection, sense of security, frustration and boredom, non-availability of selected suppliers, and inadequate supply of true information (Brooks et al., 2020). Besides, they iterate that post-quarantine stresses such as financial losses, stigma among associates, sense of being cornered, and fear of contraction of other illnesses would be essential to be addressed by the authorities. We believe that all of such negative attributes must be borne by people in a new normal in Sri Lanka. Sri Lankan government attempts to eradicate or relieve such concerns for a healthy new normal to prosper in the future.
We surmise that social distancing and health checks in public places will become mandatory in a new normal, and everyone is forced to live with such NPIs. With the social distancing enforced, mass gathering, usual office, educational, and other commercial activities are allowed subject to many limitations; hence, novel methods of engaging in such activities need to be explored. Online communication, work from home concept, and reporting to work in shifts are some of the popular techniques in the new normal. People may encounter difficulties, inconveniences, and confrontations in day-to-day activities, as such work may not be carried out at the same pace that it was done in the past. Di Corrado and his co-workers (2020) suggest that people’s physical activity routines and psychological states are greatly altered with the imposition of social distancing.
Hand hygiene practices are also a common sight in many public places in the new normal. The use of alcohol-based disinfectants (hand sanitizers with 70% Isopropyl alcohol) became popular and widely used in many parts of Sri Lanka, and it will continue at an unprecedented level in the future. The use of hand hygiene is crucial in reducing the transmission of COVID-19 by fomite. The prolonged, frequent use of different types of sanitizers could bring about eczematous changes in users’ hands (Beiu et al., 2020). In such cases, the possible onset of hand dermatitis could be prevented or managed by using the appropriate skincare products. People with sensitive skin, particularly children, need regular skin hydration for preventing hand dermatitis after hand hygiene in the new normal (Beiu et al., 2020). Mushrooming of different types of sanitizers and disinfectants in the market with substandard quality may aggravate the risk of hand dermatitis in the new normal; hence, government mediation for quality assurance is imperative.
Wearing facemasks in public places becomes mandatory in the new normal, and people are forced to wear them as a part of their daily attire. Disposal of used masks becomes a burning issue, as Sri Lanka does not have adequate clinical waste handling plants covering the entire country. Prolonged use of disposable masks inadvertently by many is a common mistake, and it yields a multitude of negative impacts. When masks are worn for long hours, people tend to exhaust faster, resulting in reduced efficacies because of blockages of pores in the masks and conversely inhale in more viral loads. The quality and volume of speech of people wearing masks are sometimes poor, and they exert more energy in correcting such discrepancies resulting in higher breathing episodes. The decisions of wearing masks are based on altruism, self-efficacy, self-serving biases, perceptions of fairness, trust in science, socioeconomic status, education level, personal experience, personality, or individual physiological differences (Scheid et al., 2020). Besides, with the use of facemasks for extended hours, we may encounter physiological issues such as headaches and face dermatitis (Scheid et al., 2020).
One of the most essential and effective NPIs that needs to be continued during the new normal is lockdown and isolation, which also accounts for travel restrictions, closure of public places, etc. Long periods of lockdown could be expected if the pandemic goes beyond control with higher numbers of daily incidences. Such scenarios bring in many psychological impacts such as job security, financial losses, boredom, and anxiety, mood, thought disorders, post-traumatic stress, suicidal behaviors, among many others (Chiappini et al., 2020). One must not forget that the country expects the economy would recover to achieve a growth of 5.5% of GDP in 2021, in which many people have a significant role to play, and they should be prepared to bear a greater responsibility. Therefore, a new paradigm shift would be imperative in contributing to the country’s expected economic growth even under the new normal. Physical activity during lockdown or isolation periods will be at a reduced level resulting in people’s mental and physical health (Füzéki et al., 2020). Increased use of alcohol, tobacco, cannabis, and other artificial drugs could be expected even among COVID-19 victims, and lockdown episodes persuade them from fleeing from being under lockdown, and as a result, extremely chaotic situations could result in (Vanderbruggen et al., 2020).
Another effective NPIs that could be imposed for averting the COVID-19 pandemic is the enhanced health-related benefits, preferably the testing of RT-PCR. By the end of 2020, Sri Lanka could afford to conduct only about 12,000 – 15,000 tests per day, which was inadequate to arrest all suspects of COVID-19. In the new normal we believe that this number should be at least doubled to cater to many parts of the country. Delay in carrying out and reporting, misreporting, evading from getting such tests done, overcrowding for testing are some of the likely issues that could crop up during the new normal. Lack of testing machines, regional laboratories, and a competent workforce will be the other imminent issues that the health authorities are faced with even in the near future.
What is next?
The key challenge for healthy wellbeing in the new normal will be how Sri Lankans are prepared to live in the so-called new normal, deviating from the old persistent habits. In respect of making a healthy new normal for the general public, we may expect long periods of impositions of NPIs, and however, it may be a nightmare for many of us to adhere to some of these stringent impositions. Many of us are tired of restricting ourselves to indoors with copious levels of denials and rebuttals. The most important question before us today is how long we have to adhere to such restrictions. Nevertheless, most of us expect the future will not be so bleak with the implementation of vaccination programs in the country. Until such time, we all need to be patient, cooperative, and receptive to a new normal that may, sometimes, be unprecedentedly unbearable.
References
Beiu, C., Mihai, M., Popa, L., Cima, L., Popescu, M.N., 2020. Frequent hand washing for COVID-19 prevention can cause hand dermatitis: management tips. Cureus 12, e7506. https://doi.org/10.7759/cureus.7506.
Brooks, S.K., Webster, R.K., Smith, L.E., Woodland, L., Wessely, S., Greenberg, N., Rubin, G.J., 2020. The psychological impact of quarantine and how to reduce it: rapid review of the evidence. Lancet 395, 912–920. https://doi.org/10.1016/S0140-6736(20)30460-8.
Chiappini, S., Guirguis, A., John, A., Corkery, J.M., Schifano, F., 2020. COVID-19: The hidden impact on mental health and drug addiction. Front. Psychiatry 11, 767. https://doi.org/10.3389/fpsyt.2020.00767.
Constable, H., 2020. How do you build a city for a pandemic? BBC. https://www.bbc.com/future/article/20200424-how-do-you-build-a-city-for-a-pandemic. Accessed date: 29 November 2020.
Di Corrado, D., Magnano, P., Muzii, B., Coco, M., Guarnera, M., De Lucia, S., Maldonato, N.M., 2020. Effects of social distancing on psychological state and physical activity routines during the COVID-19 pandemic. Sport Sci. Health. 16, 619-624. https://doi.org/10.1007/s11332-020-00697-5.
Füzéki, E., Groneberg, D.A., Banzer, W., 2020. Physical activity during COVID-19 induced lockdown: recommendations. J. Occup. Med. Toxicol. 15, 1–5. https://doi.org/10.1186/s12995-020-00278-9.
Rawaf, S., Yamamoto, H.Q., Rawaf, D., 2020. Unlocking towns and cities: COVID-19 exit strategy. East Mediterr. Health J. 26, 499–502. https://doi.org/10.26719/emhj.20.028.
Scheid, J.L., Lupien, S.P., Ford, G.S., West, S.L., 2020. Commentary: Physiological and psychological impact of face mask usage during the COVID-19 pandemic. Int. J. Environ. Res. Public Health 17, 6655. https://doi.org/10.3390/ijerph17186655.
Vanderbruggen, N., Matthys, F., Van Laere, S., Zeeuws, D., Santermans, L., Van den Ameele, S., Crunelle, C.L., 2020. Self-reported alcohol, tobacco, and Cannabis use during COVID-19 lockdown measures: results from a web-based survey. Eur. Addict. Res. 26, 309-315. https://doi.org/10.1159/000510822.
Eng. (Prof.) Mahesh Jayaweera
B.Sc. (Civil Eng), Ph.D. (Env Eng)
Professor, Department of Civil Engineering, University of Moratuwa
Chartered Engineer, Member of IESL, IWA, SLAAS-Section C,
and SLAAS-Chair of Committee for popularization of Science
