An Interview with Dr. Ananda Wijewickrama, the eminent senior consultant physician of the National Institute of Infectious Diseases, IDH

In the third episode of the SLEN Podcast, Eng. Jasmine Nanayakkara speaks with Dr. Ananda Wijewickrama, the eminent senior consultant physician of the National Institute of Infectious Diseases, IDH talks about the COVID-19 pandemic situation in the country and the engineers' contribution to the battle against the pandemic. An edited version of their conversation follows.

Eng. Jasmine Nanayakkara :

Welcome to SLEN Podcast. You are listening to the official SLEN Podcast series of the Institution of Engineers Sri Lanka, featuring a wide range of conversations on diverse engineering subjects of national importance. I am Eng. Jasmine Nanayakkara, and today we have a very special guest with us, who is none other than the eminent senior consultant physician of the National Institute of Infectious Diseases, IDH, Dr. Ananda Wijewickrama. A warm welcome to you sir. Good morning.

We appreciate the contribution that the health care workforce at IDH, led by your team, made to battle against Covid-19 at this most difficult hour of the nation. Could you briefly explain what is Covid-19 and what are the specific inherent features of this coronavirus that turned the world upside down?

Dr. Ananda Wijewickrama:

Yes, actually this started almost a year ago. It started in China. Coronavirus is a group of viruses that tend to cause infections in animals and humans from time to time. Coronavirus infections are not uncommon infections. Generally, these infections are not serious. They are these mild infections causing little fevers and so on. And they settle on their own. However, over the last so many years there have been occasions where these coronaviruses have changed their structure or mutated into viruses which can cause serious damage to the human body. One good example of the recent past was the outbreak we had due to SARS (Severe acute respiratory syndrome) virus. This occurred around 2002. I said earlier that coronaviruses are generally harmless viruses. But this SARS virus was causing death to humans. So it spread across the world. However fortunately the spread was not very rapid. or in other words, the virus was not very infectious. but even though it spread across the world it didn’t infect a lot of people. but the bad thing with the virus was it killed many people. out of the percentage of people who were found to be infected a fairly significant number died because of this. Fortunately, this virus disappeared on its own so the effect did not last for a long period. Now, this time also this started in China which we are having now is again a variation of the usual coronavirus or a mutation of the coronavirus. The main issue was the very high infectivity rate. In other words, it affects a lot of people very quickly and then many people died. if you take the total number of people infected the death rate for the number of people who died after getting the infections it's small. But because of the large numbers affected we see a large number of deaths also. That is the serious issue we have faced. because of this high infectivity, it has spread across the world within a very short period.

Eng. Jasmine :

We heard; we knew that there are few stages in the level of spread of the Covid- 19 diseases in Sri Lanka. Currently, on average, over 800 people are diagnosed with Covid-19 daily. Concerning the current level of spread, what is the stage that we are in?

Dr. Wijewickrama :

Depending on the speed that WHO has categorized countries or situations into various stages from state one to four. It depends on the number or rate of infection per population. In Sri Lanka, it varies from phase to phase. Now in the western province, we have quite a high rate of patients being detected. but it's not so in other parts of the country but still, the disease has spread to other parts of the country. So it may be a matter of time that we see large numbers in other parts of the country unless we take necessary preventive measures. Now, based on this status the WHO has recommended having some sort of some alert levels, that is again to prevent the spread. So if we take that we are in alert Level 3. When we take the Western province which means that there have to be many restrictions about the mobility about the gatherings and so on. But in other parts of the country, it hasn’t gone to that extent. But as I said earlier I think we know practically what is going on and we know that this is in the community and this is spreading and unless we take necessary precautions anybody can get the illness. If it spreads fast there can be other problems like affecting vulnerable groups. What I mean is that a certain group of people are likely to get seriously ill with this virus. Such groups are older people. People older than 65 years or 70 years and people with some other illnesses like diabetes and so on can get affected. Already we see the effect in the country. So that is why it is necessary to have all the preventive measures practiced across the country.

Eng. Jasmine :

After much deliberations, we learned that Sri Lanka received the Covid-19 vaccine from India recently. What sort of an effect, in other words, a positive outcome do you expect from this vaccine? And how is it being administered?

Dr. Wijewickrama :

Now generally when a vaccine is produced, the production process takes quite a long time, generally about 10-12 years. The main reason for that is that after giving the vaccine we have to observe and see the efficacy and how long the efficacy lasts. Because of the present situation, many countries started using the vaccines produced without waiting for that usual long period. And the WHO also approved it because of the current situation. So we know that certain vaccines are given to the public and we got the Astra Zeneca vaccine produced by the Serum Institute of India. There are two other vaccines approved by the WHO, is the “Pfizer” vaccine and the “Moderna” vaccine. Up to now the studies done using these have shown fairly reasonable, very good results and fairly reasonable efficacy. It is shown that it produces immunity in the body. We know that it is confirmed for this vaccine, which is in use. What we do not know exactly is how long this immunity lasts. That only time will tell. But at the moment with the available evidence, we believe there will be an immune for at least for more than a year. It can be 10 years or 15 or even longer than that, but without seeing what is happening in the future we don't know exactly the duration of the immunity. However, we know it is effective. The duration of the efficacy is what we don't know at the moment. It is given to frontline health care workers and the frontline military or the people in police. Then three forces who are dealing with Covid positive people and then we are very likely will be getting another by the big stock of the same vaccine towards the end of this month. If it is so, then it will be given to the rest of the people. We have prioritized the people who are going to have the vaccine in the priority order. Because we will not be getting the total needed quantity immediately. That is because the production is distributed throughout the world and no country can get the total required amount immediately. Now the production is limited even in the West. That is the situation. So after the health care workers, the people who are above 60 years of age and people who have other illnesses like diabetes, kidney disease, and so on will get the vaccine. And then the other categories will be getting vaccines such as people like the University students who have to gather to continue their work will be getting the vaccine. So it is based on priority, so the plan here is to give it to needed people. At the moment it is given to people above 18 years of age because it had been tested on that group and also people less than 18 years are very unlikely to get problems even if they get infected. So the target group is people above 18 years of age and the aim is to vaccinate at least 2/3 of the population. But that will give rise to a reasonable amount of immunity in society. That is the idea. It might take certainly several months, but the good thing is that we were able to start giving this vaccine and it is very likely we will be getting some more vaccines within the very near future.

Eng. Jasmine :

Well, on behalf of the Institution of Engineers Sri Lanka, I am forwarding this question to you, sir. What level of an assessment do you have on the current involvement of the engineering community in this country that supports the noble service of the Sri Lankan healthcare sector to fight against Covid-19? Do you think that the level contribution of Sri Lankan engineers in this regard is sufficient?

Dr. Wijewickrama :

Yes. Actually what we saw is that people are under threat of getting infected. We got a lot of support from many other sectors, especially from engineers. We have to thank all the engineers who build various things for the health sector. Especially in our hospital, the National Institute of Infectious Diseases, the involvement was encouraging. We had support from IESL, and they contributed in many ways. Some help us in building a CT scan facility in our hospital. Some help in designing various things like the negative pressure systems, that is especially that IESL was involved in designing the negative pressure systems for the Intensive Care Unit. That was an essential part for the safety of people who are working in the Intensive Care Unit. Many supported and that this was a time when people were not coming to do work in this hospital. The laborious and contractors were refusing to come. In such situations engineers gave the lead support to our hospital. In addition to that, there are many things we saw. Various inventions or innovation which help the healthcare workers, especially doctors in managing these patients. Like designing various things for the protection of health care workers, that was encouraging, I think. So they gave us a lot of confidence. I appreciate what they did. I think it is a good beginning now for collaborative work with engineers and doctors. I think in the future we should continue on this. Because I'm sure that this will provide a lot of benefit to the public and the patients.

Eng. Jasmine :

Finally, what is the message to the Sri Lankan public in general, about their lifestyle during the ‘New Normal’ situation?

Dr. Wijewickrama :

Yes, very likely that this virus will continue to be with us for at least a year, if not more. And even though we get the vaccine, we will have to continue with taking necessary precautions because one reason is we don't know exactly for how long the vaccine effective. Another concern is that viruses tend to change their structure. So sometimes this virus might change to a certain pattern where other vaccines may not be effective. That we don't know. Now that happened with certain viruses, for example with influenza that happens quite commonly. So we have to adapt to this new normal situation condition with that and of course, we have to restrict many things, but on the other hand, if you look at it positively there can be a lot of other opportunities and improvements, which we can do while considering this threat of the virus. I think that is what we should look at. There may be innovations, inventions. Starting of new productions of various things and of course, we know that there are restrictions on imports to the production in the country of certain things. We have to look at the opportunities of producing other new things. So I think even though it's it's not a very comfortable situation still there are startup opportunities. I think that is what we have to look at and also as engineers and doctors. I think we should give the lead in this situation.

Eng. Jasmine:

Thank you very much Dr. Ananada Wijewickrama, the Chief Consultant Physician at the National Institute of Infectious Diseases, IDH for spending your valuable time to share timely insights on Covid-19 with the engineering community of Sri Lanka. We wish you all the success in your noble endeavor against Covid-19. This is engineer Jasmine Nanayakkara from SLEN podcast. Have a great day.