Experts discuss Sri Lanka’s unique approach to managing the pandemic
Sri Lankan vanguards converged at a panel discussion at a Wijerama House, headquarters of Sri Lanka Medical Association to review the country’s containment journey against the pandemic. Head of the National Operations Center for Prevention of COVID-19 Outbreak (NOCPCO), Army Commander Lieutenant General Shavendra Silva, Director General Health Services Dr. Anil Jasinghe and Chief Physician at the National Infectious Diseases Institute Dr. Ananda Wijewickrama discussed the country’s approach at combating the disease. Also present was Prof. Indika Karunathilake, President of the Sri Lanka Medical Association, the discussion was a part of the Asia-Pacific Academic Consortium for Public Health international webinar on Covid-19. Exceprts.
The current situation
Sri Lanka’s efforts at curtailing the spread of the disease have been quite effective in comparison to some of the leading nations throughout the world. The stringent actions taken by the Ministry of Health, tri-forces, the Police and other administrative structures in the country have ensured that the pandemic is kept at bay to a certain extent. Dr. Ananda Wijewickrema who has been on the clinical frontline battling this pandemic said. “We are going at a flattened curve. At present, the Health Ministry’s policy is to admit all the positive cases irrespective of their symptomatology (Symptoms characteristic of a medical condition exhibited by a patient) We can do that at the moment because we only have close to 700 patients in the country. That is an incidence of about 3 per 100,000,”
Currently, 20,000 Polymerase Chain Reaction (PCR) tests have been carried out in the country thus far and subsequently, the government has requested the increase in country-wide tests as well. Once a text comes out positive, the patient then is rushed to one of the country’s five specialized hospitals for treatment. According to Dr. Wijewickrama, this is due to two reasons. “One is to monitor if they are developing symptoms and to detect early if these patients are getting any complications. The second reason is to isolate them and prevent them from spreading the disease,” he explained. “Because of the limited numbers at present we are continuing to do this,” However if the numbers increase, this strategy would have to be revised, he quoted
According to Dr. Wijewickrama two-thirds of the Covid-19 patients in the country were asymptomatic, “We have a large number of asymptomatic patients. Maybe this is because of the higher number of testing we do in relation to the population numbers and maybe it is because of the quarantine facilities, as well as the contact tracing,” he explained
As of now, 16 symptomatic patients were in a critical condition of which, 7 had passed away and unfortunately one patient died on arrival and another a few hours later. The remaining 5 patients had passed away while being under intensive care.
Hydroxychloroquine Effective Against Covid-19
Covid-19 patients all over the world have been receiving Hydroxychloroquine as a form of treatment. The drug, which is primarily prescribed for the treatment of Malayria is currently being used in Sri Lanka. “When we started, we went through the available evidence. With the limited available evidence, the experts decided to give hydroxychloroquine to patients,” he said. “I know the evidence is very limited and other available evidence says there is no definite effect of this compared to other drugs, but still we continue to give that. In fact, we are in the process of analysing the response of the patients, the physical symptoms as well as the viral clearance of the patients who were given this drug,” Dr. Wijewickrama said
The doctor informs that there have been three instances where patients have been treated with convalescent plasma. “Health authorities are meanwhile in the process of collecting convalescent plasma and checking antibodies for future use if required,” He was referring to a medical procedure used by doctors treating the novel disease worldwide.
At least eight clusters reported in Sri Lanka
Dr. Anil Jasinghe, Director General of Health Services in Sri Lanka said that while most countries, especially in the West, approached the disease by aiming to control it, Sri Lanka tackled the outbreak in its own manner. “The main approach of many western countries was detection and treatment. All these countries in the East, even if you take Singapore or China, they attempted to do the same. In Sri Lanka, based on our strong public health system, we were able to harness the inert strengths,” he noted.
Dr. Jasinghe said that there have been at least eight clusters reported in Sri Lanka since the outbreak of the disease. “We have had at least eight recognized clusters, and we have been able to sort of ‘finish-off’ those clusters. There were two very bad clusters among them, especially in urban areas. These were the clusters linked to the drug addicts etc. But even with those clusters, I believe we have been able to achieve success at least 90 to 95 per cent. Some of these clusters we have officially closed. They have a normal life going on in those areas,” he added.
As of now, there have no issues in managing the outbreak informs Dr. Jasinghe, who went on to quote “We have no issue whatsoever with our treatment capacities. We have been incrementally strengthening capacities. We don’t want to say how many ICU beds or how many hospitals are available, but I assure you we are ready for any number of cases,”
The Sri Lankan authorities have openly admitted on state media that its primary objective is to ensure the ‘curbing of the spread of infection and working towards eradicating the disease at its first generation.’ Said the experienced doctor.
“We have been able to minimize the number of patients and even with the present-day clusters, we believe that with our strong public health system, we will soon be able to curtail the numbers.”
Drug addicts, lumpens and beggars
The panels were in agreement when the topic of ‘complexities of dealing with the population of various socio-economic levels in Sri Lanka’ was discussed. Dr. Janasinghe highlighted “With drug addicts or lumpens as we sometimes call them, our approach was different when it came to these groups. It’s not discrimination but one has to detect and identify the problems of these various segments of society. This is where the army was very supportive.”
“If you have a well-designed house, quarantine is possible at home. But we have areas where shanties with very poor socio-economic conditions. Dr. Jasinghe said that one particularly bad experience the authorities had to deal with was when Covid-19 positive cases were identified from two different slum areas nearby. “Even during the curfew people have been visiting each other as it is an enclosed area. On the other hand, they were different shanty outfits,” he recalled.
The beggars have been related as a part of the country’s pandemic management efforts. “Beggars have also been taken to certain residential facilities where they are taken care of. Notwithstanding the socio-economic level, I think they have been treated well and they are given clothes and meals, their requirements have been well looked after. Even the special segments of society are well looked after,”. Said Dr. Jayasinghe.
Over 50,000 in Isolation at 50 Quarantine Centres
Army Commander Lieutenant General Shavendra Silva, who is also the Head of the National Operation Centre for Prevention of COVID-19 Outbreak (NOCPCO) highlighted that the overall goal of the establishment was to ensure the prevention of the spreading of Covid-19. “The tri-forces established more than 50 quarantine centres in Sri Lanka,” he said.
According to Lt. General Silva the biggest challenge the NOCPCO encountered was to carry out contact tracing of Covid-19 positive cases. “We have extensively used the intelligence services to collaborate with the health and public administration services. Some people argued and questioned as to how the military can do this, but it was on the job training for us,” he said.
“Contact tracing of the affected personnel remains the most important factor for containment. The intelligence services of the armed forces and the Police, with health authorities, were tasked to conduct contact tracing in to first, second and third tiers of the confirmed, suspected and exposed cases. Therefore, the quarantine process and the conduct of PCR testing were followed up as and when required,” he elaborated on the process taken by Sri Lanka.
According to the NOCPCO chief 51 quarantine centres have been established since the disease outbreak in Sri Lanka. “The uniqueness was that there was not a single spread from A to B within a quarantine centre,” he claimed. “More than 3900 were in quarantine centres as of yesterday and approximately about 58,000 were isolated in their houses through contact tracing,” he said.
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