By Maheesha Mudugamuwa With the new coronavirus being declared as a global emergency by the World Health Organisation (WHO) on Thursday (30), local health workers raised fears over the acute shortage of necessary personal protective equipment (PPE) and lack of isolation rooms in the 12 major hospitals named by the Government to provide complete recovery care for any infected patients. Last week, following the confirmation of the first coronavirus case in Sri Lanka, a 43-year-old Chinese woman who arrived from the Hubei Province in China, the Ministry of Health (MoH) announced that 12 State hospitals in the country have been prepared to deal with the virus. MoH Director General of Health Services (DGHS) Dr. Anil Jasinghe said the National Institute of Infectious Diseases (IDH) and the Colombo, Ragama, Kalubowila, Negombo, Gampaha, Jaffna, Kandy, Ratnapura, Badulla, and Karapitiya hospitals have been prepared to handle any emergency situations. In addition, authorities at the Anuradhapura, Kurunegala, Ratnapura, Badulla, and Batticaloa hospitals had also been advised to be on standby to face any incidents that may arise following the coronavirus outbreak. However, healthcare workers alleged the country was not prepared for an outbreak as yet and therefore urged the authorities to take immediate action to provide the necessary facilities to face coronavirus. As at Friday (31) evening, an acute shortage of preliminary PPE including surgical gloves, goggles, and surgical masks had been reported from major hospitals around the country. Speaking to The Sunday Morning, All Ceylon Nurses’ Union (ACNU) President S.B. Mediwatte said the situation in major hospitals situated in key cities was not good as those hospitals did not have the necessary equipment. “At the National Hospital of Sri Lanka (NHSL), there was an acute shortage of surgical gloves as of last Wednesday (29) and similarly, the Kandy General Hospital (Teaching) was given only three surgical gowns even after they had requested the authorities for more,” he stressed, pointing out that the country was not ready for any possible outbreak. Mediwatte noted that if the situation at hospitals in major cities is at a poor state, one could imagine how the situation is in remote areas. Highlighting the lack of proper laboratory facilities for the testing of possible infection from coronavirus, Mediwatte noted that for a hospital outside Colombo, it would at least take around three days to get test results as testing facilities were only available at the Medical Research Institute (MRI) in Colombo. “The most vulnerable population is the hospital staff. This is not just the doctors and nurses, but the minor staff as well. Even though the masks and gloves were provided, they were sufficient only for the nurses or the doctors. What about the other healthcare workers? In a hospital, it’s not just doctors and nurses who deal with patients; it is mostly the minor staff. And as of now, there are no adequate resources even for the nurses and doctors,” he stressed. Highlighting the lack of proper isolation rooms, Mediwatte stressed that at the Kandy General Hospital, usual wards have been separated for any suspected patients. “Those wards are open and even if there is an infected patient, the rest of the staff and patients could also be infected because the ward is unsealed,” he said. Commenting on the drug shortage, he highlighted that there were severe shortages of several drugs in the hospitals and since there has been no drug confirmed yet to combat coronavirus, it was difficult to say whether the hospitals have enough medicines. “As of now, there are enough stocks of surgical spirits, gauze, and other items needed for sterilisation, but disposable gloves are out of stock,” he noted. Stressing the importance of paying immediate attention, Mediwatte noted that the system was not yet ready to face an outbreak. Last week, the WHO declared the ongoing coronavirus outbreak as a global health emergency as the spread of this virus has reached nearly two dozen countries, sickened thousands, and impacted both travel and business around the world since it started last month. In a press conference, WHO Director General Tedros Adhanom stated that the decision was taken not because of what is happening in China, but because of what is happening in other countries. “Our greatest concern is the potential for the virus to spread to other countries with weaker health systems which are ill-prepared to deal with it,” he stressed. The WHO defines a global emergency, formally known as a Public Health Emergency of International Concern (PHEIC), as “an extraordinary event which is determined to constitute a public health risk to other states through the international spread of disease and to potentially require a co-ordinated international response.” (International Health Regulations [2005]) This is the sixth global emergency declared in the past decade. The WHO also called for an acceleration in efforts to develop vaccines and treatments, and stressed that support be given to countries with weak healthcare systems which may not be able to cope with the virus. The virus is a coronavirus, and belongs to the same family as the virus that causes severe acute respiratory syndrome (SARS). It causes a respiratory illness, can spread from person to person, and emerged in the Chinese city of Wuhan in December. MRI Director Dr. Jayaruwan Bandara said 11 out of 12 samples received so far were free of coronavirus, with the one confirmed being of the aforementioned Chinese woman. Yesterday (1), DGHS Dr. Jasinghe noted that the Chinese national who was treated at IDH has fully recovered and can be discharged at any time. MoH Epidemiology Unit Director General Dr. Sudath Samaraweera noted the health units had been successful in preventing the spread of coronavirus. However, he said that public assistance was needed for the programme to be successful. The official requested the public not to be alarmed unnecessarily and to follow the instructions issued by the MoH. DGHS Dr. Jasinghe advised the public to take immediate action and go to the nearest hospital if they develop any symptoms suspected to be of the coronavirus infection. Meanwhile, the Epidemiology Unit has issued a series of instructions for the people including students and foreign nationals returning to the country from high-risk areas. The MoH, on instruction by President Gotabaya Rajapaksa, appointed a 22-member National Action Committee (NAC) to prevent the spread of the new coronavirus in Sri Lanka. The committee members include Western Province Governor Dr. Seetha Arambepola, Additional Secretary to the President for Foreign Relations Admiral (Retd.) Prof. Jayanath Colombage, MoH and Indigenous Medical Services Secretary Bhadrani Jayawardena, DGHS Dr. Anil Jasinghe, specialist Dr. Anuruddha Padeniya, Additional Secretaries Dr. Sunil De Alwis and Lakshmi Somatunge, Dr. Nihal Jayatilake, State Pharmaceuticals Corporation (SPC) Chairman Dr. Prasanna Gunasena, physician Dr. Ananda Wijewickrama, Brigadier Dr. Krishantha Fernando, Epidemiology Unit Director Dr. Sudath Samaraweera, Dr. Paba Palihawadana, MRI Director Dr. Jayaruwan Bandara, Civil Aviation Authority Chairman Maj. Gen. (Retd.) G.A. Chandrasiri, Immigration and Emigration Controller, and six other members. A special circular containing a set of guidelines to avoid the contraction of coronavirus has been issued to doctors and officials attached to the health sector and it has been made compulsory for medical teams at Bandaranaike International Airport (BIA) and staff at all hospitals to wear protective face masks, gloves, and head coverings. The MoH has also issued a four-page booklet with a set of guidelines to be followed in order to ward off the threat of being afflicted by coronavirus. It has also been made compulsory for all passengers arriving in the island to complete the information form provided to them on arrival. Despite the efforts taken by the Government to prevent the deadly disease spread in the country, Government Medical Officers’ Association (GMOA) Secretary Dr. Haritha Aluthge stressed the necessity for the Government to take immediate steps to be prepared for a possible outbreak which could occur during the period 14-17 February, as predicted by international experts. The peak of the coronavirus outbreak was expected during the period 7-10 February in China and therefore, Sri Lanka should be ready at least one week after the expected dates in China. “There are several measures taken by the authorities after they were highlighted by the GMOA, but a number of measures are yet to be taken in case of an outbreak,” Dr. Aluthge noted. “We have already handed them over to the committee in writing and we are happy that for some of the points highlighted by the GMOA, the Government has taken measures to rectify them and as a result, in most of the hospitals, the lack of PPE issue has been sorted out at the moment,” he said, adding that there were still a number of other measures to be immediately taken by the authorities. Highlighting the lack of isolation rooms, Dr. Aluthge noted that there were only 18 isolation rooms at IDH in Colombo, one in Badulla, and none in the Karapitiya Teaching Hospital in Galle. “When an infection like this starts to spread, it is most important to have special rooms with negative pressure. Unfortunately, Sri Lanka doesn’t have a single room which matches WHO standards,” he highlighted. He also added that the rooms at IDH in Angoda were normal rooms and not special rooms as per the standards put forth by the WHO. Therefore, it is one of the immediate requirements to provide at least minimum room facilities for the 12 hospitals named as centres to treat any infected patients, Dr. Aluthge noted. In addition, highlighting the importance of institutional quarantine for all arriving from high-risk areas in China, Dr. Aluthge noted that the Government’s decision to detain them at the Diyatalawa Army Camp was not a good decision, as there were no adequate medical facilities and the climate of the area was unfavourable for such a disease. Therefore, the GMOA informed the committee of the importance of institutional quarantine of all who come down to the country from high-risk areas in China, and the necessity of finding locations near Katunayake, like a resort or an army camp. “We, as medical professionals, don’t think that home quarantine is the best way to prevent such a virus as it could pose a huge public threat. Therefore, we insist the Government take necessary steps to strengthen the institutional quarantine at least for those arriving from high-risk areas. “With regard to high-risk areas, the situation in China should also be analysed as the virus spreads really fast among all provinces. Therefore, it shouldn’t only be the persons arriving from Wuhan who should be checked, but from other provinces too. Therefore, necessary precautions should be taken to prevent the virus being spread among the country,” he added. Responding to the lack of PPE, DGHS Dr. Jasinghe said that necessary steps had been taken to secure emergency purchases, and rejected claims of a serious shortage at present in government hospitals. He also requested the public not to panic over the virus, and instead to take necessary precautions.