By Dr. Charuni Kohombange
Sri Lankans are facing unprecedented challenges to their lifestyles with the abrupt identification of new Covid-19 clusters. Along with this, the building up of insecurities and unrest in the public is inevitable. This article is based on a discussion with officials of the Sri Lanka Medical Association (SLMA), on the current Covid-19 situation in the country.
At the time of writing, the total number of cases had passed 12,000 with 24 deaths in Sri Lanka.
Revised quarantine process
SLMA Vice President and University of Colombo Faculty of Medicine Department of Community Medicine Head Prof. Manuj. C. Weerasinghe explained the current quarantine process being implemented.
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The MOH will get the patient’s history to identify the presence of symptoms and the risk factors. The staff of the MOH office have to analyse this data of all PCR-positive individuals and identify the suitable treatment centres in co-ordination with the Office of the Regional Director of Health Services SLMA Vice President and University of Colombo Faculty of Medicine Department of Community Medicine Head Prof. Manuj. C. Weerasinghe [/caption]
“If a person gets directly exposed to a known Covid-19 patient, that person is considered as a first-line contact. Formerly, these persons were identified and quarantined at institutions. However, with the increasing numbers of patients, the Government has decided to practise the home quarantine system. In this situation, the exposed person has to quarantine at home along with his family members,” Prof. Weerasinghe noted.
He added: “In the meantime, his samples will be taken for PCR testing. If the PCR test results become positive, he will be admitted to a hospital or an intermediate management centre depending on his condition. His family members have to continue the home quarantine process, till they get subjected for PCR testing.”
Is there a delay in admitting Covid-19 patients to institutions?
During the past few weeks, several incidents were reported on delays in admitting PCR-positive individuals to hospitals. Prof. Weerasinghe explained this too, noting: “When the PCR test results are received by the MOH (Medical Officer of Health), the PCR-positive persons will be contacted over the phone and informed of their results. The MOH will get the patient’s history to identify the presence of symptoms and the risk factors. The staff of the MOH office have to analyse this data of all PCR-positive individuals and identify the suitable treatment centres in co-ordination with the Office of the Regional Director of Health Services.”
Symptomatic patients and individuals identified as high risk to develop complications (e.g., elderly, those who have heart diseases/diabetes, etc.) will be admitted to a hospital. Asymptomatic individuals without obvious risk factors will be admitted to intermediate management centres. This process takes time due to the limitations in resources and facilities. “The most important fact is to stay at home until the healthcare workers come to your doorstep,” said Prof. Weerasinghe.
Covid-19 and children
This pandemic situation had a major impact on education and the activities of children. Staying at home for months has become monotonous and tedious for many kids. Speaking on this, SLMA Past President and consultant paediatrician Dr. B.J.C. Perera said: “Children are equally prone to get the disease but in general, the number of children getting infected is much less.
[caption id="attachment_104231" align="alignleft" width="210"]
In the global scenario, the percentage of children infected is less than 10%. Similarly, in Sri Lanka only about 100 children have been diagnosed so far. However, the majority of kids who are PCR positive do not have symptoms. Hence, they can be a source of the spread of the virus SLMA Past President and consultant paediatrician Dr. B.J.C. Perera [/caption]
When considering the total number of patients in the global scenario, the percentage of children infected is less than 10%. Similarly, in Sri Lanka, only about 100 children have been diagnosed so far. However, the majority of kids who are PCR positive do not have symptoms. Hence, they can be a source of the spread of the virus. Some children are more vulnerable to develop complications. Like adults, those who have other diseases are more viable to develop complications; especially the kids who are less than three months are more vulnerable.”
In Europe and the US, some cases have been identified with multisystem inflammatory syndrome in children (MIS-C), which affects several organs including the heart, lungs, kidneys, brain, skin, and eyes. There had been a few deaths due to this condition in some European countries.
Is it possible to open schools?
It was decided to further postpone the reopening of schools due to the prevailing pandemic conditions. “Children are not in the phase of the pandemic, as the number of children getting infected is much less. However, they can be the direct or indirect victims of the pandemic,” said Dr. Perera.
In the world scenario, nowhere has it been reported that a school has been the centre of the pandemic or a cluster. So far, the situation is similar in Sri Lanka. In many countries, children are suffering with this disease due to the lack of access to healthcare. However, Sri Lanka provides free health services equitably, with the free healthcare system.
“Children are the future of the nation and education is the future of children. Hence, any disruption to the education of children can affect the future of the nation detrimentally,” said Dr. Perera.
It is important to consider the space to maintain physical distancing and ventilation in classrooms. Not only the school setup, but also factors like transportation are critical and need consideration before reopening the schools.
Parents’ responsibility during the lockdown period
Children need to be provided necessary facilities for children to be children. Currently, it is seen that children are getting addicted to digital screens such as televisions, computers, mobile phones, etc. This trend needs to be changed using novel approaches which make children happy in their homes.
If a child tests positive, will that child be separated from the parents?
This issue was discussed over the last few weeks on social media with several sensational statements and pictures. Dr. Perera clarified this doubtful situation in his discussion and noted that if a child tests positive, the mother or a guardian has to be there as a bystander. Since the majority of these kids are asymptomatic, the Sri Lanka College of Paediatricians has made a plea to the authorities to authorise homecare for paediatric patients.
Rationalising PCR testing
Whether the number of tests carried out is adequate for the present situation is one of the burning questions arising at this moment. Several incidents of delays in test results were also reported during the last few weeks.
[caption id="attachment_104230" align="alignleft" width="210"]
"It is vital to adopt scientifically rationalised testing strategies to ensure the maximum utilisation of limited resources. With this rationalised approach, the turnaround time of testing can be reduced and the results can be released without a delay for the patients" SLMA President Prof. Indika Karunathilake [/caption]
SLMA President Prof. Indika Karunathilake explained the present situation on PCR testing. "
“We should thank the laboratory services of the Ministry of Health for expanding the testing capacity from 2,000 to 11,000 within a short period of time. When analysing the number of tests performed, it is clearly noted that the number of tests performed has been exponentially increased following the appearance of the Minuwangoda cluster,” Prof. Karunathilake noted, adding: “The SLMA could further analyse the positive test ratios of the tests performed and it was around 7%, i.e., if you test 100 individuals, about seven persons will be diagnosed positive. It should be noted that these tests have been performed on high-risk groups. At this moment, it is vital to adopt scientifically rationalised testing strategies to ensure the maximum utilisation of limited resources. With this rationalised approach, the turnaround time of testing can be reduced and the results can be released without a delay for the patients.”
Are there enough ICU beds in Sri Lanka to mobilise for Covid-19 patients?
The number of Intensive Care Unit (ICU) beds that can be mobilised for Covid-19 patients was a major topic discussed during the past few weeks. When we consider the global situation, not even the highly developed countries have the optimum numbers of ICU beds to manage patients. Hence, the situation would be similar for Sri Lanka. At this moment, we need to focus on preventing the country from stepping into that requirement, said Prof. Karunathilake.
Are we in the phase of community transmission?
This was one of the main questions discussed on social media during the last couple of weeks with various explanations and clarifications. During the discussion, Prof. Karunathilake explained the definition of community transmission and the present situation.
“Community transmission is the most serious stage during a pandemic. The mere detection of patients from the community is not synonymous with community transmission. The declaration of community transmission is a technical decision based on epidemiological data.”
The most recent definition of community transmission by the World Health Organisation (WHO) is “experiencing larger outbreaks of local transmission defined through an assessment of factors including, but not limited to, large numbers of cases not linkable to transmission chains; large numbers of cases from sentinel laboratory surveillance; and/or multiple unrelated clusters in several areas of the country/territory/area”.
However, regardless of the categorisation, Sri Lanka is currently facing an extremely serious situation where urgent measures are required to break the chain of transmission.
SLMA recommendations for the country to curb the disease
The SLMA recommends the 3T3C3L collaborative approach to curb Covid-19 in Sri Lanka. Prof. Karunathilake explained that this approach involves the following:
The MOH will get the patient’s history to identify the presence of symptoms and the risk factors. The staff of the MOH office have to analyse this data of all PCR-positive individuals and identify the suitable treatment centres in co-ordination with the Office of the Regional Director of Health Services SLMA Vice President and University of Colombo Faculty of Medicine Department of Community Medicine Head Prof. Manuj. C. Weerasinghe [/caption]
“If a person gets directly exposed to a known Covid-19 patient, that person is considered as a first-line contact. Formerly, these persons were identified and quarantined at institutions. However, with the increasing numbers of patients, the Government has decided to practise the home quarantine system. In this situation, the exposed person has to quarantine at home along with his family members,” Prof. Weerasinghe noted.
He added: “In the meantime, his samples will be taken for PCR testing. If the PCR test results become positive, he will be admitted to a hospital or an intermediate management centre depending on his condition. His family members have to continue the home quarantine process, till they get subjected for PCR testing.”
Is there a delay in admitting Covid-19 patients to institutions?
During the past few weeks, several incidents were reported on delays in admitting PCR-positive individuals to hospitals. Prof. Weerasinghe explained this too, noting: “When the PCR test results are received by the MOH (Medical Officer of Health), the PCR-positive persons will be contacted over the phone and informed of their results. The MOH will get the patient’s history to identify the presence of symptoms and the risk factors. The staff of the MOH office have to analyse this data of all PCR-positive individuals and identify the suitable treatment centres in co-ordination with the Office of the Regional Director of Health Services.”
Symptomatic patients and individuals identified as high risk to develop complications (e.g., elderly, those who have heart diseases/diabetes, etc.) will be admitted to a hospital. Asymptomatic individuals without obvious risk factors will be admitted to intermediate management centres. This process takes time due to the limitations in resources and facilities. “The most important fact is to stay at home until the healthcare workers come to your doorstep,” said Prof. Weerasinghe.
Covid-19 and children
This pandemic situation had a major impact on education and the activities of children. Staying at home for months has become monotonous and tedious for many kids. Speaking on this, SLMA Past President and consultant paediatrician Dr. B.J.C. Perera said: “Children are equally prone to get the disease but in general, the number of children getting infected is much less.
[caption id="attachment_104231" align="alignleft" width="210"] In the global scenario, the percentage of children infected is less than 10%. Similarly, in Sri Lanka only about 100 children have been diagnosed so far. However, the majority of kids who are PCR positive do not have symptoms. Hence, they can be a source of the spread of the virus SLMA Past President and consultant paediatrician Dr. B.J.C. Perera [/caption]
When considering the total number of patients in the global scenario, the percentage of children infected is less than 10%. Similarly, in Sri Lanka, only about 100 children have been diagnosed so far. However, the majority of kids who are PCR positive do not have symptoms. Hence, they can be a source of the spread of the virus. Some children are more vulnerable to develop complications. Like adults, those who have other diseases are more viable to develop complications; especially the kids who are less than three months are more vulnerable.”
In Europe and the US, some cases have been identified with multisystem inflammatory syndrome in children (MIS-C), which affects several organs including the heart, lungs, kidneys, brain, skin, and eyes. There had been a few deaths due to this condition in some European countries.
Is it possible to open schools?
It was decided to further postpone the reopening of schools due to the prevailing pandemic conditions. “Children are not in the phase of the pandemic, as the number of children getting infected is much less. However, they can be the direct or indirect victims of the pandemic,” said Dr. Perera.
In the world scenario, nowhere has it been reported that a school has been the centre of the pandemic or a cluster. So far, the situation is similar in Sri Lanka. In many countries, children are suffering with this disease due to the lack of access to healthcare. However, Sri Lanka provides free health services equitably, with the free healthcare system.
“Children are the future of the nation and education is the future of children. Hence, any disruption to the education of children can affect the future of the nation detrimentally,” said Dr. Perera.
It is important to consider the space to maintain physical distancing and ventilation in classrooms. Not only the school setup, but also factors like transportation are critical and need consideration before reopening the schools.
Parents’ responsibility during the lockdown period
Children need to be provided necessary facilities for children to be children. Currently, it is seen that children are getting addicted to digital screens such as televisions, computers, mobile phones, etc. This trend needs to be changed using novel approaches which make children happy in their homes.
If a child tests positive, will that child be separated from the parents?
This issue was discussed over the last few weeks on social media with several sensational statements and pictures. Dr. Perera clarified this doubtful situation in his discussion and noted that if a child tests positive, the mother or a guardian has to be there as a bystander. Since the majority of these kids are asymptomatic, the Sri Lanka College of Paediatricians has made a plea to the authorities to authorise homecare for paediatric patients.
Rationalising PCR testing
Whether the number of tests carried out is adequate for the present situation is one of the burning questions arising at this moment. Several incidents of delays in test results were also reported during the last few weeks.
[caption id="attachment_104230" align="alignleft" width="210"] "It is vital to adopt scientifically rationalised testing strategies to ensure the maximum utilisation of limited resources. With this rationalised approach, the turnaround time of testing can be reduced and the results can be released without a delay for the patients" SLMA President Prof. Indika Karunathilake [/caption]
SLMA President Prof. Indika Karunathilake explained the present situation on PCR testing. "
“We should thank the laboratory services of the Ministry of Health for expanding the testing capacity from 2,000 to 11,000 within a short period of time. When analysing the number of tests performed, it is clearly noted that the number of tests performed has been exponentially increased following the appearance of the Minuwangoda cluster,” Prof. Karunathilake noted, adding: “The SLMA could further analyse the positive test ratios of the tests performed and it was around 7%, i.e., if you test 100 individuals, about seven persons will be diagnosed positive. It should be noted that these tests have been performed on high-risk groups. At this moment, it is vital to adopt scientifically rationalised testing strategies to ensure the maximum utilisation of limited resources. With this rationalised approach, the turnaround time of testing can be reduced and the results can be released without a delay for the patients.”
Are there enough ICU beds in Sri Lanka to mobilise for Covid-19 patients?
The number of Intensive Care Unit (ICU) beds that can be mobilised for Covid-19 patients was a major topic discussed during the past few weeks. When we consider the global situation, not even the highly developed countries have the optimum numbers of ICU beds to manage patients. Hence, the situation would be similar for Sri Lanka. At this moment, we need to focus on preventing the country from stepping into that requirement, said Prof. Karunathilake.
Are we in the phase of community transmission?
This was one of the main questions discussed on social media during the last couple of weeks with various explanations and clarifications. During the discussion, Prof. Karunathilake explained the definition of community transmission and the present situation.
“Community transmission is the most serious stage during a pandemic. The mere detection of patients from the community is not synonymous with community transmission. The declaration of community transmission is a technical decision based on epidemiological data.”
The most recent definition of community transmission by the World Health Organisation (WHO) is “experiencing larger outbreaks of local transmission defined through an assessment of factors including, but not limited to, large numbers of cases not linkable to transmission chains; large numbers of cases from sentinel laboratory surveillance; and/or multiple unrelated clusters in several areas of the country/territory/area”.
However, regardless of the categorisation, Sri Lanka is currently facing an extremely serious situation where urgent measures are required to break the chain of transmission.
SLMA recommendations for the country to curb the disease
The SLMA recommends the 3T3C3L collaborative approach to curb Covid-19 in Sri Lanka. Prof. Karunathilake explained that this approach involves the following:
- “3T” for Covid frontline workers: Trace, test, treat
- “3C” for the general public: Crowded congested places to be avoided; clean hands, surfaces, and utensils; cover mouth, nose, and face
- “3L” for the Government: Legislation, legal enforcement, leadership