As Omicron sweeps across the island, it has become the main variant prevailing. At the time of writing, the daily positive cases have surpassed 1,000 which was just little over 800 two weeks ago. The number of deaths reported on 1 February was 32 and it was around a dozen two weeks ago. Hospitalised and home-based positive cases increased to 16,895 on 1 February, from 13,839 two weeks earlier.
In this context, the number of calls received by the Sri Lanka Medical Association (SLMA) Doc Call 247 helpline is overflowing with calls from the affected individuals. The SLMA introduced the Doc Call 247 service in August 2021, where the country was experiencing a challenging number of patients where the healthcare system was reaching its tipping point. With the motive of reducing the burden on the healthcare system, Doc Call 247, is managing patients with a triage process in which the people with the initial symptoms are supported with home-based care and the patients who are in need of medical attention given the emergency medical services via Suwaseriya emergency ambulance service. People who are confined to homes are provided with medical advice.
As of now, Doc call 247 has attended to over 70,000 patients. Out of the 70,000 calls received, only around 1,500 patients needed urgent care and hospitalisation. With the emergence of the Omicron variant, the system received about 250 calls daily from the needy patients. The system functions as a virtual free healthcare facility with the volunteer involvement of renowned medical specialists, medical officers, and medical students.
A webinar was conducted by the SLMA to discuss the current situation to make sense about Omicron and its management. University of Colombo Faculty of Medicine Professor in Medical Education Prof. Indika Karunathilake and SLMA Assistant Treasurer Dr. Sajith Edirisinghe moderated the webinar.
Following are excerpts of the discussion:
Children are affected the most
Senior consultant paediatricians Dr. B.J.C. Perera and Dr. Kalyani Guruge shared their experience as well as of their colleagues. The number of Covid-19 admissions to the Lady Ridgeway Hospital is increasing and currently it is around 20 patients per day. However, many patients are not ill and show only mild symptoms. Majority of infected children show no symptoms at all though parents’ anxiety needs to be handled carefully.
As all schools were opened fully, the number of children getting the infection has exponentially increased, fuelled by the highly infectious nature of Omicron.
Launching of Covid-19 vaccination programme for schoolchildren has helped to minimise the symptoms. According to the current guideline, children between 12-15 years will receive a single dose of Pfizer vaccine and those between 16-19 years should take two Pfizer doses in a three months gap. Children are considered fully vaccinated two weeks after completion of the recommended schedule.
It is interesting that so far the new cases have not developed into complications such as Multisystem Inflammatory Syndrome in Children (MIS-C). However, it may still be early to see complications as it was seen in previous waves, there is a possibility that complications may appear two to four weeks after the peak of the wave is reached. If such a situation occurs, hospitalised care of patients will become mandatory. Although the paediatric intensive care units (ICU) are not overloaded the number of Covid-19 wards have increased to accommodate the rising number of patients. As the dengue cases also are on rise, a few cases of combination of dengue and Covid-19 have been seen and more pronounced leaking phase have been seen in these patients rather than in patients with dengue alone.
Consultant paediatrician Dr. Kalyani Guruge, who has attended over 2,500 calls via the SLMA Doc Call 247 system explained about the common symptoms among children. The symptoms of children are generally mild and not lasting over 48 hours. Mild sore throat, mild fever, and diarrhoea which are not complicated are the commonest symptoms complained. Affected infants present with nasal congestion and sometimes with high fever. Currently, children are the first to get infected and they spread it to the entire household. Dr. Guruge emphasised the importance of vaccinating children specially who are having chronic respiratory diseases, to prevent possible complications.
Complications are few among the boostered
Consultant Physician of Base Hospital Homagama Dr. Mahendra Ekanayake, who has been a major pillar in 247 telemedicine service, shared his experience on managing adult patients. A marked reduction in symptoms are seen among the patients who are fully vaccinated with two Covid-19 vaccines and with the booster. Further, he has noted a reduction in test positivity among people who have had the booster dose.
Fever, cough, and difficulty in breathing are among the common symptoms in hospitalised patients. However, the disease severity is much reduced when compared to the previous wave and the oxygen dependency also is significantly less. The oxygen dependent patients who are admitted have received their last Covid-19 vaccine six months ago and not taken their booster dose. Shortness of breath on exertion is the main symptom on admissions and most of the patients are not having fever.
However, the symptom profile of patients can vary as both Delta and Omicron variants prevail in the society. Without performing a viral sequencing on each and every individual it is not possible to comment about the variant merely by the symptoms. It is clearly evident that only under-vaccinated patients present with severe symptoms.
Guiding principles for management
Early detection, testing, hydration, proper nutrition, ventilation, and rest especially during initial four days are the basic points in management. Red flag symptoms such as difficulty in breathing on mild exertion, high fever with fatigue and muscle pains should be detected early and referred to a hospital as it is the key for saving lives.
Collateral damage on patients due to Covid-19 also is noteworthy. This is mainly because defaulted clinic visits of patients who are on treatment for non-communicable diseases (NCDs) such as diabetes, hypertension, and chronic kidney diseases. Deaths are inevitable when these chronic illnesses are not managed properly.
When patients are managed at homes the initial two to three days can be managed as a viral fever. If fever is lasting over 48 hours it is advisable to get a full blood count to exclude co-existing dengue fever. It is important to monitor for symptoms of desaturation such as shortness of breath on exertion and chest tightness. Use of a pulse-oximeter at home is effective in early identification and admission of patients with red flags. Although only a small percentage of patients need hospitalisation as the numbers of patients are going up, this low percentage can reflect a large number. Hence, early detection and admission of patients will become crucial in management.
Test positive rates are increasing
Sharing her experience, Consultant Microbiologist of Colombo South Teaching Hospital Dr. Shirani Chandrasiri stated that they have noticed a high PCR positivity recently. Early January it was <10% and during mid-January it has increased up to 20%. By the last week of January it had exceeded 20% . In simple terms, every one in four PCR tests become positive. In rapid antigen tests (RAT) the positive rate is around 18%. This is an objective measurement to say that the case numbers are increasing.
According to her experience, patients in high dependency units (HDU) have either got one vaccine or unvaccinated. It is very rare to see a patient who has had the booster vaccine admitted to the HDU. Dr. Chandrasiri stated that the public is now reaching for the booster vaccine as the number of cases are increasing, which is a healthy trend. Sharing her experience at the University of Sri Jayewardenepura Immunology Department, Prof. Neelika Malavige stated that Omicron is the predominant variant in the Western Province. The good aspect of it is that the disease is less severe and the bad about it is that it spreads faster evading all barriers and can infect even the vaccinated. In this scenario people argue about the use of booster vaccines. However, it is clear that from whatever the variant severe disease and hospitalisation is reduced by vaccination. Research evidence has proven that, hospitalisation is reduced 50% by two doses of vaccines and 90% reduction is seen by the booster.
Covid-19 pneumonia cases are few compared to the previous wave
The National Hospital Sri Lanka Respiratory Physician Dr. Ranmalee Samaranayake shared her own experience in managing the current situation. According to her, the number of oxygen dependent patients is significantly reduced compared to last August to September Covid-19 third wave. Very few Covid-19 pneumonia cases are seen and almost all of them are people with chronic illnesses (poorly controlled diabetes, patients with organ transplants, etc.). In contrast to the previous wave, the hyper immune phase, which causes mild symptoms in the first two weeks and later develops into Covid-19 pneumonia is not seen yet with Omicron. However, it may still be too early to assess since still we are at the beginning of the fourth wave.
Unlike in Delta, Omicron mainly infects the upper respiratory tract, and some patients present with a severe sore throat. Home management remedies such as frequent sips of water for symptomatic relief for preventing dryness of throat will be helpful in these patients. Steroids such as dexamethasone and prednisolone should never be used in the early phase as it will blunt the immunity.
In Omicron, the loss of sensation of smell is seen less compared to Delta and a loud cough similar to laryngitis/pharyngitis is seen with a noisy breathing. These patients can be prescribed inhalers to be used for a short-term.
Adding to the discussion, consultant in critical care medicine at National Hospital of Sri Lanka Dr. Anthonie Mendis stated that at the beginning of the pandemic patients without comorbidities were also dying with Covid-19 pneumonia as there were no vaccines available. At present severe Covid-19 pneumonia is seen only in patients who are unvaccinated or partially vaccinated. With this he further emphasised the importance of complete vaccination with the booster dose.Making sense of Omicron
06 Feb 2022
Making sense of Omicron
06 Feb 2022
As Omicron sweeps across the island, it has become the main variant prevailing. At the time of writing, the daily positive cases have surpassed 1,000 which was just little over 800 two weeks ago. The number of deaths reported on 1 February was 32 and it was around a dozen two weeks ago. Hospitalised and home-based positive cases increased to 16,895 on 1 February, from 13,839 two weeks earlier.
In this context, the number of calls received by the Sri Lanka Medical Association (SLMA) Doc Call 247 helpline is overflowing with calls from the affected individuals. The SLMA introduced the Doc Call 247 service in August 2021, where the country was experiencing a challenging number of patients where the healthcare system was reaching its tipping point. With the motive of reducing the burden on the healthcare system, Doc Call 247, is managing patients with a triage process in which the people with the initial symptoms are supported with home-based care and the patients who are in need of medical attention given the emergency medical services via Suwaseriya emergency ambulance service. People who are confined to homes are provided with medical advice.
As of now, Doc call 247 has attended to over 70,000 patients. Out of the 70,000 calls received, only around 1,500 patients needed urgent care and hospitalisation. With the emergence of the Omicron variant, the system received about 250 calls daily from the needy patients. The system functions as a virtual free healthcare facility with the volunteer involvement of renowned medical specialists, medical officers, and medical students.
A webinar was conducted by the SLMA to discuss the current situation to make sense about Omicron and its management. University of Colombo Faculty of Medicine Professor in Medical Education Prof. Indika Karunathilake and SLMA Assistant Treasurer Dr. Sajith Edirisinghe moderated the webinar.
Following are excerpts of the discussion:
Children are affected the most
Senior consultant paediatricians Dr. B.J.C. Perera and Dr. Kalyani Guruge shared their experience as well as of their colleagues. The number of Covid-19 admissions to the Lady Ridgeway Hospital is increasing and currently it is around 20 patients per day. However, many patients are not ill and show only mild symptoms. Majority of infected children show no symptoms at all though parents’ anxiety needs to be handled carefully.
As all schools were opened fully, the number of children getting the infection has exponentially increased, fuelled by the highly infectious nature of Omicron.
Launching of Covid-19 vaccination programme for schoolchildren has helped to minimise the symptoms. According to the current guideline, children between 12-15 years will receive a single dose of Pfizer vaccine and those between 16-19 years should take two Pfizer doses in a three months gap. Children are considered fully vaccinated two weeks after completion of the recommended schedule.
It is interesting that so far the new cases have not developed into complications such as Multisystem Inflammatory Syndrome in Children (MIS-C). However, it may still be early to see complications as it was seen in previous waves, there is a possibility that complications may appear two to four weeks after the peak of the wave is reached. If such a situation occurs, hospitalised care of patients will become mandatory. Although the paediatric intensive care units (ICU) are not overloaded the number of Covid-19 wards have increased to accommodate the rising number of patients. As the dengue cases also are on rise, a few cases of combination of dengue and Covid-19 have been seen and more pronounced leaking phase have been seen in these patients rather than in patients with dengue alone.
Consultant paediatrician Dr. Kalyani Guruge, who has attended over 2,500 calls via the SLMA Doc Call 247 system explained about the common symptoms among children. The symptoms of children are generally mild and not lasting over 48 hours. Mild sore throat, mild fever, and diarrhoea which are not complicated are the commonest symptoms complained. Affected infants present with nasal congestion and sometimes with high fever. Currently, children are the first to get infected and they spread it to the entire household. Dr. Guruge emphasised the importance of vaccinating children specially who are having chronic respiratory diseases, to prevent possible complications.
Complications are few among the boostered
Consultant Physician of Base Hospital Homagama Dr. Mahendra Ekanayake, who has been a major pillar in 247 telemedicine service, shared his experience on managing adult patients. A marked reduction in symptoms are seen among the patients who are fully vaccinated with two Covid-19 vaccines and with the booster. Further, he has noted a reduction in test positivity among people who have had the booster dose.
Fever, cough, and difficulty in breathing are among the common symptoms in hospitalised patients. However, the disease severity is much reduced when compared to the previous wave and the oxygen dependency also is significantly less. The oxygen dependent patients who are admitted have received their last Covid-19 vaccine six months ago and not taken their booster dose. Shortness of breath on exertion is the main symptom on admissions and most of the patients are not having fever.
However, the symptom profile of patients can vary as both Delta and Omicron variants prevail in the society. Without performing a viral sequencing on each and every individual it is not possible to comment about the variant merely by the symptoms. It is clearly evident that only under-vaccinated patients present with severe symptoms.
Guiding principles for management
Early detection, testing, hydration, proper nutrition, ventilation, and rest especially during initial four days are the basic points in management. Red flag symptoms such as difficulty in breathing on mild exertion, high fever with fatigue and muscle pains should be detected early and referred to a hospital as it is the key for saving lives.
Collateral damage on patients due to Covid-19 also is noteworthy. This is mainly because defaulted clinic visits of patients who are on treatment for non-communicable diseases (NCDs) such as diabetes, hypertension, and chronic kidney diseases. Deaths are inevitable when these chronic illnesses are not managed properly.
When patients are managed at homes the initial two to three days can be managed as a viral fever. If fever is lasting over 48 hours it is advisable to get a full blood count to exclude co-existing dengue fever. It is important to monitor for symptoms of desaturation such as shortness of breath on exertion and chest tightness. Use of a pulse-oximeter at home is effective in early identification and admission of patients with red flags. Although only a small percentage of patients need hospitalisation as the numbers of patients are going up, this low percentage can reflect a large number. Hence, early detection and admission of patients will become crucial in management.
Test positive rates are increasing
Sharing her experience, Consultant Microbiologist of Colombo South Teaching Hospital Dr. Shirani Chandrasiri stated that they have noticed a high PCR positivity recently. Early January it was <10% and during mid-January it has increased up to 20%. By the last week of January it had exceeded 20% . In simple terms, every one in four PCR tests become positive. In rapid antigen tests (RAT) the positive rate is around 18%. This is an objective measurement to say that the case numbers are increasing.
According to her experience, patients in high dependency units (HDU) have either got one vaccine or unvaccinated. It is very rare to see a patient who has had the booster vaccine admitted to the HDU. Dr. Chandrasiri stated that the public is now reaching for the booster vaccine as the number of cases are increasing, which is a healthy trend. Sharing her experience at the University of Sri Jayewardenepura Immunology Department, Prof. Neelika Malavige stated that Omicron is the predominant variant in the Western Province. The good aspect of it is that the disease is less severe and the bad about it is that it spreads faster evading all barriers and can infect even the vaccinated. In this scenario people argue about the use of booster vaccines. However, it is clear that from whatever the variant severe disease and hospitalisation is reduced by vaccination. Research evidence has proven that, hospitalisation is reduced 50% by two doses of vaccines and 90% reduction is seen by the booster.
Covid-19 pneumonia cases are few compared to the previous wave
The National Hospital Sri Lanka Respiratory Physician Dr. Ranmalee Samaranayake shared her own experience in managing the current situation. According to her, the number of oxygen dependent patients is significantly reduced compared to last August to September Covid-19 third wave. Very few Covid-19 pneumonia cases are seen and almost all of them are people with chronic illnesses (poorly controlled diabetes, patients with organ transplants, etc.). In contrast to the previous wave, the hyper immune phase, which causes mild symptoms in the first two weeks and later develops into Covid-19 pneumonia is not seen yet with Omicron. However, it may still be too early to assess since still we are at the beginning of the fourth wave.
Unlike in Delta, Omicron mainly infects the upper respiratory tract, and some patients present with a severe sore throat. Home management remedies such as frequent sips of water for symptomatic relief for preventing dryness of throat will be helpful in these patients. Steroids such as dexamethasone and prednisolone should never be used in the early phase as it will blunt the immunity.
In Omicron, the loss of sensation of smell is seen less compared to Delta and a loud cough similar to laryngitis/pharyngitis is seen with a noisy breathing. These patients can be prescribed inhalers to be used for a short-term.
Adding to the discussion, consultant in critical care medicine at National Hospital of Sri Lanka Dr. Anthonie Mendis stated that at the beginning of the pandemic patients without comorbidities were also dying with Covid-19 pneumonia as there were no vaccines available. At present severe Covid-19 pneumonia is seen only in patients who are unvaccinated or partially vaccinated. With this he further emphasised the importance of complete vaccination with the booster dose.Kapruka
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Discover Kapruka, the leading online shopping platform in Sri Lanka, where you can conveniently send Gifts and Flowers to your loved ones for any event. Explore a wide range of popular Shopping Categories on Kapruka, including Toys, Groceries, Electronics, Birthday Cakes, Fruits, Chocolates, Automobile, Mother and Baby Products, Clothing, and Fashion. Additionally, Kapruka offers unique online services like Money Remittance, Astrology, Medicine Delivery, and access to over 700 Top Brands. Also If you’re interested in selling with Kapruka, Partner Central by Kapruka is the best solution to start with. Moreover, through Kapruka Global Shop, you can also enjoy the convenience of purchasing products from renowned platforms like Amazon and eBay and have them delivered to Sri Lanka.Send love straight to their heart this Valentine's with our thoughtful gifts!