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‘Guard and secure the airports and ports’
Guard and secure Sri Lanka’s gateways, urged a top health expert, as the danger posed by the new coronavirus loomed close to the country, while spreading like wildfire across the world.
Passengers who arrived on a flight from Incheon, Korea this week being checked for fever
Originating in Wuhan as the epicentre in the Hubei Province of China, COVID-19, the disease caused by the new coronavirus, has begun its “cluster-spread”. Fifty-one countries, including many close to Sri Lanka, have confirmed cases.
As of Friday, worldwide there were 83,652 confirmed cases; China has 78,961 cases and 2,791 deaths and outside China around the world 4,691 cases and 67 deaths. The World Health Organisation (WHO) risk assessment is ‘very high’ for China and also at regional and global level.
“All travellers coming from ‘any’ infected area need to be thoroughly investigated and followed up as they pose a ‘huge risk’ because they may be in the incubation period without showing symptoms,” stressed a former Chief Epidemiologist, Dr. Nihal Abeysinghe, laying down in meticulous detail how Sri Lanka should face this crisis.
Underlining that if we get one case, just one full-blown infection in a Sri Lankan, it would be an epidemic in the country, he fervently urged the “guarding and securing” of the gateways to Sri Lanka which are the airports and ports.
Otherwise, infected people can slip through and spread the disease around for 12-14 days without anyone knowing. This is why 100% cover is essential at the airports and ports, pointed out Dr. Abeysinghe, adding however that if any country in the region can tackle this crisis it is Sri Lanka with its strong public health system.
“Preparedness,” is the key and the only approach in the 21st century to face these dangers and threats, according to him, as he sets out a basic but workable plan.
This plan should include:
- Preparedness with a generic approach with flexible systems.
- Crisis management should be multi-sectoral and multi-level.
- Inclusive networks are crucial covering all aspects including disease surveillance and new technologies.
- Dr. Abeysinghe is a strong believer in following the “basics” in epidemiology – time, place and person – and he superimposes these basics onto the current coronavirus crisis.
- Time – since December that COVID-19 started spreading
- Place – whether connected to Wuhan or any other place to which it has spread; wherever the infection is. Initially Wuhan had a major involvement but now the cluster spread has begun rapidly
- Person – whoever is connected to Wuhan or any other place that the virus has spread to. These would be the people who have travelled to any infected area and includes a person who has come from China or any of those places where the virus is spreading
Dr. Abeysinghe highlights the importance of “contact tracing” and “isolation” which are also the basics in containment in a public health crisis.
Dr. Nihal Abeysinghe
What is important to remember is that there would be at least two weeks of incubation, he cautions. This means that if a person has a travel history today to a country affected by the virus, “you can’t allow that person to go around whether that person has symptoms or not. The virus is no respecter of any person as was shown by Iran’s Deputy Health Minister, Iraj Harirchi, being affected by COVID-19.
Biological principles, Dr. Abeysinghe looks at next, to pinpoint that though the virus has been around since December last year it still does not seem to have reached a peak. While seemingly ‘plateauing’ in China, clusters are occurring across the world.
He says: “A global threat requires a global response which includes investigation, characterisation and assessment of the threat; reduction of human suffering; containment of the national/international spread; and minimizing impact on travel and trade. The coordination of the response will essentially include right at the top epidemiology, laboratory science, clinical management, infection control, environmental health, health education, medical anthropology, risk communication and logistics.
“Sri Lanka should be closely following the WHO’s Technical Guidance format in our National Preparedness Plan and ticking off each and every item such as: Country readiness;Surveillance & case definitions; Laboratory guidance; Patient management; Infection prevention & control; Early investigations; Risk communication & community engagement; Disease commodity package; and Points of entry/mass gatherings. If any gaps are spotted, they need to be filled immediately.”
Contain the virus, urges WHO DG to countries,
The epidemic peaked and plateaued between January 23 and February 2 and has been declining steadily since then, the World Health Organization (WHO)-China joint mission had found, the WHO’s Director-General Dr. Tedros Adhanom Ghebreyesus declared this week.
Urging continued vigilance and stressing that this is not the time for complacency, he said that the mission had also found that there has been no significant change in the genetic makeup of the virus.
While the team had also estimated that the measures taken in China have averted a significant number of cases, Dr. Ghebreyesus said the key message that should give all countries hope, courage and confidence is that this virus can be contained.
“Indeed, there are many countries that have done exactly that. Fourteen that have had cases have not reported a case for more than a week, and even more importantly, 9 countries have not reported a case for more than two weeks: Belgium, Cambodia, Finland, India, Nepal, Philippines, the Russian Federation, Sri Lanka and Sweden. But that doesn’t mean that cases may not come back to these countries. But the cases that made it before have been contained,” he said.
Conceding that the number of new cases reported outside China exceeded the number of new cases in China for the first time on Tuesday, he has said that the sudden increases of cases in Italy, the Islamic Republic of Iran and the Republic of Korea are “deeply concerning”.
“The increase in cases outside China has prompted some media and politicians to push for a pandemic to be declared. We should not be too eager to declare a pandemic without a careful and clear-minded analysis of the facts,” says Dr. Ghebreyesus, pointing out that the WHO has already declared a public health emergency of international concern – “our highest level of alarm”.
He adds: “Using the word pandemic carelessly has no tangible benefit, but it does have significant risk in terms of amplifying unnecessary and unjustified fear and stigma and paralysing systems. It may also signal that we can no longer contain the virus, which is not true. We are in a fight that can be won if we do the right things. Of course, we will not hesitate to use the word pandemic if it is an accurate description of the situation.
“We are monitoring the evolution of the epidemic around the clock, 24/7 and are engaging experts internally and externally on this issue.
For the moment, we are not witnessing sustained and intensive community transmission of this virus and we are not witnessing large-scale severe disease or death. China has fewer than 80,000 cases in a population of 1.4 billion people. In the rest of the world, there are 2,790 cases, in a population of 6.3 billion. 
“Do not mistake me: I am not downplaying the seriousness of the situation, or the potential for this to become a pandemic, because it has that potential. Every scenario is still on the table. On the contrary, we are saying that this virus has pandemic potential and WHO is providing the tools for every country to prepare accordingly.
“The primary objective of all countries with cases must be to contain the virus. We should do the same: try to contain. At the same time, all countries, whether they have cases or not, must prepare for a potential pandemic. Every country needs to be ready to detect cases early, to isolate patients, trace contacts, provide quality clinical care, prevent hospital outbreaks, and prevent community transmission.
“There are three priorities: all countries must prioritize protecting health workers; we must engage communities to protect people who are most at risk of severe disease, particularly the elderly and people with underlying health conditions; and we must protect countries that are the most vulnerable, by doing our utmost to contain epidemics in countries with the capacity to do it.”
Concern over ships, but assurances that all protocols are in place
The ships keep sailing in, the Sunday Times found, with the next cruise-liner, ‘MSC Splendida’ due on Tuesday (March 3) at the Colombo Port with 3,959 passengers and 1,325 crew members.
The ‘MSC Splendida’ will arrive in Colombo from Thailand having been to Singapore, Japan, Hong Kong and China.
“These are the vessels which have touched base in infected areas (Thailand, Singapore, Japan, Hong Kong and China) we need to be careful about,” many sources said, while the Sri Lanka Ports’ Authority (SLPA) Chairman General (Rtd) R.M. Daya Ratnayake assured that the ports are safe.
The Deputy Director of the Port Health Services, Dr. Roshan Sampath said that ships arriving from countries such as China, South Korea and Italy are considered ‘high risk’. All passengers and crew are screened thoroughly before they disembark. If any tourists wish to travel within Sri Lanka, they would be tracked by the Medical Officers of Health (MOH) of the relevant areas. If any Sri Lankans disembark and leave for their homes, the MOHs would keep tabs on them and Public Health Inspectors (PHIs) would visit them to check on their health status until the incubation period passes. Even on any other ship, if at any point, someone is ill, he/she would be isolated in his/her cabin.
Many passenger ships have one or two of their own doctors on board. At all Sri Lankan ports too there are doctors on duty 24/7. Currently, five doctors are available at the Colombo Port, three doctors at the Galle Port, one doctor at the Hambantota Port and one doctor at the Trincomalee Harbour. The number of doctors on duty varies according to their shifts, he said.
He added that so far, no one suspected to be infected by the new coronavirus has been detected at the ports.
There is an isolation cabin at the passenger terminal of the Colombo Port to isolate any ill passengers until they are transported to the relevant hospital. All ships are inspected, said General (Rtd) Ratnayake, adding that the SLPA is coordinating with the Health Ministry’s quarantine authorities. No shore passes would be provided if a person’s health status is in doubt.
The Sunday Times learns that on February 24 – ‘Marco Polo’ with 850 passengers and 356 crew members came to the Colombo Port and on February 25 – ‘Costa Victoria’ with 2,200 passengers and 800 crew members and ‘Oceania Nautica’ with 824 passengers and 386 crew members.
While the ‘Marco Polo’ arrived from the Maldives, the ‘Costa Victoria’ sails between India, Maldives and Sri Lanka and the ‘Oceania Nautica’ from the Maldives having previously journeyed to South Africa, Namibia and Seychelles.
Assurances that the port health authorities are “proactive” also came from the Chairman of the Ceylon Association of Shipping Agents (CASA), Iqram Cuttilan, who explained that usually one of the biggest concerns would be port-entry points. While at airports you can have better control, ports are a much larger area with many ships coming in.
Last year, 4,198 vessels docked at the Colombo Port; 314 at Hambantota; 142 at Trincomalee; 43 at Galle; and 11 at Kankesanthurai. On average, about 60 cruise ships call on Sri Lanka per year.
The ships bring passengers, crew, cargo and other personnel such as security officers who then have access to the country after immigration clearance.
Explaining the ‘before’ and ‘now’, Mr. Cuttilan said that earlier, every vessel had to give one health declaration form with details of all those on board, at least 12 hours in advance of entering the port, signed by the master, submitted to the agent who would forward it to the health authorities. It was only after that, that the pilot of the Ports’ Authority set off in a launch to the vessel and guided it into the port.
“Now, however, every person on a ship has to fill up the health declaration form which would include details of any illness and the origin of travel and the ports of call in the previous two weeks, in view of the new coronavirus,” he says.
Thereafter, the port health officer will assess whether the vessel should come into the port or not and it is only then that the pilot would head for the vessel. When the ship docks, the first person who boards it will be the health officer, he said.
Asked whether there are adequate health officers, he said “yes” as vessels do not come together but about one in three to four hours.
After all these formalities are carried out, the vessel would be cleared for cargo operations and for the crew and passengers to embark/disembark.
The procedures are in place, said Mr. Cuttilan, adding that as soon as the port health office gives any instructions to CASA, its secretariat immediately disseminates them to all the agents.
All three terminals of the Colombo Port receive cargo and container ships. Usually crew members do not disembark at all times and those who disembark would vary according to their shift, said SLPA’s Communication Manager, Nalin Aponso, repeating the procedure for cruise liners.
Myth busters about COVID-19 from the World Health Organisation (WHO)
Are hand dryers effective in killing the new coronavirus?
No. Hand dryers are not effective in killing the new coronavirus. To protect yourself against it, you should frequently clean your hands with an alcohol-based hand rub or wash them with soap and water. Once your hands are cleaned, you should dry them thoroughly by using paper towels or a warm air dryer.
Can an ultraviolet (UV) disinfection lamp kill the new coronavirus?
UV lamps should not be used to sterilize hands or other areas of skin as UV radiation can cause skin irritation.
How effective are thermal scanners in detecting people infected with the new coronavirus?
Thermal scanners are effective in detecting people who have developed a fever (i.e. have a higher than normal body temperature) because of infection with the new coronavirus.
However, they cannot detect people who are infected but are not yet sick with fever. This is because it takes between 2 and 10 days before people who are infected become sick and develop a fever.
Can spraying alcohol or chlorine all over your body kill the new coronavirus?
No. Spraying alcohol or chlorine all over your body will not kill viruses that have already entered your body. Spraying such substances can be harmful to clothes or mucous membranes (i.e. eyes, mouth). Be aware that both alcohol and chlorine can be useful to disinfect surfaces, but they need to be used under appropriate recommendations.
Is it safe to receive a letter or a package from China?
Yes, it is safe. People receiving packages from China are not at risk of contracting the new coronavirus. From previous analysis, we know coronaviruses do not survive long on objects, such as letters or packages.
Can pets at home spread the new coronavirus?
At present, there is no evidence that companion animals/pets such as dogs or cats can be infected with the new coronavirus. However, it is always a good idea to wash your hands with soap and water after contact with pets. This protects you against various common bacteria such as E.coli and Salmonella that can pass between pets and humans.
Do vaccines against pneumonia protect you against the new coronavirus?
No. Vaccines against pneumonia, such as pneumococcal vaccine and Haemophilus influenza type B (Hib) vaccine, do not provide protection against the new coronavirus.
The virus is so new and different that it needs its own vaccine. Researchers are trying to develop a vaccine and WHO is supporting their efforts.
Although these vaccines are not effective against the new coronavirus, vaccination against respiratory illnesses is highly recommended to protect your health.
Can regularly rinsing your nose with saline help prevent infection with the new coronavirus?
No. There is no evidence that regularly rinsing the nose with saline has protected people from infection with the new coronavirus.
There is some limited evidence that regularly rinsing nose with saline can help people recover more quickly from the common cold. However, regularly rinsing the nose has not been shown to prevent respiratory infections.
Can eating garlic help prevent infection with the new coronavirus?
Garlic is a healthy food that may have some antimicrobial properties. However, there is no evidence from the current outbreak that eating garlic has protected people from the new coronavirus.
Does putting on sesame oil block the new coronavirus from entering the body?
No. Sesame oil does not kill the new coronavirus. There are some chemical disinfectants that can kill the virus on surfaces. These include bleach/chlorine-based disinfectants, either solvents, 75% ethanol, peracetic acid and chloroform.
However, they have little or no impact on the virus if you put them on the skin or under your nose. It can even be dangerous to put these chemicals on your skin.
Does the new coronavirus affect older people or are younger people also susceptible?
People of all ages can be infected by the new coronavirus. Older people, and people with pre-existing medical conditions (such as asthma, diabetes, heart disease) appear to be more vulnerable to becoming severely ill with the virus.
WHO advises people of all ages to take steps to protect themselves from the virus, for example by following good hand hygiene and good respiratory hygiene.
Are antibiotics effective in preventing and treating the new coronavirus?
No, antibiotics do not work against viruses, only bacteria. The new coronavirus is a virus and, therefore, antibiotics should not be used as a means of prevention or treatment.
However, if you are hospitalised for the new coronavirus, you may receive antibiotics because bacterial co-infection is possible.
Are there any specific medicines to prevent or treat the new coronavirus?
To date, there is no specific medicine recommended to prevent or treat the new coronavirus. However, those infected with the virus should receive appropriate care to relieve and treat symptoms and those with severe illness should receive optimised supportive care. Some specific treatments are under investigation and will be tested through clinical trials.
