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Contingency plan in place in Sri Lanka

By Kumudini Hettiarachchi, Ruqyyaha Deane & Meleeza Rathnayake

Be honest about the country of origin when you return, requests Health DG to Sri Lankans

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Sri Lanka has a contingency plan covering all aspects to meet the threat from the new coronavirus and the health authorities are scaling it up regularly.

Dr. Anil Jasinghe

This assurance came from the Director-General (DG) of Health Services, Dr. Anil Jasinghe, as he urged all Sri Lankans to be honest and forthright about the country of origin if they have returned from abroad, as otherwise they may endanger everyone else.

“Be honest and tell us if you have returned from a COVID-19 affected country. We will never-ever deny healthcare to anyone, but people should not endanger others,” he said.

Dr. Jasinghe cited the saga in Anuradhapura this week, where a family which had recently returned from Italy had taken their child to a General Practitioner (GP) for treatment of an upper respiratory infection. The father and mother had hidden the fact that they had come back from Italy and only disclosed this just as they were about to leave with the medication. The GP had then advised them to go to the Anuradhapura Teaching Hospital immediately.

Here too they had not informed the hospital authorities of their Italian connection, doing so only when the condition of the child became slightly bad, it is learnt.

See the repercussions of such behaviour, said Dr. Jasinghe, as the child had been in a normal ward and was not kept in isolation until the parents revealed their links to Italy. It was only then that the child was moved into the isolation area. The test for COVID-19 on the child was negative but if it had been otherwise, such non-disclosure would have endangered so many others.

The DG also ticked off the main points in Sri Lanka’s contingency plan:

Prevention of the introduction of the new coronavirus infection to Sri Lanka through surveillance and awareness
Prevention of community (local) transmission if it comes to Sri Lanka
Treatment
Readiness for any eventuality

“Currently, we have a National Committee, a Technical Committee and an Action Committee working on the threat posed by the new coronavirus,” he said, adding that the Technical and Action Committees are almost similar.

When asked whether the Action Committee has all the relevant clinical stakeholders, he said it does and includes a Clinical Virologist as well as a Microbiologist who is not a medical doctor.

On Friday, Dr. Jasinghe briefed the diplomatic corp. at a meeting which included Foreign Affairs Minister Dinesh Gunawardena and Foreign Affairs Secretary Ravinatha Aryasinha. He had explained the dynamics in Sri Lanka in relation to the global situation.

On how Sri Lanka has picked up Italy, South Korea and Iran for close tracking of those who return from these countries or come in as tourists, he said that the tool used is risk assessment of a country in relation to Sri Lanka with the focus being travel, business and tourism.

“Even though many people may not be coming here from Iran, it has come into the equation because of the high number of people affected by COVID-19 there,” he said, pointing out that when the Health Ministry announced that it was planning to quarantine people coming from high-risk countries, there was a drastic drop in arrivals but when it gave a grace period as required under the International Health Regulations (IHR), it changed but those coming in mainly are Sri Lankans as opposed to tourists.

The arrivals from South Korea on March 3 were 175 Sri Lankans and only 10 foreigners, while from Italy there were 310 Sri Lankans and only 28 foreigners, whereas earlier there would have been a balance between Sri Lankans and foreigners.

Dr. Jasinghe said that the designated hospitals are maintaining isolation units and the Health Ministry is hoping to keep this readiness measures long term. “We have drawn up plans and estimates for infrastructure and equipment to make them permanent facilities.”

There are 14 suspected cases, according to the Epidemiology Unit, in several of the designated hospitals. They are: National Institute of Infectious Diseases (NIID) – 5; Kurunegala Teaching Hospital – 3; Ratnapura Teaching Hospital – 2; Badulla Provincial General Hospital – 2; Karapitiya Teaching Hospital – 1; and Anuradhapura Teaching Hospital – 1.

The other designated hospitals are the National Hospital of Sri Lanka (NHSL); the Kandy National Hospital; the Ragama, Jaffna and Batticaloa Teaching Hospitals; the Negombo and Gampaha District General Hospitals; the Lady Ridgeway Hospital (LRH) for Children, Colombo; and the De Soysa Hospital for Women, Colombo.

Meanwhile, no passengers from cruise ships are being allowed to disembark at Sri Lankan ports from this week until further notice, said the Chief Manager Communications of the Sri Lanka Ports’ Authority, Nalin Aponso.

While ‘MSC Splendida’ arrived on March 3 with 3,959 passengers and 1,325 crew members, no one was allowed to disembark and the same would apply to ‘Azamara Quest’ and ‘Seabourn Sojourn’ due today (March 08 ) with 724 passengers and 380 crew members and 540 passengers and 330 crew members respectively, he said.

Mr. Aponso added that cargo ships, however, would follow the usual procedure and crew disembarkation allowed but with strict screening.

Mass gatherings

The Sunday Times checked out mass gatherings in Sri Lanka to see what measures are being taken to prevent the spread of disease.

With Sri Lanka hosting two Test matches with England this month at the Galle International Stadium (from March 19 to 23) and at the R. Premadasa Stadium (from March 27 to 31), Sri Lanka Cricket sources said there would be around 10-15,000 spectators and it would not be possible to check everyone.

There have not been any cancellations from travel agents with regard to those coming from abroad for these matches, the source added.

Meanwhile, the Kachchativu feast took place on March 7 with about 7,000 Sri Lankans converging on this island by boat from the north and northwestern areas of the country and about 3,000 Indian from Tamilnadu, said Sri Lanka Navy Spokesman, Lieutenant Commander Isuru Suriyabandara.

Health checks were carried out on those who attended the feast, it is learnt.

The latest developments in the testing arena

There have been three developments in the testing arena for viruses, said Consultant Clinical Virologist, Dr. Jude Jayamaha of the National Influenza Centre, Medical Research Institute (MRI), Colombo.

The sequencing of the virus of the patient who tested positive for COVID-19 (the Chinese woman tourist) who has so far been the first and only imported case to the country. This had been done in collaboration with the Hong Kong University. Explaining what this is, Dr. Jayamaha says that the genetic material of the SARS-CoV-2 (Severe Acute Respiratory Syndrome-coronavirus 2) of the patient has been identified and the phylogenetic tree drawn up. This has helped to further scientifically confirm that the virus found in the patient was closely related to the Hubei Province virus and had no significant changes or mutations.

The testing capacity has been broadened as per the case definitions by the World Health Organization (WHO) of countries where there is community (local) transmission, particularly South Korea, Italy and Iran. More than 110 samples have been tested and only one found to be positive – the Chinese woman tourist.

As per the WHO’s recommendations, testing of people with severe pneumonia is also being carried out, while five Sri Lankans who came from Mecca, Saudi Arabia, have also been tested for the Middle East Respiratory Syndrome (MERS) which is also a coronavirus. These five were negative for MERS. Coronaviruses which are a potential threat to public health are being kept on the radar.

Be prepared & respond speedily, urges SEAR Regional Director

A strong call went out from the WHO’s Regional Director for the South-East Asia Region, Dr. Poonam Khetrapal Singh to the countries in the region to be prepared for “all possible scenarios” and ensure early containment measures.

This was as India, Indonesia and Thailand confirmed new cases of COVID-19 and five of the 11 countries in the region had confirmed cases. Thailand – 43, India – 28, Indonesia – 2, Sri Lanka – 1 (the Chinese woman tourist who has recovered and returned home), and Nepal – 1.

“The top priority of countries should be to be ready to roll out speedy response to the first case, first cluster and first evidences of community transmission. Early containment measures can help countries stop transmission,” said Dr Khetrapal Singh, adding that the risk of the new coronavirus is very high across the world. More cases can be expected. Rapidly identifying these cases, isolating them and following their contacts are important initiatives to help limit person-to-person transmission. “The speed of our response is critical, which is only possible if we are prepared.”

The virus can cause mild, flu-like symptoms as well as more severe disease. Patients have a range of symptoms such as fever, cough and shortness of breath. Based on current data, globally 81% of cases seem to have mild disease, about 14% appear to progress to severe disease, and some 5% are critical, she said.

Ten things to ward off disease

Clean your hands regularly – wash with soap and water or clean with alcohol-based hand rub.

Clean surfaces regularly with disinfectant – for example kitchen benches and work desks.

Educate yourself about COVID-19. Make sure your information comes from reliable sources.

Avoid travelling if you have a fever or cough, and if you become sick while on a flight, inform the crew immediately. Once you get to your destination, make contact with a health professional and tell them about where you have been.

Cough or sneeze into your sleeve. If using a tissue, dispose of the tissue immediately into a closed rubbish bin and then clean your hands.

Take extra precautions to avoid crowded areas if you are over 60 years old or if you have an underlying condition.

If you feel unwell, stay at home and call your doctor or local health professional.

If you are sick, stay at home and eat and sleep separately from your family, use different utensils and cutlery to eat.

If you develop shortness of breath, call your doctor and seek care immediately.

It’s normal and understandable to feel anxious, especially if you live in a country that has been affected. Find out what you can do in your community. Discuss how to stay safe in your workplace, school or place of worship.

“Private hospitals are adhering to Health Ministry guidelines”