On Sri Lanka’s Health Promotion Bureau portal, the total number of COVID-19 positive cases, updated in real time, was 219 on Tuesday evening. Of those, 151 are active.
Seven patients who contracted the virus have died, while 61 have recovered, according to the official bulletin. Compared to most other countries in the neighbourhood, the cases in Sri Lanka appear to be relatively under control, even as some within the medical community here call for more testing. How is Sri Lanka, with arguably the best public health system in the region, fighting the pandemic?
Sri Lanka reported the first case of coronavirus late January, when a visiting Chinese tourist tested positive. Weeks after the patient recovered and left the country, authorities reported the first confirmed case of a Sri Lankan national, a tour guide. He tested positive on March 10, after he came in contact with a group of Italian tourists.
Since then, Sri Lanka is focused on detecting infections, referring identified patients for treatment to dedicated COVID-19 centres, isolating cases during treatment to prevent further exposure from detected cases, senior officials from the Health Ministry said.
According to Dr. Deepa Gamage, consultant epidemiologist, Epidemiology Unit, Ministry of Health, the country’s main strategy includes contact-tracing, quarantining exposed persons, an active case search among close contacts through testing at the appropriate time after exposure, follow-ups and breaking links from the index cases.
The current nationwide curfew, which came into effect on March 20, has proved crucial, in her view. “It helped the Health Ministry in controlling the community transmission and active case search as population movements are restricted. It also helped the surveillance system and the public health staff to identify close contacts early and track them down for testing at the right time,” Dr. Gamage told The Hindu.
Curfew vs lockdown
Despite its said effectiveness, however, the curfew has raised concern. Lawyers have repeatedly questioned the legal basis for the curfew even as police continue arresting “violators” on a daily basis. The State-run Sunday Observer newspaper on Tuesday reported that as many as 26,600 persons have been arrested for allegedly violating curfew regulations since March 20, when President Gotabaya Rajapaksa announced the nationwide curfew.
Further, the strict curfew has meant that daily wage-earners, much like in India, have had little or no income for over three weeks.
Ceylon Today, an English daily, reported that on April 6, Jaffna police arrested 37 persons for entering town amid a curfew, claiming they didn’t have food. This, while Sri Lanka’s tea and garment exports and remittances from domestic workers abroad —all key foreign exchange earners — have been hit very badly.
It is the apparent economic costs of the curfew, especially for Sri Lanka’s poor, that worry social health experts such as Dr. Prasanna Cooray. “We saw how, when the curfew was lifted even briefly, people panicked and rushed to the shops, greatly increasing the risk of transmission. A lockdown, on the other hand, is a widely accepted time-tested public health approach to controlling a pandemic. It gives us time to build public awareness and confidence, and is more sustainable,” he told The Hindu, adding that providing support and a steady supply of essentials would help the poor cope with the situation.
Time to test more?
While arresting spread of the pandemic is one aspect, going forward, Sri Lanka would need to test a lot more than it is currently doing, argue public health experts and doctors, including the influential Government Medical Officer’s Association (GMOA).
There is no official figure for the number of tests conducted so far, but Dr. Gamage at the Epidemiology Unit said the plan was to raise testing to about 1,500 a day in the coming weeks. Last week, Sri Lanka received a donation of 20,000 testing kits from the China-based Alibaba Group’s founder Jack Ma. “We have been very carefully implementing the strategy best suited for our country and our context, with existing limited resources,” she said, adding that in the past week all symptomatic cases tested were negative.
Dr. Manuj C. Weerasinghe, head of Department of Community Medicine, University of Colombo, concurred: “People are misunderstanding the WHO’s recommendation of test, test and test. It really depends on the context, and our resources. We cannot waste testing kits by testing more people arbitrarily. We have to reserve the tests for those linked to the clusters currently identified. So far Sri Lanka has effectively prevented leakage into community.”
Meanwhile, Sri Lanka’s Health Minister Pavithra Wanniarachchi has said that if Sri Lanka’s curfew is in place until April 19, the country could get “rid of COVID-19”, the Sunday Observer reported. Government critics read the comment as a precursor to the general elections that President Rajapaksa earlier said would be held as per schedule, but was later postponed due to the pandemic.
“It is absurd to even think of elections now. How can we even predict when the infections will stop spreading?” asked Dr. Cooray, a former manager for South Asia, for the Global AIDS programme. “The election fever seems to have preceded the government’s COVID response, as poll nominations went on from March 12-19, even as our first few cases were being reported.” he added.
Dr. Weerasinghe too said it was hard to comment on ”eliminating” the virus as yet. By April 20, Sri Lanka would have finished two incubation periods (of 14 days each) since the curfew began. “We need to consider at least four to five incubation periods to say with some certainty that things are under control. If no new clusters are sighted by April 20, we may be in a better position to decide what to do next and whether we can go for a planned, staggered, slow exit strategy,” he said, adding that a hurried exit could enhance the risk of a resurgence of the virus.
Dr. Cooray also pointed to a “high case fatality” ratio — of the number of deaths to cases. Sri Lanka has reported seven deaths out of the 219 infections. “That is not very low. It could mean that the true picture [of the total number of cases] may not have been captured in the current numbers,” he cautioned.