At a time when big and mighty countries struggle to cope with soaring numbers of coronavirus cases and consequent deaths, the official figures from 21-million strong Sri Lanka stand out — 1,070 cases, 660 recoveries and nine deaths as of Saturday evening.
Behind those promising numbers are early thinking and swift action, according to Dr. Anil Jasinghe, Director General of Health Services in Sri Lanka. The senior public health official, helming Sri Lanka’s pandemic response, along with the Army Commander who heads a task force on COVID-19, says it is “targeted and tough” control measures, rather than a generic template “based on literature”, that helped the island nation arrest the pandemic’s spread.
Data published by the World Health Organization shows that Sri Lanka remains among the least affected countries in South Asia, along with Nepal, Bhutan and Myanmar that have recorded under 1,000 positive cases so far. “We have managed this because we planned in advance,” Dr. Jasinghe notes, in an interview to The Hindu at the Ministry of Health.
In late January, Sri Lanka reported the first case of coronavirus, when a visiting Chinese tourist tested positive. Luckily, the patient had not infected anyone else. She received treatment and returned to China after recovering.
Sri Lanka put in place broad screening measures at the Bandaranaike International Airport in Colombo, to identify passengers arriving with possible COVID-19 symptoms.
First local case
Over a month later, on March 10, Sri Lanka found a local — a 52-year-old tour guide — who had contracted the infection, from a visiting Italian tourist. The development put Sri Lanka’s public health officials on high alert.
Passengers arriving from international locations were taken to quarantine centres, or in some cases, were home-quarantined. With the military stepping in, extensive contact tracing began. Twelve government hospitals across the island were identified to set up special isolation wards for suspected patients. The wards grew to over 30 in the following weeks as numbers increased — largely originating from a cluster of Sri Lankans who had arrived from Italy between March 1 and 9.
After the early isolation wards, an entire hospital each in the “vulnerable” districts of Colombo, neighbouring Gampaha, the southern Kalutara and Puttalam in the North Western Province, were readied for suspects. Where there was no hospital, an available large building was swiftly modified and equipped for the purpose — like the former Voice of America building in Puttalam. Soon, these hospitals became treatment centres, with the staff “groomed” for the job, Dr. Jasinghe says. This was in addition to the well-known Infectious Diseases Hospital in Colombo.
In his views, aggressive contract tracing, early quarantine measures and a strict curfew — over 60,000 violators arrested so far — helped “put a wall” between the virus and the country’s elderly, and ensured “a low death rate” of about 0.8 %. “Otherwise, with a rapidly ageing population, we would have been finished”
However, Sri Lanka didn’t wait for its first case to begin preparing. Well ahead of March 10, Sri Lanka had set up its first PCR testing facility, with advice from Hong Kong-based Sri Lankan origin pathologist Professor Malik Peiris, known for first isolating the SARS virus. “I think Pune and Sri Lanka were the only two places to have it at that time.” By the time the first case of a Sri Lankan national was reported here, the country had four such labs. And now 20, including four private, labs conduct PCR testing. But Dr. Jasinghe remains sceptical of the widely endorsed “test, test, test” strategy, amid prevalent concern and criticism, including from public health experts here, that Sri Lanka was not testing enough..
“Some people say that to lobby, or just based on literature. But we can’t just test like that in our context. So, we followed an algorithm,” he explains. In addition to suspected patients from the 30 hospitals and those reporting likely COVID-19 symptoms to outpatient departments elsewhere, tests were conducted at random, among persons among “high-risk populations” such as residents of shanties, drug addicts, and autorickshaw drivers.
“When tests among these highly vulnerable people showed a positive rate as low as 3 %, then how can we justify arbitrarily testing more people? So, we incrementally increased testing,” Dr. Jasinghe says. Sri Lanka currently has the capacity to conduct over 2,000 tests and has been doing about 1,500 tests a day recently, increasing “when needed”.
Meanwhile, over 600 cases of the total infections in Sri Lanka have been traced to the Navy. Dr. Jasinghe says they contracted the infection while chasing “drug peddlers”, and soon the infection spread like “bushfire” within their living quarters.
“There was some negligence on their part, but we were quick in tracing their contacts including the families of those who went on leave and everyone was quarantined,” he adds. The Navy cluster, according to official sources, remains the only live cluster at the moment.
Role of military
Dr. Jasinghe attributes much of Sri Lanka’s apparently effective response to its historically strong public health system. “When countries get richer and richer, they neglect public health, like in the U.S. But we never reduced its importance.”
A wide network of midwives, public health inspectors and field assistants are actively involved in preventive health care. “We are used to controlling and eliminating diseases — malaria, measles, mother to child transmission of HIV and so on. We have the experience in public health, you see. Like Kerala,” Dr. Jasinghe observes.
Asked why a sound public health system needed the military’s direct involvement — from contact tracing to running quarantine centres — in pandemic response, Dr. Jasinghe says: “We don’t have the capacity to build or prepare quarantine centres that fast. We have about 50 now, mostly run by the army. A few are run by the navy and air force. But for their support, we couldn’t have managed this.”