ECONOMYNEXT – Sri Lanka is continuing to send first contacts of confirmed Coronavirus patients on home quarantine with pending Covid-19 PCR tests, amid a ‘serious’ situation health officials said, showing a wide gap from strategies followed by more successful countries like Vietnam.
Though ‘serious’, the situation was not uncontrollable, a top health official who called for public co-operation to follow isolation requests and limit movements said as more areas in the densely populated capital Colombo were put under curfew overnight.
On October 23, 865 domestic patients and 01 foreign patient was confirmed taking the total in Sri Lanka to 7,153, the Health Ministry said.
On Saturday curfews were imposed on Gothatuwa and Mulleriyawa areas of the capital Colombo from 1900ours following overnight curfews in Dematagoda and Maradana and Kaluthara.
Sri Lanka’s Shangri-La and Colombo Hilton said one of their staffers had been confirmed with Coronavirus.
“There is an increase in the numerical and geographical spread of patients,” Deputy Director-General of Health Hemantha Herath told reporters on October 23.
“As of today, the situation is not uncontrollable. But the people should take it into their minds that it is a serious (barapathala) situation.
“When we look at the rate of speed of the spread, if there is not sufficient co-operation from the people, there is a chance of the trend going towards an uncontrollable situation.
(Parleneryer kala nohaki thathwayakater yaamay pravanertharwayakerter – ehemath nethnam ei dheserter gaman kirimay hakiyarwak – thiyanawar.)
“At various levels we are doing PCR tests and tracing and quarantining. We are asking for maximum co-operation.”
Officials are urging people in all areas to stay at home as much as possible and limit movements and follow requests of health or other officials.
“In areas where no patients have been reported, or if you have not been identified as a close contact, you should still limit your movements to the maximum,” Herath said.
“Unless it is very essential do not go anywhere. Many people are co-operating but a one or two are enough to turn it upside down.”
Herath said if a young and active person moves around and contracts the disease and goes home, older persons are at risk.
On Saturday the second death was reported from the new cluster taking total deaths to 15.
In the current outbreak, which officials say is more contagious than earlier ones, many patients get mild or no symptoms making it less likely to be detected.
Home Quarantine Gap
Sri Lanka is sending large numbers of first or F1 contacts on home quarantine with pending PCR results, (not applicable to random tests) in a wide gap from the strategy followed by countries like Vietnam where only f2 and f3 contacts are sent on home quarantine.
In Vietnam, a person who had been within 6 feet of a confirmed person or had 30 minutes or more contact is identified as an F1 contact.
If an F1 contact test positive, f2 contacts are quarantined in Vietnam, observers who are familiar with the practices of the country say.
In the first wave of infections till April Vietnam quarantined over 40,000 persons in the space of a few weeks, converting large numbers of state buildings and university dormitories into quarantine centres.
Sri Lanka’s quarantine centres are becoming full, though the military has expanded facilities sharply since the new clusters developed.
In the March to June period Sri Lanka had serious testing gaps compared to Vietnam with senior doctors insisting that the PCR tests was a not a screening test but a diagnostic one which should be administered at a hospital setting on the advice of a doctor.
Unlike in Vietnam Sri Lanka is sending close contacts home, pending results. The practice had been followed even before quarantine needs rose sharply.
Meanwhile, Herath said Sri Lanka had had a practice of keeping contacts in-home quarantine from the beginning.
“The contacts of persons detected in the community was subjected to home quarantine,” Perera told reporters.
“That was the practice that we practised. The majority of the practice they adhered to that.”
At the Brandix factory, officials spent several days trying to locate persons who had tested positive in the first sweep.
Quarantine vs Hospitals
Sending a contact home increases the chances of family members or roommates who are not already infected from getting infected which leads to more hospital space requirements.
While they wait at home, F1 contacts who are going through the incubation period can also develop the disease, after testing negative and infect other people increasing the need for hospitals.
Analysts say the decision to quarantine F1 contacts is a public policy choice involving building more quarantine facilities or hospital facilities.
Meanwhile, there are reports that contacts sent on home quarantine after testing have to wait for more than a day for results to come, increasing the chances of the disease being spread.
Hospitals are also filling up, though the first persons to enter hospitals have now started to be discharged after recovering.
There are 26 hospitals with wards for Covid-19 patient and 24 PCR testing centres, Palitha Kaunaperuma from the Health Promotion Bureau of Sri Lanka’s Health Ministry said.
About 8,000 to 9,000 tests are being done a day, he said.
“We are asking members of the public to voluntary follow movement restrictions and requests of health or other authorities,” Herath said.
“Do not wait for someone to come and guard you or do because you are told. To avoid a serious situation in the future, please do it voluntarily.”
Health officials have said the current strain of the virus is also more contagious raising questions whether the practise should be tightened.
However, authorities can get control by imposing lockdowns of a larger area or stopping travel between districts or divisional secretary areas.
This raises the question whether authorities should lock down any area where authorities are unable to quarantine F1 contacts and they are sent on home quarantine observers say.
Countries like Vietnam were able to avoid complete lockdowns because they were able to quarantine all F1 contacts, observers say.
In July when a cluster suddenly developed in Da Nang city, authorities cut-off the entire city and asked all people who had left the city to register with local authorities.
Vietnam also has an app, Bluezone where people can register.
On the night of October, 23 authorities imposed curfew in Maradana and Dematagoda.
Cross Cluster Infections
There are increasing concerns that clusters are cross infecting each other, where contact tracers can become rapidly overwhelmed or irrelevant.
Sri Lanka’s Chief Epidemiologist had said the Minuwangoda and Fish Market clusters may have had cross infections.
In countries with community transmission, the distinction between clusters become blurred and eventually disappear.
Chief Medical Officer for Health of the Colombo Municipal Council Ruwan Wijayamuni said out of 488 contacts and random samples from Gunasinghepura area tested on October 21, 154 had tested positive on October 23.
He said it was a high yield.
“The reports came at 6.00 to 6.30 pm,” Wijayamuni told Sri Lanka’s Derana Television. “By 2.00 am with the help of the military, intelligence officer and health ministry instructions and the Epidemiological unit we hospitalized them.
“All their contacts have been listed for testing today in Modara. We hope to do 500 tests.”
Wijayamuni said from October 08 to October 23, 4,200 tests had been conducted in Colombo city.
“This was intensified in the last few days. From March to May were 134 infections. Then there were 61 infections from the Minuwangoda and Dockyard clusters when we got samples.
“In the past two days from the Peliyagoda fish market, 472 have been found. In the past four days, the number of patients has gone up five times.
“In Colombo city, we will do the tests of the contacts without any waiting list.”
Wijayamuni said they had difficulties in finding the positive tested persons on Friday night. They were on home quarantine.
“In all the houses of first contacts, we have placed a sticker saying it is a quarantined home. Then people can see this.”
We need the support of the public. When we tried to find the patients last night to put on the military buses, some people hid. So we have to find them. Then others hide them.
“People do not understand. So we need their support.”
It is not clear whether the 500 contacts tested on Saturday, who have now become F1 contacts of the previous day’s confirmed patients will also be sent on home quarantine until the results come.