ECONOMYNEXT – Sri Lanka is ramping up Coronavirus tests, with some persons who had been released from quarantine developing Covid-19 and others also being found in society without symptoms in a bid to clamp down on community transmission, officials said.
The entire battle against Coronavirus had been complicated by finding that patients could become positive up to 20 days after contact.
Government Medical Officers Association has urged health authorities to boost Coronavirus tests to identify those who are not showing symptoms in a bid to close gaps in the country’s anti-Coronavirus battle.
Sri Lanka has conducted over 3,000 tests so far using the so-called PCR method, where the phlegm of a person is tested, but it is not being used enough, the GMOA said.
The group is also urging rapid tests, which detect antigens in blood of patients who show no symptoms.
A strategy is being developed with intelligence, the ICTA to relax curfews and re-open the country for economic activities, the head of the GMOA Anurudda Padeniya said.
Tests before Relaxing
“But to re-open the country we first need to identify the infected persons in society,” Padeniya said. “This is a difficult virus infection in which to find infected persons, because about 20 percent do not show symptoms.
“About 64 percent show mild symptoms. So only 16 percent only show clear symptoms. If we do not find all these people, there is big risk of a new surge in infections if when we open the country.
He said the World Health Organization has recommended “aggressive testing”.
One test is the so-called PCR test which is currently being done, which detects the presence of the SARS-Cov-2 virus in phlegm. The second tests the blood of a patient to find anti-bodies that have been developed to kill the virus by the body.
The GMOA has been urging that so-called ‘rapid tests’ developed in Korea and elsewhere be used.
Other GMOA officials have also urged the health ministry to quickly start using rapid tests which are said to cost less than 1,000 rupees a go and it should not take authorities five days to ‘validate’ the kits.
Testing Debate
The head of Sri Lanka’s health service Anil Jasinghe said the kits submitted to the ministry of health has so far been found to be of poor quality.
“We validate all kits, but all kits submitted were not of the required quality,” Jasinghe said on April 06. “If we get a rapid test of a better quality, we will use it.”
A video conference with the ministry’s technical committee had been held with Malik Pieris, an expert of Sri Lankan origin who has been advising the ministry.
He had been satisfied with the process followed so far, Jasinghe said.
“We are focusing on doing more tests,” Jasinghe said. “This week we are doing twice the volume we were doing last week.
Medical officials have also said that the PCR test can detect presence earlier as it may take longer for some people to develop antibodies.
GMOA’s Padeniya said whatever tests that are available will only has a sensitivity of 70 percent. When 100 infected persons are tested, only 70 will come up positive, though the others are carriers.
“So 30 percent will escape us,” Padeniya said. “The remedy given by the WHO is to repeat the test. That is why test, test, test.”
Reports said there were about 115 PCR machines in state agencies, universities and private laboratories.
In the main testing lad in Borella only 3 out of 7 were being used. An official of the lab said earlier in the week that the lab had not got samples to use machines to capacity.
Padeniya said following a meeting with officials it was assessed that Sri Lanka could conduct about 12,000 tests a day, but there was shortage of swabs to take samples. Work was underway to produce more swabs, he said.
“We do not really care what test is done, provided tests are done,” Padeniya said. “We have been insisting from Monday that more tests be done.”
“Now how many days have gone? Seven or 8 days.”
3000 (F1)s
By the first week of April about 45,000 persons were either in military run quarantine centres or under observation by police, local headmen or health officials, he said.
He said those persons should be tested.
Researchers from the Woolcock Institute of Medical Research, Hanoi, Viet Nam; Sydney School of Medicine, Faculty of Medicine and Health, The University of Sydney, Australia, supported by others in Laos say at least three generations of contacts have to be traced and two tested to successfully kill community transmission.
When a new patient is found (index case or ‘F0’) all his closest contacts (F1) and their contacts (F2) should be traced should be traced. All F1s should be tested immediately.
If any F1 is positive, F2 should be tested and F3 traced. If the process is done fast enough, the line of transmission can be extinguished quickly.
The Vietnamese researchers said every person in quarantine should be tested and no one should be released without being tested twice.
Sudath Samaraweera, the head of the Epidemiological unit of Sri Lanka’s health ministry said there were about 3000 close associates (F1) in among the 40,000 plus person in quarantine of lockdown.
Jasinghe said Sri Lanka would increase testing of targeted groups.
He said about 3,000 were close contacts in the first ring of persons and others were ‘casual’ contacts. Sri Lanka would focus on the closest contacts first.
“We think in a few days we can increase the rate to 500 a day. There are now 9 centres. Ratnapura and Jaffna has joined the network of labs.”
At least two persons, who had been released from quarantine after 14 days had apparently got the disease after 20 days.
Sri Lanka’s Army chief Shavendra Silva said he was confident that according to the processes followed in the centres they could not have got infected inside.
Jasinghe said amount from now on all inmates of quarantine centres will be tested. They will also be tested before being released.
Sri Lanka is among few countries in the world that had contained the spread of the virus and is ahead of most countries in the world.
Only few countries like Korea, which developed cluster and Vietnam, had been aggressively tracing contacts like Sri Lanka.
Vietnam, which shares a border with China also started isolating and tracing contacts during the so-called Wave I period, restricting arrivals from China against the advice given by the World Health Organization at the time.
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Community Tech
By April 08, Vietnam had conducted 106,000 tests up from 94,000 a day earlier its Health Ministry data showed, indicating that the country could now conduct 10,000 a day.
Like Sri Lanka Vietnam had been aggressively tracing contacts using the military intelligence and community support to find patients and their close contacts (F1) and the next level of contact (F2) to stop community transmission.
As soon as the patient is found, the Health Ministry publishes a contact diagram with a timeline where the patient had been asking people to come forward.
The diagram is given wide publicity in the media.
Terms like F1 (first contact), F2 (the contact of contacts) and (F3) are bywords among residents of Ho Chi Minh City and Hanoi, where most of the foreigners and returnees who brought the virus were resident.
Anyone in Vietnam can also log into a Health Ministry app, developed by Viettel, a state telecom company, input their symptoms and get a assessment of their condition. The app gives advice on whether to self-quarantine or go to the hospital.
The app will show the closest designated hospital with a Google map, which the person can call or get chat support. The public can also submit information about their friends or neighbors.
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Vietnam had 16 First Wave cases from China and successfully stamped it out with aggressive contact tracing.
Second Wave from outside China
The Second Wave from Western countries that did not block arrivals from China or quarantine them began in March in Vietnam as it did in Sri Lanka.
Among the last were involving Muslim Cham peoples who had returned from a religious ceremony in Malaysia.
In Sri Lanka Jasinghe said the initial infections from arrivals from Italy now seemed to have ended and the latest infections related to those who came back from India and Malaysia and Indonesia.
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In Vietnam about 150 of the 243 confirmed were foreigners. Vietnam gets 18 million tourists a year and has dozens of aircraft landing in several airports every hour.
Many of the rest are returnees or immediate family members.
Vietnam was also the first country to stamp out SARS according to the World Health Organization.
Next Wave
However it is not clear how the battle will be compromised by infected persons who develop the disease up to three weeks later.
Sri Lanka had confirmed 185 coronavirus patients by April 08. Two persons had had been found from the Punani quarantine centre on April 07, Jasinghe said.
The daughter and two grand-daughters of a patient who had been confirmed earlier had been found.
Two persons from Puttalam, contacts of a person who had come back from Indonesia and Malaysia had been confirmed.
“Our situation is not that bad, but if we relax clusters can develop,” Jasinghe said.
Authorities were also tying to find out about a three-wheeler driver who was found two days ago had and a child, raising some concerns.
Officials have said that that April would be crucial to check whether there was wider community transmission.
The curfews would plug any ‘leaks’ from the contact tracing.
In Vietnam Prime Minister Nguyen Xuan Phuc also warned the public not to be complacent, maintain social distance and be prepared for the next wave community transmission outbreaks.
“The current prevention and control strategy is social isolation, search for cases, localization of epidemic suppression by the method of” locking from the outside, stamping out from the inside,” Vietnam’s TouiTre newspaper quoted PM Phuc as saying.
But from April 15, the health sector, regional governments would have to be prepared for the next wave, he said. (Colombo/Apr07/2020)