Sri Lanka in multiple Coronavirus clusters as Covid-19 home deaths rise

ECONOMYNEXT – Sri Lanka has reported 30 Coronavirus deaths with 08 home deaths and authorities are placing more responsibility on containing the epidemic on members of the public with Covid-19 in multiple clusters with curfews expected to be relaxed soon.

Sri Lanka authorities have insisted that there is no community transmission in Sri Lanka.

Stages of Infection

The Health Ministry said on Friday, Sri Lanka is now in Alert 03 or multiple clusters, which is before community transmission.

Guidelines have been released for various businesses and activities and people are being asked to practice DReAM (D-Social Distancing, no gathering, mainly stay at home/Re-Respiratory Etiquette, A – aseptic practices/handwashing/sanitizing) and M – proper use of masks.

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Though the SARS-CoV-2 strain found in Sri Lanka is said to be highly transmissible, social distancing had not been increased from the current one metre.

In community transmission, clusters cross-infect and the distinctions between them disappear.

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Sri Lanka’s Public Health Inspector Union officials have warned that conditions of imminent community transmission existed in some areas of Colombo, which are densely populated.

The World Health Organization also classifies Sri Lanka as a country with clusters of Coronavirus.

Sri Lanka’s Army Chief General Shavendra Silva had indicated that curfews will be relaxed as soon as possible.

“President Gotabaya Rajapaksa has instructed us to do all the PCR tests and measures necessary during the nine days and work towards re-opening the Western province by the morning of November 09,” he said this week.

President Rajapaksa has said businesses and daily income earners were finding it difficult to cope with curfews, unlike state agencies which would anyway pay salaries.

In Colombo curfews were imposed on November 01 on areas with lower concentrations of Coronavirus cases while curfews were already in placed in northern parts of the capital with high concentration closer to a fish-market which had become the epicenter of a cluster than spread island-wide.

Health authorities would be allowed to isolate smaller areas, President Rajapaksa had said.

In the past three days, several areas in the provinces, which were isolated have been opened as contact tracers caught up.

Health authorities and public health inspectors have been engaged in a major battle to trace, test, isolate, and quarantine contacts. About 11,000 tests are being conducted daily on contacts, on those under treatment and on random and targeted samples in high risk groups.

There are around 84,000 first and second contacts of confirmed persoh

Sri Lanka confirmed 13,47 cases and 34 deaths, with 04 death and 4445 new cases being reported on November 08 by the Health Ministry.

On November 05, five deaths were reported, including three who had died at home.

On November 07 four deaths were reported, of which two persons had already died at home.

Sri Lanka’s Government Medical Officers Association had warned against discharging patients without a Coronavirus test, as discharge criteria were relaxed.

This week new cases were found in the countries largest prison in the capital and in the port.

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Cities as Epicentres

The WHO says community transmission starts in cities and spreads, though it is not classified as a separate stage.

“Cities are often national and international epicentres in the COVID-19 pandemic,” the World Health Organization says.

“Cities act as centres of community transmission, as well as entry points into further country-wide transmission through national and international travel and trade. They also often serve as points for health-care surge.”

The fish-market cluster from Peliyagoda north of Colombo has particular has spread the infection far and wide.

Officials initially attributed all discovered cases to the Minuwangoda cluster which was found on October 03.

But on October 20 random tests at the fish-market after several fish vendors were infected, found an even larger cluster at the Peliyagoda market.

Health Authorities have already said the Minuwangoda and fish-market clusters have been cross infecting.

The WHO does not have an intermediate definition for cities with cross infecting clusters.

Workers going from Colombo port and several apparel factories have also taken the disease home. In many rural areas, patients are turning up from a cluster at Colombo Dockyard.

This week Colombo Port saw a surge in cases.

Countries like China and Vietnam have stamped out clusters in cities and brought countries back to normal by isolating the city.

China locked down Wuhan where community transmission was widespread. Its economy is expected to grow 1.2 percent in 2020.

Sri Lanka’s Chief Epidemiologist Sudath Samaraweera has said that numbers from the Minuwangoda cluster have started to fall.

Home Deaths

In northern Colombo several older people with Chronic diseases have died in their homes.

Only one person in Colombo 13 was a contact of a known traced case, according to information publicly available.

Out of 30 deaths reported in Sri Lanka, 17 have been home deaths attributed to Coronavirus after post-mortem examination.

As clusters multiplied Sri Lanka dropped institutional quarantine, converted the facilities into treatment centres as started to quarantine first contacts at home.

Officials are now saying it is the responsibility of the public to protect their elders.

“If you take this virus home, and home and if your mother and father or grandparents get it, the bigger chance is that they will die, rather than recover,” Jayaruwan Bandara, spokesman for Sri Lanka’s Health Ministry told reporters.

“The responsibility is yours. Carry out the responsibility for them. If you go out do not bring it in.”

The comments came as authorities also stepped back from institutional quarantine, in contrast with the most successful countries in East Asia.

Institutional quarantine stops infections of second level contacts in a family where the first contact has not completed the incubation period, observers say.

When the first contact has not completed the incubation period, both first and second level contacts remain in the same house.

First Contacts in Home Quarantine

If first contacts are not in institutional quarantine the chances of family members including the elderly from getting infected is higher, observers familiar with the practices followed in the most successful countries in East Asia say.

If contact tracers get to the contact before the incubation period is over and takes a first contact to a centre, other family members will not get infected.

However, if first contacts are kept at home until they develop the disease and becomes a patient, there is a greater chance that other family members become infected increasing pressure on hospital beds and intensive care units

There is in general about a 6 -day window for tracers to find contacts, before they get to the next level, according to researchers in East Asia.

On November 03, a 68-year old woman from Jampettah Street died at home while under home quarantine.

“A family member of the deceased woman was diagnosed as Covid-19 and other members were under home quarantine,” the state information office said.

It was not clear whether the infected family member had already developed the disease by the time tracers found him.

Another person who had committed suicide also had a family member taken to hospital.

It is not clear whether the other home deaths are related to known contacts and whether family members were found.

Vietnam which uses institutional quarantine and probably the worlds most effective testing protocol has seen 35 deaths and 1,213 cases and 35 deaths compared to 467 deaths and 27,200 cases in Korea which relies more on home quarantine.

In Korea one or two dies every day despite having an advanced health care system with extra-corporeal membrane oxygenation and continuous renal replacement therapy.

Vietnam completely killed the epidemic in January-February (from China), March-May (from third countries) and an outbreak in July believed to be from illegal migrants from China.

Meanwhile, President Rajapaksa had asked officials to ensure that home quarantine is enforced after curfews are lifted.

“While paying special attention to close associates and the areas they belong to in the event infected persons found in the community, and if necessary, President advised to declare those areas as isolated,” his office said in a statement.

“Importance of concentrating on estates and flats was discussed in length”. (SB-Colombo/Nov07/2020 – Updated with end of day numbers)

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