ECONOMYNEXT – Sri Lanka’s health minister warned that there may be infected persons in the community who do not show symptoms, while the count rose to 771 with new cases being discovered in several locations.
“With curfew to be relaxed in the future, you must be mindful that there may be persons who do not show symptoms may be around you from time to time (inder hiter oba athara gawasiya hakiyi), Health Minister Pavithra Wanniarachchi said in Sri Lanka’s Sirasa Television.
“There is a certain trend that you may also get the disease from these persons. So you must wash hands, whether a shop, or supermarket or place of work.”
Sri Lanka is planning to relax tight curfews on May 11. In the Western province, anyone would be allowed to go to work, but authorities are have asked people to limit other activities such as shopping.
Community Transmission
Jayaruwan Bandara, the Director of Sri Lanka’s medical research institute had also warned that there may be infected people in the community, media reports said.
The World Health Organization had designated Sri Lanka as a country with domestic transmission, the head of Sri Lanka’s health service Anil Jasinghe said on March 16, after a patient who had no contact with foreigners got infected from another local.
Sri Lanka’s does not have widespread community transmission, but there have been several large clusters.
Sri Lanka’s Government Medical Association has said in late March that Sri Lanka was in stage 03 transmission of an epidemic where people at home or close contacts are infected.
But authorities who were initially not testing persons outside of discovered clusters starting from symptomatic index cases, said there was no community transmission.
In a country with community transmission, the public generally wear masks.
On May 05, new patients were discovered from Kolonnawa, Colombo 15, in the Bandaranaike Pura area of Rajagiriya causing fresh concerns.
The person in Rajagiriya may be linked to an existing cluster, reports said.
This week, a woman who had been suffering from respiratory symptoms for a month and had reportedly seen a doctor more than once had not been diagnosed or tested until her condition became worse died after being admitted to hospital.
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Her husband was distributing bread for a bakery, reports said.
Sri Lanka’s military chief Shavendra Silva told Sri Lanka’s Derana television that investigations were underway to find the infections sources of the newly discovered persons.
“There have been situations where we could not initially find the link,” Silva said. “For example in the Dabare Road case we eventually found the connection. Here also we are conducting investigations.”
New cases not linked to existing clusters point to more un-identified infected persons or clusters in the community.
Meanwhile officials had found 71 contacts of the new cases and quarantined them. Tests are now being conducted on them.
Testing Restrictions
Sri Lanka is now finding new cases from the community as well as contacts after relaxing earlier controls on Coronavirus tests.
Initially tests were denied to anyone who was not already in hospital. The persons in hospital were only symptomatic cases.
Tests were also denied to asymptomatic first contacts and quarantined person.
Authorities initially wanted all symptomatic persons to come to state hospitals to keep control of all cases.
But the rationale for denying voluntary tests to asymptomatic person who may want it because of a perceived if they are prepared to bear the cost is not known.
However close contacts of symptomatic persons are now tested, though there have been concerns that ‘casual’ first contacts may be not be tested.
The denial of tests to quarantined persons was also lifted after at least two turned up with symptoms after release.
Some public health officers who were contact tracing in a large cluster went to voluntary self-quarantine after they were denied tests.
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A large number of Navy personnel who were involved in contact tracing and quarantine were also not discovered until a symptomatic person got infected and admitted himself to hospital.
Authorities are now testing some high risk groups based on an algorithm, Jasinghe has said.
Voluntary Tests
Businesses are still denied voluntary tests of high risk groups at their own expense.
Though symptomatic persons are expected to go to a designated state hospital, the rationale for the ban on asymptomatic persons has been questioned.
“Once curfew is lifted, the front office staff of any institution including airports, quarantine workers, cleaning staff, people working in economic centres, and drivers may be exposed to higher risks,” Colombo-based Advocata Institute said last month, while also calling for testing of high risk groups.
“Those in driving/delivery related jobs in particular would also be in a position to spread the disease faster and to a greater area.”
Sri Lanka’s National Medical Regulatory Authority initially raided a private hospital and sealed test material.
In countries that are successful such as Korea, voluntary drive-in tests are conducted at state expense.
Sri Lanka is now aggressively tracing contacts of all discovered infected cases, especially a dozens of Navy personnel who were allowed to go on leave during Coroanvirus curfews which led to the spread of the disease around the country.
Many of the earlier clusters have been controlled.
On April 05, a person discovered in Kolabissa in Kandy who was linked to a relative of a sailor, 67 contacts had been quarantined, General Silva said.
Twenty seven contacts of a person in Rajagiriya Bandaranaike Pura were also quarantined.
Authorities had take 138 to quarantine centres and 4883 person were in 39 quarantine centres. A total of 339 military officers have so far been found. (Colombo/May06/2020 – Corrected paragraph 06)