- Rational and scientific approach
Brandix cluster: Are we in community transmission?
To declare a community transmission, there has to be regular appearance of patients from the community which cannot be traced to the index case. Hence, the current situation cannot be considered as community transmission. However, Sri Lanka is in stage “3b”, which is known as a stage of cluster epidemic. Hence, there’s enormous collective responsibility to contain the disease and prevent progressing to the fourth stage, which is community transmission.
“The numbers were rising rapidly during the first few days after tracking the patient from the garment factory in Minuwangoda, which reflected the rate of contact tracing and testing. Tracking of contacts had been a challenge due to deficiencies in the management of the garment factory in relation to keeping the records of the staff members. However, all contacts of the factory were traced, tested, and managed accordingly.
“Labour exchange within the garment chain was evident, and another workers was identified as being PCR-positive in the Koggala Brandix plant,” said University of Colombo Faculty of Medicine Department of Community Medicine Head Prof. M.C. Weerasinghe.
Strengthen the surveillance system
Gampaha DGH consultant respiratory physician Dr. Bodhika Samarasekara, who was the initiator of the turning point, shared his experience. “During the last two months, we were on alert. Even though the disease was apparently under control within the country, the situation of neighbouring countries did not allow us to loosen the grip. Hence, the surveillance system was increased with random sampling of patients,” he said.
With regards to patient management, the monitoring of the patients’ oxygen saturation is important and chest x-rays, ultrasound scans, and other basic lab investigations are needed in the primary management.
It is important not to overlook the management of patients with other chronic lung diseases. It is especially important to ensure early diagnosis and treatment of TB (tuberculosis) patients who can present similar symptoms as Covid-19. According to Dr. Samarasekara, a considerable number of deaths had been reported within this year due to TB.
Maximally utilise the minimum resources available
Ceylon College of Physicians President Dr. Ananda Wijewickrama, the forerunner in the frontline, shared his expertise at the discussion. With the exponential increase in numbers, it is vital to maximally utilise the minimum resources available. PCR testing should be focused mainly on the suspected patients and surveillance should be strengthened through testing at OPDs and wards. According to Dr. Wijewickrama, in the present outbreak, patients are mostly asymptomatic or having only mild symptoms. However, as the patients are experiencing a high viral load, they may still be in the early stages of the disease. Therefore, it is imperative to monitor the patients closely for about five to seven days to predict the patient outcome.
It is important to take appropriate precautions to safeguard healthcare workers. He further mentioned that some unnecessary precautions were seen, such as partitioning the wards, which was happening in some centres. Since it is vital to maintain good ventilation to minimise the disease spread, partitioning, and thereby congesting the wards, would be an unnecessary step.
He emphasised the need to take special precautions at OPDs and clinics to prevent the spread and also to treat the patients with other illnesses appropriately in a safe environment.
Although all PCR-positive patients are given hospitalised care at present, strategies regarding admission of the patients might change in the future, depending on the number of cases reported.
Dr. Wijewickrama emphasised the requirement of early detection and management of patients with dengue and leptospirosis that can be overlooked during the pandemic situation.
Prevention is key
Sri Jayewardenepura General Hospital consultant microbiologist Dr. Kushlani Jayathilaka emphasised the importance of taking precautions to preventing the spread.
“It appears that the public were relaxing a little during the last two months and we should never take chances with Covid-19.’’ Minimising nonessential visits to public places, wearing face masks correctly, and maintaining distance are simple but essential prerequisites to controlling the spread of the disease.
Educating people on the importance of adhering to preventive measures is vital. What is seen at present is that people are adhering to precautions just because of the legislation, which would not help in attitudinal change.
Legislation is also important to ensuring safety at institutions. More responsibility should be assumed by heads of the institutions for making arrangements to maintain space at the workplaces and providing hand-sanitising and hand-washing facilities. Furthermore, staff having symptoms should not be allowed to attend work, as it causes more harm than good in the long run.
Dr. Jayathilaka further stressed the need to adhere to national guidelines in all parts of the country in relation to the quarantining process.
Current virus strain is highly infectious
University of Sri Jayewardenepura Faculty of Medical Sciences Department of Immunology and Molecular Medicine Head Prof. Neelika Malavige, who is an expert in immunology and molecular medicine, shared her valuable experience on Covid-19 viral genotype sequencing. She is currently researching all the Covid-19 viral strains identified in Sri Lanka to study their mutations and virulence. According to Prof. Malavige, seven major Covid-19 strains and 153 mutations have been identified around the world up to now.
With her studies on virus strains in Sri Lanka, an important mutation has been detected, which is associated with high viral loads with high transmissibility.
“In order to contain the epidemic, precautions need to be taken irrespective of the strain of the virus,” she added.
Covid stigmatisation
Professor in psychiatry and National Institute of Fundamental Studies Chairman Prof. Athula Sumathipala emphasised the harmful effects of stigmatisation of Covid-19 patients and their families.
“Relatively, the public has failed in their duty, which has to be reflected seriously. Mobilising people has been affected due to stigmatisation, prejudice, and worries,” said Prof. Sumathipala. Using fear as a health promotional tool is totally incorrect and unacceptable, as it affects negatively by aggravating stigmatisation. Especially in the process of quarantining, it should never be highlighted as a punishment but rather as a preventive healthcare measure. Based on cognitive behavioural theory, the way people think and behave depends on how they perceive a message. If quarantine is perceived as a punishment, people tend to avoid and hide.
He requested the Covid-19 National Steering Committee to adopt evidence-based behavioural approaches and strategies in managing the patients and contacts.
“A huge shift in behaviour and attitude is important, as we have to live with Covid-19 for a significant time ahead,” said Prof. Sumathipala.
The media has to play a responsible role in engaging, empowering, and involving the public in controlling the pandemic. It is the responsibility of the media to propagate the correct message to the public.
"The Covid-19 pandemic is far from over. Hence, there is a dire need of clear policies and a support system for the healthcare workers who get exposed. Priority should be on breaking the chain of transmission based on a rational and scientific approach,” said Prof. Karunathilake, in his closing remarks.