Saturday, October 10, 2020

The COVID-19 crisis: What do we do now?

The much expected COVID-19 second wave has set in first as a local outbreak in Minuwangoda and then made its way into farther parts of the country such as Jaffna and Monaragala. The tedious task of finding the contacts that we know of, and the contacts that we don’t know of, has been given to the state intelligence services, the Public Health Inspectors and the Forces. This is a thankless job they have been entrusted with as in the end they will never find all the people who could have been infected with this virus. It is the same fact that contributed to this outbreak.

What went wrong? Firstly, this a new disease of which we have only a little understanding. Even the recognized incubation period for the disease changed with time. It is now thought some one will show symptoms of the disease between 5 to 14 days after being infected. Not all get ill after getting the virus inside their bodies. It is not known for sure whether a person who has the germ but who doesn’t show any symptoms could infect another person.

The quarantine period is 14 days. Imagine what would have happened in the beginning. Those who were transported to the quarantine centres could have got it from another passenger. At the quarantine centres, if they were allowed to mingle with others, they could have got infected. Even if kept separately individually or as families, initially many got together to celebrate the last day of the quarantine period.

Now provided that some show symptoms on the 14th day of getting infected and if they get together or use the same transport, they will definitely pass the virus to others. This was noticed and some suggested that the quarantine period should be increased to 21 days. Later it was decided to quarantine them for another 14 days in their own homes. But was this properly monitored by the health personnel is the million-dollar question. Somehow even if one infected person gets through the net that is enough for a major outbreak somewhere else which I believe is the present case. That combined with complacency shown by the people who stopped wearing masks, not adhering to social distancing and forgetting about hand-washing obviously created the present situation.

The deterioration was well noted in some supermarkets where water was not available to wash the hands as the supply had been cut, the empty liquid soap container was not replaced and in both private and govt sector offices the managers hardly wore masks setting a bad example to their staff.

Even with many ups and downs the country managed the disease very well where the forces combined with the health personnel to control the spread. Many lessons were learnt while they were on the job. The leadership given by the Army Commander Lt. General Shavendra De Silva and the former Director General of Health Services Dr. Anil Jasinghe was commendable. Unfortunately, at this grave time the latter is not in that post. But I believe the authorities will prevail upon the situation.

While treatment procedures adopted were outstanding, the PCR testing was hardly adequate. The reasons are not known but now I believe that it is raised up to 2000 tests a day. Considering that the false negative rate of the test is between 2-29% according the British Medical Journal, and 2-37% as reported by Harvard Medical School, it is necessary to test the same person twice or thrice. This means we may be not covering all the persons who are really infected. We went on carrying out tests on so-called high-risk groups in urban areas which was non-productive and a sheer waste of time and money considering that the private hospitals charge around Rs. 9000 per test. This disease doesn’t care whether one is rich or poor. Therefore, it is better to consider testing those who have the symptoms only i.e. a fever, sore-throat, cough and cold, difficulty in breathing or any one of them. If such a practice is adopted, I am sure the number of positives could be much higher and we may not miss many COVID-19 patients.

All is not lost. Although the flu season is on in the Northern Hemisphere, I am sure we could contain the spread of this disease again. Moreover, studies suggest that with COVID-19 on the rampage, the flu rates are getting lower and that getting flu will temporarily prevent COVID-19 infection.Information coming out of Duke University, USA states that countries with lower COVID-19 rates are the countries with high dengue epidemic rates in the recent past which means that there is a possibility of cross-immunity between dengue and COVID-19. Also, it states that if one has got dengue fever then there is a chance of false positive result if the antibody test is done. Is this why we have had lower COVID-19 rates?

Notwithstanding all this, what is needed is common sense to further contain the disease. Wear a mask as the disease is spread mainly by air, maintain social distancing, stop gathering, wash your hands and if ill seek medical advice. Surely, we can close down one district for a few days until we find all the contacts. This is better than imposing curfews in areas as we go on finding new patients. Public gatherings should be stopped in urban areas and the present measures imposed by the government are adequate.

What we can do is strictly support the efforts of the officials by following their instructions. With the already experienced economic downfall and COVID-19 expected to go on for another year or so, the government should not go again into the extreme of having an all-island curfew. That would be a social and economic disaster.


Dr. Pradeep Kariyawasam 

(Former Chief Medical Officer of Health, Colombo Municipal Council)


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