Is Sri Lanka Prepared to Tackle the Coronavirus?

March 2, 2020        Reading Time: 7 minutes

Reading Time: 7 min read

Image Credits: Centers for Disease Control/ Unsplash

*Dr. Anuji Gamage

Global defenses are only as effective as the weakest link in any country’s health emergency preparedness and response system (WHO).¹

Introduction

The rapid spread of the Coronavirus is causing concern globally and in Sri Lanka. Using available information, this article assesses Sri Lanka’s level of preparedness from a health and security perspective. It also makes some suggestions for improving Sri Lanka’s capacity to tackle the health risks induced by the Coronavirus.

Background

Countries to varying degrees, often neglect to project and track resources that are necessary to face a health security threat. Challenges to health can range from emerging and re-emerging diseases, communicable, and non-communicable diseases to health impacts due to climate change and environmental problems. Emerging-infectious-diseases (EIDs) might have pandemic potency, and countries may struggle to understand, research, and cure the disease, leading to delays in effectively treating the affected.²

The 2019 Novel Coronavirus; COVID-19 (previously known as 2019-nCoV) is making a substantial impact on human lives across Asia, and threatens the global stability and security due to its spread.³ It is a virus identified as the cause of an outbreak of respiratory tract illness, first detected in Wuhan, Hubei Province, China. Many of the affected in Wuhan, the epicentre of the disease, reportedly had some link to a large seafood and animal market, suggesting animal-to-person spread. However, a growing number of patients have not had exposure to animal markets which points to a person-to-person spread. As of 28th February 2020, the suspected person to person spread of the virus has infected more than 83,000 people and resulted in 2,800 deaths, mostly in Hubei province, China. A study revealed that the fatality rate which is defined as the proportion of people who die of a certain disease; is approximately 15% of the study population. This estimate could be inaccurate since case detection is highly biased towards severe cases during the initial stages. Also, a large number of mild and asymptomatic patients might not receive timely diagnosis or health care, which can conceal the actual status of the spread and allow disease progression.⁴

Novel Coronavirus (COVID-19) has surpassed SARS (final toll of 774 deaths in 2003). The reported incubation period is 2-14 days, with the basic reproduction number (the number of cases generated on average over the course of its infectious period, in an otherwise uninfected or not immune) estimated between 1.4 to 2.5. Cases have been recorded in more than 50 other countries.⁵ The WHO has declared it as a Public Health Emergency of International Concern (PHEIC) and recently upgraded the global risk of the coronavirus outbreak to “very high”, although a truly global outbreak or pandemic has not been declared yet. The international community has launched a US$675 million preparedness and response plan covering the months of February to April 2020.⁶ In Sri Lanka active transmission of this disease has been limited thus far.

Coronavirus – Assessing Sri Lanka’s Preparedness

The Sri Lankan health system comprises of western allopathic and other traditional systems. The western system caters to the needs of the majority. Services are provided through both the public and the private sector. Sri Lanka is considered a model for the world, as most health indicators have improved tremendously despite the low resource setting.⁷ These achievements are linked with a strong well-placed Public Health services of which the main services are promotion and prevention of illnesses achieved through strong grass-root-level workers and well-networked healthcare institutions in the island.⁸

Sri Lanka is an island and a regional hub for commerce, trade, and travel. Hence, the country is often categorised under moderate risk for pandemics. The Epidemiology Unit in Sri Lanka is the responsible agency for communicable-disease surveillance, control, and prevention with a network covering the whole island.⁹ Sri Lanka has faced a few major pandemics and outbreaks including the 2003 Avia influenza outbreak. Medical professionals gained invaluable lessons and practical experience by responding to the H1N1 pandemic in 2009.

Many stakeholders work together toward emergency preparedness and response, including Medical Research Institute (MRI), Health Promotion Bureau, and the Department of Animal Production and Health. Case management infectious disease hospital (IDH), a high service level treatment facility is designated as the focal point for Infectious Diseases at national level. Fourteen hospitals around the country have been identified as treatment centres for suspected persons with 2019-nCoV (these include NHSL, LRH, NIID, TH Ragama, DGH Gampaha, DGH Negombo, National Hospital Kandy, TH Karapitiya, TH Anuradhapura, TH Jaffna, TH Kurunegala, PGH Rathnapura, TH Batticoloa, PGH Badulla). Medical Research Institute, Colombo conducts the “polymerase chain reaction” (PCR) test to identify the novel coronavirus (COVID-19) and is one of the few countries that regionally do so.

Additionally, vigilant surveillance and response for rapid containment is carried out at all ports including the Airport. Thermal scanners are in place and on arrival “Health Declaration Forms” need to be filled and submitted. Health desks operating 24 x 7 are also in place. The recent returnees from China including students are advised to stay in their homes with minimal contact with others for a period of 2 weeks from the day of arrival to Sri Lanka (Home Quarantine). Such returnees are subjected to follow-up measures by community healthcare personnel until the 14 days are over. As a country with a healthcare service that has historically sustained people’s health, Sri Lanka has preparedness and response plans in place. They are the National Influenza Pandemic Preparedness plan, the National Pandemic Vaccine Deployment plan, and ongoing surveillance.

National Capacities Need to be Reviewed to Detect and Respond to 2019-nCoV

It is essential that all stakeholders are involved in i) identifying main gaps ii) performing risk assessments and iii) planning for additional investigations, response and control actions as timely review and evaluation of existing pandemic/epidemic preparedness initiatives appear mandatory, as any country would face limited international assistance in a global emergency. Additionally, the following measures also need to be addressed,

1. Stockpiling adequate medical supplies for patient management
   
   Stockpiling adequate antivirals and vaccines are a necessity and should not pose a problem, that said, procurement of safe and effective vaccines in an emergency situation will not be an easy task and the government should have a plan for this and make available adequate financial recourses.
2. Adequate human resource and capacity building planning
   
   Trained human recourses need to be available across disciplines i.e., epidemiology, clinical medicine, laboratory, logistics, and disaster. Appropriately sized and trained rapid response teams within the health sector i.e., doctors, nurses, epidemiologists, veterinarians, and laboratorians. Therefore, the availability of healthcare workers and their knowledge of an outbreak response needs to be assessed.
3. Vigilant Surveillance and Response for Rapid containment
   
   A well-geared health system should consist of competencies in managing the disease, and strong surveillance, prevention of the onset of new diseases, and a risk-communication system. Risk communication refers to the real-time exchange of information, advice, and opinions between all stakeholders.¹⁰ Surveillance describes the observance of the magnitude and patterns of infectious diseases, predicting epidemic trends, early detecting outbreaks, and discovering EIDs.¹¹ These activities are necessary to respond promptly and adequately. National capacities should be developed to identify and report any threat, analyse and interpret findings, risk assessments, mapping and rapid response. Additionally, the country should enhance capacities for modelling techniques which can predict pandemics. Sri Lanka receives technical assistance from the WHO and relevant partners to improve and integrate multi-sectoral surveillance data, enhance the capacity to rapidly detect and respond to developing biological threats, by connecting systems capable of linking information.

Conclusion

In December, 2019, a pneumonia associated with the 2019 novel coronavirus (COVID-19) emerged in Wuhan, China. While some patients recovered easily, other suffered organ failure.¹² Evidence suggest that the virus spreads from person to person with no proven treatment at hand. Good hygiene can help prevent infection. In Sri Lanka, active transmission is not seen yet. However, surveillance and detection mechanisms have been strengthened at all arrival and departure points. Steps have also been taken to raise awareness on the PHEIC among the general public. As medical professionals learn more about the novel virus, the rapid incorporation of new knowledge into treatment methods and preventive action is vital.

Notes

¹WHO. (2019). Ten threats to global health 2019. [Online] Available at: https://www.who.int/news-room/feature-stories/ten-threats-to-global-health-in-2019 [ Accessed 27 February 2020].

²Bandara, A. (2005). Emerging Health Issues in Asia and the Pacific: Implications for Public Health Policy. Asia Pacific Development. Journal From Panic and Neglect to Investing in Health Security: Financing Pandemic Preparedness at a National Level. 12(2): 33-58. [Online] Available at: https://www.unescap.org/sites/default/files/apdj12-2-3-bandara.pdf [Accessed 27 February 2020].

³International Working Group on Financing Preparedness. (2017). From Panic and Neglect to Investing in Health Security: Financing Pandemic Preparedness at a National Level. [Online] Available at: http://documents.worldbank.org/curated/en/979591495652724770/From-panic-and-neglect-to-investing-in-health-security-financing-pandemic-preparedness-at-a-national-level                                           [Accessed 27 February 2020].

⁴Xu, Z., Li,S., Tian, S., Li,H., & Kong, L. (2020). Full spectrum of COVID-19 severity still being depicted. The Lancet. [Online] Available at: https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(20)30308-1/fulltext
[Accessed 27 February 2020].

⁵WHO. (2020). Coronavirus disease (COVID-19) outbreak. [Online] Available from: https://www.who.int/emergencies/diseases/novel-coronavirus-2019; WHO. (2020). Coronavirus. Available from: https://www.who.int/health-topics/coronavirus [Accessed 27 February 2020].

⁶WHO. (2020). US$675 million needed for new coronavirus preparedness and response global plan. [Online] Available at: https://www.who.int/news-room/detail/05-02-2020-us-675-million-needed-for-new-coronavirus-preparedness-and-response-global-plan [Accessed 27 February 2020].

⁷Fernando, D. (2000). Health care systems in transition III. Sri Lanka, Part I. An overview of Sri Lanka’s Healthcare system. Journal of Public Health Medicine. 22(1): 14-20. [Online] Available at: https://academic.oup.com/jpubhealth/article/22/1/14/1560091 [Accessed 27 February 2020].

⁸Ibid.

⁹Epidemiology Unit Ministry of Health Sri Lanka. (2019). Sri Lanka: Ministry of Health Sri Lanka. [Online] Available from: http://www.epid.gov.lk/web/index.php option=com_content&view=article&id=149&Itemid=480&lang=en [Accessed 27 February 2020].

¹⁰Madhav, N., Oppenheim, B., Gallivan, M., Mulembakani, P., Rubin, E. et. al. (2017). Pandemics: Risks, Impacts, and Mitigation. In: Disease Control Priorities (third edition): Volume 9, Disease Control Priorities, edited by D. T. Jamison, H. Gelband, S. Horton, P. Jha, R. Laxminarayan, C. N. Mock, R. Nugent. Washington, DC: World Bank.

¹¹Ibid.

¹²Huang, C., Wang, Y., Li, X., Ren, L., Zhao, J., Hu, Y. et al. (2020). Clinical features of patients infected with 2019 novel coronavirus in Wuhan, China. The Lancet. 395(10223): 497-506. [Online] Available at: https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(20)30183-5/fulltext
[Accessed 27 February 2020].

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* Dr. Anuji Gamage (MBBS, MSc, MD (Community Medicine), Grad. Certificate in Economics, MSc. (Health Economics and Policy) (Australia), is a Public Health specialist attached to the Ministry of Health Sri Lanka with over ten years of Public Health experience attached to different organizations of the Ministry of Health, Sri Lanka. She is an Australia Awards Alumna. Please be informed that daily updates and information regarding the situation is available at: http://www.epid.gov.lk. The opinions expressed in this piece are the author’s own and not the institutional views of LKI, and do not necessarily reflect the position of any other institution or individual with which the author is affiliated.