Focus on hospitals/clinics & their protocols

Highlighting the importance of the “critical role” that will be played by hospitals and clinics in the response to a COVID-19 threat in Sri Lanka, former Chief Epidemiologist Dr. Nihal Abeysinghe said it is vital to establish protocols for triaging and isolating patients suspected of having the infection in emergency departments so that they do not infect others.

Establishing procedures for outpatient clinics, dialysis centres and other medical facilities, especially private hospitals, is important so that COVID-19 does not disrupt normal medical care and also does not compound the direct disease and death caused by the virus, he said.

According to this expert, protecting healthcare workers and preventing nosocomial infection (acquired in a healthcare facility) – which have been major problems in China – will need:

Planning at hospital administration Special training of hospital staff and use of personal protective equipment (PPE). Ensuring regular supplies of PPE for healthcare workers

Specific preparation in critical care interventions in ICUs

Evaluation of ICU bed capacity, the ability to augment ICU-level bed space, mechanical ventilator stock and supply chains and the logistics of isolating and cohorting patients. Planning for allocation of scarce resources Adherence to existing guidance for pneumonia, sepsis etc.

Clear information for clinicians and public health experts regarding the operating characteristics of SARS- CoV-2 diagnostic tests. They need to know the false-positive, false-negative and predictive values of these tests to make the best clinical and public health decisions.

Dr. Abeysinghe is categorical that as more countries report cases, including those with no link to the disease epicentre, it is clear that there are many more unrecognized cases in the world and that community transmission may be happening in many countries. The most “important” public health interventions to slow the spread will be rapid diagnosis and isolation of cases.

“At this early stage of the epidemic in Sri Lanka, when the number of cases is low, public health workers should track contacts of cases to the extent resources allow and have them stay home for the virus’s incubation period of two weeks. However, beyond a certain threshold, it will no longer be feasible to track all contacts,” he said.

Public health leaders will also need to clearly communicate to the public about the way that they can lower the risk of infection and spread, he added.