No community transmission but need a behavioural change among people
In a wide-ranging interview, the Chief Epidemiologist talks of clusters, preventive measures, testing & hospitals’ coping abilities
There are two active COVID-19 clusters but no community transmission of this viral disease, assured a high level health official on Thursday evening.
Pointing out that currently the navy cluster and the Kuwaitireturnee cluster are the only two active ones pushing up the number of patients, the Health Ministry’s Chief Epidemiologist Dr. Sudath Samaraweera in a wide-ranging interview with the Sunday Times explained that the cases from the community the country had were limited to ‘family clusters’.
The reported number of ‘ confirmed’ positive cases of COVID-19 showed:
· The cluster of navy personnel and their close contacts as of Thursday were 727, with 53 including the navy driver from the Gaffoor Building in Fort being on May 27.
· The West Asia returnee cluster stood at 430 on Thursday.
The last ‘ family cluster’ at Dabare Mawatha in Narahenpita ended on April 30. These ‘family clusters’ come about when a person infects relatives, friends or neighbours within a certain area. However, in ‘ family clusters’ we know how it started, unlike in community transmission where there is no indication from whom people in the community have got infected, said Dr. Samaraweera.
“When community transmission comes that means there will be cases coming up here and there with no link among these cases,” he said.
While many experts commended Sri Lanka at the way it has handled the epidemic, they also expressed certain concerns. These include – why the navy cluster is still active and has not been contained; how Sri Lanka should face the challenges posed by infected returnees; whether the strain infecting returnees is more virulent than the one already in Sri Lanka; whether hospitals treating COVID-19 would be able to manage such a large number of infected returnees; and whether the newly- opened hospitals for the management of these patients have the requisite facilities?
Focusing on the navy cluster, Dr. Samaraweera said the first case was reported on April 22, but that did not mean that he would have been the first to get infected. Even in his case he would have got it maybe one week before.
He said: “We think that the virus might have been circulating within the very large 300- acre Welisara compound, which is like a city, and home to many units comprising around 5,000 personnel living in close proximity, for quite some time, maybe even several weeks.
“When we detected the trigger (the first reported case) and began control activities, there could have been some patients who had already got the disease and had been cured (asymptomatic). Some people may be at the late stage of the disease now and some maybe in-between. There is a spectrum of cases.
“The spread of the virus is in one or two units while others have not been affected. We have segregated them and they are at different places. It will take another couple of weeks to reduce that number. Usually a cluster can be brought under control within two incubation periods (28 days). Now a month has passed and it is still ongoing. Once the level of cases has been lowered, then it will take two more incubation periods for it to be completely sorted out.”
With regard to testing, Dr. Samaraweera said that the returnees from abroad were not being tested at the airport but sent to quarantine centres and if symptoms manifest the tests are done.
This is while there is random testing of high-risk groups such as bus drivers and conductors, trishaw-drivers, vendors at marketplaces, etc. Since Sri Lanka does not have community transmission, there is no requirement for blanket testing.
Referring to the chance of returnees bringing back a more virulent strain of the virus, he said that there is no such thing as virulent and non- virulent strains. There are three clades (types) and some sub-types. No sequencing has been done yet to identify the clade which has infected the returnees.
“We will keep bringing back these people from West Asia on humanitarian grounds. Many of them have been given an amnesty to leave Kuwait and we are ethically and dutifully bound to bring them back. But it will not be fast tracked as we need quarantine facilities, laboratory capacity to test them as well as the ability for our health system to handle larger numbers. We should also prevent opportunistic leaks from happening such as the virus getting into the community through the drivers or others who come into contact with them,” he said.
Referring to the relaxation of the lockdown and the curfew, he said that in certain instances crucial measures such as social distancing and face- mask wearing were not happening with the incident in Maligawatte where three women were trampled to death in a crowd of around 500 was ample evidence of this. Even when people are boarding buses this can be seen.
Asked whether this is because the right message has not gone to the people, he said people had knowledge about these measures but what was needed was a behavioural change for which they were not geared.
Looking at the issue of whether the new hospitals being opened for the management of COVID-19 had the required facilities, Dr. Samaraweera said that it is the asymptomatic people who would be sent to these hospitals such as Teldeniya, Hambantota and Kattankuddy. They do not need treatment, only monitoring, simple medications such as paracetamol, nutrition and comfort. If they develop symptoms they will be transferred to a hospital with good ICU facilities.
When asked about the 10th death, Dr. Samaraweera said that it may not have been a direct COVID-19 death. Her death was due to a myocardial infarction (heart attack) and she tested positive only after she died.