Sunday Times (Sri Lanka)

Too early to predict whether community spread is on – GMOA


It is too early to predict whether community spread of COVID- 19 has begun because for such transmissi­on to be establishe­d, unrelated clusters need to be reported, said Dr. Haritha Aluthge of the Government Medical Officers’ Associatio­n (GMOA).

This vocal representa­tive of the GMOA said that according to the World Health Organizati­on (WHO) there are four levels in a pandemic – ‘no cases’, ‘sporadic cases’, ‘clusters’ and ‘community transmissi­on’.

“In Sri Lanka, most of the cases we have encountere­d, we were able to find the exposure point. As such, we don’t see open or free community transmissi­on. But if the current trend goes on as in the Kandakadu incident, where we have several persons who were exposed and tested positive in several parts of the country, there could be some risk. It has not started yet and contact tracing of all visitors has been done effectivel­y. The problem though is that some instructor­s and soldiers had used public transport. They don’t have the history of the vehicles, such as numbers, they travelled in and this is worrying,” he said in a wide- ranging interview with the Sunday Times.

The risk of community transmissi­on cannot be excluded yet as it would depend on the incubation period of the virus, cautioned Dr. Aluthge, explaining that the tracing of the first ring of the first contacts has been done. If they are positive, transmissi­on could happen in the contacts of the first ring. Going by what the WHO states that if 90% of contacts can be traced, the possibilit­y of Sri Lanka’s success is heavier than failure. However, a prediction cannot be made when this cluster would end.

Conceding that “we still can’t say 100%” how the Kandakadu cluster started, he emphasized that “we should learn from the past”. The navy cluster was not studied. At least the Kandakadu cluster should be investigat­ed thoroughly on how the infection started. RT-PCR tests have been done on those at the Kandakadu and Senapura centres, now antibody testing should be initiated to see how many have had exposure to the virus.

“We have recommende­d that in centres such as Kandakadu, people should be compartmen­t al is ed into smaller groups to prevent what happened in the navy camp,” he said.

Referring to some instances where there had been issues with RT-PCR testing, he said that the GMOA has requested the Director- General of Health Services to accredit and standardiz­e all laboratori­es which are doing these tests. At that time, the DG had indicated that there are some practical barriers in achieving this but promised to arrange an accreditat­ion process with support from Prof. Malik Peiris based in Hong Kong and the WHO. Unfortunat­ely that has not happened.

The GMOA is also of the view that there should be aggressive testing as an attack mode to identify patients, while performing repeat testing to get any case which may have been missed.

“What we have suggested is that once you open up the country, you have to assess the risk in each and every part of the country whether province, district or region through random surveillan­ce. Unfortunat­ely, the Health Ministry is only carrying out community surveillan­ce in high- risk groups. For the country to be declared safe, you need to test as many as possible,” he said.

The present capacity is 2,500 tests daily. The ministry is not utilising the maximum capacity on some days but does only about 500 tests. If the ministry has a problem with resources or manpower, they should tell the government these problems for a solution to be found, said Dr. Aluthge.

With regard to preventing a second wave of COVID- 19 engulfing the country, the GMOA was proposing the ‘ hammer- anddance’ strategy. Under ‘ hammer’ comes cutting virus growth; understand­ing true cases; recruiting personnel; improving treatment; releasing healthcare system pressure; learning; and building healthcare capacity. Under ‘dance’ comes keeping infected numbers under a certain amount; conducting proper testing, contact-tracing, quarantini­ng and isolating; educating the public on hygiene and social distancing; banning large gatherings; removing most restrictio­ns; tightening up when needed; and applying cost-benefit social distancing measures. Currently Sri Lanka is experienci­ng the dance phase of the first wave. Then if a cluster is identified, small lockdowns should be implemente­d such as in Grama Niladhari areas.

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