Living With COVID-19: A Year in Review
By Dilanthi Jayamanne
The country has been in the throes of the COVID-19 infection for a year now. The number of infected cases is reaching the 100,000 mark fast. The current number of cases the country has recorded since March last year is a mind blowing 81,466. The total number from the clusters that emerged from the Minuwangoda garment facility and the Peliyagoda Fish Market reached 77,868. The bright side is that 76,513 of them have recovered while a 457 of them have either succumbed to the illness or have died of complications stemming from it.
The first wave of COVID-19, which most people believe was successfully brought under control, was what gave birth to the second wave because health authorities and the Government relaxed preventive efforts and handed the duty over to the private health sector, President of the College of Medical Laboratory Science Sri Lanka (CMLSSL) Ravi Kumudesh alleged.
He added the Government and the Health Ministry had made a grave mistake by entrusting Polymerase Chain Reaction (PCR) testing to the private sector and issued instructions to all garment factories to carry out regular PCR tests on their employees. The State laboratory services were sidelined from carrying out random testing or keeping up vigilance on the possible recurrence of the deadly virus. It paved the way to the present dilemma in the form of several patients carrying the COVID-19 virus being detected from a garment factory situated in the Minuwangoda area. It was probably a twist of fate that a PCR test was carried out on a patient being discharged from the District General Hospital, Gampaha, for the viral infection early October last year. She had been receiving treatment for a fever.
It led to around 15 staff members at the hospital being self-quarantined and 40 staff members of the garment factory where she was working were also directed to self-quarantine at the time. Still very few people are probably enlightened as to how the said patient would have contacted the virus, although there have been rumours and allegations.
Kumudesh noted that during the first wave the entire country had gone into hibernation strictly adhering to health guidelines issued by Director General Health Services (DGHS), Dr. Anil Jasinghe at the time to battle COVID -19. The country went into lockdown while public too conformed to all regulations in fear of the microscopic ‘hairy ball’ identified by scientists as SARS-CoV-2. Priority was given to controlling the infection; however with the eruption of the second wave priority has been given to the economy, while control and preventing the viral infection has taken second place. The major setback that the country’s economy following the lockdown apparently sent shivers down the spine of the government when it realised that Sri Lanka could not stomach a second lockdown. Thereby the country has been opened up while people are permitted to engage in their various economic activities so long as they are not in a locality which is isolated.
The saving factor at the time was that the viral infection was concentrated in the Western Province despite the fact that employees of the Minuwangoda garment factory where the infection started had left for homes situated in various parts of the country. Throwing their weight behind the health services, the members of Sri Lanka’s Tri Forces and the Police Department helped track them down at the time.
Subsequent warnings ignored
“However, subsequent warnings issued in December last year by medical laboratory technologists and health workers engaged in carrying out random Rapid Antigen Testing (RAT) that at least 200 to 250 persons left the Western Province to travel to other parts of the country on a daily basis fell on deaf ears,” he said.
It has resulted in the disease spreading, affecting other parts of the country such as Kandy (4,934) cases, Kurunegala (2,672), Ratnapura (2,333), Galle (2,142), Ampara (1,408), Matara (1,218), Kegalle (1,204), Badulla (1,074), Puttalam (997), Matale (963) and several other areas including the Northern Province which had over 1,300 cases.
Colombo, Gampaha and Kalutara in the Western Province had 29,594, 16,514 and 6,211 cases respectively by 25 February 2021.
The President of the CMLSSL lamented that the Health Ministry’s delay in taking appropriate and timely action even when making the decision on the need for people to wear a mask. It was in April last year, that the CMLSSL repeatedly urged the Health Ministry to purchase RAT kits to carry out tests in large areas where the population density was high. The Ministry dragged its feet when taking the decision, unwilling to accept the recommendations made by a body, which did not comprise doctors, while certain sections opposed it as a whole. Therefore, the situation would be much worse if at least the private sector had not intervened in purchasing the technology.
He noted that the main reason behind the indecision and delay in making decisions with regard to COVID-19 control and prevention was the lack of communication. Ground level health workers engaged in COVID control have no way of communicating or contributing towards the decision-making process that would help expedite control and prevention of the virus. The Deputy Directors General (DDGs) who act as mediators between the Health Minister, the Health Secretary and the Director General of Health Services have also been sidetracked so that decisions are merely made at the top level while ground level workers have merely to implement whether they be good or bad.
The Government Medical Officers’ Association (GMOA) which has played a key role in most probably being the Health Ministry’s conscience in its attempts to stem the rising corona cases has also been in vain. The medical union played a key role in prompting President Gotabaya Rajapaksa to lock down the country and close airports during the first COVID-19 wave. However, the situation seems to have taken a drastic turn with the union having its differences of opinion with the Epidemiology Unit of the Health Ministry which even to the naked eye has failed in stemming the rising number of positive cases during the second wave.
Death toll rises
Adding to the woes is the number of COVID-19 deaths that have been building up on a daily basis. Although the numbers may not be in the thousands as in the United States of America (USA), Sri Lanka’s daily COVID-19 death toll is adequate to make a severe impact as most of those who fall victim are above 50 years of age. GMOA Executive Committee Member, Dr. Haritha Aluthge recently noted that by February 2021 the country was witnessing an average six COVID-19 deaths on a daily basis. For the 20 days of this month alone it has witnessed 129 deaths due to the viral infection.
The second wave has seen over 430 persons die of the viral infection within four months. In October last year with the beginning of the second wave the total number of COVID-19 patients was 7267 with a death toll of seven. The death ratio stood at a minimum (0.01) at the time. By November the number of cases increased to 13324 with a death toll of 98. The death ratio increased to 0.73.
By December, the COVID-19 patients increased to a further 19,000 while the number of deceased reduced to 84 reducing the ratio to 0.44.
By January 2021 the number of COVID-19 patients increased to over 20,000 along with the number of deaths which were 112. “If the country’s health service had been able to control the situation and move forward, the number of cases should have decreased by this month, however, while infected cases have topped 17,000 the death toll has risen to over 130. The past 20 days of February has marked the highest death ratio of 0.76 witnessed during both waves of the infection.
One of the aims of the health service should be to prevent and control the number of COVID-19 deaths and complications resulting from it.
According to statistics issued by the National Operation Centre for Prevention of COVID Outbreak (NOCPCO) recently the COVID-19 death toll of those above the age of 71 stood at 46.6% while the deaths of those between the ages of 61 and 70 were 26.15%.
A majority of COVID-19 deaths have been due to complications occurring owing to the viral infection. Those who have succumbed to it are those who suffer from non-communicable diseases (NCDs). The Health Promotion Bureau (HPB) has made several appeals to the elderly population of the country to take their quota of medication for their illnesses regularly.
Also there have been reports of delays in conveying patients diagnosed with the disease to treatment centres. Some of these delays span up to two to three days, during which time the patient would possibly have infected the other members of his or her family. Unable to stay in isolation, even inside their homes, the carrier of the virus would come out and move about. Also, they would doubt the result of the PCR test done on them when the health authorities are unable to send an ambulance or some form of conveyance to take them to a treatment centre.
However, the glaring lapse on the part of the Epidemiology Unit, to work in unison with other sections of the Health Ministry which caters to the needs of Maternal and Child care, the elderly population suffering from NCDs and Community Health services, has resulted in the Health Ministry’s and the Government’s inability to come up with appropriate policy decisions to fine tune COVID-19 preventive and control work.
The issue could possibly stem from lack of communication with ground level health workers who get spat upon by patients diagnosed with the deadly disease!