NCDs Increase Risk of COVID-19 Deaths
By Dilanthi Jayamanne
The total number of cases diagnosed with COVID-19, during the second wave, has risen to 15,324. Of them 3,039 were from the Brandix cluster at the Minuwangoda facility, while a startling 12,265 are allegedly from its sub cluster at the Peliyagoda Fish Market, which has spread its vicious tentacles to several areas of the country, including Hatton, nestled in the cool climes of Nuwara Eliya and the hustles and bustle of its close neighbour Colombo City.
Tracking back to the first wave earlier this year, the period which the country was caught up in the clutches of the SARS CoV-2 virus, the total number of cases recorded at the time was less than 1,000 while the number of deaths were 12. The 13th death being of a sea farer from Baharain, who had arrived in Sri Lanka with the onset of the viral infection, which was by then wreaking havoc in several countries of the world, including in the golden sands of the Middle East, our neighbour India and the happy go lucky United States of America; the difference being that although people had died by the hundreds in the two latter countries, Sri Lanka at the time had intermittently been losing one COVID-19 patient.
The situation changed when the second wave struck the Brandix Facility in Minuwangoda and the Gampaha District was shaken. The 14th death was recorded of a 50-year-old woman from Kuliyapitiya while the 16th death was reported on 25 October 2020 of a man from Colombo 02. The Peliyagoda Fish Market cluster was detected on 21 October 2020.
By 27 October 2020, three deaths were reported increasing the number of deaths in the country to 19. We were probably at the pivotal point because it was COVID-19 and we had jumped from death number 16 to 19 in one day. Since then the numbers have been fluctuating between three, four and five deaths per day. By Thursday (19) this week it had reached a lamentable 73.
As Sri Lankans we should probably thank the good deities for small mercies, the death toll from viral infection had not reached the epic numbers being recorded in India or the USA till now.
Nevertheless, the manner in which these deaths occur has raised major concern of the National Operations Centre for Prevention of COVID-19 Outbreak (NOCPCO), Head, Lt. Gen. Shavendra Silva and the armed forces who continuously and tirelessly carry out surveillance and quarantine work and the health services of the country. Although whether it is of concern to the general public at large is another matter and probably should be reviewed on another occasion.
Lt. Gen. Silva noted that President Gotabaya Rajapaksa was keen to know why the number of the deaths in the second wave was escalating rapidly. Worst of all, a majority of those deaths occurred at home. Only about six or seven deaths, which have occurred during this second wave, have been directly caused by the SARS CoV-2 virus. Matters have been made worse as a majority of these home deaths were of elderly suffering from chronic disease such as diabetes, cancer, high blood pressure, heart, respiratory and renal diseases. The COVID-19 virus had only aggravated a condition they already suffered from resulting in death. For instance, the deaths which occurred on Thursday (19) were of a 59-year-old woman, from, Kalutara who had died at her home as a result of her High Blood Pressure being worsened by Covid-19, an 86-year-old man, also from Kalutara, died at his home as a result of a chest infection aggravated corona.
Amongst the deaths that have been reported, five persons died due to COVID-19 on 16 November 2020. They included a 54-year-old man from Colombo13, who was being treated at the National Hospital, Colombo and had died due to complications of a long-term cancer aggravated by COVID-19, a 39-year-old man from Colombo 15, who had been admitted to the Homagama Hospital, after being diagnosed with COVID-19, died of COVID-19 pneumonia, and an 88-year-old man from Colombo 12 who died while being admitted to National Hospital Colombo for cardiac pain caused by COVID-19. The deaths also included that of a 79-year-old man from Borella, who had died at home due to complications caused by COVID-19 to a chronic lung disease and an 88-year-old man from Colombo 13 who had died while being admitted to the National Hospital, Colombo of a Cardiac pain caused by COVID-19.
Lt. Gen. Silva said that a majority suffered from non-communicable diseases (NCD) towards which COVID -19 had contributed. He said that urgent steps should be taken by families that have such patients in areas that have been isolated or were in lockdown to ensure that such patients receive urgent medical care. Call an ambulance and see that the patient receives medical help, he said.
Most of those that were affected were the low income families in the Colombo City living in confined spaces like flats and tenements, Lt. Gen. Silva said.
The Government Medical Officers’ Association (GMOA) also called for the setting up of a death review committee for COVID- 19; a requirement which had not been present during the first wave. GMOA Executive Committee member, Dr. Haritha Aluthge said that the deaths had almost catapulted from 13 during the first wave to the 73 (by 19 November 2020), a difference of 60 deaths. He noted, during a Media briefing, that the COVID-19 related deaths were less than ten while the remaining deaths were due to aggravations caused to an already existing NCD.
Over 70% deaths in Sri Lanka, before the COVID-19 crisis occurred, were due to NCDs. The number of deaths registered by the Registrar General’s Department (RGD) in 2,000 were 116,200 by 2018 it increased to 139,498. In addition to NCD’s people die in road traffic accidents (RTA), and old age. As a nation the country would probably not have known that these persons died if it had not been for COVID-19. The virus has been detected in all the bodies and even in a youth who committed suicide from Panadura and an elderly man who died following a severe head injury due to a fall in Colombo 13.
The Director General Health Services (DGHS) set up the National COVID-19 Death Audit Committee (DAC) which was tasked with scrutinising medical records to ascertain the cause of death for all COVID-19 related deaths in Sri Lanka. They had to conduct a verbal autopsy with all stakeholders and determine the cause of death, analyze overall causes that led to the deaths and report to the Director General Health Services. The Committee handed over its preliminary report on Monday (16), but the nation is still in the dark as to what was in the report.
Then again there are other similar review committees such as the one that reviews maternal mortalities and dengue deaths which the nation does not bother itself with.
Polymerase Chain Reaction (PCR) Test
What needs highlighting is that these deaths have occurred in high risk areas which have been isolated. Therefore a Polymerase Chain Reaction (PCR) test was done on the dead bodies from these areas where the risk of contracting the virus was very high. Thereby a PCR test was carried out even after death during the ensuing mortem.
Shedding light on the issue Health Ministry sources said that a majority of patients, especially the elderly, had not sought medical attention perhaps due to the lack of knowledge, fear, or negligence of the symptoms by them and the members of their households.
Also, most of them were living in areas which were in lockdown and thereby there were transportation issues due to the curfew and the ability of reaching a hospital or a medical centre were minimised even if they wanted to get help. Coupled with this is the fear that most Corona patients have of not receiving the proper care owing to their own situation and that of the hospital where even health staff are highly panicked despite their capabilities and training.
Also the staff criminalise the patient without taking personal protective measures and attending to the patient’s need.
Amongst a certain groups there was the fear of the cremation after death. COVID-19 patients were cremated to minimize the risk of further spread. Therefore those people fail to seek medical assistance and preferred to die at home. However, since an autopsy is carried out on all bodies in isolated areas these persons ended up in the crematorium if the COVID-19 virus was detected on the body.
However, the Health Ministry has repeatedly urged the people living in lockdown areas to seek medical help for their parents or grandparents or even themselves if they suffered from chronic diseases or showed symptoms of the viral infection. The Director General Health Services (DGHS) took measures to issue a circular to ensure that all patients being treated by the private sector for their NCDs too to be provided their quota of medicines for two weeks by State hospitals owing to the present difficulties in reaching those private clinics or hospitals.
Also the postal services in areas under isolation or lockdown have been rallied to deliver medicines to patients instead of the usual letters through their postmen.
Further, a special ambulance service was set up at to assist Colombo City dwellers, living in areas which have been isolated, at Meethotamulla Vidyalaya under the Regional Director Health Services, Colombo. It could be reached on 011-3422558.
1990 Suwaseriya Ambulance Service
The 1990 Suwaseriya ambulance service was available for those living outside the Colombo city. While the Health Department is currently making an effort to take medical assistance to the doorsteps of the people living in the city’s under privileged areas to ensure that those with chronic diseases received the care they needed.
But, while the health services have been endeavouring to do its best for the Colombo city dweller, the same does not apply to those living outside the Colombo City, such as in Gampaha, Kalutara or other areas that were under lockdown or isolation - especially those people who go to Government hospital clinics. They too comprise the under privileged and the middle income families. Does this mean that the people living outside the City of Colombo were more intelligent and would seek medical attention during a medical emergency? Several areas in the Gampaha District too are in isolation and were in the same predicament as those in Colombo City. Or is it that Colombo is more privileged than the rest of the country?
Every successive government has followed the dual policy of ‘Colombata kiri, apita kekiri!’
The people in isolated areas of Gampaha which include, the Police divisions of, Kadawatha, Ragama, Negombo, Ja-Ela, Kelaniya and Peliyagoda, for several weeks, have still no respite to at least purchase their essential food items from the corner boutique let alone get medical attention for an NCD.
Here too there are in under privileged areas those who earn a living by selling vegetables on the way side or plucking coconuts or selling fish. These are the people who cue up at the Teaching Hospital, Ragama or the National Hospital Colombo on their clinic days. Perhaps people in these areas too should start dying for the Health Ministry to bring its medical staff to the doorsteps of the communities.