Covid 19: how has the island of Sri Lanka handled it so well?

Dr Navindi Fernandopulle writes about the early response of her home country to the COVID19 pandemic and its impact on curbing the spread.

Despite welcoming over 2,000,000 tourists annually to its tropical shores1Sri Lanka has a remarkably low rate of COVID19 infections, certainly compared to the rest of South Asia, and possible even the rest of the globe. The Health Minister has just declared no more community spread of COVID19, and the caseload is 1028 patients, 584 recovered and 9 deaths.  

How has it managed to achieve this?

Being a developing country, it certainly does not have the facility to carry out PCR testing on its entire 21.67 million population. It currently carries out testing on suspected cases with high fever. 

What has helped is something the US, UK and most other developed countries did too late- as quarantine of passengers on flights originating from high risk zones, contact tracing, island wide curfew and wearing masks in public. 

How did it all start?

Closing the airport and an islandwide curfew were no light measures- Sri Lanka relies heavily on its tourist industry, which accounts for 10% of its GDP2which has been severely affected. This time last year, the Easter Sunday bombing slowed down the influx of foreigners into this pearl of the Indian Ocean. This year, it is the dreaded COVID19- yet it could be argued that having slowed the spread of COVID19, Sri Lanka is in a much better position to welcome tourists than other parts of the globe. 

On the 12thof January, the WHO confirmed that a novel coronavirus had caused cough, shortness of breath, fever and originated in Wuhan in Hubei Province, China.  

The government informed the Quarantine Unit at the Colombo international airport to screen passengers by taking their temperature and asking passengers to declare any symptoms. A warning was issued to the elderly, children, pregnant women and those with chronic conditions to avoid visiting crowded places. 

The first COVID19 case in Sri Lanka was detected on 27th January, when a 44-year-old Chinese lady from Wuhan was detected at the airport with a high fever and admitted to the National Institute of Infection Diseases.The government acted swiftly and evacuated 33 Sri Lankan students and families that had been in Wuhan on 1stFebruary and were kept under quarantine at a military facility for two weeks. 

How did the public respond?

Following this, the demand for facemasks in the country rose, resulting in a shortage. The government responded by imposing a maximum retail price for masks at Rs 50 (20p) and restricted exports of facemasks. Facemasks in public were made mandatory for all. 

What other steps did the government take to ensure the curbing of CVODI19 spread?

Contact tracing by the intelligence service and public health inspectors was key to controlling the spread. Index cases and close contracts were quarantined, including asymptomatic individuals. They went through PCR testing prior to release. 

All individuals travelling on flights from high-risk zones entered a mandatory two week quarantine process. 

The airport was closed on the 19thMarch followed by an island wide curfew which was imposed the next day. These measures were implemented when the number of cases was a little over a hundred and no deaths had been reported. The first COVID19 death occurred on the 28thMarch.

How does the quarantine process work?

Quarantine isdefined as the ‘restriction of people who have no symptoms, but who have had contact with people with confirmed or suspected infection’. A recent Cochrane review on 29 studies including 10 modelling studies on Covid19 and the rest on SARS/MERS concluded that ‘early implementation of quarantine and combining quarantine with other public health measures is important to ensure effectiveness’4

All individuals traveling on flights from a list of high-risk countries including those in Italy, Iran and South Korea entered a mandatory quarantine period from early March, which was extended to Europe on the 16thof March. 

Bags are sprayed with chlorine; regular hand washing, face masks and keeping a two metre distance from each other is enforced. Following immigration checks, passengers are taken to an army camp (free) or a hotel (£40/night).  Basic amenities such as food, toiletries and Wi-Fi are provided. A doctor arrived daily to check temperature and inquire regarding symptoms. 

Is it more effective than self-isolation?

  1. Daily temperature and symptom checks by the medical team meant that a quick transfer could take place to a local COVID19 unit if individual shows any symptoms. 
  2. Leaving the camp is strictly prohibited unlike in self isolation in which it would be harder to regulate travel

How could it be improved?

  1. Temperature check prior to boarding the flight and requesting passengers not to board if they showed any symptoms
  2. Keeping those on the same flight together rather than mixing individuals from different flights
  3. Separate bathroom and living space for each individual. If this is not possible, aim to isolate vulnerable groups such as the elderly, those with chronic conditions from the rest 
  4. Daily temperature checks were not recorded. Doing this would enable better monitoring of trends in temperature 
  5. Requesting patients to declare the use of any antipyretics prior to temperature checks

The government’s proactive approach to the pandemic have helped keep the numbers in Sri Lanka much lower than the global count, leading to widespread praise5

The author had no competing interests to declare

References:

  1. https://www.sltda.gov.lk/pages/monthly-tourist-arrivals-reports-2019?q=monthly-tourist-arrivals-reports-2019accessed on 13 April 2020
  2. https://www.sltda.lk/know_your_industryaccessed on 13 April 2020
  3. https://www.newsfirst.lk/2020/04/11/police-make-it-mandatory-to-wear-a-face-mask-when-travelling/accessed on 13 April 2020
  4. https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD013574/fullaccessed on 13 April 2020
  5. http://www.dailymirror.lk/breaking_news/EU-provides-EUR-22-million-grant-to-Sri-Lanka/108-186413accessed on 14 April 2020

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