Anugget of good news spreading relief among the beleaguered people of
The wholesale fish vendor from Piliyandala who was suspected of having COVID-19 was negative for the new coronavirus and discharged from the NIID on Friday, for home isolation for two more weeks.
Assuring that community spread does not seem to have begun in the high-risk areas and those who are detected with COVID-19 are from 'clusters', NIID's Consultant Physician Dr. Eranga Narangoda told the Sunday Times that the fish wholesaler being negative for COVID-19 is a relief.
'It was worrying when he was suspected to have got COVID-19 because we didn't know from where he had got the exposure to the virus. There was no contact history. His family was screened and found to be disease-free. He himself had come into contact with many others and there were fears that he may have infected them as well. Even though his symptoms were not compatible with COVID-19, we kept him in isolation but now he has gone home,' said Dr. Narangoda, pointing out that this particular case had also raised concerns of the start of a community-spread. Now those concerns have been allayed.
His assurances brought relief, as social media messages went around like wildfire that
When asked for his views on easing the lockdown, Dr. Narangoda said that it should be done step-wise, starting with areas where there are no COVID-19 infections after strong evaluations, screening of people and active surveillance.
'We should not be in a hurry to ease all restrictions in the red-flagged high-risk districts,' he cautioned. This was because while there was testing of those suspected of having contact with those who have got infected so far, there could be asymptomatic (without symptoms) people in the community.
Dr. Eranga Narangoda
Asymptomatic people have a viral-load less than those who are symptomatic. Those who are symptomatic are in hospital under treatment but asymptomatic people are in the community and could infect others, as no one knows they are carriers, he said.
Commending
When asked whether patients he and his team have treated have had blood-clotting which has been reported in other countries as causing serious complications, Dr. Narangoda said that in the few critically-ill patients who needed ICU care, they did not witness these complications. Currently they have nearly 100 under their care, with no patient needing ICU management.
'Blood-clotting could result in major cardiac (heart) and lung complications but we didn't encounter such patients or even those going into multi-organ failure. We had a few cases of respiratory failure and septicaemia (bacteria getting into the blood and causing blood poisoning),' he said.
The NIID team has also not seen frostbite-like skin lesions in their patients as reported in some countries.
Study on hydroxychloroquine to be launched at NIID
An important clinical trial (CT) is to be launched among patients with the new coronavirus at the NIID, with regard to the efficacy of hydroxychloroquine, the anti-malarial medication, in the treatment of COVID-19, Dr. Eranga Narangoda said.
Initially, they are hoping to conduct this study among 50 patients.
Tests being carried out at the Peliyagoda fish market
Timeline: The clusters erupt
First 100 COVID-19 positive cases including the Chinese tourist - detected in 58 days from
Second 100 positive cases - detected in 18 days from
Third 100 positive cases - detected in 7 days from
Test, test and test.
This is being heavily advocated as a way to muzzle the tiny virus that causes COVID-19.
Where does
The Sunday Times found that 876 tests had been done on Friday (
The breakdown of Friday's tests: Sri Jayewardenepura Faculty of Medical Sciences - 231;
On Thursday: MRI - 344; Sri Jayewardenepura Faculty of Medical Sciences - 314;
The samples sent for testing included those from patients in hospitals, in the quarantine centres and in the community.
The Sunday Times understands that the
Meanwhile, the
Many pointed out that with Sri Lankans having to live with the new coronavirus, processes should be in place not only to do more testing but also to ensure that all items needed such as swabs, viral transport media (VTM), enzymes and reagents are supplied without a disruption. Another need is the training of staff in getting the sample right as it requires skill and expertise, it is learnt.
How the test is performed
Healthcare workers wearing personal protective equipment (PPE) extract nasopharyngeal samples with swabs from a patient and despatches it in VTM, named and labelled, to a laboratory where the testing is carried out. These potentially-infectious samples are transported in a triple package, in keeping with national and international regulations.
In the laboratory, the sample is treated with several chemical solutions to remove substances such as proteins and fats and in the case of the new coronavirus, the RNA (ribonucleic acid) is extracted. This RNA is a mix of a person's own genetic material and, if present, those of the virus.
Thereafter, the RNA is reverse transcribed using a specific enzyme and placed in the RT-PCR machine, with a mixture of viral-specific primers. The machine cycles through temperatures that heat and cool the mixture, to trigger specific chemical reactions that create new, identical copies of the target sequence of the virus. Marker labels get attached to the newly-synthesised viral nucleic acid and release a fluorescent dye, which is measured by the machine's computer and presented in real time on the screen.
It is when the measurement goes over a certain level of fluorescence, through the cycle-process that there is confirmation of the presence of the virus. How many cycles it takes to reach this level is also an indicator of the degree of the viral copy numbers present.
Highly sensitive and specific, the RT-PCR can deliver a reliable diagnosis as fast as three hours, though usually laboratories take about 6 to 8 hours.
28% patient load from
Twenty-eight percent of the entire patient load in the whole country is from
'As of Friday evening, we have 107 cases from
The call that came on
Immediately Dr. Wijayamuni and his team called the Suwa Seriya ambulance service and transferred her to hospital.
This was the infection which launched a cluster in Keselwatte.
Meanwhile, the Welisara navy camp has been isolated after another cluster of COVID-19 patients surfaced from there.
Many of the personnel who have tested positive were involved in quarantining the group of positive cases from Suduwella, navy spokesperson Lt. Commander Isuru Suriyabandara said.
As of
This was while Army Commander Shavendra Silva in March confirmed that a soldier who was involved in managing returnees at the
Quick but honest review a necessity before lockdown is eased
An immediate review of the ground situation is a must before the lockdown is eased in stages and the trust of the people won to ensure that they will be supportive of measures to keep the new coronavirus down in this 'new normal' situation.
This is the urgent call from many experts, with a former Chief Epidemiologist, Dr.
Questioning whether meticulous plans have been drawn up while the country, especially the hotspots, were in lockdown from
'What we need now is an independent group whom the government can trust to give an honest and frank review of what the situation is, what has worked and what has failed,' says
The former Chief Epidemiologist's
exit strategy is:
Evaluate the current situation at a lower administrative level such as an assistant divisional level to find out quickly how
Initiate firm plans to maintain the current status in
Strengthen the health facilities - this should include stringent plans as to which hospitals COVID-19 patients would be sent to and which hospitals patients with other illnesses would be directed to. Each hospital should have protocols, formulated by an efficient team to manage its system and take decisions when an emergency arises. This should be a collective view.
For the high-risk hotspots -
How will places such as markets, bus-stands and railway stations where large numbers gather be managed. There is also a need to look at homes where disabled and old people live in limited confines. How will the health and security forces cover these hotspots?
Do the schools have plans? No class should have 40 children. So should the schools work in sessions to accommodate smaller groups? Initially, should only children who are sitting for examinations be brought in to schools, while online teaching platforms are launched for other children using the tabs that have been distributed to schools?
Minimise the risk of importing the virus again with people returning in their numbers to
When there is a lockdown, what we do is keep the virus suppressed and the spread controlled. To stop a rapid spread on easing the lockdown, the government needs to get people on board as its partners. The authorities need to educate, engage and empower the people to support all actions taken with regard to the virus. The most important weapon is the trust of the people, making them have faith in the government's measures.
Analysing the lockdown,
The navy personnel getting infected needs immediate epidemiological investigation - how did this number get the infection? Was it through a few who got exposed or have many got exposed and how? These are the questions that beg answers, he adds.
© Pakistan Press International, source