Sri Lanka’s Covid-19 response and the challenge ahead

11 June 2020 12:02 am - 0     - {{hitsCtrl.values.hits}}

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Sri Lanka’s handling of the Covid-19 outbreak has, comparatively speaking, produced commendable results. Tracing the trajectory of the response, it may be seen that early moves to prepare for what lay ahead served well to mitigate the outcome. A Task Force drawing on expertise of all relevant sectors was appointed by President Gotabaya Rajapaksa on January 27, the day the first COVID-19 case was reported—that of a Chinese woman tourist. The first local case was detected on March 11—a tour guide who had been infected by an Italian tourist. School closures were announced the next day, followed by the shuttering of theatres, cinemas, libraries, sports grounds and other public places along with prohibitions on public and private gatherings. Around mid-March Colombo’s international airport was closed to inward passengers. The rupee plummeted, the stock market crashed. As part of a now-familiar narrative of lockdown, Sri Lankans hunkered down to an islandwide curfew on March 20.   


The moves to arrange for essentials of food and medicine to be delivered to people’s homes served to cushion the impact of the restrictions. Farmers and fisher people were allowed to go about their routine activities regardless of the curfew, to sustain rural livelihoods, and for food security. The government intervened in purchasing and distributing produce and getting it across to consumers. There were predictable difficulties during these operations amid the new health and safety measures.   


Compared to many Western states whose daily statistics of death and infection were mind-boggling, Sri Lanka’s report card on containment of the coronavirus looked good. Two months after the emergence of the first local patient, as of May 9, Sri Lanka counted a total of 835 confirmed cases of COVID-19. Of them 255 had recovered while 9 had died, leaving 571 active cases.   

 


Right track
“Sri Lanka is on the right track to contain the epidemic through the increased tracking, testing, isolation, and treatment strategy,” said the World Health Organisation (WHO). “Containment is feasible and remains the top priority in Sri Lanka,” it said in a statement on May 10. The ambassadors of France, Germany, Italy, the Netherlands, Romania and the EU Delegation in Colombo met the head of the Presidential Task Force on Essential Services, Basil Rajapaksa, to commend the government’s cooperation in assisting their nationals. The EU said in a statement that they were “impressed with the low number of cases in Sri Lanka so far” and made a EUR 22 million grant to help fight the disease. Heads of missions representing US, UK, Australia and Canada are reported to have likewise acknowledged the government’s progress in dealing with the pandemic and pledged continued support, as have the governments of India and Japan.   


The most steadfast assistance to Sri Lanka in the wake of the pandemic has come from China. Having pledged to share its knowledge and expertise with Sri Lanka’s Health Ministry, China continued to make donations of tons of medical supplies, tens of thousands of masks, PCR test kits and other supplies. China’s Acting Ambassador assured President Rajapaksa that his government would help rebuild the economy.   

 


Public health system
Sri Lanka’s robust response to the COVID-19 outbreak could be attributed to its well-heeled public health system, helmed by dedicated medical professionals, despite being underfunded. Dr Ramya Kumar from the Department of Community and Family Medicine, Faculty of Medicine, University of Jaffna, wrote in a conference paper last year that “The most remarkable feature of Sri Lanka’s public healthcare system is that it offers services on a walk-in basis with no charges at points of use. Financed chiefly through (regressive) indirect taxation, the system has achieved impressive geographic spread at relatively low levels of spending (< 2% of GDP).” 


In its bid to curb the spread of coronavirus, Sri Lanka adopted a strategy of aggressive contact tracing and isolating in quarantine facilities, with positive cases being hospitalized for treatment. The approach to testing did not follow the dictum of ‘test, test, test’. “Testing is being conducted on a targeted algorithm and policy and not just on a whim at every junction,”Director General of Health Services Dr Anil Jasinghe is reported as saying in the Sunday Times. “Those who are tested are in the highly-vulnerable group like those in Intensive Care Units (ICUs), those having Severe Acute Respiratory Illness (SARI), those whom the clinicians want tested, those in quarantine centres and other vulnerable groups such as those living in congested areas, substance abusers, municipal workers, trishaw drivers, fish vendors etc.” Between 1500 - 2000 PCR tests (Polymerase Chain Reaction tests) are said to be carried out per day.   


Asked if Sri Lanka’s approach to testing was appropriate and adequate, the WHO office in Colombo in an email response said, “The current testing is appropriate and in line with the cluster phase testing plan and all appropriate groups are currently being tested.”   


Health officials say there has been no ‘community spread’ of the disease. This assertion would seem to be based on the random testing carried out in the community, which according to Dr Paba Palihawadana, Deputy Director General of Health Services, comprises about 50% of samples collected.   

 


Navy cluster 
The Sri Lanka’s armed forces make a significant contribution to the COVID-19 response under the direction of Lt. Gen. Shavendra Silva, Chief of Defence Staff and Commander of the Army, who heads the National Operations Centre for the Prevention of COVID-19 (NOCPC). Forces personnel are tasked to move identified persons to the quarantine facilities run by the military at 44 locations around the country. Diverse groups leaving after their 14-day stay, and interviewed on public television, have without exception praised the high standard and the attentive treatment they received. The State Intelligence Service focuses on contact tracing, while forces personnel continue to assist in a variety of tasks.   


So it is ironic that the first major spike in numbers was triggered within the Sri Lanka Navy. An officer had been infected while on duty during an operation in Ja-Ela to round up drug addicts for quarantining, who later tested positive, a statement by the Army Commander said. The largest cluster yet, resulted from this calamity. A Situation Report of the Epidemiology Unit showed that between April 22 (the start date of the Navy cluster) and May 31, a total 794 out of 1,312 confirmed cases reported were Navy personnel and their close associates. However the recoveries within this group have been swift, possibly owing to their age and fitness profile.   

 


Sri Lankan returnees
The bigger challenge that emerged recently has been an increasing number of Sri Lankans returning from overseas under a government repatriation program, and found to be COVID-19 positive on arrival. Health authorities say these returnees were already infected at the time of their departure, and categorise them as ‘imported’ cases. Out of 466 migrant workers who returned from Kuwait on May 19, a total 324 were reported to be COVID-19 positive.   


The new development has presented a complex set of issues. The anxiety of health officials is palpable. Dr Sudath Samaraweera, Chief Epidemiologist has urged vigilance saying, “At this point there is no undue pressure on the health system. It can be carefully managed. Right now there are no cases reported from within the community. But this does not mean we can claim there are no cases within the community. Therefore we must continue to assume there may be infected persons out there. That’s the only way we can bring it under control because we are not 100% safe as yet.” (Ada Derana TV 28.05.20) The total number of confirmed cases of COVID-19 as of May 31 stood at 1,620, which included 10 deaths. With 801 having recovered, this left a total of 809 active cases. 

 
There has been a clamour among Sri Lankan migrant workers to return, owing to the worsening risk of contracting COVID-19 in host countries, lack of access to medical facilities, loss of job or lodging and other contingencies in the wake of the pandemic. Around 40% are believed to be working illegally, making them more vulnerable. 

 
As at May 27 a total 42,522 persons from 123 countries were seeking to return to Sri Lanka, according to a statement from the Ministry of Foreign Relations on May 29. “Of these, migrant workers amounted to 34,881 of which 20,893 are living in the Middle East, while 4,961 were short term visa holders, and 2,016 were students,” it said.   


It added that the repatriation programme would continue, with priority being given to those who have lost their legal status or employment. Of the 466 returnees from Kuwait 379 arrived on the basis of an amnesty agreement between the two governments, the ministry said, while 87 were from Kuwaiti prisons and detention centres.   

 


Government’s responsibility
Migrant worker remittances have been Sri Lanka’s top foreign exchange earner for the past several years, ahead of apparel and tourism. Worker remittances constituted 58.9% of export earnings in 2018, of which over half came from West Asia, according to Central Bank statistics.   


On the instructions of President Rajapaksa, returnees from overseas will now be subjected to PCR testing at the airport, where a lab will be set up for the purpose. They will be sent for quarantine only after the results are known. “Everyone who wishes to return to the motherland’ should be given the opportunity to do so as soon as possible,” the president’s office reported him as saying.   


The plight of migrant workers caught up in the pandemic raises questions as to why so many are working illegally—making them more vulnerable—and why such a large numbers of citizens need to leave the country to provide for their families in the first place. If more decent employment was generated within the country, would they not be spared these ordeals?   


These are issues for which long term solutions would be needed—assuming the government has the political will to address them. The immediate challenge is that of fulfilling obligations towards Sri Lankans in distress overseas, without compromising the safety of its citizenry at home. As the country gradually comes out of a grueling two-month lock-down to resume life under the ‘new normal,’ this could be the acid test that determines whether Sri Lanka’s impressive record (so far) of battling COVID-19 can be sustained.  

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