CORONA/ COVID 19 VIRUS –Misleading News and Responsibility of the Public and Government

A responsible Government Medical Officer publicly opined that the situation of corona virus of initial stage of Sri Lanka was worse than Italy. This is not correct comparing Italy and Sri Lanka figures. It is unrealistic to consider only one variable or one factor (the number of patients) prior to arrive at a decision and make a statement of national interest. It can be categorized as a misleading news with the ulterior motive to create panic among public. There are so many differences in the situation between Italy and Sri Lanka.

Firstly, it is the flu season in Italy as it’s winter and cases of flue are on the rise now in any case as it’s cold. Secondly, most Italians live in flats so hundreds if not thousands living clustered together in one building. Thirdly, Italians greet each other male and female by kissing and hugging. Fourthly, Italy has bigger older population.

Fifthly, in Italy the virus was spread by over 10 million Chinese tourists that they visit every nook and corner of Italy. Sixthly, their medical system was not prepared for this. Seventhly, Government didn’t take it very seriously until it was too late. Lastly, no one knew about COVID 19. Therefore, the present rate of increased patients in Italy was due to above reasons including the citizens taking the pandemic so lightly hence resulted in amounts of huge deaths. 

This was amply proves by the testimony of by Dr Marco Pavesi an Italian Anesthesiologist - March 18 2020. “I’m a Doctor in Italy. We Have Never Seen Anything like this. My country’s health care system may soon collapse. None of us have ever experienced a tragedy like it.

We know how to respond to road accidents, train derailments, even earthquakes. But a virus that has killed so many, which gets worse with each passing day and for which a cure — or even containment — seems distant? No.
We always think of calamity as something that will happen far from us, to others far away, in another part of the world. It’s a kind of superstition. But not this time. This time it happened here, to us — to our loved ones, our neighbors, our colleagues.

I’m an anesthesiologist at the Policlinico San Donato here in Milan, which is part of the Lombardy region, the heart of the Italian corona virus outbreak.”

The writer scientifically proves that the corona virus situation in Sri Lanka in the initial stage is totally different to that of Italy. 

DEATH TOLL IN EUROPE AND ITALY
The death toll from the new coronavirus has surpassed 5,000 in Europe - the new epicentre of the pandemic - as Italy, Germany and Spain reported a steep rise in infections. Italy announced 627 more deaths on Friday, the biggest day-to-day increase in the country's four-week epidemic, a day after surpassing China's death toll. The total number of deaths in Italy reached 4,032. as of 21.03.2020

DEATH TOLL GLOBALLY
As of March 21, 2020, the outbreak of the coronavirus disease (COVID-19) had been confirmed in around 186 countries or territories. The virus had infected 277,055 people worldwide, and the number of deaths had totaled 11,423. At least 87,000 have recovered from COVID-19, according to data collected by the Johns Hopkins University in the United States. The most severely affected countries outside of China include Italy, Iran, Spain, and Germany. 

DEATH TOLL IN SRI LANKA 
As of March 21 st 2020 no one died of corona. 77 were infected and one recovered.

WHAT IS CORONA VIRUS, HOW IT TRANSMITTED AND PREVENTION?

Novel Corona Virus 2019 [“2019-nCoV]: The Disease
2019 novel coronavirus (2019-nCoV) is a virus identified as the cause of an outbreak of respiratory illness first detected in Wuhan, China. Early on, many of the patients in the outbreak in Wuhan, China reportedly had some link to a large seafood and animal market, suggesting to animal –to person spread. However, a growing number of patients reportedly have not had exposure to animal markets, suggesting person to person spread is occurring.
 At the moment, this coronavirus is called novel coronavirus or “2019-nCoV”. A novel coronavirus (nCoV) is a new strain that has not been previously identified in humans.

Coronavirus: a type of common virus that infects humans, typically leading to an upper respiratory infection (URI.)  Seven different types of human coronavirus have been identified. Most people will be infected with at least one type of coronavirus in their lifetime. The viruses are spread through the air by coughing and sneezing, close personal contact, touching an object or surface contaminated with the virus and rarely, by fecal contamination. The illness caused by most coronaviruses usually lasts a short time and is characterized by runny nose, sore throat, feeling unwell, cough, and fever. 

Coronaviruses (CoV) are a large family of viruses that cause illness ranging from the common cold to more severe diseases such as Middle East Respiratory Syndrome (MERS-CoV) and Severe Acute Respiratory Syndrome (SARS-CoV).

Coronavirus disease (COVID-19) is a new strain that was discovered in 2019 and has not been previously identified in humans. Coronaviruses are zoonotic, meaning they are transmitted between animals and people.  Detailed investigations found that SARS-CoV was transmitted from civet cats to humans and MERS-CoV from dromedary camels to humans. Several known coronaviruses are circulating in animals that have not yet infected humans. 

Common signs of infection include respiratory symptoms, fever, cough, shortness of breath and breathing difficulties. In more severe cases, infection can cause pneumonia, severe acute respiratory syndrome, kidney failure and even death. 

BE AWARE OF HOW THE COVID 19 SPREADS
This virus can be transmitted from person to person (when they are within a proximity of about 1m) when someone breathes in droplets coughed or exhaled by persons infected with the virus. Further, when an infected person coughs or exhales, droplets of infected fluid may get released and contaminate nearby surfaces and objects, such as desks, tables or telephones. An uninfected person may contract the virus by touching these surfaces and then touching their eyes, nose or mouth.

BE AWARE WHO IS MORE AT RISK
Most persons infected with the virus develop mild symptoms and recover without any complications. Those with reduced immunity and people suffering from conditions such as diabetes, heart, liver and lung disease are more at risk. The risk also increases with advancing age and people over 40 years seem more vulnerable.
    

SIGN AND SYMPTOMS 
Mild to severe cases were reported among affected. Fever, cough, shortness of breath and breathing difficulties are the main manifesting disease symptoms among cases. Pneumonia, sever acute respiratory syndrome, kidney failure and death have been reported according to the severity of the disease. Chest radiographs show invasive pneumonic infiltrates in both lungs.

LABORATORY DIAGNOSIS 
There is no specific test for Novel corona virus 2019. Virus isolation is done through Polymerase Chain Reaction (PCR) assay by using upper respiratory tract samples (nasopharyngeal swab and viral throat swab), lower respiratory tract samples, if possible and sputum if patient has a productive cough, according to the guideline given.

Collection of samples should be done under the guidance of standard precaution and dispatch of samples should be carried out under the correct temperature.

TREATMENTS 
There is no specific antiviral treatment or vaccine available for 2019-nCoV. When a disease is new, no vaccine is available until one is developed. Symptomatic and supportive care is recommended according to the severity of the case.

PREVENTION
Prevention methods recommended for other corona viruses are applicable to the 2019 novel corona virus prevention. The World Health Organization (WHO) recommends measures to reduce the general risk of acute respiratory infections while travelling in or from affected areas by:

 Frequent hand cleaning by using soap, water or alcohol based hand rub.
When coughing and sneezing need to cover mouth and nose with flexed elbow, handkerchief or tissue and dispose used tissues correctly with hand washing.

Avoid close contact with people suffering from acute respiratory infections
If you have developed fever, cough and shortness of breath, need to consult a medical practitioner and need to tell travel history, if any.

Consumption of raw or undercooked animal products should be avoided as good food safety practices.

Avoid close contact with live or dead farm or wild animals.
Shopping malls, religious places etc...
    
 For the convenience, the writer would like to educate on the following questions faced by the general public based on the directives of the World Health Organization (WHO) on Novel Coronavirus (2019-nCoV) 

IS IT SAFE TO RECEIVE A LETTER OR A PACKAGE FROM CHINA?
Yes, it is safe. People receiving packages from China are not at risk of contracting the new coronavirus. From previous analysis, we know coronaviruses do not survive long on objects, such as letters or packages.

 
CAN PETS AT HOME SPREAD THE NEW CORONAVIRUS?
At present, there is no evidence that companion animals/pets such as dogs or cats can be infected with the new coronavirus. However, it is always a good idea to wash your hands with soap and water after contact with pets. This protects you against various common bacteria such as E.coli and Salmonella that can pass between pets and humans.

DO VACCINES PROTECT YOU FROM NEW CORONAVIRUS?
No. Vaccines against pneumonia, such as pneumococcal vaccine and Haemophilus influenza type B (Hib) vaccine, do not provide protection against the new coronavirus.

The virus is so new and different that it needs its own vaccine. Researchers are trying to develop a vaccine against 2019-nCoV, and WHO is supporting their efforts.

Although these vaccines are not effective against 2019-nCoV, vaccination against respiratory illnesses is highly recommended to protect your health.

CAN REGULARLY RINSING YOUR NOSE WITH SALINE HELP PREVENT THE NEW CORONAVIRUS?
No. There is no evidence that regularly rinsing the nose with saline has protected people from infection with the new coronavirus.
There is some limited evidence that regularly rinsing nose with saline can help people recover more quickly from the common cold. However, regularly rinsing the nose has not been shown to prevent respiratory infections.

 CAN GARGLING MOUTHWASH PROTECT YOU FROM NEW CORONAVIRUS?
No. There is no evidence that using mouthwash will protect you from infection with the new coronavirus.
Some brands or mouthwash can eliminate certain microbes for a few minutes in the saliva in your mouth. However, this does not mean they protect you from 2019-nCoV infection.

CAN EATING GARLIC HELP PREVENT-INFECTION WITH THE NEW CORONAVIRUS? 
Garlic is a healthy food that may have some antimicrobial properties. However, there is no evidence from the current outbreak that eating garlic has protected people from the new coronavirus.

DOES THE NEW CORONAVIRUS AFFECT OLDER PEOPLE OR YOUNGER PEOPLE ALSO SUSCEPTIBLE?
  People of all ages can be infected by the new coronavirus (2019-nCoV). Older people, and people with pre-existing medical conditions (such as asthma, diabetes, heart disease) appear to be more vulnerable to becoming severely ill with the virus.
WHO advises people of all ages to take steps to protect themselves from the virus, for example by following good hand hygiene and good respiratory hygiene.

ARE ANTIBIOTICS EFFECTIVE IN PREVENTING AND TREATING THE NEW CORONAVIRUS?
No, antibiotics do not work against viruses, only bacteria.

The new coronavirus (2019-nCoV) is a virus and, therefore, antibiotics should not be used as a means of prevention or treatment.

However, if you are hospitalized for the 2019-nCoV, you may receive antibiotics because bacterial co-infection is possible.

NECESSITY OF CURFEW AND CONTROL MEASURES
Curfew is an essential tool in controlling and prevention of spreading of the virus because we don’t have hospital facilities to cope up if there is a sudden escalation of patients. Therefore, the Citizens should be continuously educated of the need of such preventive measures by the government in order to bring the situation back to normal as fast as possible. As our country is not equipped with additional medical kit and equipment including other facilities to cope up to a larger quantum of patients, we can’t think of situation going beyond control. If the situation goes beyond control and if the effected numbers increase like in Iran and some western countries, Sri Lanka will have to face a disastrous situation. Therefore, there is a huge responsibility by the citizens to cooperate with the Government to win over COVID-19 at it’s earliest.

Guidance for workplace preparedness for COVID-19
COVID 19, the novel coronavirus infection, which began in Hubei Province, China in December last year has now been declared a pandemic by the World Health Organization. All sections of society should engage with the public health authorities to take action to prevent and contain the spread of the virus.

t is crucial to remain vigilant as Sri Lanka has recently reported cases of COVID 19. Businesses and employers, in particular, have a major role to play to keep workplaces safe if we are to stop the spread of this disease as workplaces are frequented by a large number of people.

This document outlines the key steps to be taken at workplaces to prevent the spread of the virus. Employers should start doing these things now, to keep the workplaces safe to prevent the spread of the virus. This may help to reduce working days lost due to illness and stop or slow the spread of COVID-19. The following simple measures can be easily adopted in the workplace to reduce the spread of infections.

 Promote good hand hygiene among employees and customers
 Hand hygiene includes either cleaning hands with soap and water or with an alcohol-based hand rub.
Make it mandatory to clean their hands before entering the workplace by employees and customers.

Make hand washing facilities or sanitizing hand rub dispensers available to employees and customers to clean their hands at the main entrances as well as suitable other places.

Ensure the hand rub dispensers are regularly refilled and soap and water are freely available at all time.
The correct hand washing technique can be demonstrated by posters, leaflets, via LCD panels and, dissemination of information at meetings.

Why? Because washing hands with soap and water or an alcohol-based hand rub kill the virus on hands and prevent the spread of COVID-19

Ensure the cleanliness and hygiene of the workplace
Pay attention to regular disinfection of surfaces (e.g. desks and tables) and objects (e.g. shared used telephones, keyboards, teller machines, door handles and railings etc.) with a suitable disinfectant several times a day.
Keep the doors open as much as possible (eg. non-air conditioned areas) – This will minimize the necessity to touch the door handles.

In air-conditioned areas – open the doors with your body by pushing (this will minimize the contact of door handles, places, where you have to pull to open - it is advisable to use a disposable tissue for the door handle and immediately discard it)

Minimize the overcrowding of customers (supermarkets, shops, banks, government offices, etc) inside the workplace. Control the incoming customers to the premises through the main entrances with the support of the security officers. Let them enter in manageable numbers where the staff can handle. Arrange a suitable place outside of the office until they get their turn.

Try to keep at least one meter (1M) gap between the customers and the officers who have direct customer relationships. If this is not possible, it is advisable to wear a face mask by such officers while on duty, wash their hands more often than others and should not touch their face with unwashed hands.

Why? Because touching surfaces contaminated with infectious material is one of the main ways that COVID-19 spreads. These instructions are more important for the workplaces where a large number of customers/clients are regularly visiting. Eg. Banks, Hospitals, Shopping malls, religious places etc...

 Promote good respiratory hygiene in the workplace
Keep surgical masks and/or paper tissues at your workplace for use by those who develop a runny nose or cough at work, along with closed bins for their hygienic disposal.

Why? Because good respiratory hygiene, including covering a cough or sneeze with a tissue or flexed elbow, prevents the spread of COVID-19 Ensure access to Information
Employers can take steps to display posters promoting hand washing and respiratory hygiene.

It is advised to brief employees to stay at home if anyone experiences a mild cough or low- grade fever (37.3 C or more). Keep communicating and promoting the message that people need to stay at home even if they have just mild symptoms of COVID-19.

 How to manage COVID-19 risk when organizing meetings & events
BEFORE the meeting or event, Consider whether a face-to-face meeting or event is needed. Could it be replaced by a Teleconference or online event?
If a meeting is essential to be held,
Minimize the number of attendees
Do not shake hands with other participants, instead say ‘Ayubowan’
Pre-order sufficient supplies and materials, including tissues and hand sanitizer for all participants.

Have surgical masks available to offer anyone who develops respiratory symptoms.

Maintain a distance of 1m between participants
Follow all the hygienic measures outlined above

THE RESPONSIBILITY, GOAL AND FUTURE OF THE GOVERNMENT 
The responsibility and goal of the Present Government should be to prevent a temporary crisis from permanently harming people and economy through loss of lives, job losses and bankruptcies. The people of the country are uncertain as to what will happen tomorrow and doubtful about their future. The utmost priority should be to take care of all the citizens, develop Confidence and take all necessary, practical and prompt steps and decisions by the leadership to prevent a possible human disaster. 

At present, all sectors of the country has been badly effected by the virus and depending on the correctly and timely decisions taken by the leadership of the country will determine not only the safety of the citizens but also the fate of the Government in the future.

 It is praiseworthy to mention the efforts taken by the Government, medical staff and also the armed forces and police which resulted in bringing situation under control up to now. It is of utmost important to place the task force under the able leadership of a subject qualified medical professional to handle the technical and practical aspects in preventing and controlling of corona virus and all other elements including the armed forces to function under the professional body.

It is up to the policy makers to take stern actions to prevent further spread of the virus in the country and subsequently implement substantial fiscal and monetary policies to help consumers and businesses cope with the economic harm of the coronavirus outbreak. The governments should consider measures like cash transfers, wage subsidies or tax relief, while central banks should be prepared to provide liquidity to banks and companies, as the epidemic disrupts supply chains and consumer demand.

Sri Lanka could in its future readiness strategies consider the development of a state-of-the-art quarantine facility, which may include a hospitals in isolation. Sri Lanka may need some form of technical assistance from the WHO. Sri Lanka is in an age where global biological risks are outpacing the capability of scientific communities, and hence the country should look to prioritise national health as a key security concern through greater financing of its research wings and emergency response units. Routine tests like preparedness for Tsunami could also be conducted annually to review overall preparedness levels and capability gaps. All of this requires clear policy directives, high degrees of transparency, and a unified policy response from the Sri Lankan government as the country can ill afford any additional national security calamities after the tragic 2019 Easter Sunday

The writer Deshakeerthi Lanka Puthra,, Major General, Dr Boniface Perera (RWP,RSP,USP,NDU,PSC, DPM, PhD) is the former Security Forces Commander East and Wanni region, Competent Authority for Internally Displaced People in the North, World top 10 in National Security and presently working as an International Researcher and International Writer.