Covid-19 outbreak: Tedious task of combatting a virus

Strict quarantine regulations should be established and should be implemented to the letter

PCR tests being conducted on people

• They say the virus can survive on surfaces for up to 28 days. So, this is not only an air-borne disease and the importance of hand washing is highlighted
• This disease doesn’t care whether one is rich or poor. Therefore, it is better to consider testing only those who have the symptoms

The total number of COVID -19 patients found in the country has passed 4800 and it keeps rising. The much expected COVID -19 second wave has set in, first as a local outbreak in Minuwangoda and then made its way into the farther parts of the country such as Jaffna and Moneragala.  
The number of patients from the outbreak related to a private firm has already passed the 1,500 mark. The tedious task of finding the contacts that we know of, and the contacts that we don’t know of, has been given to the State Intelligence Services, the Public Health Inspectors and the Armed Forces.   

This is a thankless job they have been entrusted with, as in the end, they will never find all the people who could have been infected with this virus. It is the same fact that contributed to this outbreak. One Medical Officer was bold enough to say that there is a community spread in the country only to find that he had been removed from his post the very next day. He was acting in the post so it was easy to replace him!  

What went wrong? Firstly, this is a new disease caused by a virus of which we have only a little understanding. Even the recognised incubation period for the disease changed with time. It is now thought someone will show symptoms of the disease between 5 to 14 days after being infected by the virus.   
Not all get ill after getting infected with the virus. It is not known for sure whether a person who has the germ would show any symptoms of the disease. Such people could infect others without their knowledge.   
They say the virus can survive on surfaces for up to 28 days. So, this is not only an air-borne disease and the importance of hand washing is highlighted. The quarantine period is 14 days. Imagine what would have happened in the beginning.   

"What went wrong? Firstly, this is a new disease caused by a virus of which we have only a little understanding. Even the recognised incubation period for the disease changed with time. It is now thought, someone will show symptoms of the disease between 5 to 14 days of being infected by the virus"

Those who were transported to the quarantine centres could have got it from another passenger. At the quarantine centres, if they were allowed to mingle with others, they could have got infected. Even if they were kept separately, individually or as families, initially many got together to celebrate the last day of the quarantine period.  
Now, provided that some show symptoms on the 14th day of getting infected and if they get together or use the same transport, they will pass the virus to others. This was noticed and some suggested that the quarantine period should be increased to 21 days thinking that the incubation period was longer, which was not reported by any other country, and later it was decided to quarantine them for another 14 days, in their own homes.   
But whether this was monitored by the health personnel properly is the million-dollar question. Somehow even if one infected person gets through the net that is enough for a major outbreak somewhere else which I believe is the present case.     

That combined with complacency shown by the people who stopped wearing masks, not adhering to social distancing and forgetting about hand-washing obviously created the present situation.   
The deterioration was well noted in some supermarkets where water was not available to wash the hands as the supply had been disconnected, or the empty liquid soap container was not replaced and in both private and govt. sector offices the managers hardly wore masks, that set a bad example to their subordinates.  
Even with many ups and downs, the country managed the disease very well where the armed forces combined with the health personnel to control the spread. Many lessons were learnt while they were on the job.   
The leadership is given by the Army Commander Lt. General Shavendra Silva and the former Director-General of Health Services Dr Anil Jasinghe was commendable.   

Unfortunately, at this grave time, the latter is not in that post. But I believe the authorities will prevail upon the situation. While treatment procedures adopted were outstanding, the PCR testing was hardly adequate. The reasons are not known but now I believe that it has increased to 2,000 tests a day.   
Considering that the false-negative rate of the test is between 2-29% according to the British Medical Journal, and 2-37% as reported by Harvard Medical School, it is necessary to test the same person twice or thrice. 
This means, we may be not covering all the persons who are really infected.   
We went on carrying out tests on so-called high-risk groups in urban areas which were non-productive and a sheer waste of time and money considering that the private hospitals charge between Rs.6,000 to 9,000 per test.   
While tracing the contacts, it is important also to do reverse contact tracing with an open mind, not to try to connect the link only to Minuwangoda. 

This disease doesn’t care whether one is rich or poor. Therefore, it is better to consider testing only those who have the symptoms  i.e. fever, sore throat, cough and cold, difficulty in breathing or any one of them. If such a practice is adopted, I am sure the number of positives could be much higher and we may not miss many COVID-19 patients.  
All is not lost. Although the flu season is on in the Northern Hemisphere, I am sure we could contain the spread of this disease again.   
Moreover, studies suggest that with COVID -19 on the rampage the flu rates are getting lower and that getting flu will temporarily prevent COVID -19 infection.   

Information coming out of the Duke University, USA states that countries with lower COVID -19 rates are the countries with high dengue epidemic rates in the recent past which means that there is a possibility of cross-immunity between dengue and COVID -19.   

Also, it states that if one has got dengue fever, then there is a chance of false-positive result if the antibody test is done. Is this why we have had lower COVID-19 rates? But then, this year we had very low dengue fever incidence.
Notwithstanding all this and although this is a complicated disease, what is needed is common sense to prevent further spread of the disease. Wear a mask as the disease spreads mainly by air, keep the social distancing and stop social gatherings, wash your hands, keep working tops germ-free, and if ill, seek medical advice.   
Surely, we can close down one district for a few days until we find all the contacts. This is better than imposing curfews in areas as we go detecting new patients as we could be allowing some contacts to spread the disease. Working from home should be encouraged for those who use computers and the internet for their work in the govt. and private sectors.   

"But whether this was monitored by the health personnel properly is the million-dollar question. Somehow even if one infected person gets through the net that is enough for a major outbreak somewhere else which I believe is the present case"

Public gatherings should be stopped in urban areas and the present measures imposed by the Government are adequate. All hospitals and General Practitioners should try and send those persons who have the symptoms for PCR testing.   
Considering that the virus changes even slightly with time, the researchers here must sound the alarm if there is a change in the virus strain so that we can be prepared for it. It is known that the virus found in the USA, Canada, Europe is a more transmissible strain and maybe it started spreading here.   

We know that this is also the dominant strain in India although different lineages are found regionally. What we can do is, strictly support the efforts of the officials by following their instructions. It is good if strict quarantine regulations are implemented to the letter. The media should not overdo their act by showing individuals who have unfortunately got the disease, as this will discourage others from coming out to seek treatment or get tested.   
With the already experienced economic downfall and COVID -19 being expected to go on for another year or so, the government should not go again into the extreme of having an all-island lockdown.   
That would be a social and economic disaster from which recovery would be very difficult in the foreseeable future.  
The writer is former Chief Medical Officer of Health of the Colombo Municipal Council