Dear Members of the Sri Lanka Medical Association,

Sri Lanka was returning to near normal life over the last couple of months, until the detection of a COVID-19 infected patient at the District General Hospital Gampaha on the 3rd of October. It was an incidental finding through a screening process to monitor for influenza-like infections (ILI) which has been in practice for about three months. Till this recent outbreak, the number of patients in the community was low and the situation appeared under control. This is evident by low test positivity rates of community random samples, ILI screening, and observations of clinicians.

However, it may be possible that we may have missed certain critical points for samplings and some leakage has occurred. A relaxed attitude towards COVID preventive measured was developing and observed at all levels in spite of cautioning by health authorities. A combination of ignorance, very large number of workers in confined spaces, poor ventilation, lax attitude may have played a role in the current outbreak. Thereafter, usage of pubic transport systems, supply chains, cross over between zones and other behavior patterns have contributed towards the propagation of the infection within the affected district and beyond to other parts of the country.

Currently, the pattern observed is hundreds of positive cases being detected daily, the numbers varying depending on the settings affected, with higher numbers being reported from crowded, confined places such as factories, markets and hostels. At this rate, the capacity of the hospital system to isolate and treat every positive case will be exceeded within few days. Testing capacity is stretched to the maximum, with a backlog of 1000-2000 samples every day. Spread within the free trade zone (FTZ) and Fish Market has been faster than in other parts of the country. It must be noted that both these settings are governed by a different set of rules and behaviors. Even though the spread within other parts of the country is slower, previously unexposed categories such as young and elderly are affected now. This will alter the morbidity and mortality patterns.

The approach of mass quarantine has created concerns and uncertainty among the general public as well as health workers. Inter-sectoral coordination in the process is seriously lacking. This will negatively affect the trust of the general public and the morale of the health system. Criminalization of disease leading to a reduction in self-reporting will hamper the preventive process. Sensationalization and stigmatization by media has worsened the situation. Using fear as a health promotional tool is totally incorrect and unacceptable as it affects negatively by aggravating stigmatization. Specially the process of quarantining should never be highlighted as a punishment but as a preventive healthcare measure. In such a situation it is very important to plan ahead to use our resources to the maximum benefit.

The utmost important thing is to prevent infection among healthcare workers while minimizing the casualties among COVID-19 infected patients. With the exponential increase in numbers, it is vital to maximally utilize the limited resources available. PCR testing should be focused mainly on the suspected patients and surveillance should be strengthened through testing at outpatient departments and in-ward settings. It is important to take appropriate precautions to safeguard healthcare workers.

The COVID-19 pandemic is far from over. A major shift in behaviour and attitude is important as we have to live with COVID-19 for a significant time ahead. Media has to play a responsible role in empowering and engaging the public in controlling the pandemic. There is a dire need for clear policies and support systems for healthcare workers who get exposed. Priority should be on breaking the chain of transmission based on a rational and scientific approach, which is the only way out.

Stay safe and contribute in the best of your capacity during this hour of need for the nation!

Professor Indika Karunathilake
President, Sri Lanka Medical Association.