Community Spread of Covid -19: Not Yet

By Dr. Lakshman Abeyagunawardene

MBBS; MPH; MD (Community Medicine)

Consultant Community Physician

It is quite possible that some sections of the general public may be confused by the constant reference to “semi technical” terms when discussing the Covid-19 outbreak. To put the record straight, let me at the outset explain that these are really epidemiological (or technical) terms. I refer here to pandemics, epidemics and endemics. Though it sounds simple, “community spread” is also a technical term in that it means that the victim picked up the disease from some unknown infected person with whom the person had come into contact (as opposed to those who have had some form of contact with a foreigner, tourist guide, chef etc.)

The Centers for Disease Control (CDC) refers to such terms as pandemic, epidemic and endemic with the technical aspect in mind. The media in Sri Lanka use the term pandemic more broadly to describe the present outbreak of Covid-19 .  The local media cannot be found fault with because the disease has spread over several countries or continents and appears to be presently out of control. It is also affecting a high proportion of the population.  An epidemic in its true sense, refers to an increase, often sudden, in the number of cases of a disease above what is normally expected in that population in that area (eg. Outbreaks of smallpox in Sri Lanka in the past). For the sake of completeness , an endemic refers to the constant presence and/or usual prevalence of a disease or infectious agent in a population at the baseline level within a geographic area (cholera was endemic in some areas in Sri Lanka some time ago)

This explanation is considered important because terms like these direct the public health response to better control and prevent the present outbreak. Moreover, the WHO and the Ministry of Health also use these terms quite liberally.

An Epidemiologist’s Dream

Although I have specialised in a different branch of Public health, I had an abiding interest in the subject of Epidemiology even when I was doing my MPH in Berkeley, California, 46 years ago. This has continued up to date and I always look at epidemics and pandemics in a special way. The present outbreak of Covid-19 is not an exception and in my opinion, has proved to be an Epidemiologist's dream.

The very first case of the deadly disease in Sri Lanka was confirmed on 27 January when a 44-year-old Chinese woman from Hubei Province in China was admitted to the National Institute of Infectious Diseases (IDH). She had arrived as a tourist with a group of travellers and had been screened at the Bandaranaike International Airport after having a high fever. She had fully recovered and was released from hospital on 19 February.

Like other countries, Sri Lanka too has gone through troubled times due to the pandemic. However, although we have 233 confirmed cases as of 15^th April, we have not yet gone into the stage when community spread of the disease has occurred. All cases confirmed so far, have had some contact with the outside world (employees returning from countries like Italy and South Korea, foreign tourists, tourist guides or their relatives). For instance, the uncharacteristic spike of 21 cases in one day, includes many members of one family. Similarly the sharp rise of confirmed cases seen on April 14^th when only those from quarantine centres were PCR tested, the results of which ruled out free community spread. In other words, Community spread has not yet begun. Therefore, it is not difficult to contain the outbreak at this stage.

I must confess here that I have only a passing interest in Sri Lankan politics. Like most other citizens, when elections come round, I dutifully exercise my voting right. Depending on the prevailing situation, both leading political parties in turn have succeeded in securing my vote. Whatever others may say, I feel that we are in the fortunate position in that we have a militarily trained President in His Excellency Gotabaya Rajapaksa and a Defence Secretary Major General Kamal Gunaratne to guide our destinies at this time. The Director General of Health Services Dr. Anil Jasinghe and the present Army Commander Shavendra Silva who heads the Media Task Force, have an abundance of intelligence and a good grasp of the problem. The communication support provided by DIG Ajith Rohana who is a lawyer, is also commendable. The professional associations, medical consultants, community physicians (especially of the Health Promotion Bureau) and even trade unions like the GMOA have chipped in by providing much needed technical advice to the government. Particular mention should be made of Dr. Paba Palihawadana and Dr. Sudath Samaraweera who have been in the forefront offering technical support from Day 1.

Another important supportive group has been the Intelligence Unit of the Sri Lanka Army. I believe Sri Lanka is the only country in the world that has utilized the services of Army Intelligence for epidemiological investigations. They have done a tremendous job in successfully carrying out contact tracing.

I wonder whether we have already begun to see the light at the end of the tunnel. Other than the districts (Colombo, Gampaha, Kalutara, Puttalam, Kandy and Jaffna) which have been classified as high-risk areas, in the other districts, the curfew is being relaxed gradually. Even in the so called high-risk areas, moves are afoot to bring in more relief to the masses. These are all good signs. The government is anxious to see that SL's citizens are given lesser burdens and more freedom, but they simply can't do it all at once due to the enormity of the outbreak.

On the part of the general public, I wish to make this concluding fervent appeal to continue with behaviours such as social distancing, proper hand washing, wearing face masks as advised by the Health Ministry and avoiding congregation in public places. It is only then that we would be able to close this unfortunate chapter.

If Wuhan could do it, we certainly can!