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 15th 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 14th
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!
