Saturday 26 September 2020

The 28th WACEM-ACAIM Special Global Web Conference on COVID-19


28th in the series of WACEM-ACAIM Joint Group Meetings

We starting this weekly meeting with the grim recognition that Europe is indeed seeing a second wave of infection. We spoke again about the influence of blind spots on this second wave.

COVID-19: The Sri Lanka Story

Dr. Eranga Nrangoda (Sri Lanka)

The National Institute of Infectious Diseases (NIID), Colombo, Sri Lanka, is the only designated quarantine hospital and only specialized hospital for communicable diseases in Sri Lanka. 

The first case of COVID-19 in Sri Lanka was a Chinese tourist visiting Sri Lanka in January 2020. She presented with fever, retro-orbital pain, loss of appetite and sore throat. The hospital sent a nasopharyngeal swab for PCR, which confirmed coronavirus infection. She fortunately recovered from a mild course of disease in a period of 10 days. 

The first Sri Lankan patient, reported to hospital in early March. He again, had mild illness with good recovery. Most early patients had contact from international travelers. Studies from Sri Lanka showed a male preponderance, and mean age of 40.8 years, as well as co-morbidities, similar to those noted across the world. 

Like any other place, NIID also faced challenges initially. Among these, anxieties of healthcare personnel, short supply of PPE, poor understanding of a new disease, limitations in isolation rooms, labs, and imaging, which they overcame quite magnificently. 

Antibodies and Biomarkers

Dr. Neelika Malavige (Sri Lanka)

Dr. Malavige presented where Sri Lanka is presently, compared to other countries, which in short, is better positioned than most, with low level of cases and low mortality rate related to COVID. But her focus of discussion was antibody responses and vaccines.

They studied neutralizing antibody responses, but were faced with infrastructural limitations, not having the specialized laboratories to study these. With some help, they received kits to progress beyond this obstacle. They studied antibody responses and followed up patients in community. They found that the mean duration of hospital stay was 17 days. Many patients had prolonged viral shedding (in some cases, up to 50 days). Of the antibodies that were generated against the virus, neutralizing antibodies were thought to be associated with protective function, and they seemed to be present up to 8 weeks in relation to clinical severity. Nearly all patients had detectable antibodies after 5 weeks of illness, but became undetectable in many patients after >90 days of illness. 

Reinfection was confirmed by the differences in the virus strain causing the first versus the second infection. The second infection had a more severe illness. 

In developing vaccine, scientists have measured antibody responses, but not memory B cell responses, this provides some hope for future studies. Viruses, historically, also become less virulent with time, providing some more hope.

Role of Military in COVID

Col. (Dr) Saveen Semage (Sri Lanka)

Sri Lanka saw clusters of infections, mostly brought back from travel abroad, or brought to from travelers to Sri Lanka. Quarantine process, contact tracing and isolation, and point of entry operations (decontamination, thermal surveillance, passenger handling and seafarer crew exchange) were run by the military, in addition of course to maintaining law and order. They had a dedicated treatment center for military cases. Additionally, the military was assisting communities during the lock down. 

Their contact tracing system was a hybrid of public health surveillance and state intelligence services. Tracing carried on till the 3rd degree of contact. Decision between institutional quarantine versus home quarantine was dependent on vulnerability. People returning from overseas were tested, but regardless required to self-quarantine at home. 82% of infected patients were in quarantine centers. 

Some of the strengths of their response came from effective communication between health and military, hybrid contact tracing as mentioned above, testing strategy and timing, leadership commitment, strong public heath system, and of course the degree of military involvement in the pandemic response. 

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