ECONOMYNEXT – Almost all confirmed Coronavirus patients in Sri Lanka are linked to foreign returnees and investigations are underway in four cases where links to existing patients have not been confirmed, officials said, indicating major progress is being made against the spread of COVID-19.

Sudath Samarawera, the head of the Epidemiological Unit of Sri Lanka’s health service said authorities were investigating four cases to confirm and locate the index case (F0) of the patients who apparently had no links to existing cases.

Cases that have been reported in the media include a three-wheeler driver and another patient from the Kotelawala Defence University.

Samaraweera said in the case of the taxi driver, it was suspected that his links with a German tour group may have been the source of his disease.

Index Case Lacuna Risk

By April 14, 218 patients have been confirmed, and 59 have recovered while seven have died.

The new patients relate to the index case who returned from Malaysia or Indonesia, mostly Muslims, and a person who is a community transmission case, where the index case has not been found.

The lack of an index case is a potential risk as it indicates that there may be infected persons running loose who passed the disease and may have given it to others.

Health Minister Pavithra Wanniarrachchi said, except for two cases, all of the 218 patients confirmed in Sri Lanka were close relatives or associates of foreign returnees (F1 also called First Ring in Sri Lanka). The contacts of F1 and F2 or second ring.

“All the cases we have confirmed so far are linked to foreign returnees,” Health Minister Pavithra Wanniarachchi said on local television on April 14.


“It is only in two cases that we have not been able to find links. Most have been close family members (F1 also called First Ring in Sri Lanka) or close associates of people who returned from abroad.”

“All the new patients we have found recently have been from those that have been identified and taken to quarantine centres.

“We think even these cases there may be links they are not telling.”

Closing the Testing Gap

The sudden surge in confirmations is partly due to a gap in contact tracing that was recently closed.

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In Vietnam, whenever an index case is found F1 contacts are immediately tested and F1 and F2 traced.

If any F1s are confirmed F2 is tested and the next ring traced. In the early days, Sri Lanka did not test returnees from abroad or close contacts and simply kept them in quarantine.

Unlike Korea, which had 4,000 infections, both Sri Lanka and Vietnam nipped the Wave I infections from China in the bud. Sri Lanka found one case from China in Wave I and quarantined all Chinese returnees (without testing) while Vietnam traced 16 patients linked to China.

By killing Wave I, neither country exported patients to contribute to the global pandemic. The success raises hopes that Wave II could also be killed, and all arrivals quarantined as China is doing now.

It is not known whether any asymptomatic mild cases developed in quarantine and recovered without anybody’s in either Wave I or during Wave II before contact testing began. At first, Sri Lanka was only testing those in the hospital.

However, since they were in quarantine, there was no community transmission and the same objective was achieved.

Though Vietnam carried out over 100,00 tests, with around 40,000 including foreign returnees in quarantine they also found only 266 patients so far, 97 have recovered. No one has died.

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The curfews now in place in Sri Lanka are expected to flush out any cases running loose as they develop fever or they get better on their own if they are asymptomatic with mild infections.

“It is generally the practice in Sri Lanka for people who get ill to go to the hospital immediately,” Minister Wanniarachchi said.

“So I am confident that we will be able to clear up most cases. So we are in a good position, but that does not mean we will not have isolated cases after we lift the curfew.”

She had said that April 19 marks one month or two 14 day periods where an F(0) and (F1) can develop the disease.

However, at least in one case in Sri Lanka had developed the disease after 21 days.

Sri Lanka’s Military Chief Shavendra Silva said in local television there was almost no chance of a person getting infected in quarantine because in case a person got infected within a building, the set of inmates were kept for another 14 days.

They were released after 28 days, he said.

The key to getting all cases including those possibly without index cases is for any sick person to come forward without fear.

Nationalist Targeting

Sri Lanka’s nationalist activists including the media have been turning the public against minority members of the public who have got infected.

A public health inspector was quoted as saying on television that the Sri Lankans could not celebrate New Year due to Muslims.

However several Muslim index patients escaped the quarantine due to a policy error made by the authorities in not quarantining arrivals from Malaysia early, where the community transmission had taken place but there was little awareness.

Sri Lanka, and also Vietnam which is also contact tracing aggressively, first quarantined passengers from Korea, Italy, and then a series of European nations.

The Muslim patients discovered so far are either index cases or linked to index cases. Patients in quarantine are close associates (F1) or their associates (F2).

Britain which was at first trying to get immunity was also quarantined late in Sri Lanka but early in Vietnam.

Malaysian and Indonesian arrivals were the last to be quarantined as authorities in both Vietnam and Sri Lanka were not aware that the country had then developed community transmission and the countries were the last to be listed for quarantine.

Some were home quarantined though nationalist media portrays them as hiding.

Driven to hiding by Nationalists, Media pundits

Many Cornavirus patients in Sri Lanka who are already frightened for their lives due to the disease are racially scapegoated by media personalities or lambasted for being ‘irresponsible’.

The repeated winding up of the population against Coronavirus patients in general and Muslims, in particular, promoted the head of Sri Lanka’s Health Service to appeal to the media to stop scapegoating victim of Coronavirus earlier in April.

“Please refer to persons infected by Coronavirus as ‘patients’ and not as a person ‘who spread Coronavirus’ to others,” he appealed in a statement.

“When referring to patients taken to quarantine or dead persons do not mention their religion or race.”

Sri Lanka is also cremating the remains of Muslims saying it is to contain the spread of the virus, though the Government Medical Officers Association has pointed out in writing that burial is allowed under World Health Organization rules.

It is not known how long the virus can survive in a dead body.

“Please do not report in a way that increases the mental tension, hopelessness but foster co-operation,” he appealed.

“If not the biggest negative outcome will be that, because infected persons are scared, they will hide and try not to get medical help.”

Sri Lanka’s police have also asked sick persons to come forward pointing out that they have not ‘done anything to be ashamed of to get sick.” (Colombo/Apr14/2020-sb)