Are The Doctors From Polonnaruwa Hospital Guilty For Failing To Prevent A Large Covid-19 Cluster In Sri Lanka?

By Wichakshana Dharmawardena –JULY 25, 2020

It’s now July 2020 and the Kandakadu Rehabilitation Centre cluster has happened. The way it appears to me, it happened because two major stakeholders dropped the baton. Those baton dropping stakeholders were A) Primarily, the Epidemiology Unit of the SL Ministry of Health headed by the Chief Epidemiologist B) The doctors who attended on the sick parades of the Rehab Center inmates.

Let’s take the less guilty party first. The doctors who attended the sick parades of the inmates. According to an interview with the Rehabilitation Commissioner General who is a retired and recalled Major General, daily, as is usual with any large enclosed population (such as in boarding schools, resident campuses, military camps) a certain number of the 1000 plus inmate population in the twin centres Senapura and Kandakadu report colds, fevers, coughs, sore throats and stuff. This daily presentation of various symptoms is called ‘the sick parade’. A visiting doctor from the Polonnaruwa hospital attended to this Kandakadu/Senapura Rehab sick parade daily and treated them.

On the face of it, you might feel very strongly that these doctors from the Polonnaruwa Hospital are to blame for disregarding these coughs. sore throats and fevers without conducting PCR tests. You might feel that if they had had the competence, foresight and the smartness to test some of these on the sick parades, Sri Lanka today would be without the heart ache of the widespread Kandakaadu cluster. You might feel that just like a whole bunch of government officers are held accountable today for failing to prevent the Easter attacks, these Polonnaruwa doctors should be sued for medical negligence. But would you be right in feeling this way? If not, why not? Why aren’t these Polonnaruwa doctors guilty of gross negligence at worst and incompetence at best? – 

These doctors are technically not guilty because they had to technically follow testing guidelines set out by the Epidemiology Unit of the Ministry of Health.

But being not guilty on a technicality does not mean there is no guilt. I believe they are GUILTY of not being sharp enough, not being alert enough to the possibility of HIDDEN VIRUS in a community which had up to that point, only been reporting infections from quarantine centres, navy camps and the imported cluster.

That, one or few infected individuals could have escaped the drag net of the active case finding enterprise of the government and may have spread the virus around and given birth to underground cells of the infection was a possibility that the Epidemiology Unit of the SL Ministry of Health constantly warned the public about.

In this, the Epid Unit was acting like the typical government department. It was missing the elephant in the room.

The Epid Unit was too busy warning the public- beware of the hidden virus, there may be some infections that we failed to find and these may have created secret underground infected cells and you might run into these secret carriers of the virus in busses, trains, election rallies, crowded places. so beware, wash hands, wear masks and avoid crowds

All the time, the Unit was missing something, a vital life lesson the CHIEF EPIDEMIOLOGIST should have learnt at his mother’s knee – ඔවා දෙනු පරහට තමා සම්මතයෙ පිහිටා සිට. Before pontificating to the public about the threat of the hidden virus, secret infection cells, he should have put his own house in order by updating the clinically suspected case definition of Covid 19, to enable non-specialist medical practitioners, dealing with the general public, to detect underground infected cells.

IF there were some infected persons they missed in their first round of cluster extinguishing, active case finding missions, and if these escaped infections had created secret infected cells, these new secret infections will NOT present with an open contact history, they will NOT have a travel history because Sri Lankans have not been travelling overseas since March. They will NOT have a history of travel or residence in an area designated as a high Covid transmission area. 

Trying to detect a person from the community who had got infected through one of these hypothetical secret cells, using the Epid Unit case definitions would be like trying to detect an ISIS terrorist using the following definition- ‘if a person wears a black burka, carries a long sword and displays on his garment in Arabic letters, the legend ‘Kill the infidel’, investigate him he could be a terrorist’. When the terrorist presents as a clean-shaven handsome youth in Levi’s and a funky t-shirt, this definition will fail and those depending on the definition will fail to investigate.

Similarly, during the first round in Sri Lanka, infected Nalin, infected Haneem and infected Anjan would have had a clear contact history, travel history, residence in a high transmission area when they presented to the not too sharp, non-specialist medical practitioner with cough, sore throat, fever, phlegm and sneezing. The Epid case definitions would have been enough then, to enable the not too sharp, non-specialist medical practitioner to categorise them as suspicious cases and refer them for testing. But not in the second round. When the infected Roshan, infected Ijaz and infected Mallar, having been inducted into Covid 19 by a secret cell, birthed by an infected person who escaped the active case finding drag-net during the first round, presented with cough, fever, sore throat, sneezing, the average medical practitioner will pass them by with a yawn because the Epid case definitions do not have them covered.

So, what are these Epid case definitions?

The Epid Unit of Sri Lanka, on the face of it, are good fellows. According to (https://www.epid.gov.lk/…/final_draft_of_testing_strategy_v…) the latest published version of Sri Lanka’s Covid testing strategy, CASES WITH COVID-19 LIKE SYMPTOMS FROM THE COMMUNITY THAT FIT INTO SUSPECTED CASE DEFINITION should be tested. This is good right? Way better than some areas of the world where they require your Oxygen Saturation level to drop to a certain dangerous level before you are eligible to get any medical assistance let alone a test? It Sounds better certainly. But is it? A lot depends on THE SUSPECTED CASE DEFINITION. According to the latest circular, (https://www.epid.gov.lk/…/Corona_v…/covid-19_cpg_version.pdf), “The present recommendation is to isolate and test all clinically/epidemiologically suspected cases of COVID-19 infected patients”

And a clinically suspected case is?

. A. A person with ACUTE RESPIRATORY ILLNESS (with Cough, SOB, Sore throat; one or more of these) with a history of FEVER (at any point of time during this illness), returning to Sri Lanka from ANY COUNTRY within the last 14 days.

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