Institutional preparedness and response to COVID-19

The Sri Lanka Medical Association (SLMA), in collaboration with the Ceylon Chamber of Commerce and the National Chamber of Commerce, successfully concluded a webinar on institutional preparedness and response to the COVID-19 outbreak. The webinar had over 300 registered participants, and was aimed at members of both Chambers.

Moderated by SLMA President Professor Indika Karunathilake, the panellists included prominent professionals in the medical field; namely Ceylon College of Physicians President Dr. Ananda Wijewickrama, University of Colombo Faculty of Medicine Professor of Medicine Prof. Saroj Jayasinghe, University of Colombo Faculty of Medicine Professor of Community Medicine Prof. Manuj Weerasingha, Ministry of Health, Nutrition and Indigenous Medicine Deputy Director General, Environment and Occupational Health and Food Safety Unit Dr. L.T. Gamlath, Sri Lanka College of Microbiologists President Dr. N. Shirani Chandrasiri, National Chamber of Commerce Health Sector Advisor Prof. Lal Chandrasena and SLMA President Elect Dr. Padma Gunaratne.

Following were some of the issues raised and clarified

Q: How does COVID-19 transmit from person to person?

COVID-19 infection is transmitted by droplets from both symptomatic and asymptomatic infected persons. However, it is believed that the rate of transmission from the asymptomatic person is much lower.

• Direct transmission – Greeting / Physical contact (handshake, hugging)

• Indirect transmission – by droplets during cough, sneeze and touching a contaminated surface

Q: Are there antiviral drugs effective against COVID-19 infection?

Not at the moment, but many drugs are being tested. Ministry of Health has issued detailed guideline for patient management in Sri Lanka.

Q: What is the gold standard test for diagnosis of COVID-19?

A: It is the real-time PCR test done 1 week after the exposure to detect presence of viral RNA. Antibody tests are not useful for diagnosis of the disease. There is no place for screening of all workers with RT-PCR tests. Even if a PCR test becomes negative, it should be repeated if there is a high degree of suspicion of possible infection. There is no guarantee that a person testing negative will not get COVID-9 in future.

Q: Do we have to live with COVID-19?

A: COVID-19 is highly infectious and at present no vaccination is available  against in the foreseeable future. As such, adherence to said measures of avoiding exposure to the infection for at least another 1 -2 years is essential.

Q. Can anyone walk in and get the PCR Test done? 

A: No, It is a medical decision based on the risk of exposure. However, community surveillance in hotspots and contact testing is carried out.

Q. What stage of community spread is Sri Lanka at present?

A: The epidemic is still confined to clusters and there is no evidence of community spread up to now. Tests are carried out among the high-risk community that include the associates of COVID-19 patients and the rate of positivity is much lower even among them, when compared to other countries. However, as country returns to “normalcy”, there is a potential risk of transmission of infection, unless prevention practices are strictly adhered to. Leaving room for errors would lead to development of new clusters and stoppage of work at the company.

Q. Is resurgence of epidemic possible and if so, when?

A: Yes, it’s possible, specially within vulnerable populations such as crowded confined spaces. Therefore, it is essential to be prepared for the worst-case scenario such as a surge of patients in mid-May.

Q. What measures should be implemented to prevent resurgence?

A: A four-pronged, highly coordinated mechanism has to be implemented

1. National Level

2. Institutional measures

3. Law-Enforcement: Prevent overcrowding, spitting in places

4. Individual level

Q. What are the national level measures to control the epidemic?

A: • Daily monitoring, risk assessment based on real time data, surveillance

• Policy on gradual reopening based on risk assessment and economic impact

1 Low risk – high impact industry- eg. Farming, fishing

2. High risk – high impact industry e.g. High populated industrial factories, hospitality

3. Low risk - low impact industry-Where work from home is possible

3. High risk – low impact industry e.g. schools, universities

Q. What are the institutional measures to control the epidemic?

A:• The management should Identify a team/unit for the risk assessment and to develop, implement and monitor an institutional COVID-19 plan.

• Team should develop institutional plan based on guidelines released by the Ministry of Health.

• They should conduct awareness programmes using videos, posters and preparedness drills for workers on hygienic practices

*Company should screen workers at the entrance for temperature and using a questionnaire to reveal on exposure and symptoms of COVID-19  infection.

• Measures should be taken to reduce overcrowding and movement between different sections, dining areas, exit and entry.

• Management should plan for maximum efficiency using minimum number of workers

• Facilities for hand washing/sanitization at entrance, work areas, dining areas and washrooms should be made available.

• There should be a mechanism for waste disposal.

• All surfaces that are frequently touched should be cleaned with disinfectants with 70% alcohol.

• Ensure adequate ventilation keeping doors and windows opened as much as possible.

• Workers should avoid sharing instruments and equipment.

• In case a worker develops suspicious symptoms of COVID-19, there should be a mechanism to isolate the patient ensuring confidentiality and to get medical advice avoiding stigmatization.

• Company should follow the guidelines prepared by the Ministry of Health for workers with risk exposure following a risk assessment.

Q: What about using A/C in a factory/office setting? is it advisable?

• There is a higher risk of transmission if the air is recycled in a closed compartment. If ventilation is with fresh air coming in, the risk is minimum.

The number of people in an A/C room at a given time should be a minimum and use of standard precautions should be encouraged. It is advisable to have good natural ventilation at workplace.

Q: Are decontamination chambers effective in preventing the spread of COVID-19?

A: There is a minimum concentration and a contact time for any disinfectant (alcohol, ozone, TCA) to be effective. These requirements are not met in decontamination chambers. Concentration of certain disinfectants such as ozone that is needed to kill viruses is harmful for humans. All disinfectant chemicals have their own harmful effects. It may either cause asthma or other respiratory symptoms or dermatological symptoms such as allergies. Ozone may cause chest pain, vomiting and abdominal pain. Therefore, disinfectant chambers are not recommended.

• WHO does not recommend the use of decontamination chambers. Please refer the media release posted on the website of the Sri Lanka College of Microbiologist for further information.

Q: Is spraying disinfectants on vehicles effective in prevention?

A: • There is no scientific basis for spraying disinfectants on all types of vehicles.

There are guidelines developed by MOH for disinfecting vehicles that have been used to transport COVID-19 patients. Frequent cleaning and decontamination of surface areas that are frequently touched Eg; handrails, doorknobs etc. is recommended. Ministry of Health has issued detailed guidelines.

Q. Why should we stop the stigma associated with COVID-19?

A: • The stigma will discourage patients to reveal the truth particularly with regard to important points in the history, leading to delayed diagnosis. Therefore, there should not be stigmatization. The employer could display a simple message such as “COVID-19 is a preventable disease” and promote the employees to follow the measures of prevention and to inform the management, in case they develop symptoms. Media should take all measures to maintain confidentiality of patients and to avoid the stigma associated with the disease at present.

A: Q: What is the personal protective equipment (PPE) to be used at the workplace?

• Surgical mask or simple 3-layer cloth mask is adequate for day-to-day use.

Surgical mask gives better protection than the cloth mask. The mask should adequately cover the nose, mouth and chin. After wearing the mask, touching face and adjusting the mask frequently should be avoided. Cloth mask could be boiled and washed with soap and water. Face shield is recommended for industrial settings where splashes can occur. N95 masks are recommended for aerosol generating procedures. Gloves may be worn in environments where there are many customers to deal with (Wearing gloves is not a replacement for hand hygiene or decontamination of surfaces)

Q: What are the individual level measures at workplace? 

A: By following the 4 key steps at your workplace

• Maintain one meter distance from each other

• Wash/sanitize hands regularly

• Minimal touching of possibly contaminated surfaces

• Properly wearing mask

• If you have fever, sore throat, dry cough/suspicion of contact, inform office and get immediate medical advice.

Q: What should be done if a worker develops symptoms of fever or respiratory tract infection?

A:• All workers should be made aware of possible symptoms of illness. The management should promote workers to remain at home if they develop symptoms of fever or respiratory illness. If symptoms develop at workplace, they should isolate the patient immediately and request medical help.

Q: How to be safe when using public transport?

A: • It is useful to carry a pocket, alcohol-based hand rub and to disinfect the hands before getting in and as soon as getting out of the public transport. It is necessary to adhere to the guidelines issued by the government for seating.

Touching of face MUST be avoided during all time.

Q: What precautions should be taken after returning home from work?

A: • Children should not be cuddled soon after returning home. If using a disposable mask, dispose it properly. There should be a dedicated place to keep the belongings. Number of items that you will bring home must be minimised. After returning home, must have a proper body wash straightaway in the washroom. Worn clothes should be washed thoroughly with soap and water, dried and ironed before reuse. If clothes are left for washing later, they should be kept in a sealed bag. Car keys and mobile phones should be disinfected using a sanitizer with 70% alcohol prior to keeping them on the dedicated place.