By Sulochana Ramiah Mohan Courtesy Ceylon Today

The Eastern Province of Sri Lanka, one of the most salubrious provinces that is home to both an internationally-known natural harbour and locally-infamous lover’s leap, remains calm in the face of the raging pandemic, as none of its residents have reported the contraction of COVID-19.

The Province, comprising the three Districts of Batticaloa, Ampara and Trincomalee, and of four regions including Kalmunai, has performed outstandingly at a time the country, like much of the world, was brought to a standstill due to the rapid spread of the virus.

The curfew was lifted many times in the East, unlike in other provinces, and the people had more freedom of movement. Most towns were active, unlike those in Districts such as Colombo, Gampaha and Puttalam, which remained ghostly in the last one-and-a-half months.

This is because the people of the East had been cautious about the situation ever since Sri Lanka’s first COVID-19 case, when a woman from China was diagnosed in February. The mission that was then mounted by the East to prevent the disease is worth noting.

Not a single case of COVID-19 was reported among residents of the Trincomalee District. Outsiders accounted for all cases in the region, two of whom had returned from overseas and others that were sent to a quarantine centre in the area.

This successful effort to keep Easterners safe from the life-threatening disease that has paralysed the world in the last three months or so, was made possible by the Eastern Province Health officials, along with the Police and the Tri Forces, who began planning to combat it from the month of February, when the world saw it coming from Wuhan, China.  

When the World Health Organisation (WHO) urged nations to treat the pandemic as an extreme situation, the Public Health Service of the Eastern Province took it seriously and began their mission to combat it as if it had already spread in the Province.

Moreover, people in the East, like Northerners, are not culturally inclined to shake hands, or hug and kiss each other, which could have contributed to controlling the spread of the pathogen. They also tend to live within their communities and traditionally cook their own meals, avoiding fast food and restaurants.

Today there are 14 quarantine centres in the East for COVID-19 cases, namely two in Ampara, four in Batticaloa, four in Trincomalee and four in Kalmunai, and the Government has spent Rs 43 million in the last three months on the Eastern Province’s mission to combat COVID-19.

The war-ravaged North and East have been classified as neglected provinces, where the demand for facilities and proper services from the public and private sectors are comparatively higher than other provinces.

The Easterners’ way of life calls for sharing and caring among their own communities, a practice that evolved naturally over decades of war. In the face of the ongoing pandemic, however, they have prioritised personal health, being vigilant of strangers visiting their areas.

This is because the Easterners were given special programmes on avoiding contact with others and maintaining social distancing. Health officials also taught them not to wait till masks are available, but to stitch their own using clean cloth.

Health Services’ efforts to fight COVID-19 in the East

Provincial Director of Health Services for the Eastern Province, Dr. Lathaharan Alagiah told Ceylon Today about the success story of keeping the East safe from COVID-19.

He recalled how in mid-February they began conducting awareness programmes in the four regions to warn people of the spread of COVID-19 and how entire neighbourhoods would be affected by even a single infected individual. These were conducted via mobile announcements, door-to-door awareness campaigns, and pocket meetings for officials.

He said the Public Health Service in partnership with the Tri-Forces began their preventive efforts at the early stages of the crisis, which brought about the campaign’s success.

“The hospitals and Medical Officers of Health (MOH) units were involved in rigorous COVID-19 preventive measures, even when there were no cases reported in the East. The public health service of the Eastern Province also had a daily activity chart, explaining what they did for the day, and holding conference calls to share information with the relevant bodies,” he explained.  

“These activities were in line with the World Health Organisation (WHO) guidelines, which encouraged all countries to continue preparedness activities and issued interim guidance on how to do this. This included information on how to monitor for sick people, test samples, treat patients, control infection in health centres, and maintain the right supplies.”

Prevention over cure:Coordinated efforts

He noted that the first reported cases were from Batticaloa, when a man from the UK tested positive for COVID-19, and Akkaraipattu, when a man who had returned from Dubai was found to be carrying the virus, which had also spread to his wife. “These three cases were within the region and they were cured,” he said, adding there were also two Navy personnel who were sent from Welisara from the Western Province, and not from the East.

During their early planning to combat the virus, Dr. Alagiah said they held a series of meetings, for internal and sectoral coordination and among MOH units, and between regional leaders and the Senior DIG of the Eastern Province.

The awareness programmes then began in mid-February 2020. “We began telling the public how fast COVID-19 could spread. There are 46 MOH in the East working in the four regions and three districts. The MOH started working with the Public Health Inspectors (PHIs) and midwives to educate the public.”

He pointed out that another success story was how the Kattankudy Quarantine Centre was established at the Base Hopital within a few weeks, allowing for suspected patients to be isolated for treatment.

This location saw 62 suspected cases arriving from quarantine centres in the East, 55 of whom were discharged by 10 May. Despite only presenting mild symptoms, they were treated as COVID-19 patients, and were given a nutritious diet that included fish, vegetable and fruit.

The regional technical officers of the Epidemiology Unit work with the Public Health Service doctors in the four Regional Directors of Health Services (RDHS), who in turn work with the Senior DIG of the Eastern Province, Nilantha Jayewardene.  The MOH are assigned to work with the SSPs of the 43 divisions of the Eastern Province. 

Also, the RDHS and the district’s COVID-19 Taskforce, along with all categories of public administration, are linked up with the Tri-Forces, especially the Army, which have offered excellent coordination for the COVID-19 mission thus far.

The first case onwards

The best way to restrict the spread was by tracing the primary and secondary contacts of the infected person, which happened quickly when the patient from the UK was detected.

When it was discovered that this man was positive for COVID-19, the PHI rushed with his team to trace his primary and secondary contacts, which amounted to 17 in number, all of whom were sent to quarantine centres within a day. Likewise, the teams have quarantined 17 people from Batticaloa, 81 from Kalmunai and 18 (Navy personnel) in Trincomalee; 114 in total. They were all treated, cured and released.

Although the COVID-19 spread was initially curtailed through the prolonged lockdown, it spread quite rapidly, given the fact that many Sri Lankans from overseas returned home before the airport was shut down. “However, the public health system in Sri Lanka is one of the best in the Asian region and we have set a good example,” noted Dr. Alagiah.

He pointed out the Health Ministry intermittently issued circulars, which were quickly acted upon, and provided all facilities to fight the spread of COVID-19.

“The simple rule of having one’s personal health be the top of the agenda saves everyone; this is the only message we can give to start with,” Dr. Alagiah stated.

Balancing civil life with safety

Eastern Province Governor, Anuradha Yahampath noted that their efforts got off to a good start when the first patient was identified and all those who associated with him were sent to quarantine. Subsequently, village-level lockdowns, which required people to remain at home for 14 days, were implemented days whenever suspected cases came to light. She added, “There was no big shout over this. We explained the situation and calmed the villagers.”

She also added that tourists were asked to remain indoors and not move about in towns when the curfew was lifted, adding, “Before the Bandaranaike International Airport was shut down, we provided transport for tourists who wished to leave the country.”

Public Health Service, Eastern Province Director of Planning, Mohammed Faiz said that they followed two methods to fight the virus – prevention and curative. 

“We primarily wanted to take all preventive measures against COVID-19, on seeing the fast-spreading nature of the virus. We acted swiftly to ensure foreigners remain indoors and cancel their tour plans within the country. By 15 March, all activities were halted and people were asked to live in isolation as much as possible.”

Meanwhile, quarantined families and individuals are given dry rations to cook their three daily meals, while the curfew was lifted every three days, so there was no confusion; and the Tri-Forces continue to do their best to serve the people during this time.

Wearing a mask is a must for anyone stepping outside the house, while vendors have been permitted to sell vegetable and dry rations from house to house. Fish markets are being run on district borders so that trading can carry on without people crossing over, as travel between districts is strictly prohibited.

While the authorities’ efforts to curtail the spread of COVID-19 are commendable, it must also be noted that the Eastern Province’s residents have played their part by taking responsibility and cooperating with the guidelines and directives issued. As Governor Yahampath stated, “People are continuing their lives in this manner these days.”