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Sri Lanka’s early success in the containment of COVID-19 through its rapid response: Clinical & epidemiological evidence from the initial case series

BACKGROUND: Despite the rising global burden, Sri Lanka reported a relatively low caseload and mortality (13 deaths as of 20 October 2020) for COVID-19. This warrants exploration of the clinical and epidemiological characteristics of the case series during the initial passive case detection phase in...

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Autores principales: Arambepola, Carukshi, Wickramasinghe, Nuwan Darshana, Jayakody, Surangi, Hewage, Sumudu Avanthi, Wijewickrema, Ananda, Gunawardena, Nalika, Dhanapala, Sapumal, Prathapan, Shamini
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Public Library of Science 2021
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8321098/
https://www.ncbi.nlm.nih.gov/pubmed/34324587
http://dx.doi.org/10.1371/journal.pone.0255394
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author Arambepola, Carukshi
Wickramasinghe, Nuwan Darshana
Jayakody, Surangi
Hewage, Sumudu Avanthi
Wijewickrema, Ananda
Gunawardena, Nalika
Dhanapala, Sapumal
Prathapan, Shamini
author_facet Arambepola, Carukshi
Wickramasinghe, Nuwan Darshana
Jayakody, Surangi
Hewage, Sumudu Avanthi
Wijewickrema, Ananda
Gunawardena, Nalika
Dhanapala, Sapumal
Prathapan, Shamini
author_sort Arambepola, Carukshi
collection PubMed
description BACKGROUND: Despite the rising global burden, Sri Lanka reported a relatively low caseload and mortality (13 deaths as of 20 October 2020) for COVID-19. This warrants exploration of the clinical and epidemiological characteristics of the case series during the initial passive case detection phase in Sri Lanka, in order to understand the success in containment of the disease for more than nine months in the country through its initial early and rapid pandemic response. METHODS: A retrospective study was conducted using secondary data (hospital records and investigation reports) extracted from all laboratory-confirmed patients admitted to the three main state-sector hospitals in Sri Lanka from 11 March to 7 April 2020. Clinical outcomes were categorized as mild, severe and critical, as per the international classification. Kruskal-Wallis H, Mann Whitney U and Fisher’s exact tests compared differences between the variables. RESULTS: The case series comprised 146 live discharges and six deaths. Majority were males (63.2%); mean age of 40.9 (SD = 17.9); and symptomatic (72.4%). Sixty-one (40.1%) had co-morbidities, the commonest being diabetes (20.4%) and hypertension (17.8%). Mild (93.4%), severe (2.6%) and critical (4.0%) disease outcomes were noted. Disease severity was significantly higher with older age (p = 0.037), co-morbidities (p = 0.026); and higher white-cell (p = 0.045) and lymphocyte (p = 0.043) counts; but not with being symptomatic (p = 0.683). The commonest symptoms were fever (62.5%), dry cough (48.0%) and sore throat (26.9%). The median duration (IQR) was 3.0 (1.0–5.0) and 18.0 (15.0–29.5) days, respectively before and during hospitalization. CONCLUSIONS: In contrast to high-risk countries, the younger age, milder disease and low mortality observed in local patients during the initial phase of the pandemic, reflect the early success in containment of the pandemic in Sri Lanka. However, once the disease becomes severe, the factors determining disease fatality remain the same as in other countries. This highlights the value of establishing strong public health systems and disease surveillance in a country, which could provide long-term effects on disease control.
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spelling pubmed-83210982021-07-31 Sri Lanka’s early success in the containment of COVID-19 through its rapid response: Clinical & epidemiological evidence from the initial case series Arambepola, Carukshi Wickramasinghe, Nuwan Darshana Jayakody, Surangi Hewage, Sumudu Avanthi Wijewickrema, Ananda Gunawardena, Nalika Dhanapala, Sapumal Prathapan, Shamini PLoS One Research Article BACKGROUND: Despite the rising global burden, Sri Lanka reported a relatively low caseload and mortality (13 deaths as of 20 October 2020) for COVID-19. This warrants exploration of the clinical and epidemiological characteristics of the case series during the initial passive case detection phase in Sri Lanka, in order to understand the success in containment of the disease for more than nine months in the country through its initial early and rapid pandemic response. METHODS: A retrospective study was conducted using secondary data (hospital records and investigation reports) extracted from all laboratory-confirmed patients admitted to the three main state-sector hospitals in Sri Lanka from 11 March to 7 April 2020. Clinical outcomes were categorized as mild, severe and critical, as per the international classification. Kruskal-Wallis H, Mann Whitney U and Fisher’s exact tests compared differences between the variables. RESULTS: The case series comprised 146 live discharges and six deaths. Majority were males (63.2%); mean age of 40.9 (SD = 17.9); and symptomatic (72.4%). Sixty-one (40.1%) had co-morbidities, the commonest being diabetes (20.4%) and hypertension (17.8%). Mild (93.4%), severe (2.6%) and critical (4.0%) disease outcomes were noted. Disease severity was significantly higher with older age (p = 0.037), co-morbidities (p = 0.026); and higher white-cell (p = 0.045) and lymphocyte (p = 0.043) counts; but not with being symptomatic (p = 0.683). The commonest symptoms were fever (62.5%), dry cough (48.0%) and sore throat (26.9%). The median duration (IQR) was 3.0 (1.0–5.0) and 18.0 (15.0–29.5) days, respectively before and during hospitalization. CONCLUSIONS: In contrast to high-risk countries, the younger age, milder disease and low mortality observed in local patients during the initial phase of the pandemic, reflect the early success in containment of the pandemic in Sri Lanka. However, once the disease becomes severe, the factors determining disease fatality remain the same as in other countries. This highlights the value of establishing strong public health systems and disease surveillance in a country, which could provide long-term effects on disease control. Public Library of Science 2021-07-29 /pmc/articles/PMC8321098/ /pubmed/34324587 http://dx.doi.org/10.1371/journal.pone.0255394 Text en © 2021 Arambepola et al https://creativecommons.org/licenses/by/4.0/This is an open access article distributed under the terms of the Creative Commons Attribution License (https://creativecommons.org/licenses/by/4.0/) , which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
spellingShingle Research Article
Arambepola, Carukshi
Wickramasinghe, Nuwan Darshana
Jayakody, Surangi
Hewage, Sumudu Avanthi
Wijewickrema, Ananda
Gunawardena, Nalika
Dhanapala, Sapumal
Prathapan, Shamini
Sri Lanka’s early success in the containment of COVID-19 through its rapid response: Clinical & epidemiological evidence from the initial case series
title Sri Lanka’s early success in the containment of COVID-19 through its rapid response: Clinical & epidemiological evidence from the initial case series
title_full Sri Lanka’s early success in the containment of COVID-19 through its rapid response: Clinical & epidemiological evidence from the initial case series
title_fullStr Sri Lanka’s early success in the containment of COVID-19 through its rapid response: Clinical & epidemiological evidence from the initial case series
title_full_unstemmed Sri Lanka’s early success in the containment of COVID-19 through its rapid response: Clinical & epidemiological evidence from the initial case series
title_short Sri Lanka’s early success in the containment of COVID-19 through its rapid response: Clinical & epidemiological evidence from the initial case series
title_sort sri lanka’s early success in the containment of covid-19 through its rapid response: clinical & epidemiological evidence from the initial case series
topic Research Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8321098/
https://www.ncbi.nlm.nih.gov/pubmed/34324587
http://dx.doi.org/10.1371/journal.pone.0255394
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