(MENAFN- Colombo Gazette)
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Charter flight arrivals underwent 28-day quarantine - Will implement corrective measures based on investigation outcome, says DGHS
- Latest developments show Covid reinfection after one month possible, says Chief Epidemiologist
By B. Mohan
Whilst the second wave of the pandemic in the island is showing no signs of abating, the ground situation is getting worse with it compounding larger socioeconomic issues.
Tensions continue to rise almost two months following the emergence of the second wave from the Brandix apparel factory in Minuwangoda on 3 October and stigma and discrimination are rife within society against the company and its workers.
Adding to the strife is the investigation, at the instructions of Attorney General Dappula de Livera, into the source of the second wave; government servants and Brandix and its agents are at the center of the investigation.
Brandix, having chartered three flights to bring down its employees from Visakhapatnam, India, the last of which landed on 22 September, was blamed for bringing the virus into Sri Lanka, in spite of the Army Commander and Head of the National Operations Centre for Prevention of Covid-19 Outbreak (NOCPCO) Lt. Gen. Shavendra Silva confirming the employees had adhered to the stipulated health guidelines.
Meanwhile, as per media reports, Brandix's factory employees seem to be facing the worst backlash and discrimination in their communities.
It is in this context that the Colombo Gazette sought to get in touch with Brandix employees who had returned to Sri Lanka on the three flights chartered by the company, to investigate the matter.
We were informed that the flights landed at Mattala Rajapaksa International Airport on 25 June, 8 August, and 22 September and had carried 167, 125, and 48 employees, respectively.
Meanwhile, we learned that only Sri Lankans were flown in, and the company's Visakhapatnam Sri Lankan cadre have designations of the executive level or above.
First-hand accounts: From the time of landing
'Upon arrival, before entering the (Mattala) airport building, all of us were asked to remove our PPE (personal protective equipment), which was disposed of by the Sri Lanka Army. We were issued fresh equipment,' shared Manager – Human Resources Harsha Liyanage, one of the returnees on the third flight. 'The employees had to undergo PCR tests which were administered by Durdans Hospital staff whilst the Sri Lanka Army supervised.'
Senior Executive Saman Ekanayake travelled on the second flight with his family. His two-month-old daughter was born in India as they were unable to travel to Sri Lanka in time for her birth, in spite of the company making the request to local authorities some months prior.
Speaking to the Colombo Gazette, he said: 'Once we were in the airport, the Army supervised our every move. Once we had cleared immigration, we were all transported in buses, where they allowed only a maximum of 20 persons per bus.'
Senior Executive Senaka Ekanayaka, who had also arrived on the second flight which landed on 8 August, said: 'Once we got to the hotel, we went through the disinfection process along with our baggage. Then, the Army Major gave us a briefing on the 14-day quarantine.'
Asked whether the PHIs were present to supervise the quarantine at the hotel, Senaka stated that there were no PHIs.
Liyanage informed the Colombo Gazette that all the employees at the hotel were isolated in their rooms and were only allowed to communicate with each other over the phone. 'Our movement was highly restricted. We were confined to our rooms and not allowed to come out.'
The Colombo Gazette learned that while the employees from the first flight were sent to two hotels – Sheraton Kosgoda and Blue Water, those from the second and third flights were sent to Koggala Beach and Sheraton Kosgoda, respectively.
The results of the PCR tests taken at the airport by the Durdans Hospital staff were sent to the hotel one-and-a-half days later, and those who tested negative had to complete the quarantine at the hotel.
On the 10th day of quarantine, they were subjected to a second PCR test.
Figure 3 Employees who arrived on the third charter flight lining up for PCR tests at Sheraton Kosgoda on the 10th day of quarantine
If the employees' tested negative again, upon completion of the 14-day quarantine period at the hotels, they were issued clearance certificates signed by Army Commander Lt. Gen. Silva and the Director General of Health Services.
The Colombo Gazette examined the certificates issued to Liyanage, Saman, and Senaka, and all three were signed by the Army Commander.
In addition, Saman's and Senaka's certificates, which were dated 8-22 August, displayed the signature of Dr. Anil Jasinghe.
Interestingly, Dr. Jasinghe was transferred from his post as the Director General of Health Services, and assigned to the Ministry of Environment as its Secretary. A call to the office of the Secretary to the Environment Ministry on Thursday (26) confirmed he had assumed duties in his new role on 14 August, a week prior to the date on these certificates which bear his signature.
Meanwhile, Liyanage's certificate was dated 22 September-6 October. He had arrived on the third and last flight.
His 14-day quarantine at the hotel, along with the other 47 arrivals, ended three days after the first Covid-19 patient of the second wave was reported in Minuwangoda, meaning the employees were at the hotel when the second wave was discovered.
14-day home quarantine
Prior to departing the hotel, the employees were instructed to inform their area PHIs and Police of their imminent arrival.
Senaka, a resident of Katana, shared: 'The area PHI and Police spoke to me after I got home. They monitored me during the next 14 days.'
Asked if the PHI had requested information on Senaka's employer, he responded in the negative, but said he had volunteered the information, which meant his area PHI was aware that Senaka was an employee of Brandix.
The Colombo Gazette spoke to Katana PHI R.E.R.P. Ishan Nadeera, who had supervised Senaka's 14-day home quarantine and whose signature was on Senaka's MOH certificate issued at the end of his home quarantine. PHI Nadeera shared: 'Yes, I knew he was from Brandix.'
Asked if it was required to obtain information on the employer in this circumstance, he responded: 'No it is not and we do not have such a requirement.' PHI Nadeera added that the documentation only requires that the country from which the individual travelled be recorded.
An examination of the certificates issued to Saman (Kuliyapitiya MOH) and Harsha (Horana MOH) too contained information on their country of departure only.
'Lifeline of the organization': Walking the talk?
Responding to inquiries by the Colombo Gazette on why Brandix opted to bring down their workers during such a concerning time, amidst a pandemic, the employees we spoke to shared that the company was granting the requests of the employees themselves.
Several employees in Visakhapatnam had requested to travel to Sri Lanka due to various pressing matters they had to attend to at home.
Saman said he had to ensure his two-month-old daughter received all the medical attention she needed such as vaccines, etc. as he did not want to take the risk of exposure in hospitals in India; Senaka shared his father's health was in critical condition, who had passed away after Senaka's arrival in Sri Lanka; and Liyanage stated his last visit to Sri Lanka was in January when he got married, and he had not seen his wife since.
In addition, they clarified that not all the employees who made requests were granted the necessary approval, as it was given on a case by case basis.
Asked if any of them visited the Minuwangoda apparel factory, they responded that there was no necessity for them to do so. Senaka explained that the company operates in clusters, and the Visakhapatnam cluster has no connection to the factory in Minuwangoda.
After the first cases in Minuwangoda were discovered in October, Brandix issued a statement which said the factory had been adhering to the workplace Covid-19 health guidelines stipulated by the Health Ministry since its introduction earlier in the year.
Curious about the monitoring process in place for workplaces in general, including factories, the Colombo Gazette reached out to Health Services Director General Dr. Asela Gunawardena, who stated: 'Whether they are adhering to the guidelines will be periodically monitored by the area MOH and PHI.'
Asked him to clarify, Dr. Gunawardena said: 'It is up to the area PHIs and MOH offices depending on their workload. So they may monitor weekly, monthly, twice a week; it essentially depends on their workload at the grassroots level.
'However, the responsibility to adhere to the guidelines is vested with the head of the organization because the health sector, Police, or tri-forces cannot practically be responsible 100%; the general population has to bear 50% of the responsibility.'
Asked if he had any information about the source of the Minuwangoda cases, he stated that investigations were ongoing to get to the bottom of the matter. He added: 'On the basis of the results of the reports, we will have to revisit all the guidelines and implement corrective measures if necessary.'
What of the employees who tested positive?
We learnt that of the total employees who returned to Sri Lanka, none tested positive on the third flight; one tested positive on the second flight, and was sent to the Infectious Diseases Hospital (IDH) for treatment; and 13 tested positive on the first flight after undergoing their second PCR test at the Blue Water hotel.
The Colombo Gazette had the opportunity to speak to one employee from this group.
Senior Executive – Administration Rohana Mallawarachchi arrived on the first charter flight that landed on 25 June this year.
Mallawarachchi stated he was part of the group that was sent to Blue Water hotel, while another group from the same flight was sent to Sharaton Kosgoda. He said he had arrived at the hotel on the morning of 26 June. None of the employees tested positive for Covid-19 at the time based on the results of the PCR tests taken at the airport.
'After the 10th day at the hotel, they took another PCR test. And the results came in the evening the day after. 13 out of the 78 of us who were at Blue Water tested positive for Covid. We got to know at the time that no one from the other lot who were staying at the Sheraton Kosgoda had tested positive after their second PCR tests,' Mallawarachchi explained, who was part of the 13 who tested positive.
They were taken to the Panadura Hospital in an ambulance the next morning, where they underwent an additional PCR test. Nine out of the 13 tested positive for Covid-19 once again, including Mallawarachchi, and they were then admitted to IDH.
Speaking of his treatment at the hospital, Mallawarachchi shared: 'They took PCR tests five and eight days after I was admitted. We were also given medication, while their main intention was to strengthen our immunity to the virus.'
'11 days after being admitted, they took a blood test from me to determine my level of immunity. And upon receiving the results, they discharged me.'
Mallawarachchi meanwhile informed us that following his discharge, he was required to quarantine at home for a period of 14 days which was supervised by the PHI of Mahawilachchiya. Seen by us, the MOH certificate issued to him confirms this.
Upon inquiry, Mallawarachchi stated he did not at any point visit the Minuwangoda factory.
Asked whether a PCR test was taken before he was discharged, Mallawarachchi responded: 'The last PCR test they took from me was three days before I got discharged, which came back positive.'
Concerned about the release of a patient whose latest test result came back positive, the Colombo Gazette spoke to Chief Epidemiologist Dr. Sudath Samaraweera about the criteria by which Covid patients are released.
'If patients are asymptomatic, world evidence suggests that after 10-14 days they will not be transmitters of Covid-19, even if they test positive,' said Dr. Samaraweera, adding that once the patients are released, they are required to undergo mandatory quarantine at home for 14 days which is supervised by the area PHI.
He then clarified that the criteria was different for patients who continued to display symptoms, and explained that the clinician overseeing the treatment would decide on the same, which could also differ on a case by case basis.
Balancing risks and benefits
The World Health Organisation's (WHO's) interim guidance on the clinical management of Covid-19, updated on 27 May 2020, provided updated recommendations on the criteria for discharging patients from isolation. This updated criteria reflects recent findings that patients whose symptoms have resolved may still test positive for the Covid-19 virus (SARS-CoV-2) by RT-PCR for many weeks. Despite this positive test result, these patients are not likely to be infectious and therefore are unlikely to be able to transmit the virus to another person.
It also stated: 'The updated criteria for discharge from isolation balances risks and benefits; however, no criteria that can be practically implemented are without risk. There is a minimal residual risk that transmission could occur with these non-test-based criteria.
'There can be situations in which a minimal residual risk is unacceptable, for example, in individuals at high risk of transmitting the virus to vulnerable groups or those in high-risk situations or environments. In these situations, and in patients who are symptomatic for prolonged periods of time, a laboratory-based approach can still be useful.'
Asked Dr. Samaraweera if Sri Lanka adopts the WHO's procedures for releasing patients, he clarified: 'It is not based on only that. We consider worldwide clinical evidence, and a technical expert group meets regularly and reviews all the findings, based on which we develop our management criteria.'
Covid-related recommendations are based on the limited knowledge gathered so far by scientists and experts over the past year since the virus was discovered. Testament to this is the discovery of its ability to evolve into multiple strains only some months ago, with information still lacking on how and why exactly it reacts differently in different people.
We asked Dr. Samaraweera if this could mean that patients who are discharged from hospitals may still be transmitters of the virus. In response, the Chief Epidemiologist explained that the possibility was very, very remote, adding: 'Whilst we know that patients recover after 14 days, we still send them home for quarantine for another 14 days. That means that if there is that chance of transmission, that will be counteracted by that process.'
He also added that some latest developments have revealed that people can be reinfected as well. 'In several countries, reinfection has been detected. However, the numbers are small. For example, 243 were identified in Qatar, 285 in Mexico, 150 in Sweden, 95 in Brazil, 50 in the Netherlands, which are small numbers when you consider the millions of cases that are reported in the world.
'But that risk is still there. As such, now even after a patient who has been discharged develops similar symptoms a month afterwards, they should be tested, and if positive for Covid-19, it will be considered as a possible reinfection.'
The source of the second wave in Sri Lanka is yet a mystery to the authorities, one that will hopefully be solved upon completion of the CID investigation sooner rather than later. (Colombo Gazette)
Image shows Brandix employees from the third charter flight (which landed on 22nd Sept.) submitting samples for PCR tests before being allowed into the airport premises. The tests were taken by Durdans Hospital staff
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