Abstract
BackgroundDespite 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.MethodsA 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.ResultsThe 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.ConclusionsIn 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.
Highlights
COVID-19 pandemic has become the greatest calamity that the humankind has faced since World War II
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
The information related to South Asia on COVID-19 pandemic is scarce, we report the disease epidemiology, clinical presentation, course, treatment and outcomes of the series of laboratory confirmed patients in the initial passive case detection phase in Sri Lanka, in order to understand the successful containment of the disease for a sustained period in the country
Summary
COVID-19 pandemic has become the greatest calamity that the humankind has faced since World War II. Quite ironically, Sri Lanka, an island nation in the Indian Ocean reported one of the lowest number of deaths in Asia (13 deaths along with 5811 cases as of 20 October 2020), which had stabilized around not more than five deaths per day until late March 2021 [3] This signifies a unique situation in contrast to the rising number of cases as well as deaths during this period within its closest neighbour, India. 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
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