Indika Karunathilake -

IntroductionSri Lanka is a lower-middle income country in the South Asian region. Sri Lanka’s COVID-19 response is characterised by a strong focus on a preventive approach with rational utilization of available resources. For most of the course of the pandemic, all patients who tested positive were managed at healthcare institutions. Asymptomatic or mildly symptomatic patients were admitted to Intermediate Care Centres for monitoring and symptomatic management and discharged in 14 days. Those with marked symptoms, uncontrolled comorbidities and other complications were admitted to hospitals for closer monitoring and specialized management1,2 .Even though this approach proved efficient during the initial phase of the pandemic in 2020, it was sustainable due to the rapid rise in case numbers since July 2021. During the peak of the surge, the number of daily reported test positive patients exceeded 5000 (220 cases per million population and ranked 50th in the world-wide affected country list) and the actual number of estimated new patients per day was around 6000 to 90002,3. Even an increase of the number of beds allocated for COVID-19 patients to 34000 was not adequate. Increase in number of deaths was unprecedented. The number of healthcare workers available for the functioning of the system too declined with a significant proportion acquiring the infection and the remaining workforce on the verge of physical and mental exhaustion. The healthcare system of the country was reaching a tipping point4,5. The priority shifted towards triaging and identifying those who need immediate medical intervention at the earliest stage of the disease to reduce severe disease and death. This was necessary to prevent overburdening the already fraught hospitals as well as staff and to conserve bed space for severely affected or vulnerable patients who needed specialized care in hospitals3.