Introduction
Sri 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.