By Kalinga Tudor Silva, University of Peradeniya, Sri Lanka
This essays builds on my previous research on history of malaria epidemics in Sri Lanka, intergenerational support mechanisms for elderly and ongoing research work on identity, infection and fear within the context of CIVID-19 pandemic. This work points to the relevance of ageing within the Sri Lankan population as well as the participation of Sri Lankan migrant workers in overseas destinations in home-based elderly care in understanding and responding to the COVID-19 epidemic in the country.
Ageing in Sri-Lanka
Sri Lanka is a middle-income country with a rapidly ageing population. In 2018, people aged 65 years and older comprised 9.67% of the total population in the country. Sri Lanka has many risk factors for COVID-19 infections. A substantial section of Sri Lankans (an estimated 20 to 25 per cent of the total working population) work overseas. Two of the more popular destinations for Sri Lankan migrant workers are Italy and South Korea, two leading COVID-19 hot spots in the world. On the other hand, a large number of Chinese workers are employed in development projects in Sri Lanka. Sri Lanka also relies heavily on tourism, as an expanding sector of the economy. In fact, the very first COVID-19 patient discovered in Sri Lanka on March 11, 2020, was a tourist from China, Later, a tour guide serving a different tourist group became the first Sri Lankan to be identified with the virus locally. A rapidly ageing population is another significant risk factor adding to the potential infection rate in the country, but from the information available so far its potential impact on corona infections has been neutralized. Why this is so, requires further reflection.
COVID-19 in Sri Lanka
The total number of confirmed COVID-19 patients in Sri Lanka as of May 25, 2020, was 1141. The total number of deaths attributed to the disease was 9. As a population ratio, COVID-19 morbidity was 0.5 per 100,000 population, a relatively low figure compared to other COVID-affected countries. The mortality rate among COVID-19 patients was 0.79 per 100 patients. In the data published by the Ministry of Health in Sri Lanka, gender and age distribution of patients or the deceased is not mentioned, making it not possible to do a thorough analysis of COVID-19 infections in relation to population ageing. However, with a few exceptions, a vast majority of the infected persons appear to be working-age people who were exposed to the disease while working in Sri Lanka or abroad. A good indication of this is that 640 out of 1141 patients diagnosed as of May 25, 2020 (56 per cent) were currently employed in the security forces. Almost 80 per cent of all elderly in Sri Lanka live with their children or in close proximity to their children, usually within a walking distance. This has prevented the rapid spread of the disease to the elderly through elderly homes or elderly communities as reported in some western countries. One could argue, however, that the co-residence with children makes them vulnerable to cross infections from younger generations. This has indeed happened in a few cases reported in mass media, but generally, the rigorous quarantine process and contact tracing followed in Sri Lanka where security forces have worked side by side with public health personal to trace every contact of the infected or those vulnerable for infection such as travellers returning from certain overseas destinations has minimized cross infections from the infected to the home-bound elderly.
Local vs. official responses
One person who died of coronavirus in Sri Lanka was a 72-year old man named “Mohamed” from a crowded neighbourhood in central Colombo and he was reportedly infected by his son-in-law who had returned from overseas prior to the quarantine process noted above was instituted. Mohamed, who was admitted to Sri Jayawardenepura Hospital with complications due to diabetes, hypertension and kidney failure, was later diagnosed with the coronavirus and transferred to the Infectious Disease Hospital (IDH). He died on admission to IDH. His body was cremated following the official protocol imposed by health authorities disregarding the religiously sanctioned Islamic practice of burial of Muslim dead bodies. Mandatory home quarantine was imposed on the entire Maradana neighbourhood where he came from and his family and some of the neighbouring families were moved to a quarantine centre outside Colombo in order to monitor their disease status and make sure that they will not infect others. This example illustrates how a young Sri Lankan worker overseas brings home the disease and infects an elderly person with other health complications in his family within an urban low-income setting. It also shows how the official response to the disease has disregarded the cultural diversity and the Islamic custom of burying the dead body in spite of many protests against this practice by Islamic leaders in the country.
Mobility and the pandemic
Finally, it has to be noted that population ageing in other countries had a considerable impact on the onset of the epidemic in Sri Lanka. In the early phase, the epidemic in Sri Lanka was largely triggered by Sri Lankan workers returning from Italy, with caregiving for home-based elderly in Italy being a key occupation among Sri Lankans working in Italy. As of March 27, 2020, the contract tracing carried out by the Epidemiology Unit indicated that 42% of all COVID-19 patients reported in Sri Lanka (102 at that time) were either workers returning from Italy or their local contacts. In this instance, it is very likely the Sri Lankan workers were infected by their care recipients in Italy prior to their return to Sri Lanka where they underwent the mandatory quarantine process. This indicates the multiple ways globalization triggered international labour migration impacted on the rapid transmission of the disease across national borders. This pattern, however, did not apply to Sri Lankan workers returning from South Korea, where migrant workers from Sri Lanka were mostly employed in factories. They reported no COVID-19 infections in spite of South Korea being a COVID-19 hot spot at the global onset of the disease.
Thus even though the population ageing in Sri Lanka itself may have made only a marginal contribution to the pattern of CVID-19 transmission in Sri Lanka, paid elderly care by Sri Lankan workers overseas perhaps played a more significant role in the emerging pattern of infection in Sri Lanka.
Kalinga Tudor Silva, BA (University of Peradeniya); PhD (Monash University) is professor emeritus at University of Peradeniya, where he served the Department of Sociology and Faculty of Arts in various capacities for almost 40 years. He served as executive director of CEPA from 2001 to 2002, Executive Director of ICES from 2007 to 2008, and director research ICES Kandy from 2016 to 2018. He is the author of “Decolonization, Development and Disease: A Social History of Malaria in Sri Lanka” published in 2014 by Orient Blackswan and a joint author of “Checkpoint, Temple, Church and Mosque: a Collaborative Ethnography of War and Peace”, published by Pluto Press in 2015.
This is our eleventh post in The Age of COVID-19 series, co-edited by Celeste Pang, Cristina Douglas, Janelle Taylor and Narelle Warren. Please send your contribution to Narelle.Warren@monash.edu
All contributions will also be published on Somatosphere