The impact of the COVID-19 pandemic and post-pandemic economic crisis on snakebite patterns in rural Sri Lanka.
Toxicon · 2025-07-24 · Observational study
Abstract
AIM: We aimed to compare the pattern of snakebites and the pre-hospital practices of snakebite victims during, before, and after the COVID-19 period in a region of Sri Lanka with a high snakebite incidence. METHODS: Data were extracted from the Anuradhapura snakebite cohort from March 2018 to October 2023. The cohort recruits all snakebite patients (>16 years) admitted to the Teaching Hospital, Anuradhapura. For this study, data from pre-COVID (March 2018-October 2019), COVID (March 2020-October 2021), and post-COVID (March 2022-October 2023) periods were analysed. RESULTS: There were 1141, 1312, and 1375 patients in the Pre-COVID, COVID and Post-COVID groups. Authenticated Hypnale hypnale bites increased during COVID (454/784, 58 %) and post-COVID (501/849,59 %) compared to pre-COVID (234/658, 36 %), while Daboia russelii bites decreased during COVID (210/784, 27 %) and post-COVID (205/849, 24 %) compared to pre-COVID (259/658, 39 %). The proportion of home garden bites increased during post-COVID (560/1375, 41 %) compared to pre-COVID (378/1141, 33 %) and COVID (416/1312, 32 %). The percentage of patients who intentionally delayed hospital admission was greater in post-COVID (26 %) compared to groups pre-COVID (18 %) and COVID (16 %). The percentage who sought native treatment before hospital admission was greater post-COVID (15 %) compared to pre-COVID (6 %) and during COVID (7 %), as was the application of tourniquets as first aid post-COVID (37 %) compared to pre-COVID (22 %) and COVID (22 %). During the COVID-19 pandemic, the rate of patients leaving the hospital against medical advice rose to 4 %, up from 3 % in the pre-COVID period. This trend continued to increase after the pandemic. CONCLUSION: During and after the COVID-19 pandemic, H. hypnale cases increased and D. russelii bites decreased, coinciding with shift of snakebites from farmlands to home gardens. More patients delayed hospital treatment, used harmful first aid, or left against medical advice during and after the COVID-19 pandemic.