Introduction: COVID-19 is caused by Severe Acute Respiratory Syndrome coronavirus 2 and it spread throughout the world and turned into a severe global pandemic in 2020. The severity of the COVID-19 is wide, ranging from asymptomatic to severe illness that requires mechanical ventilation. Although the curative sector response of Sri Lanka was somewhat different from other countries, it was remarkably effective in preventing community spread. objective: To assess the average cost of treating Covid 19 patients at Covid Treatment Centre (CTC) in District General Hospital (DGH) Hambantota.Methodology: This retrospective costing study was conducted in CTC at DGH, Hambantota in December 2020. The step-down costing method was used in this study. Key informant interviews with the accountant, deputy director, and staff of CTC, reviewing expenditure records of the accountant's office, visiting and taking measurements of the floor area, reviewing relevant literature were used to gather data in this costing study. Results: The average cost of treating a Covid 19 patient per day at CTC, DGH Hambantota was Rs 2317.60. The total cost of treating a Covid 19 Patient at DGH Hambantota for 10 days was Rs 23176.00. The cost of treating Covid patients at CTC, DGHH was exceptionally low when compared to other countries. Discussion and conclusion:Treating Covid 19 patients is an economic burden to any health system. Treatment cost was extremely low at DGH, Hambantota and only about 23000 rupees was spent for one patient for 10 days. Drug cost was comparatively low and transport cost was relatively high.

Research question Is a symptom questionnaire per the French IVF guidelines adequate for screening patients during the Covid-19 pandemic? Design Patients planning IVF from June 2020 through February 2021 were included in the study. In compliance with French IVF guidelines, all fever-free patients on day of oocyte retrieval were screened for risk of Covid-19 by completing a symptom questionnaire after being counseled regarding importance of a Covid-19 free medical practice. Patients cycling between June and September 2020 only completed the questionnaire (Group 1), while those planning IVF after September, also underwent the RT-PCR test for SARS-CoV-2 RNA (Group 2). Cycle cancellation rates between groups were compared. Group 1 patients consented for follicular fluid (FF) testing for SARS-CoV-2 and an interview post-cycle completion to determine Covid-19 exposure during 6 months before and after retrieval. Results Cycle cancellation rates for Groups 1 and 2 were 0% (0/214) versus 1.4% (8/577), respectively, (p=0.116). All 183 FF samples from Group 1 were negative for SARS-CoV-2 RNA. Of 171 patients interviewed post-IVF, 16 (9.3%) developed COVID-19 symptoms or a positive RT-PCR test, but none within two months pre- or post-retrieval. Conclusion These results provide reassurance that consistent with the Covid-19 French IVF guidelines, use of a symptom questionnaire is effective in screening patients planning to undergo IVF. Failure to detect viral RNA in any FF sample does not negate the possibility that FF is a viral reservoir. However, the findings provide reassurance that the follicular environment in our carefully screened population was COVID-free.

Study question Is it possible to find viral Sars-Cov–2 RNA in FF of women undergoing treatment during Covid–19 pandemic that may compromise gamete and embryo safety? Summary answer No viral RNA was detected in tested FF of women undergoing IVF in compliance with recommendations. This was reassuring and supported good medical practice. What is known already Risks due to SARS-CoV–2 during IVF remain difficult to assess despite the screening recommended by French health authorities based on a symptom questionnaire of the couple (systematic testing by RT-PCR for the virus before egg retrieval (ER) is not mandatory). In this context, this is a real challenge for IVF laboratory to guarantee procedure, patients, gametes and embryos safety. Most studies have reported the absence of virus in sperm. No data are available for FF and only one study looked for the presence of the virus in oocytes of Covid-affected patients (Barragan M et al, 2020). Study design, size, duration Between June 17 and September 24, 2020, FF of consenting women were prospectively collected and symptom questionnaire recorded. During this period, women undergoing IVF in our center did not benefit from systematic PCR testing for the virus within 72 hours prior to ER through our health authorities’ recommendations. All collected FF were retrospectively tested to research viral RNA by RT-PCR and patients were recalled to answer an epidemiological follow-up questionnaire. Participants/materials, setting, methods For all couples, symptom questionnaires were prospectively recorded and verified at each step of IVF procedure. For all consenting women, a sample of 1 ml of FF was collected the day of ER and stored at –80 °C. After thawing, a Sars-Cov2 multiplex RT-PCR using CFX96 (Biorad*) was performed, after RNA extraction using Nimbus (Seegene*). A comprehensive epidemiological evaluation was made afterwards by phone interview and data were recorded and analyzed. Main results and the role of chance A total of 183 women was included out of the 214 treated during this period (85.5%). Retrospective epidemiological evaluation showed that 8 patients contracted Covid more than 2 months before the ER, 6 more than 2 months after and only one patient 1 month after ER (diagnosis based on pathognomonic signs as agueusia and anosmia or/and positive PCR ). We observed a prevalence of symptomatic Covid forms in our IVF population of 8.2% during a 6-month period surrounding their IVF cycle. Moreover, until the introduction of systematic testing by RT-PCR for the virus before ER since the end of September 2020, 3 patients have been cancelled out of the 403 planned for positive PCR despite a negative questionnaire, which represents a prevalence of asymptomatic forms on the day of the ER at 0.7%. All the 183 FF tested did not reveal any viral RNA detection, which was reassuring concerning our medical practice and patient compliance and transparency. The absence of detected viral RNA may be due to several reasons: 1) women were not infected the day of ER 2) women had an asymptomatic form of the disease with low viral load 3) FF is not a virus reservoir. Limitations, reasons for caution Not all patients were included (85.5%). Post-diagnosis stays uncertain because PCR tests at the beginning of the epidemic were not mandatory and hardly available. Wider implications of the findings: The absence of viral RNA in FF of women only screened through a symptom questionnaire is reassuring concerning the safety of IVF during Covid pandemic. Trial registration number Not applicable