By M.M. Janapriya –
“Man is least himself when he talks in his own person. Give him a mask, and he will tell the truth” ~ Oscar Wilde. Those of you who are not acquainted with who Oscar Wilde was, he was a French Poet and a playwright who lived in the 19th century AD. While respecting the writing and philosophical prowess of the former, I find no great reason to pay much heed to the above quote of his as these are dramatic quotes with mostly poetic overtones. There is no need to go that far. There is a famous age old Sinhalese adage “the two things one should not fear to do is to tell the truth and to sit on the ground”. As such I have not feared to put my real name in all the articles I have written for I have not deviated from or distorted the truth. There is a good chance the writer of Pseudonym Janaka Goonatilake would not have heard of the above adage, Singhalese probably not being his mother tongue.
The above article purported to have been written by this gentleman is a well composed article in which some of the statistics produced too are accurate enough. For example, the mortality figures table and even the number of tests done per day in Sri Lanka as being 100 which was nearer the truth at that time, even though he got the number of PCR machines available terribly wrong. Additionally, a lot of others are inaccurate too viz. As I have said in my previous articles the basic severity figures of SARS COV-2 infected people are as follows. 81% are mildly or moderately affected (mildly affected have no pneumonia and some may be asymptomatic), 14% severely affected, 5% critical with 2.3% of the critically affected dying no matter what you do. The writer has conveniently increased this mild to moderately affected group to 85% and classed all of them as asymptomatic. This seems to be deliberate and wanton distortion of the truth and is downright disinformation.
If, as the writer alleges the Ministry of Health has issued strict guidelines to define a ‘test worthy’ patient that ties the hands of Consultant Physicians behind their backs, it is wrong but I have not been able to find credible evidence of this despite contacting two of my colleagues in active government service. In my last article I have suggested we should start testing more and more. In this background if the writer’s allegation is correct I think we are not doing as well as we should be at this point of time. However there is a circular issued by the DGHS dated 7th April 2020 extending the use of laboratory testing for Strengthening Covid-19 Surveillance. This circular definitely gives physicians a free hand as per point No 5 of page one of the said circular which says “Any other patient in whom the treating clinician decides to exclude Covid-19”
Also the writer alleges that a multimillion rupee new laboratory project which is going to take months to build is being talked about and there is much less interest in improving the existing facilities to increase the testing capacity. I am unaware of the first part of the revelation but if it is true this will be a clear case of someone trying to ‘make hay while the sun is shining on them’ (and setting on the country) and as per the second, the Minister of Health, at a recent TV interview reiterated that the testing numbers would increase to 800/day by the end of the week. So the writer seems to be not very generous in coming out with the truth but seems to adopt a liberal approach to converting social media small talk etc. to a kind of gospel.
Let us concentrate on the following sentence of the writer. “It should be observed where the rapid spread of disease is present, the mortality is high as the testing rate increases. In simple the more you test the more deaths will be diagnosed as Covid-19 deaths”. The writer seems unable to analyze a simple matter such as this. In countries where the spread is rapid the mortality is high, clearly because all or some of the factors below could be in operation.
* People were more susceptible and had a poor prognosis (as in Lombardy where there was a high percentage of very old people)
* The health care facilities were overwhelmed so that some who could have been saved died because of failure to accord life support
* As the numbers were so high the front line health workers were so demoralized (some committed suicide) that they were unable to accord even simple straight forward medical care
“In simple the more you test the more deaths will be diagnosed as Covid 19 deaths”. There is some merit in this statement but the writer should be made aware that all suspicious deaths (every normal death is registered and a death certificate issued) are cremated after taking saliva, throat swabs etc. from the dead. This may not be ideal but it is worth remembering that this virus stays alive on many surfaces for a long time. Also in high testing countries, the number of new patients discovered is large and as such the mortality rate as a percentage of total affected, goes down. The gross number of deaths actually might be more than if one tested less, but the former is a bad indicator of how well a country is doing. It is the percentage that is all important.
Clearly with all his disinformation and lopsided analysis he eventually approaches his goal which is a conspiracy theory of letting the virus run through the country to build herd immunity.
“The cumulative effect of lack of testing and hence the deaths as well as patients being undetected, is the figures remaining “acceptable” while the disease may be spreading within the community.” This analysis lacks credibility. If we tested more and more so that a large number of asymptomatic or mildly symptomatic people were discovered, then, even if the number dead increases by a few digits the overall death rate comes down. The simple arithmetic being (N/Total infected) x 100= Mortality percentage. Look at US figures. Total cases 468566, total deaths 16691 and hence the percentage is 3.5%. This is clearly because the total infected is a colossus of four hundred and sixty eight thousand five hundred and sixty six. I am at a loss to understand why the writer failed to see this. As I explained earlier there is a possibility of Corona deaths being slightly under reported here in Sri Lanka but nowhere near what this gentleman is trying to make out. If patients are allowed to go on and infect to the extent he is postulating, Corona R0 being 2-2.5 (R0 being the basic reproductive number pronounced R naught which is the number of people each infected person can infect in turn) the disease would have galloped in Sri Lanka. This did not happen and the writer seems extremely unhappy about it.
There are a few things that emerge from his article as blindingly obvious. The gentleman was expecting Sri Lanka to make a mockery of the Covid-19 situation and when he realized that it was not so and indeed Sri Lanka has done very well to contain the spread of the disease he was very disappointed. He then set out to do two things to pull the rug from underneath the government’s feet. Firstly he has tried to show that the SL government is doctoring the figures. Secondly he has tried to use this hypothesis to discredit the government as irresponsible enough to let the virus run through the community to achieve ‘herd immunity’.
What the writer has to understand is that with substantial slowing down of the spread of the virus we are in a great position to look after the symptomatic, inclusive of according life support to the critically ill. This is the exact position we are in, right now. While the country is in lockdown it is entirely possible for the virus to infect the population at a slower rate albeit according the infected, some immunity. However this is nowhere near enough to achieve the level needed for ‘Herd Immunity’. This though is a desirable by product and there is absolutely no reason for someone to be despondent about.
As I have pointed out previously in my second article, we probably had Corona coming our way in Dec 19/Jan 20 without our knowledge blew across the country masquerading as a bad flu taking with it some susceptible lives and conferring immunity to others. I said therein that this could account for the low mortality rate we were experiencing. Recent research from Australia suggests that countries that have embraced the BCG vaccination in to their Expanded Programme on Immunization (EPI) from the very outset in 1949 such as Sri Lanka which vaccinated all newborns in 1963 have shown a greater resistance to invasion by the Corona virus. Please read this article for more information. Together with these nature’s gifts our government deployed a lockdown in good time and with the help of nice hot weather we seem to be slowly but surely getting out of the woods. Of course we got to be patient for a little longer. So let’s give ourselves a pat on the back and sing Namo Namo Maatha than dive deep to try and find even the flimsiest of reasons to wrong the government.
I agree testing could have been and by now should be a lot better. In fact I suggested to the health authorities to try and look towards testing around 5000/day in my last article. I also suggested a way of raising money for this. The big advantage in such testing is that we can relax a bit on the lock down as in Singapore and South Korea. This is important for people in the districts of Colombo, Gampaha and Puttalam districts who are clocking in towards a month of lock down in a few days time. We have not complained. I live in the Colombo district with my family and we do face hardship. Our psychological health has taken a bit of a bash as has the physical health. I have been jogging 3 miles twice a week to keep my coronaries patent for over 50 years. As I cannot do it anymore I started jogging inside my premises.
We must try and adapt ourselves to the situation. There is just no point in writing articles massaging figures at that and castigating the government which is doing its duty of ensuring national safety. We must try our level best to support the government’s efforts in this hour of need. In almost all the countries in the world people have come together forgetting petty differences and have stood up as one to fight the common enemy the, Corona virus whereas here in Sri Lanka some people are perpetually fishing in troubled waters. We certainly have to keep putting pen to paper to try and get our ideas across to the Health Authorities and the Law Makers but our ideas should be of constructive nature and should encourage the frontline doctors, nurses and others who constantly put their lives on the line to help us.
Mr Goonatilake’s intentions seem as mysterious as his real name is. If one really works hard one can find shortcomings even in the best thought about and well deployed control mechanisms such as ours. I cannot see any worthwhile reason why anyone should write articles of this nature except to pull the government through mud. Every article we write and those, the newspapers and electronic media publish should convey a strong and an authentic message which is of use to the country. I have often seen as a regular contributor to the Colombo Telegraph, some other regular contributors not so much as writers but as those who critique articles, not infrequently turning the clearest of messages in to a topic with a political hue to have a lash at some members of the governing machinery of the country. I strongly feel that this kind of irresponsible contributions should find it difficult to procure space in responsible journals like yours.