By Janaka Goonatilake –

“Man is least himself when he talks in his own person. Give him a mask, and he will tell the truth” ~ Oscar Wilde

Sanctioned by the editor of Colombo Telegraph himself, I write in the disguise of a pseudo name so I can expose the truth.

The fight against COVID-19 has taken many shapes around the globe. It differs from country to country and even within countries the strategy and policy to tackle the deadly virus changes with time.

While the entire world is grappling with the pandemic, Sri Lanka seems to be quietly handling itself. There seems to be good control over the spread of disease and the mortality is well within the percentages described in the academic publications.

However, a closer look at few important aspects in the process of curtailing COVID 19 would cast some doubts about the figures published by the government.

The testing

The Medical Research Institute of Sri Lanka has acquired the standard laboratory facilities for RT-PCR method which is the diagnostic test for COVID 19 at a very early stage. At least one other private sector laboratory was capable of doing the test at the beginning but was quickly ordered not to do the test by the authorities. Hence, at present the MRI is the only place doing the test and its daily capacity is between 150 to 200 tests. Taking in to account the number of repeat tests done for the in-patients who are already diagnosed with COVID19 the number of new cases done per day is around 100. This brings us to an estimated total of around 3000 persons being tested for COVID 19 to date in the entire country (3248 to be exact). As of 07^th April 2020, the number of “diagnosed” COVID19 patients in the country is 185. The number of confirmed deaths due to COVID 19 is 6 to date. This gives us a mortality rate of 3.2%.

Mortality rates

It should be observed that in countries where rapid spread of disease is present, the mortality is high as the testing rate increases. In simple, the more you test, the more cases diagnosed. As a result, more deaths will be “diagnosed” as COVID 19 deaths.

It is interesting to observe that Sri Lanka and India both having a very low rate of testing per 1 million population maintains a “text book” rate of mortality. The other countries who maintain such low mortality rates are Singapore, South Korea and New Zealand. Both Singapore and South Korea managed the pandemic aggressively with the maximum utilization of their highly sophisticated healthcare systems and New Zealand went in to a 30 days complete lockdown from 25^th March when there were few hundreds of patients only.

So, what is the secret behind the successful controlling of the pandemic by the Sri Lankan authorities and keeping the numbers low.

It seems that the military style operation in tracing and isolating contacts of identified persons with infection, aggressive quarantine protocol and the Island wide curfew effectively imposing social distancing seems to be working. Also, the relentless efforts by the health sector workers have contributed to the seemingly satisfactory outcome.

Unfortunately, the good things about the efforts by the government ends there and the shortcomings and daring gaps in the health sector, the reliability of data collection and most importantly the capacity of testing are all blemishes in the governments slate.

The number of complaints by different categories of health care workers regarding inadequate personal safety equipment and basic facilities are increasing by each day. Some trade unions have even threatened walk off due to lack of personal safety equipment. Social media chats are filled with discussions on various incidents which have caused concern among health care professionals regarding their own safety as well as the safety of public. Number of incidents have occurred where certain lapses have caused many health workers to go under 14 days isolation.

Among the many complaints by doctors, one of the main complaints was the lack of testing. The ministry of Health has issued a very rigid guideline to define a “test worthy” patient. Many doctors have raised concerns about this “clinical criteria” which puts the attending physician in jeopardy as his own judgment to test the patient for COVID 19 is over-ruled by the circular.

It was disclosed at a professional forum recently by the leading Professor in Clinical Genetics that the number of tests that could be done may be increased by at least up to 1500 per day by making use of the facilities available at state medical faculties and private sector laboratories. Strangely, there seems to be much less interest in improving the testing capacity which could be utilized during this pandemic while a multimillion-rupee project to establish new laboratories, which obviously will take months, is being discussed.

On the above context, the figure of mortality which currently sits pretty at a comfortable 3% becomes that much more suspicious. 

The current death rate of Sri Lanka is 6.8 per 1000 population. That is about 400 deaths per day. These includes death due to natural causes, accidents as well as all other illnesses and diseases. Few additional deaths per day may not be noticeable unless “categorized” in to a special category which is of concern to the nation.

The inadequacy of testing has led to the widely accepted consensus that there may be many more COVID 19 patients in the community who are undiagnosed. Many mathematical projections taking in to account the demographic data as well as the behavior of the pandemic in other countries have projected a large number of patients infected by the virus giving an exponential rise to the number of positive cases.

However, the limitation of testing has hindered the chances of truly appraising the extent of disease transmission in the community and as a result the number of infected cases may be recorded as a very low number. The fact that 85% of COVID 19 patients are asymptomatic or mildly symptomatic complicates the issue even further.

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.

Yet, from a very different vantage point, it could exactly be the master plan of “someone” who has foreseen that the ultimate target of the fight against the pandemic is to build herd immunity. Therefore, the only sustainable “plan” would be to let the disease run through the community and build herd immunity.

Many affluent countries have failed in building herd immunity as the health facilities are overwhelmed by the vast number of cases seeking health care. However, if the general public could be kept unaware / ignorant of the fact that the common cold or the flu they are suffering right now is in fact COVID 19 and very few of them may develop “pneumonia” and succumb, the widespread panic could be prevented. Its only a matter of keeping the disclosed numbers in the “comfortable” range and disguising the excess with pre-existing disease, age etc.

Who would have thought of this ingenious plot ? who is the master mind behind this grand strategy ?