By M.M. Janapriya –
The whole world, young and old, rich and poor, powerful and powerless, religious and nonreligious, atheists and polytheists no matter what, have been pushed against a massive brick wall by this intensely infectious and incomparably virulent virus that seems to hoodwink it’s victims, virtually knocking on deaths door, believe all is well by virtue of its ingenious ability produce `happy hypoxia’. To put those of you not in to any medical science in the picture, our blood is nearly 100% saturated with oxygen in health. When the levels are below 70% one is in grave danger of dying in the next couple of hours or in some cases, in the few minutes if not corrected urgently. Those with Covid-19 keep `pecking on their cell phones whilst the oximeter connected to them is reading 50%’. Such is the enigma of this invisible killer.
Whether it jumped from bats cats or rats to humans is now irrelevant but whether the Chinese played it down for close to or indeed over a month with or without the help of the W(h)orl(e)d Health Organization though of utmost importance should be pushed to the back burner for the present as in `Sama Jathakaya’ where Buddha impressed upon his disciples the importance of attending to the injured prince than trying to find out from which direction the arrow came. So here we are trying to do our best to keep the deadly virus away.
As I have pointed out in my last article those countries that were ready and waiting like, Germany, Hong Kong, South Korea, Singapore and Communist Vietnam being quick responders are having good outcomes whereas Corona sceptics like the US and the UK have had devastating consequences of their actions. This is not a time to play the blame game. While congratulating the victors and commiserating and empathizing with the countries struggling to keep their heads above water as per numbers dead, I feel it is time opportune for us as a country with the most stringent of lockdowns, in 4 highly populated districts spanning over 7 weeks, to sit back and appraise where we have done well, what we have got wrong and indeed what we can do to mitigate the damage so caused.
I have been studying the subject of SARS COV-2 virus ever since the curse befell our world and also have been writing about what I felt as to the progress or regress of the measures Sri Lanka has taken as the Corona events kept unfolding before us. As such I envisage referring to the series of articles I have written in chronological order to substantiate my fears and ecstasies.
In my first article ever on Corona dated 17th March I urged for a complete lockdown because at that time I saw the country as a sleep walker heading towards the cliff edge. Here is the link for that article. A considerable number of returnees from badly affected countries abound in a country devoid of resources and discipline, the corona figures appeared too good to be true. Sri Lanka too was slightly late in bringing on strictures like Airport closure and even the lockdown but still managed to keep number infected down as well as percentage mortality at well below the WHO declared epidemiologically established figures. As a man who wants to know the scientific basis of practically everything, I was always in pursuit of the truth but I made myself believe the figures published by the health authorities that came out every day on 10`O’ clock news were indeed authentic.
Being an investigator in to medical illness, I needed to dispel my own fears of figures falling short of being genuine, I started to wonder as to how to explain these figures with an open mind and came out with my second article. Therein I put forward the hypothesis that by Dec 2019/January 2020 we have already had the first wave of corona and hence were partially immune. This partial immunity and hot weather I felt were the key reasons the virus failed to hit us as hard as it hit some of the western world. In this essay, I praised the government for all the action it had taken up to that point in time to keep the SARS COV-2 infection at bay. Here is the link to my second article dated 21st March 2020. In this article I suggested doing some random samples of 1000 subjects from different parts of the country for SARS COV-2 antibodies which would have told us and the Presidential Task Force if we indeed have already had the first wave coming our way. However this did not happen probably because the members of the Presidential Task Force lacked the knowledge required to comprehend what was said and assimilate in to their systems the importance of the information so disseminated.
While the country was in lockdown there seemed to be a lull period of about a week and a bit in which quit a few so called experts appeared on TV channels some seriously believing they were educating the public. One such person was the life president of the most Gullible Medical Officers Association and a vociferous medical member of the Presidential Task Force who tried to use the Corona platform as a springboard to launch his future political campaign. He instituted a staunch disinformation campaign grandstanding as one of the key members of a successful Task Force that has started not just to plateau the curve but would eventually be completely crunching it. I exposed this poor soul who appeared he knew not what he did, in my next article dated 1st April 2020 titled Downright Disinformation…….. and the link is this. In most of my articles I have praised the government on the containment measures it had adopted and this article was no exception. Also frequently, I have emphasized the importance of maintaining health departmental transparency in order to win public confidence and compliance.
Lethargy during the Lockdown
With the kitchen sink thrown at the Corona virus by imposing a police curfew it appeared to me that the authorities quickly embraced the angel of somnolence which was very concerning because lockdown only `buys time’ till either a) those countries with precarious health care facilities could better their fronts b) a medicine is discovered that cures corona or modifies its course to a milder version or indeed c) a vaccine becomes available that accords immunity to the masses. Professor Devi Sridhar, Chair of Global Public Health, University of Edinburgh who has written extensively on the subject of Covid-19 describes what lockdowns should be used for in one of her articles titled ‘The lockdown only buys time: to really defeat the virus we need mass testing now’ This is the link for the article. She is an extraordinarily clever woman who is an ultimate authority on global public health and predicted this pandemic 2 years ago at a meeting in Wales and still Bojo went bonkers on the subject! Starving amidst plenty!
A plea for More Tests
As I was very alarmed at the `apparent inactivity’ of the health task force in not going after the virus during the time `borrowed’ by the lock down, I wrote my fourth article titled Lockdown 3 weeks and reappraise, did I say? What next? Test, Test and Test! In here I tried to drive home the point that just waiting for patients to come through the door and finding their contacts and may be their next layer of contacts and isolating them was not sufficient action to get on top of the virus and that it was necessary to actively go after the virus by doing at least 5000 tests/day preferably 10,000 in order to catch the asymptomatic patients carrying the virus who were the biggest threat to the society. Even though the number of tests gradually increased to the present number of 1500-1800 tests/day, this is an apology for a proper scheme genuinely searching for subclinical sufferers. It was in the wee hours of the morning of 3rd April 2020 that I wrote this article almost in a haste wanting to write a more comprehensive essay on exiting the lock down in a few days’ time. Here is the link to my 4th article. It is very unfortunate that the task force failed to ramp up the testing to the realistic numbers as I had suggested. Is it because they felt that military intelligence is equally or more effective than rRT-PCR in catching the multilayer of contacts? There is absolutely no doubt that the former comes with no added cost to the government. I am not sure whether having the cake and eating it of buying the horse for a penny and wanting it to win the steeple chase is the better proverb for this.
Defending the Figures
A few days later an article purported to have been written by a gentleman calling himself Janaka Goonatilake appeared in the Colombo Telegraph. By and large the figures he had produced were accurate enough though interpretation of some of these figures was lopsided. Reading through it was clear to me that he was trying to drag the government through mud. As the Corona Task Force seemed to be doing its job extremely well at that time I felt deeply committed to write on behalf of the government and my fifth article was the culmination of this commitment. Point by point I argued out how wrong the writer was and tried to extricate the government from blame. Here is that article dated 10th April 2020.
Attempted Exit from Lockdown
In order to ‘alleviate the suffering’ of the people living in areas under the police curfew and also to let the wheels of the economy turning again the Government set an arbitrary date of relaxing the lockdown for the 20th April 2020. There were guidelines issued by the DGHS to various ministries as to how to ease the lock down. These guidelines appeared to have been drawn up in a haste and lacked far sight in many areas. I think the President was pressurized to consider this move by the six Professors of Medicine who wrote a joint letter to the former about the importance of the exit and how to set about it. This bit of work to me appeared hastily done and lacked mastery in methodology, detail and accuracy. To be honest the country was not ready for the easing of the lockdown at that time. Fortunately this unpreparedness manifested in the form of 17 new corona cases being discovered on the 19th April 2020 that did clear the wool off the eyes of the powers that be and the lockdown stayed in place for the badly affected districts of Colombo Gampaha Kalutara and Puttalam district where the police curfew is still on. Thank goodness for that.
Testing could be better
If the planned easing went off it would have been a disaster as we had not ramped up our testing numbers. This prompted me to write my article number six dated 21st April 2020 titled ‘Let us not leap but tread our way out of the lockdown‘ and here is the link for that. I impressed upon the health authorities and the powers that be, the dire need for a strong testing tracing and isolating program before the lockdown could be eased. For this I brought in examples from many countries that have done well such as Germany, Singapore, South Korea, Vietnam, Australia and New Zealand. I also showed that these countries were testing very large numbers per day to keep the virus at bay. I am sure those of you who read this article of mine would remember the following table. This was as of around the 20th April 2020, i.e. less than 3 weeks ago and our testing was at an unacceptably low level of 0.21/1000 population whereas Germany was testing 21/1000, South Korea 10.4/1000 and Singapore 8/1000 population.
Just to put it in perspective Germany was testing 100 times, South Korea 50 times and Singapore 38 times what we were doing in Sri Lanka. This was a recipe for disaster that was waiting to happen which eventually did happen.
Nasty Navy News
A navy sailor holidaying at home in Polonnaruwa tested positive for Corona on the 23rd April 2020. He had gone home from the Welisara camp crossing borders. With this man so many other navy sailors had been allowed to return home. Another navy sailor contact of the former from Panduwasnuwara was admitted to the Kurunegala Hospital the same day. It was alleged that those who got the disease were the ones who wrestled with the uncooperative drug addicts from Suduwella in Ja-Ela on the 10th of April or so. Watch Ada Derana News on the clip between 2.55 and 5.30 minutes. It was only at this point that the task force decided to up the test numbers significantly.(same video 9.05-1014 minutes). The rendezvous the Polonnaruwa navy sailor has done on route home is incredibly tortuous and he sure infected a large number on route. This is the link to see the rendezvous. (Watch between 4.47-6.15 minutes). The fact that this incident gave rise to a cluster of several hundred inside the camp is no secret. Same news channel declared that more navy sailors with the virus were found in Ratnapura, Kurunegala Badulla and Dambulla (1.00-1.15 minutes)
As one can see clearly the creation of this `cluster’ of navy sailors at Welisara and a large number they may have infected on their rounds appears to be a case of the health authorities `taking their eye off the ball’. In relation to this the task force and the rank and file had to do a great deal of contact tracing, and isolating which in my opinion looks to have been eminently avoidable. I will reserve my questions on this to the DGHS to the end of my article.
Positive or Negative?
Few days went by with navy numbers rising exponentially and a few others trickling in to up the infected numbers whilst the number dead remained fairly constant. It was on the 5th May 2020 that we were told over the news that 2 quite unrelated patients had sprung up from Kolonnawa and Rajagiriya whilst a special grade nursing officer from the National Hospital Colombo also had tested positive for the virus. This was concerning as, if proven to be authentic, this would have meant community spread if these people could not be associated with any of the known clusters. Ada Derana News 5th May 2020. (watch 4.00-5.25 minutes). In order to maintain the spread only at cluster level it was necessary to either establish a connection with one of the clusters or indeed prove the reports wrong. Lo and behold DGHS came on TV together with 3 other specialists and reiterated that the reports of the said patients were indeed wrong and on retesting they were found not to have the virus! Ada Derana news 6th May 2020. (watch between 4.44-5.59 minutes). Though the DGHS was straight faced, the other three had guilt written all over their faces.
Dark clouds over news briefings
Where does this take us to from here? Up until the navy cluster cropped up the Task Force for Corona control was up to the task and from then on things seem to have gone pear shaped. Navy debacle is a disaster of the highest grade and a big blunder on the part of the whole team. I am posing some very important and pertinent questions to the DGHS on these two matters and I request him to answer these questions clearly and in simple language for the general public to understand and also for me personally to be able to keep the trust I always had in his department in particular and the government in general.
The Great Navy Debacle
1) Do you think the Navy sailors who wrestled with the Suduwella drug addicts in order to arrest them should have been quarantined for the usual length of time?
2) Even though the Army Commander says they were indeed quarantined most of them did not complete even 14 days (let alone 28) at the time they were allowed to go away on holiday because the Suduwella incident took place around the 10th April and the first man got away before the 20th April. Do you agree?
3) Did you as the DGHS or the Army boss as the head of the task force release them to go home?
4) If the latter did, did he get your approval?
5) I personally think all those who were going to be released to cross the borders (of districts) should have been subjected to rRT-PCR testing on 3 consecutive days before being released. Do you agree?
6) Judging by the speed of spread within the Welisara camp there is a good chance that the sailors who grappled with the drug addicts were never separated from the rest of the camp. Do you agree?
7) If answer to 6 is No how do you explain the wildfire kind of spread in the camp and from where they got the virus?
8) Do you agree that this scenario is gross negligence on the part of the Presidential Task Force that has actually led to Community Spread?
9) Do you agree on this debacle some heads should roll?
Positives that became Negative in 24 hours
1) The television news of Ada Derana 5th May 2020 was categorical and showed no doubt whatsoever when it said the Rajagiriya found and the Senior Nursing Officer NHSL were positive for corona virus. Do you agree?
2) Do you agree a large number of contacts of these people were taken away to be quarantined?
3) Do you agree that if the Rajagiriya, Kolonnawa and the NHSL cases remained positive you would have had to find a strong association with one of the many clusters in order to maintain your position of `No Community Spread Yet’ and that would have proven an uphill task?
4) Out of 700 odd positive cases so far exactly these three cases had to be retested for `oona aasaadanaya’ which is extremely odd. Do you agree?
5) By `oona aasaadanaya’ you mean weakly positive. Is that correct?
6) You are talking about a protocol that you adhered to in these three cases that included retesting. Can you please make this protocol public for all to see?
7) Weak positives are usually seen in serological tests like the SAT for Typhoid, Wassermann Test for Syphilis etc. Do you agree?
8) Polymerase Chain Reaction (PCR) involves generating Billions of DNA (or cDNA in RNA viruses such as SARS COV-2) from a trace of viral RNA or DNA which is a huge number of virus particles and hence weak positives are quite rare. Do you agree?
9) Dealing with a deadly virus such as the SARS COV-2 it is best to err on the side of accepting the test as positive rather than retest to prove negativity and send the patients home. Do you agree?
10) Do you agree that even though the sensitivity of the PCR test is between 65-80% the specificity is 100% and therefore it is foolish to repeat the test in rare weakly positive cases and send patients home?
11) The public would like to know what you did with the contacts of these people whom you took to quarantine. Are they still in or out?
12) Do you agree this saga appears to be a last ditch attempt to dispel fears of probable community spread?
I honestly hope and pray that you would be able to prove me wrong because I am hell bent in retaining my trust in your department and the specific task force.
Just to recapitulate from my previous article this is what population in successful Germany thought about their government’s honesty and transparency.
Beyond mass testing and the preparedness of the health care system, many also see Chancellor Angela Merkel’s leadership as one reason the fatality rate has been kept low.
Ms. Merkel, a trained scientist, has communicated clearly, calmly and regularly throughout the crisis, as she imposed ever-stricter social distancing measures on the country. The restrictions, which have been crucial to slowing the spread of the pandemic, met with little political opposition and are broadly followed.
The chancellor’s approval ratings have soared.
“Maybe our biggest strength in Germany,” said Professor Kräusslich, “is the rational decision-making at the highest level of government combined with the trust the government enjoys in the population.”