By M.M. Janapriya –

Dr. M.M. Janapriya

This article should not be construed as trying to undermine and /or belittle the good work done by members of the anti-corona Presidential task force. Sri Lanka is doing a sterling job of containing the spread of this deadly virus. Fortunately the job is being done in military style with military precision with great results which is indeed the only way to go about it. There is a good chance that any other government presiding over this pandemic could well have made a mockery of it. All the same if any individual ‘expert’ comes on popular TV and misinforms the public we, as educated and senior members of the public have a duty of care by our brethren to try and highlight it.   

This is exactly what my endeavor is, by trying to correct the barrage of disinformation delivered on the management of Covid-19, directed towards an unsuspecting public at a recent episode of a weekly panel show telecast over a private albeit nationwide television channel. The show is “Aluth Parlimenthuwa” and the date is 25^th March 2020. There were 3 medical personnel, a high ranking police officer and another person on the panel. The factual inaccuracies were glaring and staring at one’s face but yet the other two doctors were either too timid to correct this particular panelist or the misrepresentations flew over their heads or indeed the poor doctors were genuinely unaware of the correct facts. 

You can watch this entire episode below. Please concentrate on what the participant says from 1:12:35 to 1:15:12.

This program is being conducted in Singhalese and for those of you out there who may not fully understand what is on the video here is an English translation.

“When you ask us to quantify the number of beds (he means ICU beds) in hospitals it is a case of 12/100,000 in Italy and 2/100,000 in Sri Lanka. However there are specific ways in which this should be factored in. When we take these numbers in to consideration we have 570 ICU beds but there are only 2 (Corona) patients in the ICU as at present. The question is this. This is the amount of resources physically available. If we fail to push the spread level backwards from 3a to 2 with all our containment measures and it goes from 3a to 4 even the hospital employees would be affected. We need enough personnel to be able to put the available resources in to full use. If people act irresponsibly and if the hospital employees need to be quarantined we will not be able to use the available resources as we would be short of staff to use them.  

This is what happened in the said Italy. Not that they lacked resources but their trained staff also had gone in to self-quarantine. This is why I am reiterating the importance of pushing back the spread from 3a to 2 again. If by chance the spread moves to 4 then we will have to face a major challenge. This is what the arithmetic says. (Comment MMJ:  So far so good. Argument stands to reason. The crunch statements however start with the next paragraph) 

How did the so called developed countries face this situation? They declared no ICU bed should be given to anyone over 70 years of age. They brought in legislation to stop those over 50 years with malignancies being entitled to an ICU bed and you showed us how people in the so called developed world protested over this using abusive language. This is what has happened to us who have been so jubilant about globalization, today.

Because of this, people in developed countries want to come back to Sri Lanka. Even today some asked me if they could come back chartering a flight and were prepared to pay any amount of money to go straight in to quarantine.

People must know we are not a nation that do such things. We are a country that says “siyak ayu leba, mageth ayu gena matath wada kal geewath wenna” meaning “please take the hundred years of my life and live longer than me”. Hence we are not prepared to deny the said machine (ventilator) not only to 70, 80, 90 and 100 year olds but to even 110 year olds. Our health workers want to save the lives ranging from infancy to any age.”  

This is bordering on drunken gibberish. Those of us who are medical professionals who would have watched this program must have, no doubt, been angered the way I have been at the dissemination of false information to the innocent public. In my near half a century long medical practice I have come to respect our public more and more as they proved to be a lot that have utmost faith in our doctors. So much so Sri Lankans are a nation who would unreservedly thank doctors almost falling at their feet, for according medical care to their loved one who has just passed away not despite but, because of the treatment the person received. This is why I feel so aggrieved about the matter. 

Please pay your attention to the first para of the highlighted text. This was said exhibiting a high degree of pomposity and a similar degree of contempt towards European countries worst affected by the Corona outbreak. You would appreciate it as an utterance coming from a person occupying an imaginary high pedestal in the vast expanse of the unfamiliar field of the Corona virus. He is talking as if we have won the virus and the western world have gone completely crazy. I agree as would most people that there is a much wider spread of and a much higher mortality rate from the Covid-19 in these countries than in ours and in the south eastern part of the globe. There are so many reasons why this could be so over and above being a bit late on bringing in social distancing. 

Firstly the virus hit them in the thick of winter when they were most vulnerable. Most viruses play havoc during the cold weather. The seasonal flu, winter vomiting virus etc. Secondly the virus also hit the most vulnerable age, the elderly. Lombardy the worst hit part of Italy had the highest population of the oldest in the world. Naturally Corona crowned itself there killing large numbers. The average age of the dead in this part was 81 years. Thirdly the virus started to spread very rapidly in northern Italy than the rest of the country for some inexplicable reason. Fourthly as we know very little about this virus it may well be that the brown and the black races are genetically more resistant to this virus than the white and the yellow races. Finally letting the virus spread at a reasonable pace through the whole population might well have been what they planned for. As we know very well some countries like the UK wanted to let the virus run through the entire population at a slower pace by delaying the exposure in order to achieve herd immunity. It looks that their strategy is still the same though they have brought in some strictures to slow down the spread and the death rate. Eventually, either way, the number of dead is very likely to be the same. Italy is experiencing almost an apocalypse primarily because of its’ high concentration of rich senior citizens in their midst.

At the beginning, the Italians offered ITU care for all needy patients independent of age if their premorbid functional capacity was good. Later on when they were getting overwhelmed the demand for ventilators become more than the number available. This is when they had to prioritize and prioritize they did. It is at this point that the attending doctors had to use a triaging system to accord intensive care and there is absolutely nothing wrong with that. Times became extremely hard for the Italians. You may have read about the previously fit and healthy 72 year old Italian priest who gave away his ventilator to a younger patient and gracefully embraced death. One Italian nurse watching people fall one after another and another feeling helpless committed suicide. Nearly 40 frontline medical doctors have died in Italy so far.

In peace times (as opposed to now which can be regarded as a war setting) intensivists prioritize admissions to ICUU all the time. As surgeons we interact with the ICU staff much more than the doctor (he must be having an ICU of his own) who made these unpleasant utterances and as such we know exactly how difficult it is to get a patient in to the ICU. I am referring to the ICU of one of the best West London Hospitals where I worked for over 12 years to March 2017. We have to empathize with these hard hit countries and offer them any help if we can in this hour of need than speak of them contemptuously from a position of temporary and imaginary strength.

The rhetoric, the tenor and the content is despicable to say the least and not in keeping with the standards expected from a senior doctor occupying a high position in the department of Health Services of Sri Lanka. Now I would like to draw your kind attention to the last paragraph. This utterance reminds me of that urban fox who accidentally drank a potful of illicit brew in a bush and challenged the lion. The fox deflated at the sound of a lion roar. Please read the said paragraph several times. It is very interesting. I watched that part of the video about 20 times, may be more! This doctor is reading off a script including the quote “Siyak ayu leba etc. So, this seems a low level delivery of inflated deliberate disinformation.

“Hence we are not prepared to deny the said machine (ventilator) not only to 70, 80, 90 and 100 year olds but to even 110 year olds” Take this sentence which is absolute downright political trash. It is possible that he genuinely believed this to be so. This is evident from one of the previous statements he made that appears in the first paragraph in italics which goes as “When we take these numbers in to consideration we have 570 ICU beds but there are only 2 (Corona) patients in the ICU as at present”. So with his hyped up pre-emptive and premature confidence in containing the virus his arithmetic was simple. 570-2=568. We have 568 beds to play around with so that if containment proceeded at a reasonable pace we would still have enough ICU beds to accord even a 110 year old an ICU bed. This could have been his line of thinking which is clearly, way off the mark. This is an extremely sad state of affairs and could be due to any one or more of the following. 1) The poor man is genuinely incapable of scientifically analyzing the facts and figures of the current situation and a possible worse scenario 2) This is just an euphoric bluster of miserable misinformation 3) Playing politics with facts and figures 4) A rare but a dangerous manifestation of Covid-19 itself similar to the ENT surgeon who died in the UK of Corona presenting with loss of voice 5) a politically intoxicated cerebrum, the Betz cells of which letting the poor doctor down. Before I leave this paragraph I must reiterate that I have never seen a 100 year old or even a 95 year old on a ventilator in any of the hospitals I worked in, both in Sri Lanka and abroad. I worked in Sri Lanka for 35 years, and in the UK 14 years and counting. I was an observer at the Tokyo Women’s Medical School Hospital, Tokyo Japan for 3 months, Queen Mary Hospital, Pokfulam Road, Hong Kong for 3 months, University Hospital of NSW, Kograh, Sydney, Australia for 1 month and Royal Prince Alfred Hospital, Sydney Australia for 2 months. Since I left the regular job in the NHS in March 2017 I have done locum work both as Registrar and as Consultant in more than 10 hospitals in and around London and also in Cardiff. My last job was just a few weeks ago at the University Hospital of Coventry and Warwickshire as an on call Consultant General Surgeon for 28 hours on the 18^th and 19^th February 2020.  

The good doctor had been completely oblivious to those patients with traumatic brain, chest, abdominal and multiple long bone injuries, non-trauma surgical emergencies like bowel perforations, obstructions etc., Obstetrics and Gynaecological emergencies like postoperative respiratory support, amniotic fluid embolism and pelvic sepsis leading to septicaemia, complicated medical problems like encephalitis (inflammation of the brain), ascending myelitis (inflammation of the spinal cord) etc. who would already be occupying a lion’s share of the functional ICU beds. He has indeed accepted that this is the case just 9 days prior to making this `lose cannon’ statement. This is an excerpt of a letter he wrote jointly with another doctor to President Gotabaya Rajapaksa, No. GMOA/HE/2020/0003 dated 16/03/2020 titled GMOA Proposes drastic measures to control COVID 19 pandemic. “Furthermore, containing the disease is the only path available to our country as our ICU services, including ventilator support, which is necessary to treat patients with advanced COVID19, is already at maximal utilization with virtually no reserve” (penultimate paragraph of the letter)

If, at the time of saying he was going to offer ICU beds to even 110 year olds, he had already forgotten the fact that he had written a letter to the President of the country to the effect that there is no ICU reserve left, time interval being just 9 days, then this seems to be a case of recent memory loss. As such the question arises as to whether such individuals should be allowed to continue to practice medicine without being subject to an expert panel to check their fitness to practice. 

Politicians can be excused for using slogans, rhetorical language and even downright lies, for, the whole world knows that is what they do. On the other hand, professionals in state service or for that matter independent ones too, even if their balance has got a bit upset by imbibition of party politics, they should be careful enough to read through their notes several times, if necessary get them edited by someone better prior to them placing the material before the public. True, you are absolutely right, the majority of our television audience especially of the channel involved is innocent unsuspecting public but what you forgot is that there are those eagle eyed people like us who would very quickly notice the dichotomy and falsehoods entrenched in any utterances such as yours.

The bitter truth is though only a negligible number of us would take the trouble to try and flag it up so that the perpetrator has a chance to correct himself.