By Darini Rajasingham-Senanayake –

Five weeks after an economically devastating curfew was imposed to stem the World Health Organization’s Covid-19 panicdemic it is evident that the lockdown has not worked in Sri Lanka. 

It is also clear that rather than more crippling curfews, new thinking is needed. So too, we need better analysis of the data, to ascertain whether the Covid-19 flu is as bad as WHO and John Hopkins University models, and GMOA’s “hammer and dance” theories claim. We also need more information on how many of the 570 Coronavirus cases reported in Sri Lanka were mild or asymptomatic? 

The death rate relative to infection rate is what matters in assessing the severity of a disease outbreak. The current death to infection ratio despite low rates of testing in Sri Lanka is certainly a cause for optimism at this time of general gloom in the island and indeed the world

Militarization and Coronavirus in the Indian Ocean 

While Covid 19 numbers are low in Sri Lanka with just 570 cases and a mere 7 deaths reported, this week saw a small spike in infections despite a highly militarized curfew that saw over 4,000 “curfew violators” arrested over the past month. At this time curfew has been again extended for a week and further militarized with the leave of all armed forces personnel cancelled.

The very good news is that death rates from Covid 19 have not increased for weeks in Sri Lanka: A mere seven (7) deaths from Covid 19 have been reported in the island.  While there are some concerns about the accuracy of the numbers, at least 2 deaths were instances of co-morbidity. Indeed, the first so called Covid 19 death in Sri Lanka was of a kidney transplant patient who also had diabetes.

Ironically, the increase in Covid 19 infections just when the Rajapakse regime was set to lift curfew this week happened among some of its armed custodians – the Sri Lanka Navy, which it appears caught Covid 19 as part of a trend in the increasingly militarized Indian Ocean region: The US Navy’s Air craft carrier Theodore Roosevelt led the way with 900 plus Covid-19 cases on board – in Guam, followed by France’s De Galle Aircraft carrier. At this time Covid 19 has also spread to the Indian Navy camp in Mumbai and Sri Lanka’s Welisarra Navy camp and from there to many sailors and their families all over the country.

US – Sri Lankan military training in Sri Lanka had continued despite travel sanctions due to Coronavirus spread globally, during the March and April 2020 at the Navy’s Special Boat Squadron Training School in Trincomalee Sri Lanka.

Clearly, with a majority of cases spreading through the Navy whereas previously, Muslim and Christian minorities had been mysteriously targeted by the virus in Sri Lanka and India, it is increasingly clear that the lockdown has not worked to limit the spread of the disease. Rather, the militarized curfew in with the parliament in abeyance has devastated the national economy. Does Sri Lanka face a situation of double jeopardy at this time?  

The Corona fear psychosis and a curfew fear psychosis appears to have paralyzed civil society and created a double calamity in the country. Unlike in other countries with far larger Covid 19 caseloads where there are protests against the lock downs, Sri Lankan citizens are yet to come to the streets and demand their right to information and accurate Covid 19 Data in order to do the Covid 19 math and dissipate the fear psychosis that the WHO and GMOA had whipped up so skillfully, everywhere.

Death to infection ratio is what matters

There has been no increase in the number of reported Covid 19 deaths in Sri Lanka and the number of death remains in single digits, at lucky 7?

As the testing rates increased so too the numbers of infections had increased as may be expected. The higher number of infections without a concomitant rise in death rates is very good news, as it reduces the death to infection ratio and indicates that Covid 19 is not as deadly as made out to be by WHO and GMOA in Sri Lanka. 

After all, between 5000-6000 people die of influenza annually in Sri Lanka, as flu is the third highest reason for death in the county according to the Ministry of Health. Influenza affects a billion or one in seven people in the world annually and up to 750,000 may die of the flu according to the Centers for Disease Control. It is increasingly clear that the Covid 19 flu seems to behave like any other flu in Sri Lanka and indeed this statement may be extrapolated to the South Asian region.

 It would be interesting to know if indeed 80 percent of those who have got the Coronavirus in Sri Lanka had mild symptoms or are asymptomatic?

At any rate, there are NO reports of hospitals in the country being overwhelmed by Covid 19 patients as feared by WHO and GMOA, who seemed to forget that Sri Lanka’s health indicators and national healthcare system is ranked among the best in the region.

Meanwhile, large private hospitals like Asiri Central Hospital had been totally shut down in the first two weeks of curfew, and many wards and hospital floors remain closed because patients suffering from other conditions and illness are scared to visit hospitals because of the Covid 19 fear psychosis that has spread around the country and indeed the world.

Hence we need to ask some serious questions about the need for economically destructive lockdowns and the fear psychosis this feeds at this time in Sri Lanka.

Indeed, if as in California where it is now apparent that the first Covid 19 cases had occurred in December 2019, much earlier and many more had had the Covid 19 flu than initially thought, as the research of Professor of Medicine at Stanford University, Dr. Jay Battacharya indicates, it is highly likely that many more people in Sri Lanka too had or have been infected with the Covid 19 flu in past months than previously thought. 

However, in the absence of anti-body tests we cannot know how many Sri Lankans have already had or may have the asymptomatic version of Covid 19 flu, or if indeed the country is on the way to achieving herd immunity?!

In any case it, analysis of the Covid 19 data and impact of the curfew indicate that the lock down has been less than efficacious and should be drastically eased to enable a phased return to normal life in Sri Lanka, even as we seek to explain the low death to infection rates in the country. Is this because of climate, a good health system, health Sri Lankan diet, BCG vaccination that confers a level of resistance if not immunity to Covid 19 that Sri Lanka’s  Covid-19 case load is low?

BCG the Game Changer in the Global South?

Numerous studies in many parts of the world have linked the BCG (Bacillus Calmette-Guerin), vaccination, widely used in the developing world with fewer Coronavirus cases. This is good news for countries that have universal BCG vaccination in tropical Asia and Africa. Many of these countries cannot afford Originally developed against Tuberculosis (TB), the hundred year-old BCG vaccine offers broad protection and sharply reduce the incidence of respiratory infections. According to Prof Luke O’Neill, at Trinity College Dublin a combination of reduced morbidity and mortality could make BCG vaccination a game-changer in the fight against coronavirus as the BCG maybe a flak-jacket against the Coronavirus. Experts note that the vaccine seems to “train” the immune system to recognize and respond to a variety of infections, including viruses, bacteria and parasites. The vaccine is now being tested in several countries including Australia, Germany and Netherlands against the new Corona virus – to protect frontline health workers.  

In many countries of the global south’s tropical regions Covid 19 cases and deaths are in single digits, double digits or hundreds; certainly not in the thousands, unlike in the US and EU, and other temperate regions where the Coronavirus seems more virulent. This variation has been attributed to differences in climate, cultural norms, mitigation efforts, and health infrastructure. 

Increasingly research indicates that countries whose populations have high levels of BCG vaccination had significantly fewer Covid-19 deaths. Countries that do not have universal policies of BCG vaccination, such as Italy, the Netherlands, and the United States, have been more severely affected compared to countries with universal and long-standing BCG policies,” noted Gonzalo Otazu, assistant professor of biomedical sciences at NYIT. 

BCG seems to flatten the disease curve since countries that use BCG vaccination programs had a fatality rate of four per million people, while countries without BCG vaccination programs were 10 times more likely to die at a rate of 40 deaths per million people. The chart below shows stark differences in mortality ratios between countries with and without BCG vaccination programs. 

The map below from the medical journal Plos Medicine displays BCG vaccination policy by country. Bacillus Calmette-Guérin vaccine is a vaccine primarily used against tuberculosis. Yellow: The country now has a universal BCG vaccination program. Blue: The country used to recommend BCG vaccination for everyone, but now does not. Red: The country never has a  had a universal vaccination program. While he stressed the research was largely a statistical one and so came with caveats, there was a case for authorities moving to provide a BCG vaccine top-up for everybody age over 70. “This is feasible and should be considered.

BCG in South Asia

In South Asia the Vaccine has been universally used for decades. India and Pakistan started using BCG in 1948 and in Sri Lanka BCG vaccination became mandatory in 1949 according to the Ministry of Health epidemiology unit. Compared to case numbers in Europe and North America, and relative to population size South Asian countries have registered low numbers and Covid 19 case load.

Three weeks after a pandemic was declared by the World Health Organization (WHO) it is increasingly clear from the Covid 19 data that Asian countries which practice universal BCG vaccination are relatively better positioned to fight Coronavirus — despite the crippling curfews that saw millions of migrant labourers walking hundreds of miles and dying in the process to get home. 

In addition to BCG hot and humid tropical weather may be another factor inhibiting the spread and strength of the Covid 19 flu in South Asia. Countries that have a late start of universal BCG policy (Iran, 1984) had high mortality, consistent with the idea that BCG protects the vaccinated elderly population.

Pakistan as Control Group in assessing efficacy of Curfew

Pakistan a country with 200 million people that shares borders with both China and Iran which were both hit hard by the Covid 19 flu did not impose the crippling curfews that neighbouring India and Sri Lanka did.

Pakistan may thus serve as a “control group” or comparison in relations to India and Sri Lanka, in assessing the efficacy of lock downs to halt the Covid 19 flu spread in South Asia. A control group may be defined as the group (or country) in an experiment or study that does not receive treatment (such as curfew), and hence is then used as a benchmark to measure how the other subjects that did have a curfew in this case fare.

At this time, Pakistan has reported 301 Covid 19 deaths, while India a county with over a billion people has reported 937 deaths, indicating that the absence of curfew has not dramatically increased Covid 19 infections rates in that country. 

Pakistan Prime Minister, Imran Khan, sensibly pointed out that more people would die of poverty caused by lockdowns in the long run. In Sri Lanka where a brutal curfew was imposed there have been 570 Covid 19 cases with 7 deaths. 

There have been under 30,000 confirmed cases with 7,538 deaths in all 10 Association of Southeast Asian Nations (ASEAN) member states which have a population of 670 million as of April 28, 2019. This is a small number compared to Italy, Spain and the United States, given Southeast Asia’s population of 622 million.  

While lack of testing may be cited as a reason for the relatively low numbers, by now – five weeks after Covid-19 was declared a global pandemic and months after the epidemic in neighbouring China – the region surely should have expected an explosion of cases similar to Italy and Spain. Clearly in tropical Asian countries, including those with poor health systems the epidemic is far more limited. 

This fact raises questions about the Indian and Sri Lankan government’s imposition of economically devastating and socially crippling curfews at the urging of the WHO and Central Intelligence Agency (CIA) funded Johns Hopkins University (JHU) which is collecting Covid 19 data for a global database, while providing analysis seeming based on simulated pandemic from the mysterious EVENT 201 which was staged last October with the WHO and Gates Foundation and others modeling a fictional novel coronavirus.

Five weeks after a global panicdemic was declared by the WHO it is clear that the Covid 19 data in Sri Lanka and much of South Asia does on support or warrant extended lock downs and curfews since the ensuring economic and supply chain disruption, loss of livelihoods, and poverty could kill more people than than the Covid 19 flu in the long term.