By Sarath de Alwis –
“Epidemiology is like a bikini: what is revealed is interesting; what is concealed is crucial. ~ Peter Duisburg – Molecular Biologist, Berkley
On 2nd March 2020 the President dissolved parliament. Should he have done it? The answer is plain, effortless. There was no reason for him not to do it. He did not see the pandemic coming.
The bird sings not because it has an answer. The bird sings because it has a song.
I did not vote for this president. That said, since a majority decided to pluck lemon, in this season I am reconciled to drink lemonade. In this hour of existential crisis, we must not blur the thin line between solidarity and stupidity.
No epidemiologist, no immunologist, no virologist told us or the President that we should not hold elections in April.
No one knew. No one knew, because we did not have the means of knowing. That is the point of departure of this essay. We do not have an authoritative national watchdog agency to audit disease control, protect environmental health and formulate guidelines of community medicine.
Such an authority with the expertise and recognition to articulate an opinion could have made such a determination. The President would have listened.
The Pandemic tells who we are and where we are. Plagues hold a mirror to the society they afflict.
The Black death epidemic in the fourteenth century laid the ground rules of the modern state. It devised methods of isolation and adopted rules of quarantine.
Societies had to evolve methods and means to halt terrifying disease that struck seemingly healthy people.
Otherwise the ruling elite would have focused only on protecting themselves, their surfs and their slaves. There will always be forensic flunkeys of Wijedasa Rajapakse types to trivialize parliament and our liberty.
The Pandemic crisis has exposed the inadequacy of our public health administration. Our health system should not be the popularity vehicle for Minsters of Health.
We must have a director of public health with a’ weltanschauung’ that will build a new generation of researchers who will build links with peers beyond our shores.
There is a separate and an evolving discipline of Medical Anthropology that addresses issues of stigmatization and marginalization.
It explores new avenues of understanding the links between technologies of epidemic control and the distribution of mortality and vulnerability in and after pandemics.
We must make greater investment in prevention-based health care.
The coronavirus is on a mission of its own. It is surveying our political landscape. It is testing the tensions of our political systems. History will judge how we respond.
I invite the reader to visit the Government of Sri Lanka website.
The website informs you that it has been last updated 04.28 pm on 7th January 2020 that is a week after China informed the WHO of the mystery virus.
The epidemiology unit of the Ministry of Health makes its first situation report on the Corona virus on 28th January 2020.
It imparts the following information.
An outbreak of pneumonia of unknown reason was first reported on 31st December 2019 from Wuhan City in Hubei Province of China.
On 7th Jan 2020, it was diagnosed as “Novel Corona Virus”
As of January 27, 2020, the Novel Coronavirus has been reported from 11 countries with 2798 confirmed cases and 80 deaths.
The incubation period is reported as 2-10 days.
Initially, the disease was reported to be spread from animal to human but now the human to human transmission has been observed
First confirmed case of Coronavirus infected person was reported from Sri Lanka on 27th January 2020. The patient was a Chinese national who came to Sri Lanka as a tourist 2 weeks ago.
Currently, the patient is admitted to the National Institute of Infectious Diseases (NIID). ï So far 5 other suspected individuals are at NIID under surveillance. Out of them, 2 are Sri Lankan.
12 hospitals around the country have been identified as the treatment centers for the suspected persons. (NIID, TH Ragama, DGH Gampaha, DGH Negombo, National Hospital Kandy, TH Karapitiya, TH Anuradhapura, TH Jaffna, TH Kurunegala, PGH Rathnapura, TH Batticoloa, PGH Badulla)
Returning Sri Lankan students who were in China are advised to stay in their homes with minimal contacts with others for a period of 2 weeks from the day of arrival to Sri Lanka.
In the event of the development of symptoms, inform the area PHI / MOH office and seek treatment at the closest above identified hospitals.
At present there is no official Health Ministry directive to wear face masks by the general public including school children.
In the event of wearing face masks, the colored side should be faced outside.
It reports the global situation as 2798 confirmed cases with 80 deaths. Local situation one confirmed patient. It lists preventive modalities.
Avoid close contact with people suffering from flu
Frequent hand washing
Avoid contacts with live or dead animal
Always cover the nose and mouth while coughing or sneezing (with disposable tissue / cloth or cough to the arm pit)
Do not touch mouth / nose / eyes unnecessarily.
It informs you of steps taken for Surveillance at airport
Thermal scanners are in place
On arrival “Health Declaration Form”
24 x 7 health desk
Since 28th January the epidemiology unit has issued daily situation reports. Reproducing them serves no purpose in this essay. As Einstein famously advised don’t bother with details you can find in some place. Knowing it is there is adequate knowledge.
Now, we should look up the situation report of the epidemiology unit of the Ministry of Health dated 1st March 2020.
This is what it reports:
An outbreak of pneumonia of unknown reason was first reported on 31st December 2019 from Wuhan City in Hubei Province of China. On 7th Jan 2020, it was diagnosed as “Novel Corona Virus”. On 30th Jan 2020, World Health Organization has declared it as a Public Health Emergency of International Concern (PHEIC). On 11/02/2020 the WHO has introduced a short form for the diseases as COVID-19.
The incubation period is reported as 2-14 days.
RO (Basic reproduction number) is estimated as 1.4 to 2.5. (R0= the number of cases one case generates on average over the course of its infectious period, in an otherwise uninfected or not immune.
[ I did not understand this RO stuff. I looked for an explanation. It is the measure scientists use to determine how easily a virus spread. It is known as the “basic reproduction number,” or R0 (pronounced R-nought). This is an estimate of the average number of people who catch the virus from a single infected person] ,
Our State Agency monitoring global disease dynamics refers the curious who bother to look up the website of the European Respiratory Society- www.ersnet.org 29/01/2020. I leave it at that.
The Government websites confirms that as of 1st March, the virus has been reported from 53 countries. The structure and substance of the website reveals a pivotal truth.
The epidemiology unit of the Ministry of Health functioned as an information clearing house.
It is a far cry from a regulatory and supervisory agency dedicated to the study of global disease dynamics.
The GMOA, the country’s premier trade union of doctors, has stepped in to fill that void.
They stepped in. They subdued the panic.
As the saying goes the GMOA rushed in not because, angels feared to tread on the pandemic. When the Pandemic hit us, there were no angels around.
It is the GMOA that assessed the menacing magnitude of the pandemic with stark brutal probity.
Axiomatically this President is a decisive leader. As I said in the beginning, I did not vote for him. If I am around, I will not vote for what he represents at the next parliamentary elections either.
I don’t idolize him. I respect the office he holds. He is the President.
In times of panic and peril, a decisive leadership is what matters. That said, decisive leadership does not exclude or negate the need to consult and listen to experts.
Truly great leaders listen to a wide range of opinions – not just those at the top or the sycophants hovering near.
The great leader is focused on asking questions rather than trying to provide all the answers himself.
In his novel ‘The Plague”, Albert Camus makes a perspicacious observation.
“A pestilence isn’t a thing made to man’s measure. Therefore, we tell ourselves that pestilence is a mere bogey of the mind, a bad dream that will pass away.”
May be as Camus did, the President would have felt ‘that it was a bad dream that would pass away.’ Many other leaders of better equipped lands did.
With the novel ‘Plague’ its author attempts to capture the absurdities of life. To infuse his heart and intellect in to the narrative, he creates a character – Jean Tarrou.
Jean Tarrou is a stranger, a visitor to the ravaged land – the plague-stricken city of Oran in then French Algeria .
He keeps a diary of events of the plague. He works hard to organize sanitary squads. And then, days before the plague ends, he succumbs to it.
The driven stranger trapped in tragedy, captures the essence of the panic and the totality of the peril that the plague brought.
“Each of us has the plague within him; no one, no one on earth is free from it. And I know, too, that we must keep endless watch on ourselves lest in a careless moment we breathe in somebody’s face and fasten the infection on him. What’s natural is the microbe. All the rest – health, integrity, purity (if you like) – is a product of the human will, of a vigilance that must never falter.”
In lockdown melancholia, I am captivated by Albert Camus. In utter helplessness, I realize, as did Camus, “the bleak sterility of life without illusions.”
This essay written in these bleak times, is dedicated to my daughter presently orphaned by the pandemic in a distant city state. She furiously, feverishly ‘works from home’, so that she has no time to worry. She is too young to contemplate life without illusions. That state of mind is called hope.