By M.M. Janapriya –
Introduction & Chronology
Covid came, Covid saw and Covid conquered. This was despite our attempts at educating the impervious runners of government and their men in uniform who were trying to literally gun down the virus. I was following Covid’s course in my motherland very intently to make sure my friends in the Department of Health Services and those in power did not sidestep the process of containment. I wrote at least 12 articles to the press on Covid control in Sri Lanka, its goods, its bads, and its uglies and copied the links to the President of the country. Government’s initial attempts seemed to have paid off with the disease spread getting under control and fatality figures for the entire period from Feb to Sept 2020 remaining in single figures. Even though there was a raging cluster within the navy camp and another in the rehab camp in Kandakadu due to shortsighted and/or insane actions of the task force these too came under fair control soon.
We are a blessed land which Lord Buddha graced on 3 occasions. Be it, our climatic conditions, our housing design and distribution, a degree of immunity granted by previous infection in Oct-Dec 2019, BCG vaccinations, or be it our innate resistance to this kind of calamitous infection we seemed to be winning the fight against Corona when it all went pear shaped due to the government taking it’s eye off the ball in late September 2020 and allowing an apparel company to import infected labour from Vishakaputnam in India. This virus seemed different, a European strain probably’ made in India’ (like the Oxford Astra Zeneca vaccine made by Serum Institute!) and did spread like wildfire. From Minuwangoda it spread to almost everywhere within days. Even though there were many cases that could not be traced back to an established cluster the authorities kept on pulling wool over peoples’ eyes saying there was no community spread.
Spread of the virus was relentless and so was the false state propaganda. This was understandable because by now the authorities have lost the battle and had nothing tangible to offer the country to halt the spread. They then started dropping pots of holy water from air as advised by the black magic specialist who strangely happened to be some Dr. White. Health minister volunteered to sacrifice herself to the sea if it would halt Corona on it’s tracks but nature declined the offer, instead Corona wanted to test her mettle. Unlike Wordsworth who saw a host of daffodils fluttering and dancing in the breeze when he was wandering like a cloud I was frozen stationary like a ship dead in the water sick and tired of what’s happening around us and was hoping for a pleasant dream when indeed I had this nightmare. A cardboard professor who unfortunately had studied allopathic medicine came on tele and tried to promote a potion called sugarshana peniya as a remedy against Corona. (This fellow should have been struck off the SLMC register for associating with unqualified people, Instead media kept on calling him ‘Professor’ when he should not be because once he left his university job he also left his title at the doorstep. Also they are not the end all and be all in the subject; certainly not in my specialty, Surgery, in which there are many Surgeons more learned and better skilled. Professorship in the faculty is like that of a master in charge of a subject at Advanced Level of a school)
Another peniya erupted from Kegalle when a carpenter turned Weda Rala was spoken to by Kali Amma in his dreams about a potion made of Nutmeg, bees honey and 2 other secret ingredients started churning out thousands of bottles of the product for prophylaxis against and a cure for Covid. I had my share of dreams too when I saw the above mentioned cardboard Professor again giving the bass his fullest support. He seemed either to be a peni avid human form who must have been an ‘embalaya’ (a kind of ants which often appear drowned in honey pots) in his previous birth or seemed to have been under military or some such higher orders to promote the peniya on live electronic media. In either case he seemed to cut a sorry figure and proved himself to be a dishonest individual unfit to hold high public office. A government minister doled out a costly machine purchased using public funds, to the Weda Rala to produce the decoction in bulk. Thanks to an MD MRCP quack from Wathupitiwela the bass managed to get some kind of access to the state hospital to test his decoction and announced to the masses that the peniya was the long awaited magic brew for Covid-19. [This BH Wathupitiwela doctor also should have been struck off the Sri Lanka Medical Council Register of Medical Practitioners for a) association with unqualified people b) for carrying out unethical tests on human patients and c) malicious advertising. None of these happened because he too seems to have received the backing of the law makers]
This ‘Kali Puthra’ potion under normal circumstances should have seen the bottom of the garbage bin. Instead it managed to get the powers that be to appoint a team comprising of University professors to carry out scientific research on western medical lines to establish or refute its efficacy. I battle with myself to fathom how these learned or not so learned so called academics agreed to test the potion. There should have been some indication on initial testing that this peniya was showing a degree of promise. Without any such reason for them to have agreed to test the decoction is just a case of being subservient to political power and an ignominious defeat for the entire medical academia of Sri Lanka. This exercise would see these six people degrade (or I don’t know may be ennoble) themselves as ‘Mahadenamutta and the 5 disciples’. I have pointed out in one of my previous articles how the testing was going to be an uphill task and am eagerly waiting to see the results.
Professors Fake or Real?
I consider this an opportune moment to pen a few words of wisdom about this most prostituted word Professor. (By the way when one uses this word prostitute as a verb to signify misuse it is not infrequently misunderstood. On an incident where I used the expression “my theatre boots seem to be getting prostituted” meaning being given to others to be used when I am not using them and the nurse misunderstanding the expression as if I called her a prostitute, the monk president of the nurses’ union came on national TV asking for my scalp. He ended up not getting even a hair from around my proctodeum.) Media bring these men and women on the air waves to terrorize the masses with information junk. Politicians bring these people to the fore to cover their backs like in the case of reversal of cremation order on Covid dead. Professors themselves use this word to suck life out of the sick masses who beg borrow or steal money and get in to a scrum to see them at 4 pm. My ‘kid brother’ is a Professor too but I know for sure he would not get offended for he does not belong to this category. He is a Surgeon and a gentleman. I would write a separate article on what a Professor is all about on a later occasion.
The Kali potion was being promoted with so much intent and passion by all and sundry in the government that the boot lickers of the powers that be forming a wide plethora comprising of individuals of the public, university teachers like the said cardboard professors, members of ‘wiyathmaga’ which was sarcastically termed ‘Kiyathmaga’ on social media based on the patronage wanton destroyers of rain forest seem to have received from the rulers, some prominent TV channels etc. I was under the impression that this was indeed the government’s formula to combat Covid supplemented of course by the sacred pots of water. At this point I empathized with the Government or may be more apt to say I sympathized because they seemed to be scraping the barrel and looked unable to generate necessary money to buy any credible make of a vaccine in enough numbers needed to immunize the masses. In this sombre backdrop the Health Authorities were going to depend on the free quota of the vaccine WHO promised and also on a stock coming as a possible gift from India.
People thronged the ‘peni pharma lab’ premises in Kegalle in their thousands to obtain the magic potion in what looked like quarter bottles of ‘Arrack’, quite oblivious to the health guidelines such as maintaining one metre distance and wearing face masks. This may have contributed to the galloping spread of the virus that took place in the days and weeks followed. Peniya found its way in to the Parliament and indeed ended up in the speaker’s chambers. Some drank the potion in front of TV cameras to promote its compliance with the masses. The Minister of Health was a notable participant who ended up embracing Covid with the ‘Dutch courage’ she received by drinking the Kali peniya. Poor woman had to be treated in the ITU of the IDH as her immunity seemed to have been shattered by the peniya. Virus may have hit her Betz cells that she ended up going home taking the respirator machine with her it is being said on social and other media. Several other ‘peni MPP’ too contracted Covid and it was being said on social media that the Kali Puthra himself was convalescing from Covid in an unknown location.
The Vaccine Arrives
By now the politicos in power and their advisers realized that Peniya had done its job of giving the gullible masses some hope and it could do no more. They had no option than to turn to a vaccine to help slow down the raging spread. WHO dole was not ready so Modhi’s generosity helped. President’s lack of faith in the medical fraternity of this country was further exemplified by the fact that the committee launching the immunization campaign is being headed by a senile ‘sil-hil servant’ (Pardon my spelling. I may have got it awfully wrong). Naturally it has become blunderbuss. First of all there was some hesitancy in the acceptance of the vaccine. As a senior doctor I too had squirms about the Indian vaccine. I don’t trust Indians. I don’t buy Indian products unless as an emergency measure like to replace till a proper one is bought, a car tyre that has come away in pieces in some remote corner of the country.
Poor Dr. Ananda Wijewickrema became one of the guinea pigs and took the vaccine first before the TV cameras to allay public anxiety. I would like to believe he took it at his own volition and there was no compulsion for him to do so whatsoever. I am personally acquainted with the Wijewickrema family very much. I knew the old gentleman and his wife long before Ananda was born. They are very respectable people indeed. Even if he had squirms about the vaccine there is a good chance Ananda would have taken it in public to boost public confidence putting his own wellbeing at risk. As it turned out the vaccine is quite safe to be administered and I had no hesitation whatsoever to have the jab when it came to my turn as a retired doctor last week but we have a bigger problem here in how the government dropped like a hot potato, the priority list formulated by the college of Community Physicians and got on with their own way of allocating the vaccine in order to get their minions and lackeys vaccinated. It was excruciatingly painful to watch how a 77 year old husband of a retired Consultant Anaesthetist colleague of mine was refused the vaccine at the Accident Service, NHSL Colombo when I went there to receive my own vaccine as a retired doctor about 10 days ago. There appeared to be an air of ‘mortal fear’ like in a period of martial law amongst the nurses and doctors over there, of punitive action on those guilty of ‘deviation from the norm’ even to immunize a well deserving recipient. The Health Secretary to the Ministry in charge of Covid control was recently disciplined for apparently facilitating the issuance of the vaccine to a cricketing legend. This is sheer madness when you consider the fact that the recipient of the vaccine allegedly so facilitated is national treasure, one of the top few of an eleven that put us on the world map (match fixing aside) and needs to be protected with all our might. In countries with sane rulers this incident would have been used to national advantage to promote the vaccine compliance, the Secretary would have been commended and stayed put in the Ministry to oversee the good work. Not to be. What a period? What a country?
The National Advisory Committee on Communicable Diseases (NACCD) and the Department of Health Services approved in January 2021, the consensus statement between the politicians and the Medical Professionals in the field that came out named National Vaccine Deployment Plan for Covid-19 (NVDPCovid-19). This had been conveyed to all stakeholders including the WHO. Though I personally don’t agree with priority vaccination of ‘frontline security forces and frontline police personnel and high risk individuals and high risk groups in economically important and essential services’ (which probably left enough wriggle room for corrupt politicians to manipulate) I must congratulate my CCP colleagues and other public health specialists in formulating a strategy accommodating the sensitivities of the politicos who display a significant degree of dependence on the forces than masses for their survival and wellbeing. There may have been internal circulars and other guidelines to the health workers on the intricacies of the program but to my knowledge no priority list has ever been publicized either by splashing on print media or putting it on the internet. When there is nothing in black and white corrupt politicians including those with a medical background run amok in the gray area and this is exactly what happened in the vaccine arena. I was told 3 circulars came out within as many days or so superseding the previous ones. This is clearly to accommodate some people who came very low down on the priority list. Given below is the priority list agreed to by the NVDPCovid-19.
Frontline health staff
Frontline security forces personnel
Frontline Police personnel
Those above 60 years of age specially those with co-morbidities, like diabetes, high blood pressure, chronic heart and lung disease etc.
High risk individuals and high risk groups of any age in economically important and essential services
The first 3 categories were swiftly vaccinated in the first round itself. Next it should have been the turn of the 60 years and above but the authorities decided to drop the scientifically agreed priority list like a hot brick and went on to substitute a sector called “those between 30-60 years” This is typical political manipulation causing a smoked screen for which a Peni Minister held the brief, at an obnoxious panel show with a name sounding like ‘new house of representatives’ on a stooge (or king maker) TV channel. This man is being depicted as a professor on electronic and print media when indeed he should not be. The above substitution of the 60+ group with 30-60 9is extremely damaging to the country in general and the Covid-19 control program in particular. It also shows scant regard to the senior citizens of the country. The following is a list of points for drivers of this blunderbuss campaign to ponder.
1. The two most important objectives of a vaccination program launched during a pandemic is a) to reduce mortality for which the most vulnerable group (sixty year olds and over) needs to be vaccinated swiftly and b) to reduce basic reproduction number (R0) i.e. number of individuals an infected person can infect to a figure under 1 so that the pandemic would slowly die down. For the latter to be achieved 80% of the population need to be vaccinated quickly which is unlikely to happen in Sri Lanka
2. In the case of the vast majority of young people this illness is either asymptomatic or mild with no or negligible mortality
3. The 30-60 year group is close to a mammoth 60% of population of Sri Lanka which would work out to 12.6 million and with measly vaccine numbers available we will forever be vaccinating this group having no respite to even look at the above 60 year most vulnerable group
4. The vaccine scrum that this scheme has generated which we often see on TV seems to offer 60 year olds only slim chances of getting to the finish line for the vaccine
5. The over 60 group, a paltry 10.6% of the population which is actually around 2 million is eminently coverable very quickly but right now this group has been hung to dry!
6. It is the above 60 group that have served the country longest, hardest and whose mortality and morbidity is highest and as such deserves the vaccine as a top priority.
7. Boris Johnson on the advice of his confidant Dominic Cummings (who later resigned) let the virus run through the country according ‘herd immunity’ and saving the all-important British economy. Cummings is supposed to have said “if this meant some oldies dying so be it”. Nearly 100,000 Britons have died so far of whom around 90% are above the age of 60. Boris and Cummings have blood on their hands and Boris’s political future is coffined nailed and buried with those who paid the ultimate price. How does this analogy apply to Sri Lanka? Whilst Boris’s government action led to the death of so many, Sri Lankans are doing exactly the same thing by their inaction.
8. This pandemic will take at least another 6 months or so to simmer down to a low endemic level by which time our death toll would be close to or over a thousand and out of these more than 800 would be over 60 years of age. I have no recourse than to personally hold the Government including the President of the country responsible for these deaths by presiding over outrageous and scant regard paid to the agreed National Vaccine Deployment Plan for Covid-19 (NVDPCovid-19) of January 2021 by the political stooges at the helm of the steering committee.
Here are some of the excerpts of a hard hitting message issued to the press by the College of Community Physicians of Sri Lanka on 22nd Feb 2021 on the high handed and reckless deviation from the plan.
“the first priority identified in National Vaccine Development Plan for Covid-19 (NVDPCovid-19) was to vaccinate frontline healthcare workers and those who are directly involved in Covid-19 activities, which was completed in the first round of vaccination; whilst the remaining priority groups include those over 60 years of age and specifically those suffering from non-communicable diseases in which severe disease and deaths are happening on a daily basis in the country.
Therefore the decision of the Ministry of Health to initiate vaccinations targeting individuals of 30-60 years implemented in a few selected communities is a clear deviation from the scientifically agreed prioritization stated in the NVDPCovid-19
This strategy is neither an evidence based practice nor a public health decision considering the wider public health and economic outcomes. It derails the Covid-19 preventive activities in the country, dangerously undermining the public health response to Covid-19, especially with regard to the objectives of reduction of complications and deaths due to Covid-19.
Disregarding the recommendations of the National Advisory Committee on Communicable Diseases (NACCD) at this stage of pandemic response may jeopardize the entire Covid-19 control activities. We the College of Community Physicians of Sri Lanka earnestly request the government to urgently implement scientifically recommended vaccine priority list rather than talking ad-hoc decisions on vaccination policy”.
Nature’s effect on Pandemics
Epidemiologists know that the pandemics caused by new viruses end in several ways bearing in mind the fact that we do not yet have an antiviral drug which effectively kills the virus. Presently available drugs would alter the course of some diseases so that the body can either get rid of the virus or reduce the viral load to such an extent that the sufferer can lead a life span of which could be near normal or indeed normal. The latter happened with the HIV AIDS virus. Thirty years on we still have the virus and the disease but people do not die from it anymore.
With SARS COV-2 virus being an acute respiratory virus we didn’t have a great choice and the end game could be unpredictability different to what we are prophesying or indeed what we are hoping for. As at present those who contracted the disease either got better quickly, or battled it out in an ITU and emerged victorious or indeed succumbed to the illness. Outcome depended to a great extent on one’s age, fitness and co-morbidities. Drugs were ineffective. Dexamethasone reduced ITU mortality by 30% though.
In this bleak picture we had to avoid getting the disease. This was done by wearing masks, maintaining a one metre distance and keeping hands clean by either washing with soap and water or using alcohol sanitizer to rinse hands with frequently. This was the individual responsibility and still is.
The government’s responsibility as per advice by the public health authorities was to close down borders as quickly as possible, Test, Trace and Isolate patients and contacts. The more numbers one tested, the more earnestly one traced contacts and the more stringently were the contacts isolated, quicker and better was the result of getting the spread under control. Some countries like Vietnam, Taiwan, New Zealand and Australia did this successfully whilst some others were less effective and a few made a mess of it altogether. These measures were only buying time till either a vaccine was rolled out or some drug that could cure the disease was discovered.
In case neither of these happened the virus would go on spreading the illness till it had infected all susceptible individuals, had no more hosts left and would start slowly withering away. By then however, it would have taken its toll of deaths. Also it would have left some others permanently incapacitated. What we do by social distancing etc is reducing the ease with which the virus would spread i.e. bringing R0 or basic reproduction number (number of cases directly generated by a single infected person) down to less than1 in which case the epidemic would come to an end sooner and damage caused by the virus before it leaves would be lessened.
If there was an effective viricidal drug that too would have brought the pandemic to a conclusion sooner but the large number of drugs trialed during the pandemic did not have any significant viricidal effect. So the world had to persevere with other preventive measures till a vaccine appeared in the scene.
Vaccine’s Effect on Pandemics
Vaccination is a very old concept of according immunity to the masses. Thanks to pioneering work of Edward Jenner Small Pox a killer disease has been eradicated completely from the planet. Similarly childhood killer diseases like diphtheria and whooping cough are hardly heard of today. Tetanus which I have seen in plenty in Sri Lanka nearly 50 years ago as a young Intern House Officer is very rarely encountered today. Thus we have come a long way in preventing dreadful diseases for which there is no cure.
5 vaccines against Covid-19 appeared on the scene almost simultaneously. They all claim effectiveness ranging from 70% to 90 percent in preventing getting infected. The rationale of vaccination during a pandemic is to reduce mortality and bring R0 down to less than 1. It is well known that the elderly are the most at risk of dying from the illness. Hence in almost all vaccination programs in the world 60 years and above were vaccinated as the next top priority following the vaccination of frontline health workers. In Sri Lanka too this was indeed going to be the case when the National Advisory Committee on Communicable Diseases (NACCD) and the Department of Health Services approved in January 2021, the consensus statement between the politicians and the Medical Professionals in the field that came out named National Vaccine Deployment Plan for Covid-19 (NVDPCovid-19).
However the Government through the DHS openly flouted this priority list when they started vaccinating a mammoth 12.6 million group called those between 30 and 60 years of age with a measly number of the vaccine being available. Even if the government of Sri Lanka managed to vaccinate this big group it would not have reached the 80% needed to accord ‘Herd Immunity’ for which the numbers needed to vaccinate would have been around 16 million. Hence the government advised by the sil-hil servants and Peni avid cardboard professors have caused enormous damage to the nation’s physical and mental health and also to the nation’s trust in their rulers than that done by the Easter Sunday bombers. Just like the political future of England’s Boris Johnson being coffined nailed and buried with the thousands who paid with their lives there is no doubt that the political future of the Rajapaksha Dynasty of Sri Lanka would meet a similar end purely on this matter. A ‘know it all’ President is as bad as a President advised by some ‘know it all’ buffoons but the voices of a few disgruntled people like me would not be effective in stopping this ‘feathering their own nest’ clique. An ‘Appalled Nation’ thinking straight and getting together in their numbers would certainly be.