By M.M. Janapriya –

We the Sri Lankans were doing exceptionally well during the first few months of the pandemic led by a strong President. The special presidential taskforce headed by the Army Commander ably supported by the Health Administrators and Preventive Health Doctors were indeed up to the task as per contact tracing, quarantining and maintaining the multiple state of the art quarantine facilities scattered all over the country. They were also up to the mark on guarding our borders which included screening passengers coming through air and sea ports during the time our portals of entry to the country remained open. Barring a couple of occasions when the taskforce seemed to have “taken their eyes off the ball” the disease spread seemed adequately controlled till suddenly it all went pear shaped courtesy the springing up of a cluster in a garment factory in Minuwangoda. To me it is now clear that the virus is indeed there in the community. This article is to analyze as to what went wrong and once we get the genie of the present cluster back in the bottle how best not to let it come out. 

WHO Lying to the world

Ever since the first Corona case was reported in Sri Lanka, I have been wearing an effective face mask. This was often a CE0194 which is a heavy duty industrial mask which I had in stock for use during hobbies like carpentry and masonry. I am one of the few who argued for the usage of masks even when the WHO and health organization of countries like the UK and SL were discouraging its use. On my up journey to London on the 2^nd Feb 2020 I was one of the very few i.e. less than ten, out of 250 passengers on board the flight who wore masks. A much larger number were seen to be wearing masks on board on my return journey on the 9^th March 2020.  

WHO, the worst health organization I know lied to the public on the use of face masks because they feared an acute shortage that would have impacted adversely on even the front line health care personnel and mind you the majority of unsuspecting people fell in line. I was travelling by Chiltern Rail from London to Aylesbury in the afternoon of the 10^th Feb 2020 and I was the only man as far as the eye could see inside the train who was wearing a mask. It is very unusual for an Englishman to talk to a stranger but the man sitting next to me who looked like an executive of some kind asked me if I was wearing the mask because of the Corona scare. I said “yes”. He quickly pulled out a small bottle of alcohol sanitizer gel and dispensed some on to my palm and said “this is what is going to save you, not the mask”. I thanked him for his generosity with the gel and information on keeping Corona away while pulling out my own little gel bottle from the coat pocket and said to him “I too do believe in the gel but I believe equally or more in the mask because I am a pragmatist, a common sense user and above all, a medical doctor, a Surgeon at that who has got Fellowships from two of your Royal Colleges of Surgeons. He apologized and we continued to have a general chat till the end of our journey.

Worse than that was my youngest daughter, an Astrophysicist living in Sheffield, England arguing with me that, going by the WHO recommendations face masks were not needed. She was quoting communiques from the WHO, Professor Patrick Valance the chief scientific officer England and Wales and from some others to substantiate her arguments, all based on scientific data it seemed. I said to her “my darling doni, you are my little girl and I am very concerned about your health and safety. These donkeys are not. Please listen to me. Covid 19 is a respiratory illness. I do not know of any respiratory illness that does not spread from the breath of an affected person either exhaled normally or with force like coughing or sneezing. You don’t need big droplets that fall within 1 metre that you need to feed yourself with, in to your facial orifices to cause such disease, just a fine spray is enough”. “Why should I believe you because you don’t have any evidence?” she asked.  “Because as an expert (a senior doctor, not in preventive health though) mine is level IV evidence and I am your dad” I said semi-seriously. She could not be convinced.

Two or three weeks down the line the WHO accepted, based on some work by a Japanese researcher that air borne infection could take place in Corona transmission and wearing face masks is an important adjunct to practicing hand washing and social distancing. Then panic buying of face masks started which created an acute shortage. I myself made a you-tube video in April 2020 on how to make a mask at home and wear it effectively by ‘non touch’ technique. This is the link and if you decide to watch the video please use a headset or just ordinary ear phones for better sound quality.

You would also remember how WHO colluded with china in watering down the infectivity of the virus obviating the need to close China’s borders because of the fear of significantly damaging the booming Chinese economy. This is the link for the above clandestine act by Tedros the destroyer. 

Please analyze the text in the snapshot of the video depicted above. This stooge said “Preliminary investigations conducted by the Chinese authorities have found no clear evidence of human to human transmission” What does this mean? There has been some evidence of it at least by the 14^th Jan 2020. (Actually by 31^st Dec 2019) In the context of a deadly illness of this nature one does not need clear evidence to act. Some evidence is all that is required and he should have advised the relevant authorities to impose a travel ban in to and out of China by the 31^st December last year. Had he done so this Chinese epidemic could have been stopped on its tracks in China itself and the pandemic could have been avoided. In essence this liar has got blood of 1.1 million who paid the ultimate price, on his hands.

From the foregoing it is crystal clear that dishonesty is the faith by which the Chinese and the WHO lived during the initial period of the epidemic. Once the epidemic got out of China to the rest of the world so did dishonesty. Practically all governments that did badly lied to their respective people. UK and USA are the best examples. Understandably the countries that did well like, Singapore, south Korea, Australia, New Zealand and Germany kept their people updated with authentic information. This is an excerpt from an article in the New York Times of the 4^th April 2020 by Katrin Bennhold,

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.”

Sri Lankan Perspective  

I must apologize for not being here during the month of February. When I returned on the 9^th March 2020 there was a public outcry asking for closure our borders but the government seemed to be dragging its feet. I joined the many like Mahela Jayawardene who took to twitter to voice his opinion. Mine was an article captioned “What are we waiting for? Lockdown for three weeks and reappraise the situation”. From the very outset I wasn’t happy with the way we kept the public informed and requested that more information be put before the public. Country was indeed locked down in the next 3 days or so. Led by the army, contact tracing isolating and quarantining continued efficiently. This was cheap and effective and could give a good run for its money for rt-PCR. Loud requests from many quarters for the number of test done daily to be increased went unheeded for a while. Despite all this our daily new cases kept low and the number of deaths was rather static at a single figure. In addition to government’s flagship contact tracing, isolating and quarantining led by the Army, other factors too may have played a role that made our numbers as low as they were.

* It is very likely that the virus came our way late last year or early this year and spread through the length and breadth of the country taking it’s toll while immunizing the survivors. If more than 60% had got the disease the rest would have been protected by herd immunity. Link for arguments for my theory can be find here.  

* Hot atmosphere of our country was not conducive for long survival of the virus outside the human body.

* Houses being open and located far removed from the next most likely made transmission of the virus difficult 

* Sri Lanka was infected with a milder form of the virus. A SARS-CoV-2 mutation that appeared in East Asia early in the pandemic is linked to symptoms milder than those caused by the un-mutated version of the virus. In early 2020, researchers in Singapore identified a cluster of COVID-19 cases caused by a SARS-CoV-2 variant missing a chunk of RNA that spanned two genes. To determine the consequences of this change, called a deletion, Lisa Ng at the Singapore Immunology Network and colleagues compared people infected with viruses carrying the deletion with those infected by normal viruses. None of the 29 people whose viruses had the mutation needed supplemental oxygen, but 26 of the 92 people whose viruses lacked the mutation did.

Did we pat ourselves on the back too early?

If the above bullet points are valid which I think is the case, we certainly patted ourselves on the back too much too early. Our print and electronic media have often said that we have done so well while our western counterparts were trying to find unused space to bury their dead! We have even been very vocal about this in Parliament too. I recently watched a senior Cabinet Minister pompously reiterating how well we have done to contain the Corona virus for which we have been commended by the WHO and countries individually. 

Did we misinform the Public? 

It appears so. Free press is an integral part of a five star democracy where as a press that suppresses the truth is a sad reminder that we are an enslaved nation. Health department spokespeople and the media appeared to have made a valiant attempt to keep the truth away from the people. Following are two instances in which such misinformation or even disinformation may have taken place. 

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. It is humanly impossible for the best contact tracers in the world to have caught all the contacts made on such a long and a tortuous rendezvous. Hence it is possible that a significant number of contacts could have been left undetected in the community which meant that the disease could have been there in the community at least from then on. 

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 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 clip between 4.44-5.59 minutes. Though the DGHS was straight faced, the other three had guilt written all over their faces.

This seems to me a clear attempt at trying to show there was no community spread when indeed there was a high likelihood that the virus was present in the community.

The Minuwangoda ‘cluster’is being blamed on the nation not observing preventive health guidelines. While conceding that people were indeed pushed into a state of complacency by the politicians and their minion health officials, the fact that a probable source of infection of case No 1 of the cluster has not been found yet and the speed at which the virus is spreading makes me suspect this virus probably is of Indian origin. The way to accept or refute this theory is to study the genome of the Minuwangoda virus. This genome sequencing can be done by the MRI or the Genetics laboratory of University of Colombo fairly quickly. 

It is said that Brandix Company brought down about 60 workers from their Vishakaputnam, India site to Sri Lanka in order to hasten the production of items needed for a recently obtained order and through urgency they may have been whisked away from the airport without being quarantined. For this kind of thing to happen strong connections with the governing machinery of the country is needed. Even though the DIG associated with corona control informed the public on ‘Aluth Parlimenthuwa’of the 7th October 2020, of this saga as 48 people coming on board the flight UL1159 to Mattala on the 22nd September 2020, all 48 of whom had been quarantined at Sheraton hotel in Kosgoda, the Association of Public Health Inspectors of Sri Lanka has publicly denied any knowledge of such a group. Clearly one side is lying and as the aggrieved party, we, the nation need to know the truth. I have started a petition online on change.org to pressurize the President to hold a swift independent inquiry in to this matter. May I take this opportunity to request the CT readers to kindly go to the website and sign the petition and share it widely too?

Consequences of misinformation

People by and large continued with hand washing, mask wearing and social distancing for a period following both these debacles till the famous or infamous Thondaman funeral took place flouting all health guidelines. Then the elections came in a background where people felt normality was around the corner for which they were ever grateful to the government. The victors romped home with a landslide and were basking in the new sunshine oblivious to any threats viral or otherwise. Director General of Health services received a secretary post of a Ministry for services rendered to the government. Masks of both the victors and losers fell off their faces. Social distancing became a thing of the past. 

In this milieu Minuwangoda `cluster’ was an incident waiting to happen. This ‘cluster’ does not seem to have any connection with any other known clusters or indeed any other source of contact and hence seems be due to community spread.

I was at a pharmacy near SJGH about a week ago when a tall young man who appeared unwell coughing away merrily arched over me to ask for something from the pharmacist. I turned back and said “sorry son, have you forgotten the one metre distance you have got to keep?” He was a decent man who immediately withdrew to where he was and kept silent. On my way out I told him “Son sorry I had to remind you of health guidelines the society has forgotten keep Corona away” “No worries uncle, I am normally a home bird. Besides we don’t have corona in this country anymore” he said. He was not even wearing a mask. I said to him “look son you are not even wearing a face mask. If the country is rid of the virus it is because of people like us. Indians next door are competing with the Americans for the first place in the number dead. So we are in grave danger from them. Please wear a mask at least” It is very difficult to keep a mask on 24 hour uncle he quipped”.

This incident summarizes the complacency in to which the nation has been pushed, courtesy misinformation by the irresponsible politicians, media and preventive health officials and in no small measure would have led to the latest health debacle.

Lessons to be learnt      

Lies don’t last long. To keep a lie going one has got to keep lying which is impossible because the truth comes out eventually. So please don’t lie to the public especially in a situation such as facing a deadly disease like the Covid 19. Had the public been told the truth from the very outset, once the naval officers went around freely distributing the virus and the 3 sporadic cases of the senior nursing officer NHSL, men from Rajagiriya and Kolonnawa became positive, public would have accepted the possibility of there being community spread and continued to observe the good public health measures they have been hither to observing. 

At least in the future, I hope the health task force would be more transparent and in the daily media briefings be more open and authentic. This is the only way to win public confidence in the government. Only then will it be possible to get the public to follow the health guidelines which is of utmost importance in quelling the Corona pandemic.

Also, the strategy of using stringent contact tracing isolating and quarantining more and testing less has proven insufficient to keep the virus at bay. Whilst new contacts, those in quarantine and those suspected of having the illness on clinical grounds need to be tested without doubt, it is also important to test random samples from the population from time to time in order to assess the presence of the virus in the community and take appropriate action. 

A quick, cheap and painless test that detects SARS-CoV-2 RNA in spit could be used for this mass testing. This is a simple saliva test called SalivaDirect developed by a medical school in Connecticut, USA which takes only 30 minutes to give a result. It is cheaper than the conventional RT-PCR being around 2 USD/test. This is a bit less sensitive than RT-PCR and hence should not be used to confirm a suspected clinical diagnosis but is of more than enough sensitivity to be used as a tool to see if virus is there in the community. 

I hope the powers that be give due consideration to my suggestions so that we as a nation would raise our pretty heads once again.