Thursday Sep 19, 2024
Thursday Sep 19, 2024
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We need a new communication campaign, separating ‘tests’ from ‘cases,’ setting the record regarding ‘mortality’ straight, reminding people of the limited ways this can be spread, and how they can ensure we stay ‘open’ and ‘at liberty’ by following these guidelines – Pic by Shehan Gunasekara
Okay, perspective first. In our geographical corridor re C-19:
India, population 1.35 billion
Pakistan, population 212 million
Bangladesh, population 161 million
Nepal, population, 28 million
Sri Lanka, population, 21 million
Clearly, Sri Lanka should panic immediately, shut down, lock down the districts, blow up the economy further, inflict more suffering upon its citizens, because this ‘uncontrollable’ scourge has clearly devastated the land!
Clearly, I’m joshing. Lanka should be beaming comparatively!
Just post these comparative figures, which are some of the most positive in the world (India in terms of caseload exempted, mortality-wise perspective is gained by realising more than one million die of air pollution in India per annum and more than 30,000 from cobra bites!). This is particularly so against population in terms of mortality against percentage of ‘positive test results’ (without even adjusting for ‘false positives’ and the like). By comparison, let’s realise that during the Spanish flu, 20 million perished in India. This is currently not the basis for existential ‘terror’ anywhere in South Asia.
And Lanka, our beloved Lanka, even post these dire cluster surges, is skating through, and our worst enemy is our own irrational expectations of ‘eradication’ (not in our control unless we completely blow up tourism, trade and world engagement for the foreseeable future, and what do we do when the next pathogen comes calling?). We are winning, by and large! We now decisively and reliably need a sustained open economy and the lack of ‘positive test result’ fetishism that lets us move forwards.
Army Commander: We have even less deaths than we think!
A few articles back, I tried to respectfully look at each of the published deaths and suggested many of them did not seem to be ‘caused’ by COVID. In some, clearly chronic illnesses were the culprit. In others, C-19 may have contributed, they were ‘with’ COVID but not ‘from’. I also said this given the age profile, as COVID deaths, those that seem outright caused by the pathogen are overwhelmingly in the 70 year and above profile. We have too many listed in the 40s and 50s for it not to seem a statistical anomaly. Care has to be taken here, hence as I pointed out.
Singapore with 50,000 ‘cases’ (positive tests) has 28 deaths, because they are scrupulous with assigning causality as opposed to other jurisdictions where if there is a positive test, they are tagged with ‘COVID’ even if say they actually died in a motorcycle accident.
I was therefore heartened to read the Army Commander’s assessment, where he indicated that only “5 of the deaths from the total death toll reported during the coronavirus pandemic have been reported as COVID-19 deaths in Sri Lanka”. This statement came from the National Operations Centre for the Prevention of COVID-19 (NOCP). General Shavendra Silva said the Secretary of the Health Ministry verified that “the remaining deaths are not caused mainly by the virus, but due to other chronic diseases”. Hallelujah! While this ‘report’ showed up in several sources, I cannot fathom why it has not attracted more discussion?
While urging people not to fear seeking medical attention, and assuring them that special arrangements have been made even for locked down areas, he emphasised again, and I urge everyone to pay attention (including his colleagues who influence policy, who seem not to have either read or certainly not to have digested this factually impeccable recommendation): “…only close to .2% have been reported to have died due to the virus…” Therefore, seek medical attention, and don’t be unduly afraid.
And may I add, do not therefore paralyse the life and recovery of this nation over 5-10 direct deaths from a pathogen with a .2% or so fatality rate!
However, this revelation seems not to have affected or influenced our continued reporting of the mortality number, which remains seemingly detached from this guidance. On Friday, 13 November, five deaths were announced, only ‘one’ arguably or even plausibly should go in the ‘from’ COVID part of the ledger and we are skewing perceptions and more, by continuing to classify in this way, despite the conclusion shared above.
So, four males aged 64, 68, 69, 78, and a female aged 83 were indicated among the deceased.
The 83-year-old female, died at her residence, high blood pressure and diabetes along with COVID-19 (presumably this was determined posthumously from a test, as we trust she wouldn’t have been at home if being actively treated for it), so at most ‘with’ and maybe not even that.
The 68-year-old died ‘on admission’ to Mulleriyawa Hospital, where while being classified as a C-19 patient, ‘cause of death’ was high blood pressure and internal bleeding in the brain. Frankly, adding ‘C-19 infection’ to that is meaningless and pointless.
The 69-year-old was also pronounced dead on admission, cardiac arrest, high blood pressure, diabetes, again saying ‘C-19 related cardiac arrest’ adds very little to this. With that cocktail of comorbidities, it is unlikely that distinctively tipped the scales.
The 78-year-old, also cardiac arrest, no other chronic illnesses cited, so perhaps ‘with’ COVID-19.
The 64-year-old was dead at his residence. C-19 cited. But for that to have been ‘from’ C-19 he would have been at an advanced state of symptomatic distress. Did no one notice? Did he live alone? He presumably wasn’t walking around, coughing and in a fevered state? If these weren’t the case, the death diagnosis is highly suspect.
My point here is the Army Commander’s input, clearly ratified by health professionals, should convert into protocols for classification, otherwise we have misleading psychological ‘optics’ that will serve only to deceive and delude people in assessing the situation.
To add to this further, on 15 November, another 5 highly suspect mortalities insofar as being associated with C-19 as a “cause.” Very briefly: 54-year-old died of cancer. Saying “exacerbation of a chronic cancer by C-19” is pure rhetoric. Cancer killed him, age profile off for COVID and Cancer compromises immune systems, so indeed may have rendered him susceptible to viral infection. But when you have a leading cause of death, just slapping “COVID” onto it, makes little sense.
Next one, 39 year old, statistically highly improbable again by global metrics for C-19, cause of death cited as cancer “and” COVID pneumonia (pneumonia is something that may develop in the latter stages, as the immune system fails). Again, not credible as a primary causal factor.
Then 88-year-old, admitted due to chest pain, and then heart attack. Saying “caused” by C-19 is speculative. Surely if C-19 was symptomatic, they would not have waited for chest pain for admission?
A 79-year-old, chronic lung disease, “due to C-19 infection.” Was it “chronic” or not then? And if a lung disease already there, then “with” perhaps, not “from.”
Finally an 88 year old, heart attack once again, with a vain attempt to speculate it was “caused” by C-19. At least the age profile is correct, and “with” C-19 is likely here.
But you see the clear, over-riding comorbidities, or in the case of cancer, likely core cause, and wonder why this behooves us to “trump” up C-19 deaths that are clearly so tenuous and unpersuasive as being “from”? What narrative are we trying to advance?
Unlike many exemplar countries, whose death rates are not moving much at all in the “COVID” column, though people continue to naturally die, there is a clear distinction between “from” and “with” or even asymptomatically “incidentally” present. Even with all this dubious ascribing, thankfully, we are at such tame and unremarkable mortality numbers, and factually far closer on the merits, it seems, to the Army Commander’s assessment.
Tackling the propaganda
As explained, we are well below a rational fear threshold, based on reported numbers. Taking WHO guidelines, we would need to see 800 or so cases a day (5% of 16,000 positive test results), untracked and untraced, to show a level of concern for the situation spiralling out of control. Even cumulatively, we aren’t there. 300 or so cases from Colombo a day, which has been cited as ‘a cause for grave alarm,’ cannot be terrifying, given false positives, the distortions mathematically as to the infectiousness of any one person given low prevalence overall in the country (once more, 1% of the country having the infection, with even a 1% false positive rate, would mean each test per 100,000 may only have about 50% reliability relative to that person being infectious).
However you slice it, even if this was sustained, and 9,000 cases persevered in Colombo per month, allowing for zero errors or distortions, we ‘may’ see 27 deaths (.3% fatality rate) in a month, among 670,000 people in a critical GDP epicentre for the nation. If Colombo is closed, economically, essentially, so is Lanka.
And you cannot operate by issuing ‘curfew passes’ (again, please, let’s get over the curfew mania, we can apply circuit breakers, applying guidelines, without ‘locking people up’ and crippling lives pointlessly), as a lot of the GDP requires movement in and out, customer facing businesses, local tourism critically needed to keep the sector afloat until we open to tourism at large and more. There was another attempted ‘panic’ scare a few headline cycles ago, alleging that perhaps 30,000 people may be infected in Colombo. The source for this little titbit was a random sampling of 400 people in Colombo, of which 19 were apparently ‘positively tested’ and in the vernacular of the COVID panic, deemed ‘cases.’ I cannot wait for the Antigen tests to be applied, as we will at least initially then deal with people with relatively higher viral loads and posing more evident danger of contagiousness, and it behooves us to first focus there.
But back to Colombo, while a 400-person sample is better than the current Pfizer vaccine sample (a discussion for another article), it is hardly definitive. That gives us 4.8% for 19 people roughly. If it held up across the population, yes we’d get close to 30,000, and again, absent any distortions, then potentially 90 deaths. All to be treated, and many we hope we would avert, but far from apocalyptic if you look at the death toll in Colombo daily and monthly from a slew of causes, including road accidents. Just under 2,000 pass away in Colombo per month from various causes as per published reports.
So perspective, and context, and balance are needed. Can we shelve the panic porn? This is a serious virus, it is being treated with the full zeal and dedication of Sri Lanka’s care providers and experts. We are winning (see stats at the opening of the article), this is not an epochal, life altering pathogen, it globally shaves off roughly five years from .15 of the population. We have hyped it beyond the bounds of hysteria, and a nation that in the past made progress undeterred by ravages and wars and national disasters, cannot be petrified into paralysis over this.
‘Isolation’ and hospitals
Let’s start with hospitals. The current “system”, not the “virus” creates the emergency. Imagine a system where if you tested “positive” and were asymptomatic, you went to home curfew. If you had mild symptoms, you went to a quarantine center. And only if you had severe issues, requiring specialist attention, would you go to a COVID hospital. In one fell swoop, all the “tens of thousands” of feared “positive tests” (of which only a tiny fraction ever require ICU or specialist hospital attention) evaporate as inducements for economically suicidal “isolations” and “shutdowns.” Just for perspective, 40,000 to 50,000 in the US are hospitalized in this current massive US surge for COVID-19, which though is only 7% of all hospital beds. So it is “how” and “when” and “if” you hospitalize which is key.
Asymptomatic, stay home. Do your 10 days or whatever is designated and move on. Mild symptoms, why not the quarantine centers? And keep the hospitals for when they are actually needed. Today, if someone goes for a doctor’s visit, and one of say several symptoms is a “mild” sore throat, a PCR test is likely done. Despite all the uncertainties, if tested “positive”, that person is whisked away to Jaffna or wherever, removed from family and life (which is probably why so few go the hospitals even when they need to, likely causing at least as many if not more mortalities than the pathogen). If mildly symptomatic, why not home curfew, or an isolated room in the hospital? If guidelines are followed, they surely cannot infect anyone, surely less so than in a massive pass-off chain that relays them to the northern tip of the island.
And we now are “isolating” parts of districts. If there is an unprecedented surge, for short-term contact tracing, that’s understandable. However, for weeks, it is silly. The collateral damage to lives and livelihood is far greater than the “phantom menace” of “x” number of positive tests posing as “cases” seeking to “imply” mortal danger (which is never to be taken lightly, but is overwhelmingly nominal here, as demonstrated above).
What are the guidelines for?
I am delighted to see that the MoH guidelines are being more rationally applied of late. So, a hotel, with four employees testing positive, does not have to immediately be shuttered, completely disinfected, the entire neighbourhood quarantined, etc. No, they get these people care, they contact trace from their interactions, they heighten the sanitary protocols and temperature checking, and move on.
The purpose of the guidelines should be that those regions, areas, businesses, gathering sites, that adhere to them (exempting say superspreader environments where space or the nature of the gathering precludes that), are then ‘shutdown proof’ or ‘curfew proof.’
Hotels desperate to build on their success with local tourism have asked me bewildered, why when following the protocols, are they obliged to be shut or to shun travellers? Surely, if India and Japan can have a ‘travel bubble,’ you can have one between non-isolated parts of Colombo and say Kandy or Galle? We have to crack that.
Moreover, such a hotel, has to assume the purpose of the guidelines is that even if an infected person checked in (which must have been anticipated, as we’re not testing everyone who checks in), the distancing, masks, sanitation and other protocols would keep them from infecting others, and keep others safe from them.
This is not a disease that oozes out of pores, nor can you imagine an infected person running around hacking on everyone, spitting on them and every stray surface, in some kind of ‘infection crusade.’ And even if they did, you are sanitising, and they don’t need to be hermetically sealed. It may not be 100%, but it must be close. Perfection can’t be the standard anyway, completely isolated areas, still have cases percolating as the President pointed out. So the job of the authorities is to quality control the execution of the standards, which ensures us we are safeguarding staff and visitors and everyone else.
And therefore, outside of large festivals and gatherings, why would you stop people traveling, and engaging in commerce, and providing business to each other? Then are the guidelines meaningless? Are they just to have healthy people pointlessly keep their distance while wearing masks?
Transmissibility again is by close quarters personal contact in an overwhelming number of cases. If we don’t explain that to people, even when not ‘locked down’, they will be frozen. And their irrationality will hobble the very economic livelihood we need to stir, stimulate and sustain. So why terrify people into hiding from each other, rather than applying the guidelines which are in some ways, overprotective? For example, at one metre or more, a mask is not needed, it was meant for when such distance could not be maintained. Double up if we like, but let’s keep the superstition out of it.
Again, if we don’t believe the guidelines keep us safe, what are they there for? And if they only keep us safe if no one is infected, then that is utterly spurious. It is to allow us to continue to engage and conduct commerce, without spreading the disease, despite the uncertainties of infections, asymptomatic or otherwise.
And remember, mortality is anyway very low, so we are not taking ‘chances’ with say radioactive matter, or by having unprotected sex with someone who may have HIV. Nothing even in the outer perimeter of those risk profiles. We are making it less likely we catch a particular strain of a cold. We can probably ‘survive’ that and exercise even more caution if we are demographically at higher risk, which surely we would do anyway.
But we essentially disincentivise people from following the guidelines when they see it gets them nowhere, and we shut everything down despite guidelines if there is a surge or some spike, and so then telling them once we’re open, to follow these, runs the risk of falling on deaf ears.
When walking through a nature reserve some weeks back, I was told they were closing early to ‘protect against COVID.’ Why are these parks and reserves shut anyway? The Vitamin D in the sunshine acts as a disinfectant, outdoor transmission is virtually unheard of and considered ‘impossible’ outside of superspreader gatherings by most experts. Are they thinking we will all salivate upon each other in these outdoor settings? Outside of that, there isn’t a risk. Zero. Why is it better, to shut us up in close proximity to each other, in often poorly ventilated spaces? We are flirting with detachment from reality of a high order.
So we need a new communication campaign, separating ‘tests’ from ‘cases,’ setting the record regarding ‘mortality’ straight, reminding people of the limited ways this can be spread, and how they can ensure we stay ‘open’ and ‘at liberty’ by following these guidelines. But then we can’t be shutting provinces down and curfewing in a panic simply at the mass superstition of PCR tests which were never intended to be ‘diagnostic’ in and of themselves, as testified to in their own accompanying material, and as per the guidance (previously discussed) of the founder of these tests, a Nobel laureate in Chemistry, who told us they are for ‘identifying’ and simply cannot ‘testify’ as to viral load or contagiousness or how ‘live’ the fragments being detected are.
Sri Lanka again is winning! And that is thanks to the leadership and the dedicated service of so many. So let’s reap the benefits, the fruits of that success, and let’s let those guidelines do what they were intended to: not just be ‘good luck charms’ but living protocols allowing us to function and flourish.
And so…
The President says we should stay open, the economy has to function. He’s right.
The Army Commander says we haven’t failed, we’ve contained the pathogen, even within Colombo. Across the whole of Colombo, he’s certainly right, and he’s right about the classifying of deaths, which should now be reflected in our protocols going forward. Could we direct the alarm merchants in other directions, as people need to build the confidence to reclaim their lives and start to rebuild everyone’s future? There is no data point that suggests we need to cower or flee, or which suggests that any of this is asking for something unduly epic or heroic. It is in fact the only thing pragmatic and practical.
And can we sanely realise, we have to open back up, use our advantages to help lead Asia’s recovery, and not be the most paranoid in the neighbourhood when we are the best off in the neighbourhood?
Let us be bigger than these fevered fears and be defined again more by the depth and daring of our audacity as we reach for progressing our dreams.
