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The Government’s strategy is very much at odds with the valuable self-realisation the Buddha enabled by asking Kisa Gotami to bring back a mustard seed from any house that had not experienced any deaths
By Tilak Dissanayake
Dear Mr. President, most Buddhists remember the story of Kisa Gotami 1 and its core lesson that death is inevitable to all beings. The Buddha enabled this valuable self-realisation by asking Kisa Gotami to bring him a mustard seed from any house that had not experienced death. She returned empty-handed, and realised that death is very much part of life.
…Jati paccaya jara maranam… (through birth are conditioned decay and death) – Paticcasamuppada
The COVID-19 virus is here to stay, regardless of the length of the lockdown. All of us will get infected and a small minority of us will die. There will be no vaccine for one to two years.
The good news is that most of us won’t even notice that we got the virus. A percentage of the aged (I am one of them), especially with pre-existing medical conditions will die.
The lockdown is harming the immune systems of every citizen with every passing day since we live in fear psychosis and cannot get access to the proper nutrition, medicines, exercise, sunshine and social interactions. Our immune system is our only weapon against the virus.
The lockdown is causing staggering economic harm to individuals, families and the nation.
The medical community advice which has resulted in the Government’s lockdown policy, is concerned about those that may potentially die if their 500 ICU beds are ‘overrun.’ However, the Government has to “do the right thing” for all 22 million citizens so that they can take their lives and the nation forward.
I respectfully urge you Mr. President to implement the following measures:
Lockdown delays – not prevents – deaths
The reality is that no matter how long the lockdown, the COVID-19 virus will not go away. The worldwide fatality rate for the seasonal flu is 0.1% (about 1,000/day) 2 , and the current best ‘guesstimate’ for COVID-19 is 1%, but that number will come down as more testing is done and the denominator increases. The ‘good news’ of this pandemic is that 80% of the population will not notice any significant symptoms after getting the virus (current WHO ‘guesstimate’) 2 and would have developed immunity. Unfortunately, no widespread antibody testing – which would give people a great sense of comfort that they are already immune – has been done.
If we assume:
Regardless of which number it turns out to be, our 500 ICU beds will not be able to handle the potential flood of patients when the curfew is lifted weeks, months or years later. Even if we have 220,000 ICU beds, some from the vulnerable groups who get COVID-19 will die. We all wish none of this were true, but we must embrace the reality that COVID-19 will infect virtually everyone worldwide and a small minority will die.
Worldwide, COVID-19 mortality is dominantly among older people (I am one of them); and significantly, from those with pre-existing medical conditions 3 such as heart disease, diabetes, chronic respiratory disease, high blood pressure and cancer. Sri Lanka has many citizens, young and old, with these medical conditions; so our numbers may be potentially higher than 1%. There is speculation that the virus does not spread as fast in tropical countries and people with BCG vaccinations (which we all have had in our childhood) may make us less susceptible to infection. But the reality is that only a minority of us will die, and that exact numbers cannot be determined until after the fact.
However, to put that speculation in proper perspective, it is informative to know that today in Sri Lanka, about 400 people will die of various causes 4 (140k/year) and the world death rate is about 164,000/day (60 million/year). 5
Lockdowns immediately ruin persons, nations and immune systems
The exact number of COVID-19 related deaths after lockdown is lifted cannot be predicted accurately. But what is known for sure is the ruin to individuals, families and the nation that began on 20 March with the lockdown.
Daily wage-earners, pola vendors, kadey owners, eateries, transport providers, factories, hotels and large companies alike went into a tailspin. Millions suddenly have no income, further millions have lost jobs, and a fear psychosis is rampant because of an uncertain future.
Already, there are reports of increased domestic violence; and murder, suicide, and anarchy may follow as despair and desperation work their way into our 5.2 million households with every passing lockdown day. The ruination of the Sri Lankan economy because of the lockdown is nothing compared to the immense harm done to the psyche and physical well-being of all citizens.
Mr. President, when you were Secretary for Urban Development some years ago, you created many walking paths and exercise areas around the country. Exercise, sunshine and fresh air are well-established are excellent ways to boost one’s immune system. A balanced diet, social interaction and freedom from worry are other ways to boost one’s immune system.
With the lockdown, all of those aspects have been eliminated. When the lockdown is eventually lifted, citizens will emerge with weakened immune systems, potentially increasing COVID-19 fatalities in Sri Lanka. The military equivalent would be like sending the army (cf. we citizens) into battle after weakening us with hunger, confinement to barracks, no training, and low morale to blunt our weapons (viz. our immune systems).
Lessons learned from defeating terrorism
Sir, you as Secretary of Defence along with the Tri-Forces Commanders, architected a strategy that defeated the LTTE in two years after decades of stalemated secessionist conflict. The core of that strategy was attrition in which the State would take heavy casualties but could recruit replacements while the LTTE would take heavy casualties as well, but could not do the same.
During the final phase of the conflict, over 6,000 of our security personnel were killed of the over 25,000 killed in total – indicating a high casualty rate in the final two years. We as citizens were fully supportive of your strategy, and many joined the Tri-Forces. Many made the ultimate sacrifice so that their fellow citizens could enjoy the peace that we have had for the past 11 years.
Unfortunately, the battle against COVID-19 is being conducted in a totally different way. The primary KPIs (Key Performance Indicators) are to minimise infections – so that it results in minimum hospitalisations, does not exceed hospital capacity, and doctors do not have to make life-and-death decisions as to whom to treat and whom to let die.
The best analogy I can come up with is that the armed forces’ medical corps dictates to the Generals how to prosecute the war based on their hospital capacity. All other consequences re the outcome of the war are to be ignored, according to the medical corps!
Ironically, these very same doctors who are hypersensitive about potential COVID-19 related deaths, have been making life-and-death decisions and denying us treatment—for a variety of reasons, mostly due to lack of access to facilities and medicines—for other common diseases such as cardiac conditions, diabetes, kidney problems, cancer, etc. for decades.
Realities of lockdowns
Unfortunately, you have many more KPIs to be concerned about since as our Executive President, you are responsible for the functioning of an entire nation and its citizens.
The success of the State comes from the capability of its citizens to provide goods and services to themselves and to other countries, along with a variety of social indicators. With the lockdown, this has ceased to exist, and fear and despair exists where there was hope which started growing on 17 November 2019 when you were elected as Executive President by an unprecedented majority of us.
You began your presidency with many positive steps, and we citizens were heartened by that video of your visit to the RMV, where you stated that your duty and the duty of Government officials, was to serve the people. That one visit has resulted in millions of us enjoying vastly improved services from the State over the past few months.
However, much of that goodwill was compromised on 20 March when the lockdown was announced by the Government. While the subject of death is always a sensitive one, the hue and cry from the medical community advising Government, press and social media appear to say that COVID-19 fatalities are special deaths to be avoided at any cost. These ‘influencers’ would be gob smacked to know:
Sri Lanka’s death rate is about 400/day
It appears that a vocal majority of our fellow citizens have become Kisa Gotamis who don’t know that death is a natural part of life and is inevitable for all!
Proposed way forward
Unless we spend the rest of our lives in an isolation chamber, all of us will get COVID-19 – just as we have all gotten the common cold virus – and no vaccine will be available for one to two years.
The proposed way forward is based on my compassion and empathy for the lives of the vast majority (99+%) who will get COVID-19 and not even notice it, some who will be hospitalised and survive, and also for the small minority (1% or less) that will succumb to it. I am in that small minority, and many of my dear friends are potentially in the same demographic because of age and pre-existing medical conditions.
I respectfully submit the following proposal elements for your kind consideration even though many people would disagree with them:
1. Lift the lockdown immediately
Let people get on with their lives and take the country forward. Inform them that most will contract the virus and won’t even know about it, and that a small minority will die. Remind them of the wisdom that Kisa Gotami realised for herself with the Buddha’s help.
Every day, each of us make conscious or unconscious personal risk/reward decisions. We drive on the road knowing eight of us die every day in road accidents. Trishaw drivers sit in clouds of pollution all day because that is the only way they can make a living. Mothers and daughters go to work in the Middle East under horrendous working conditions, because that is the only way they will be able to pay off the staggering debt of the family. Please Mr. President, let us make that very personal decision with regard to COVID-19 as well.
The COVID-19 daily death rate can look sensational initially, compared to our current death rate of 400/day, until the herd develops immunity. The medical service will provide what they can with our limited capabilities, but that is the reality in any country when it comes to a ‘Black Swan Event’ such as this, a tsunami or an earthquake.
2. Encourage vulnerable citizens to shelter
Encourage those who are in the vulnerable category because of age or pre-existing medical conditions to take whatever precautions they choose to until a vaccine is developed. This could include sheltering at home, or choosing to stay for an extended period at a quarantine facility if the Government chooses to offer such a service.
With the vast majority of the population out and about and doing their own shopping to run their households, those sheltering at home can get vastly improved and affordable delivery services of all the items they need to run their households as well as medication for an extended self-quarantine.
3. Promote common sense precautions
Take common sense precautions such as enforcing physical distancing, temperature scanning when entering public spaces, wearing masks, scrupulously sanitising public transport, providing hand sanitisers widely and banning large gatherings.
Provide guidelines for healthy lifestyles to strengthen everyone’s immune systems and build a stronger nation by promoting reduced consumption of sugar, processed foods, alcohol and cigarettes, as well as encouraging the drinking of water, exercise and eating in moderation.
4. Introduce widespread antibody testing
Start extensive antibody testing across the population to understand the level of ‘herd immunity’ that has developed. The hypothesis is that COVID-19 was already here late last year since many Chinese nationals travel to Sri Lanka, and the herd may have been developing immunity over the past four months. I, and many other people (young and old), were sick with COVID-19-like symptoms late last year and early this year. If positive for antibodies, citizens can potentially be issued a badge that shows they are immune. This will help people get over the fear psychosis that currently exists where everyone is viewed with suspicion.
The ‘Big Matches’ that happened in early March across many parts of the island would have been ideal breeding grounds for COVID-19, but almost three weeks later on 9 April, there has not been a reported rise in cases. So, I encourage the Government to start wide antibody testing, perhaps starting with those who had symptoms late last year and early this year.
The other advantage of widespread antibody testing is so that those who are immune can donate their blood, and have their plasma used on active COVID-19 patients.
5. Ease travel restrictions sensibly
In order to kick start our tourism industry, only grant entry visas for those who have tested positive for COVID-19 antibodies. Our citizens returning from overseas should also test positive for antibodies.
In a show of reciprocal responsibility, all departing citizens should be allowed to travel only if they are positive for antibodies. This will ensure that neither returning nor departing citizens are carriers. Foreigners are allowed to depart only if they are positive for antibodies or negative for a COVID-19 PCR test which shows an active infection.
6. Provide compensation and create new opportunities
Provide compensation for daily wage-earners and others who have been negatively impacted by the lockdowns and layoffs. Laid-off workers could be repurposed to work in new ventures such as Controlled Environment Farms (CEF) across the country to grow fresh food for us, and for same day export and delivery to 82% of the world’s population in the Eastern Hemisphere. These CEFs, in addition to providing new employment opportunities, address the pressing problems that climate change has created for our food security, and need for foreign exchange earnings.
Policy changes should be made across a variety of areas to ‘shock-proof’ our economy against pandemics and other disasters that are certain to appear in the future, and some such as climate change which is already here.
Silver linings in dark clouds
The first silver lining is the amazing work our healthcare workers and Tri-Forces personnel have done in taking care of the sick, and creating additional hospital care and quarantine facilities. I salute them and extend my heartfelt thanks for their service.
The second is the way various people have come together locally to design and manufacture, or concept-demonstrate products, to address the COVID-19 crisis. These products have ranged from apparel sector manufacturing PPE (Personal Protective Equipment) for healthcare workers to various mechatronics products such as ventilators, robots to deliver items to ward patients, drones to deliver test samples to test centres, and even mobile crematoriums.
This shows the creative product design engineering talent of our people, and I encourage you to establish the appropriate Government policies to encourage these locally designed and manufactured products for local use and export to global markets. On the services delivery front, many creative remote services have been established, or expanded in banking, grocery delivery, pharmaceutical delivery etc., and these online services should be further expanded, including moving to a cashless society.
Finally, the generosity of our fellow citizens is legendary, and this COVID-19 crisis has been no exception. There were many individuals who unstintingly aided fellow citizens in need, at a personal and organisational level. I know of people who paid their employees and daily workers even though they could not show up for work, and others who sent money to servers and service providers they have known for years. They far exceed those who used this crisis to sow racial and religious dissension, and are to be commended.
In closing – an entreaty to ‘do the right thing’
Dear Sir, most people – even your detractors – willingly admit that you are one who excels at ‘doing things right’ based on your impressive track record of ‘doing the right things’ when it came to ending the war, and urban development.
In the same vein, while the Government has been ‘doing things right’ with the impressive service rendered by mobilising healthcare workers and the Tri-Forces, I respectfully urge you to consider ‘doing the right things’ per the proposals above.
Please start by lifting the lockdown so that we can move ourselves and the country forward.
Ayubowé and Theruwan Saranai!
(Tilak Dissanayake is a product design engineer with over 40 years of experience in envisioning and implementing practical solutions to real-world problems in a variety of fields. He is also a vulnerable category senior citizen concerned about the welfare of all Sri Lankan citizens, including the small minority that will die. He can be reached at [email protected])
Footnotes
1 https://buddhiststories.wordpress.com/2012/11/03/kisa-gotami-and-the-mustard-seed/
2 https://www.who.int/news-room/q-a-detail/q-a-similarities-and-differences-covid-19-and-influenza#
3 https://www.worldometers.info/coronavirus/coronavirus-age-sex-demographics/
