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A science-based strategy to control the current covid-19 situation

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by Malik Peiris

Chair/Professor of Virology, School of Public Health, University of Hong Kong, Faculty of Medicine, Hong Kong and

Kamini Mendis

Professor Emeritus, University of Colombo, Public Health and Malaria Expert formerly at the World Health Organisation.

I. The current covid-19 situation in the country

There is a high intensity of transmission of covid-19 in the country just now. Although it became apparent with cases increasing in the last week of April, the increase in transmission began about 4 weeks before that. The incubation period of the virus (3-14 days) together with testing / reporting delays mean that the cases detected and reported now were the result of transmission that took place 1-2 weeks ago. Since deaths follow with a lag period of a further two weeks, the deaths occurring now were the result or transmission that took place around one month ago. The mortality impact of the increase in cases is only just starting to be felt now.

The B.1.1.7 variant of the virus spreading now is more transmissible, and possibly more virulent, than in previous “waves”. An even more concerning variant B.1.617 (first detected in India) has also been detected in Sri Lanka and it remains to be seen how widespread it will become. WHO has designated it a “variant of concern,” it is now spreading in the UK and is the cause of some of the recent case clusters in Singapore.

There was an exponential increase of cases from mid-April to date. Although case numbers appear to plateau in recent days, it is likely that this is a result of limitation in testing capacity. Testing numbers have remained flat, in spite of high positive rates (exceeding 10% in most laboratories), raising concerns of whether the epi-curve we now see reflects reality. ICU admissions and deaths continue to increase, as will be inevitable, from infections that have already occurred.

As a result, the capacity of the health system to manage covid-19 patients has already been exceeded, the inevitable consequences being more avoidable deaths. With increasing cases, even the implementation of the public health measures that were being implemented– i.e. testing, isolating, contact tracing and quarantining, have exceeded the capacity of the health sector. In addition, health staff in the curative and preventive sectors is becoming victims of covid-19 themselves, which makes the situation grave.

The vaccination programme, currently getting under way within the constraints of limited vaccine supply, even if targeted to those at highest risk of death, i.e. the elderly and those with co-morbidities (a policy that has NOT been consistently followed in Sri Lanka so far), will take many months to translate into an impact on mortality. Vaccines, which require two doses at least a month apart, take optimal effect >2 weeks after the second vaccine dose. As of now, only 1% of the population have received both doses of vaccine and 6% received at least one dose, that too, mainly in one province of the country. Even under the most optimistic scenarios, it will be over 6 months before most of the high-risk population receives protection from vaccine across the country.

The only available option in the short-medium term to arrest this impending catastrophe is to significantly curtail transmission through social and public health interventions.

Although a few public health interventions have been implemented in the past week, we explain below why these recent measures of small-area isolations, prohibiting inter-provincial travel, intermittent and short period lockdowns, as the one during 14 – 17 May, together with mild restrictions on human movement such as those based on identity card numbers, will not arrest this wave of the epidemic.

We explain why a nation-wide lockdown of at least 14 days (defined below) is absolutely necessary, if increasing ICU admissions and deaths from this wave are to be contained. We also comment on the likely economic impact of these different approaches.

II. Why small-area isolation, preventing inter-provincial travel, short and intermittent lockdowns and mild restraints on human movement will not work

 

1. The testing is not sufficient to make small area isolation have an impact.

Small area lockdowns are based on obtaining information of a cluster(s) of cases from a particular location. The detection of these clusters are based on testing a population in an area in response to detecting a few cases from that location – i.e. reactive case detection rather than proactive surveillance. Thus, by the time the cluster has been detected, multiple weeks have lapsed since the initiation of each cluster and therefore the people in that cluster would have already spread the virus through their movement, to many other areas, adjacent and distant. In other words, isolating that small area will not have much effect on the spread of the virus to other areas, because it has already happened. If small-area isolation is to work, then an extensive amount of active surveillance and testing in the population (as opposed to being based on contact tracing) is necessary, but this is currently not feasible given the laboratory system being already overloaded. Initiating these small-area lockdowns are sucking up a huge lab testing capacity at the moment, which will be more productively deployed elsewhere.

2. Since all provinces have ongoing high transmission already, stopping travel between provinces will have little effect.

By the end of April, all provinces had ongoing high transmission of the virus and therefore stopping inter-Provincial travel will be of no avail at this stage. It may have had a role in early or mid-April, soon after the B.1.1.7 variant was detected in the Western Province. But not any more, with the virus entrenched in every province.

3. Countrywide lockdowns of 3 days will not block even a single cycle of virus transmission or cover the period of infectiousness of an individual.

Intermittent countrywide lockdowns (such as the one from 14 – 17 may or the proposed one from 21 – 25 May) will only have effect during those three days. Three days is far shorter than the incubation period of the virus, i.e. from infection to manifestation of illness and transmission, which is around 5 days (range 3- 14 days). It is even shorter that the infectious period of one infected individual, which is around 8 days. For example, if an infected individual begins to be infectious on day one of a 3-day lock down, he/she will remain infectious at the end of the lockdown, at which time the person will be again moving in the community. In order to even partially interrupt transmission, one needs to cover at least two cycles of transmission, i.e. 10-14 days of intervention. That will allow an exponentially higher probability of chains of transmission being interrupted. Therefore, the minimum period of lockdown should be countrywide and at least 2 weeks in duration. The impact of 5 successive intermittent lockdowns of 3 days each (i. e. 15 days in aggregate) will therefore, be much less than that of one continuous 14 day period of lockdown. Furthermore, the former strategy will be spread out over a much longer period, when we do not have the luxury of time any more.

4. Partial restriction of human movement using ID card digits will not have much impact on virus transmission.

Limiting the movement of people and crowd-gathering through means such as restricting them to alternate days based on identity card numbers is not sufficient to prevent the congregation of people because up to half the population could be out of home at any given time. This is not sufficient for transmission is to be halted.

5. Standard preventive measures are not having optimal impact because of overcrowded living conditions

Even the strict enforcement of social distancing and mask wearing will not have its optimal impact because they are not ideally implementable under overcrowded living conditions in urban areas.

6. People working in enclosed environments e.g., office spaces will enhance virus transmission

Offices such as banks, and industrial working places such as garment factories require people to be in enclosed and confined spaces with insufficient ventilation for the entire working day. These are extremely and highly conducive to the spread of the virus.

Thus, these recent measures have impeded economic activity and sucked up huge resources and effort from the security forces for a marginal public health gain, at best. Moreover, repeated, intermittent short-duration restrictions also carry significant economic costs. The uncertainty associated with the introduction of these measures/future measures create an unstable environment for most economic activities. Most daily wage earners are not given work by employers because they travel daily from unknown risk situations at home. Most industries and offices are working within a context of uncertainty and are unable to plan even for the medium-term. This is not conducive to economic growth.

A rational, determined and convincing strategy is needed, both to get control of an impending public health disaster and also to restore economic confidence.

 

III. A countrywide lockdown for at least 14 continuous days is immediately necessary for the following reasons:

 

1. Only a degree of restriction of human movement enabled by a total countrywide lockdown of 14 days will lead to interrupting at least one (preferably two) cycles of virus transmission in the community. Such an intervention would give an opportunity for the health sector, currently at or beyond breaking point, to catch its collective breath, to face the future. Otherwise, exponential increase in the number of cases (and deaths) will lead to health staff succumbing and the consequent collapse of the health system.

2. Such an intervention can be signaled >5 days in advance so that the community, traders and businesses can make adequate preparations. It will give some level of certainty for planning and instill confidence in the population, the business community and the health sector.

3. The daily wage earners will need to be given an allowance to tide over this period. But this investment will be amply repaid by the opportunity to get faster control of an epidemic that is rapidly spiraling out of control.

4. Access to essential commodities – food, fuel, medicines, health care will not be compromised because the necessary logistical arrangements can be made. The experience of the March-April 2020 lockdown will be an asset in planning and implementing the distribution of essential goods to the people.

We recommend the following:

All persons to remain in their homes at all times for a period of at least 14 days continuously, and all schools, industries, commercial enterprises and places of worship to remain closed, with the exceptions listed below. These exempted places will be subject to social distancing, capacity restriction, wearing of face-masks, hand sanitizing and operating under conditions of optimal ventilation.

1. All essential services to be functional.

2. A minimum number of grocery stores, pharmacies, and fuel stations to remain open in every district. A limited number of vegetable, fruit and fish/meat, bakery and other food delivery vehicles permitted to operate on the basis of permits.

3. Restaurants able to prepare food for delivery on order, but not allow in-house dining.

4. Government departments deemed essential, to keep an office open for a few hours a day and function with a skeleton staff on a roster basis.

5. Any organization or enterprise may allow its employees to work from home.

6. A person can leave home only for a health need (including vaccination), any other emergency, or to purchase food supplies, but only one person can leave home at any one time for these purposes.

7. Gatherings of more than 4 people to be prohibited.

8. Outdoors agricultural work permitted to continue.

We request, in addition, that all ongoing preventive measures be enforced rigorously, including increasing vaccination coverage, and that case management and treatment interventions are greatly strengthened in the country.

 



Features

Tree planting along road reservations and banks of streams

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Typical View of a tree plantation along roads

Reservations of Roads & Natural Streams which extend to about 10 to 20 on either side are not actively protected in Sri Lanka though it is very common in other countries. Those reservations are owned by the government. Therefore, public use of this land can be considered as a fair use of the land. Main purpose of this proposal is to introduce an intervention to connect the Forest Patches in urban areas such as Gampaha using the reservations of roads and natural streams, by planting trees so that those strips could also act as Urban Bio Corridors while enhancing the tree cover at national level. These trees also absorb the fumes emitted by vehicles while addressing global warming caused due to lack of tree cover. It also serves as a roof top for pedestrians who use reservations along public roads while adding aesthetic value to the area. Enhancing the community awareness about BioDiversity of Sri Lanka and the importance of maintaining a clean environment along road reservations is also another objective of this type of intervention. This intervention also addresses the needs of all sectors of the local communities.

Tree Plantation along reservations of roads and natural streams

 Concept

The Green Road is a relatively new concept for roadway design that integrates transportation functionality and ecological sustainability. This project addresses the transport sector also because it facilitates Environmentally Sustainable Transport (EST) for local people. Therefore, Provincial Road Development Authority (PRDA) is the ideal institute to implement this project. It is also possible to introduce cycle tracks along stream banks as short cuts by improving the banks of natural streams as roads. This intervention would reduce vehicle congestion in main public roads while supporting Clean Sri Lanka programme because local communities themselves become watch dogs against culprits who pollute road reservations and water bodies of natural streams.

 Already implemented projects in Mahaweli Areas

In Sri Lanka, the concept of Bio Corridor was introduced in 1988 under a Project called Mahaweli Agriculture and Rural Development project implemented in System B under an USAID funded programme. Similar to highways which connect main cities, in this case the Bio Corridors were introduced as “Bio Highways” connecting fragmented forest patches (“Bio Cities”) in paddy field areas. At the same time those corridors were improved as Cycle Tracks for the local farmers.

 Figure 1 indicates the present status of a tree plantation programme implemented in Mahaweli Area (Thambuttegama) in the 1980s along newly introduced roads.

Past Experience of PRDA (WP) related to similar interventions

In 2010, similar intervention was introduced in Gampaha District in parallel with a flood mitigation project implemented by the Provincial Road Development Authority (WP). For example, while Uruwal Oya running adjacent to Gampaha Urban Area was improved to mitigate floods, riparian tree belt areas were also introduced.  Later, parts of that stream running adjacent to Gampaha Town were improved as Recreational purposes such as jogging tracks for urban communities. As an additional benefit, it was expected that the shades provided by riparian tree cover would discourage growth of invasive plants such as Japan Jabara, which clogs the drainage outlets resulting in floods in urban areas.

 by Eng. Mahinda Panapitiya

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Has Compass lost direction?

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Sri Lankan voters have excelled in the art of changing governments in executioner style, which they did in many elections including that of 1977,1994, 2015, 2019 and, of course, 2024. They did so, giving massive majorities to parties in opposition that had only a few seats, because the preceding governments were so unpopular. It invariably was a negative vote, not a positive vote-endorsing policies, if any, of the incoming governments, the last election being no exception. NPP, contesting under the compass symbol, was essentially a revamp of the JVP and their main strategy, devoid of any specific policies, was throwing mud at opponents and promising a transparent, corruption free government. They made numerous promises on the hoof. Have they stood up to the challenges?

What the vast majority of the public wanted was a significant reduction in the cost of living, which has spiralled out of control due to the misdeeds of the many preceding regimes, resulting in near starvation for many. The NPP promised to renegotiate the deal with the IMF to give relief to the masses but soon found, to their dismay, that it was a non-starter. Of course, the supporters portrayed it as a display of pragmatism! They promised that the price of fuel could be slashed overnight as it was jacked up by the commission earned by the previous minister who was accused of earning over Rs 100 for every litre! It has not happened and the previous minister has not received the apology he deserves. The cost of living remains unbearable and all that the government continues to do effectively is slinging mud at opponents.

To the credit of the NPP government, financial corruption has not set in, but it cannot be forgotten that most previous governments, too, started this way, corruption setting in later in the cycle of government. However, corruption in other forms persist contrary to the promises made. Had the government sacked the former speaker, the moment he could not justify the claimed PhD, it could have claimed high ground and demonstrated that it would not tolerate corruption in any form. For some reason, unknown to the public, he seems to have a strong hold on the party and he seems indispensable!

As for bringing to justice those previously corrupt, only baby steps have been taken. During the election campaigns AKD promised to get Arjun Mahendran from Singapore within 24 hours of his election and now they are blaming the Singapore government! It looks as if promises were made without any idea as to the practicality of implementation. According to social media posts circulated, the list of assets held by Rajapaksas would have made them richer than Elon Musk! A lady lawyer who described in detail, during the election campaign, the wealth amassed in Uganda by Rajapaksas admitted, after her election, that there was no basis. Her justification was that the NPP government ensured free speech; even to tell lies as the truth.” Government media spokesman has just admitted that she lied about the cost of new year text messages sent by previous presidents and she remains an ‘honourable’ MP!

As far as transparency is concerned, Compass is directionless. MoUs/Pacts signed with India, during the recent visit of PM Modi shines bright with opaqueness! After giving various excuses previously, including that those interested could obtain details by making requests under the Right to Information Act, the official cabinet spokesman’s latest is that it needs the permission of India to release details. This makes one wonder whether there is a lot to hide or it may be that, de facto, we are already under the central government of India and that AKD is just the Chief Minister of the 29th state!

Whilst accusing the predecessors of misuse of power, the NPP does the same thing. AKD’s statements that he would be scrutinizing allocation of funds to local bodies, if opposition parties are elected, surely is an indirect threat to voters. Perhaps, it is not an election offence as the Elections Commission has not taken any action despite complaints!

Whether the exposition of the Tooth Relic, which was done in a mighty hurry, to coincide with the mini-election campaign would backfire remains to be seen. As it was done in a hurry, there was no proper planning and even the basic amenities were not provided to the thousands who queued for days. AKD, as usual, was quick with a political gesture by the unplanned visit meeting those in the queue. What he and his government should have done is proper planning but, instead, government supporters are inundating social media blaming the public for bad behaviour!

To cap this all is the biggest faux pas of all; naming the mastermind of the Easter Sunday attack. AKD built up expectations, and the nation was waiting for the exposure on 21 April, which never materialised. His acolytes are doling out excuses. Dr Nalinda Jayatissa was as evasive as possible during his post-cabinet meeting briefing. Perhaps, there is no mastermind other than those identified by all previous investigations including that by the FBI. All that the president did was handing over the Presidential Commission of Inquiry report to the CID. The acting IGP appointed a committee of three to study, but the next day a fourth person was added, a person who is named as one of those who did not act on intelligence received!

Perhaps, as an attempt to give credence to the allegations made in the Channel 4 programme, Pillayan was arrested. Though it was on a different offence, the alleged abduction of the former chancellor of the Eastern University, Minister Wijepala had the audacity to state in the parliament otherwise. Pillayan has been detained under the PTA, which the NPP promised to abolish! The worst is the campaign of character assassination of Udaya Gammanpila who has decided to represent Pillayan. Dr Jayatissa, who has never practised his profession, took exception that Gammanpila, who has not practiced as a lawyer, is representing Pillayan. Gammanpila has corrected him by listing the cases he had been involved in. In any case, Gammanpila need not be in court but get a set of lawyers to defend, if and when, a case is filed. It begs clarification, the ministerial comment that Gammanpila should be ashamed to represent Pillayan! Has the government already decided the guilt of Pillayan?

Compass has lost direction, indeed, and far too soon!

By Dr Upul Wijayawardhana

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Canada holds its own as Americans sour on Trump

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Jubilant Carnay after Canadian elections

On Monday, April 28, Canadians gave the Liberal Party its fourth successive mandate, albeit as another Minority Government but much stronger than in the last two elections, and, more importantly, with a different Prime Minister. Justin Trudeau who had been Prime Minister from 2015 was forced to resign in January 2025 on account of his perceived electoral unpopularity. Trudeau was succeeded by Marc Carney, 60 year old former Governor of the Bank of Canada and later the Bank of England, who dramatically revived the falling fortunes of the Liberal Party and secured its fourth mandate in 10 years.

The Liberal Party and Prime Minister Mark Carney owe their good fortunes to the presidential madness that is going on south of the border, in the United States of America. With his mercurial obsession over tariff’s and recurrent musings about making Canada America’s 51st State, President Trump painted the backdrop to the Canadian election. Trump’s antics did not go down well with the Canadian public and in a rare burst of patriotism the people of Canada overarched their diversities of geography, language, culture, religion and ethnicity, and rallied round the Maple Leaf national flag with utmost determination to stick it to Trump and other Ugly Americans of his ilk.

People and businesses in Canada shunned American products, stopped travelling to US holiday destinations and even took to booing the US national anthem at sporting events involving US and Canadian teams. The threat of economic pain due to a tariff war is real, but Canadians are daring to suffer pain rather than become a part of the US. And Justin Trudeau showed his best leadership in his last days as Prime Minister. Combining diplomatic skill and splendid teamwork with eloquent defiance, Trudeau succeeded in forcing Trump into what has since become Trump’s modus operandi in implementing his idiosyncratic tariff policy: tariff, one day; pause, the next day; and uncertainty, extended indefinitely.

100 Days of Disaster

What he began with Canada and Mexico, Trump has since writ large upon the whole world. His second term is already a term of chaos not only for America but also for the whole world economy. The US economy is officially in first quarter contraction. Another four months, it could be a man made recession of what was in January an economy that was humming sound and was easily the best performing one in the world. It’s only 100 days of the second term, and what is left of it is looming as eternity. “Only 1,361 Days to Go,” is the cover page heading of the latest issue of the Economist. That sums up America’s current state of affairs and their global spillover effects.

Americans are beginning to sour on Trump but there is no way for them to channel their frustrations and anger to force an immediate executive retreat. Trump has reduced the Republican Party to be his personal poodle and with Republics holding slender majorities in both the Congress and the Senate, the Legislative Branch of the US is now wholly beholden its Executive. The traditional wait is for the midterm Congress elections in two years. But Trump has no respect for traditions and conventions, and it would be two years too much before a Democratic majority in the two houses could bestir the Congress to check and balance the runway president.

The Judicial Branch is now playing catch up after the Supreme Court had given Trump near absolute immunity and enabled his second coming. The lower courts are applying the law as they should and stymieing Trump’s palpably illegal orders on everything from deporting immigrants, to downsizing government, and gutting the country’s university system. The tariff cases are slowly making their way to courts and they will add more confusion to the running of the economy before some kind of sanity is restored. Overall, by upending a system of government that has been constitutionally evolving over 200 years, Trump is providing a negatively sobering demonstration that no system is foolproof if a capable fool is elected to take over the reins of government.

Fortunately for the world, other governments and polities have been quick in drawing the right lessons from the demonstration effects of Trump on their American cousins. Trump’s excesses have had a dampening effect on right wing populism in other countries. The Canadian elections are one such demonstration. Another is expected in Australia where national elections are scheduled for Saturday, May 3. In Europe, right wing populist parties are scaling down their rhetoric to avoid facing local backlashes to Trump’s American excesses.

No populist leader anywhere wants to go where Trump is blindly heading, and no one is mad enough like him to think that imposing tariffs is the way to grow a national economy. In Hungary, its strongman Viktor Orbán after securing super majorities in four elections since 2010, is facing the real possibility of defeat in the national elections next year. Orban is regressively anti-Eu while 86% of Hungarians want to strengthen their EU ties, and they are naturally getting tired of Orban’s smearing of the EU just like all Europeans are getting tired of Trump’s and his VP Vance’s anti-European rhetoric.

Canada Holds its Own

Canada, despite its proximity to the US, has never been a haven for Trump’s right wing populism. Yet there have always been and continue to be pockets of support for Trumpism in Canada, and they have found their sanctuary within the Conservative Party of Canada and behind its leader Pierre Poilievre, a 45-year old career politician who entered parliament in 2005 at the age of 25 and became Leader of the Conservative Party and Leader of the Opposition 18 years later, in 2023.

Clever and articulate with an ability to spin rhyming simplistic slogans, Poilievre cultivated his political base by feeding it on a diet of vitriolic and vulgar personal attacks and advertisements denigrating then Prime Minister Justin Trudeau. Poilievre identified himself with the 2022 truck convoy protest that stormed Ottawa, cheered on by MAGA America, and he came to be seen as Canada’s Trump-lite (not unlike Peter Dutton, the Leader of the Opposition in Australia). Nonetheless, Poilievre’s attacks on Trudeau worked in the post-Covid climate of economic hardships and Trudeau’s popularity sank to the point that his own MP’s started calling for his resignation.

Alas for Poilievre, Trudeau’s resignation in January took away the one political foil or bogeyman on whom he had built his whole campaign. In addition, while his attacks on Trudeau diminished Trudeau’s popularity, it did not help enhance Mr. Poilievre’s image among Canadians in general. In fact, he was quite unpopular outside his base of devotees. More people viewed him unfavourably than those who viewed him favourably. Outside his base, he became a drag on his party. He would even go down to defeat in his own electorate and lose his seat in parliament that he had held for 20 years.

Mr. Poilievre’s troubles began with the emergence of Mark Carney as the new Liberal Leader and Prime Minister – looking calm, competent and carrying the ideal resume of experience in dealing with the 2008 financial crisis as Governor of the Bank of Canada, and calming market nerves after the 2016 Brexit referendum as Governor of the Bank of England. Carnie, who had never been in formal politics before, seemed the perfect man to be Prime Minister to weather the economic uncertainties that President Trump was spewing from Washington. Almost overnight Liberal fortunes shot up and after resigning themselves to face a crushing defeat with Trudeau at the helm, Liberals were suddenly facing real prospects of forming a majority after two terms of minority government.

In the end, thanks to the quirky genius of the electorate, Liberals ended with 168 seats with 43.7% of the vote, and four seats short of a majority in the 343 seat national parliament, while the Conservative Party garnered 144 seats with 41.3% vote share. Both parties gained seats from their last election tallies, 15 new seats for Liberals and 16 for Tories, and, unusual in recent elections, the two parties garnered 85% of the total vote. The increases came at the expense of the two smaller but significant parties, the left leaning New Democratic Party (reduced from 24 to seven seats); and the Bloc Québécois (reduced from 45 to 23 seats) that contests only in the French majority Province of Quebec. The Green Party that had two MPs lost one of them in the election.

In the last parliament, the New Democrats gave parliamentary support to the minority Trudeau government in return for launching three significant social welfare initiatives – a national childcare program, an income-based universal dental care program, and a pharmacare program to subsidize the cost of prescription drugs. These are in addition to the system of universal public health insurance for hospitals and physician services that has been in place from 1966, thanks again to the programmatic insistence of the New Democratic Party (NDP).

But the NDP could not reap any electoral reward for its progressive conscience and even its leader Jagmeet Singh, a Sikh Canadian, lost his seat in the election. The misfortune of the NDP and the Bloc Québécois came about because even their supporters like many other Canadians wanted to entrust Mark Carney, and not Pierre Poilievre, with the responsibility to protect the Canadian economy from the reckless onslaughts of Donald Trump.

Yet, despite initial indications of a majority government, the Liberals fell agonizingly short of the target by a mere four seats. The Tories, while totally deprived of what seemed in January to be the chance of a landslide victory, managed to stave off a Liberal sweep under Mark Carney. The answers to these paradoxes are manifold and are part of the of reasonably positive functioning of Canadian federalism. The system enables political energies and conflicts to be dispersed at multiple levels of government and spatial jurisdictions, and to be addressed with minimal antagonism between contending forces. The proximity to the US helps inasmuch as it provides a demonstration of the American pitfalls that others should avoid.

by Rajan Philips

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