Of lives and livelihoods

by Usvatte-aratchi

We seem to face a complicated set of problems in handling the epidemic Covid-19 in our country. The infection rate is well above 1. The number identified to have been infected during the last few days has been counting up to 2,000. That is alarmingly high. Consequent upon the rapid rise in infections, there are four tightening bottlenecks: there is an emerging scarcity of hospital beds; the number of acute-care-beds is well short of probable requirements; healthcare personnel are exhausted and short in supply; and the supply and distribution of clinical oxygen may dangerously fall well short of the number of patients distributed over the island that need such care. That is when the capacity of the system will be tested and the current death rate of those being infected will rise rapidly from the present 0.65 per hundred of the infected. The conversion of existing hospitals to accommodate corona patients and the construction of field hospitals may solve the first problem. It is well to remember that the conversion of existing hospitals to accommodate corona patients will be at the expense of beds for non-corona-virus patients.

The scarcity of acute care beds can be very dangerous and there is no alternative to emergency purchase of equipment, when other countries themselves may find it difficult to release such equipment. As with hospital beds, the diversion of health care personnel to treat corona patients will be at cost to other patients. Eventually, when other morbidities are counted, departures from the normal will tell its own tale. Health care personnel from physicians to those that disinfect premises have worked with tremendous dedication and high efficiency. The availability of such persons may be the most strictly binding constraint to saving lives. We have been re-assured that the two factories that produce clinical oxygen have capacity to increase production fast enough to avoid shortages. Distribution to hospitals, as their locations spread wide, may pose problems. All these exigencies arose because we failed to stem the tide of invading infections. We have had ample time to prevent the emergence of these exigencies. Incompetence and complacency among policy makers seem to have conspired to put the population at severe risks and to their unfortunate consequences. Our government did well in early 2020 to lockdown the country, close boundaries and keep the invasion at bay. That may have engendered a sense of undue complacency.

The corona-19 infection is far more widespread than the Spanish flu that ravaged most parts of the world 1919-1920. Although the numbers are not beyond dispute, the best judgement is that some 3.5 percent of those infected died in that epidemic. That wider spread of the epidemic in 2020-21 is explained by the increased mobility of people and goods now compared to that which prevailed 100 years ago. With advances in medical care, the fast discovery of effective vaccines and more effective organization, we should do much better this time round. With nearly 18 months from the beginning of the epidemic in China, there was a wealth of experience that we, in this country, could have learned from. The first experience in fighting the epidemic was in Wuhan, a city of about 11 million people in Hubei Province with some 60 million people.

The Chinese authorities locked down the city completely for more than six weeks. The lockdown was strict with no political ignoramuses countermanding the restrictions imposed by the officials, supported, of course, by CCP. Gates to some apartment buildings were barred from outside with strips of steel. When the epidemic appeared further east, the same prescription was administered. China was the first to be infected and the first to see its back, the latter a truly remarkable achievement with the crowded eastern seaboard. These methods may not be replicable in other societies but variants were applied in other parts of the world. Vietnam closed its long border with China very early. It closed its airs pace for flights from southern China. It locked down the country effectively. The government spoke to the people frequently. Vietnam has had for some decades a commendable public health system (see its infant mortality and maternal mortality figures for the 1980s). New Zealand and Australia stand out as success stories. New Zealand closed its air space to those outside and imposed a lockdown inside the country. Australia down communities, even large cities like Melbourne, as the threat of widespread infection appeared. Australia had gone so far as to keep out their own citizens, when they wished to return from a dangerously infected land.

There is both thought about the policy and determination in its execution. Now neither New Zealand nor Australia runs the risk of runaway infection. Among other countries, some expected the epidemic to run out if steam when it had infected a large enough number in the population (herd immunity). Among those were Sweden, US with Donald Trump as president, and Brazil with seemingly idiosyncratic Jair Bolsonaro as president. Sweden soon realized the implausibility of its expectation and they still suffer very high infection rates. US had to await the arrival of Joseph Biden as president, who took the advice of scientists and physicians, to galvanise a program of vigorous vaccination and has now 200 million persons fully or partially vaccinated. Britain, after a period of strict lockdown has used its excellent NHS to vaccinate about 67% of its population. The outstanding success is that small country Israel, which is so free of the virus now, that they shake hands casually.

The information below from Johns Hopkins (copied from The Economist) shows you success in vaccination in several countries up to May 6, 2021 . The small population of Bhutan (Bho tan, land’s end), up in the tail end of Himalayas, as well as atolls Maldives have wisely vaccinated their populations. Maldives is especially instructive to us because of the importance of tourism in its economy. In contrast, the massive population of India has been reeling under the weight of the irresistible spread of the infection. The attitude of the government with a population not alive to the true nature of the infection has left that population helpless against the onslaught. Even the rich states of Gujerat and Maharashtra have been hotbeds of infection.

The unregulated celebration of Kumbh mela where millions of devotees assemble in the small town Hardwar for several days provided the ideal fertile ground where SARS–Cov-2 thrived. The enthusiasm of both Trinamool and BJP to win the election in Bengal caused the gathering of large crowds in various parts of that densely populated state. The spread of the infection in Bengal is yet to be seen. These lackadaisical attitudes of the BJP government have made India one of the most severely infected countries in the world.

We have to take account of inadequate public health in the country, despite the first rate AIIMS hospitals in cities. India has some of the largest vaccine producing facilities in Maharashtra. Yet, there has been no plan for vigorous vaccination of the population, formidable as that task will be. In Sri Lanka no more than 5% of the population has been vaccinated to date.

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Sri Lanka has had excellent public health services for decades. The elimination of childhood diseases and infectious disease bear witness to their excellence. Derivative evidence is the low infant mortality rate, the low maternal mortality rate and the consequent high average expectation of life at birth.

The public health services have been constructed with the commitment of wise and farseeing government leaders who provided the physical facilities and the dedication and commitment of physicians and support staff, on wages unattractive in most countries. In this compact land, communications are very good by most standards, now vastly improved with highspeed motorways. To an impartial observer there are long standing reasons why the covid epidemic should not take hold here. But alas, it has.

It has because the government opened airports and new mutations of SARS-CoV-2 marched in the company of visa holders. The new mutations evidently transfer themselves from one person to another, faster than the ones that prevailed locally. The government decided that in the race between lives and livelihoods that livelihoods are what mattered more than lives. The argument, which runs as follows, is not without merit. Covid-2019 kills. But so does the scarcity of livelihoods. It is more important to maintain livelihoods than prevent infections. Therefore, do not lockdown the country but lockdown localities selectively; the selection depending on the incidence of infections in the locality. By the time a locality is locked down, it has high infection; the community has been wounded and then it is locked down to lick its wounds, so to say. In the meanwhile, people from other parts of the country had been infected by people who now ae sequestrated. The three districts in the western province, for several days now, have contributed more than half the high number of infections in the country. Selective lock down of localities have not abated the rate of infection either in those districts or elsewhere. More intensive interaction among people in these districts contributes to the growth of infections. Consequently, it is more sensible to strictly lock down the country, as Wuhan and Hubei were locked down for nearly two months. More intense infection and high number of deaths compel people to lock themselves down. The evidence is in the cancellation of passenger trains by CGR and buses idling in depots for lack of passengers. In Colombo itself, roads are almost empty. There is no evidence anywhere that the denial of livelihoods consequent upon such lock down killed any large numbers. Nor is there evidence yet, that they contributed to stunting and wasting in children. Government must spend to maintain minimum standards of living during the lockdown. Yes, doing so will reduce the value of the rupee both internally and externally but that is the way that the population at large rather than those in low income groups alone bear the burden of the policies. That is also the way that the rampant ravage of the infection can be brought under control.

The respite gained by the lockdown must be used to vaccinate some 65%-70% of the population. The development of vaccines to prevent the spread of SARS-CoV-2 is a triumph of modern science, medical technology and the strength of pharmaceutical companies and other organisations. Governments which foresaw the use of vaccinations in controlling the infection contracted with providers to supply them with vaccinations. Some either did not foresee that need, could not find the resources to contract with suppliers or were pre-occupied with other concerns. We fall into the second category and pay a price, in both in lives and in livelihoods for our failure to procure vaccines. We have seen the effectiveness of vaccination in checking the spread of the infection in US, Britain and Israel and other countries. We have also seen the failure of US with Donald Trump, Brazil with Bolsonaro and India with Modi to vaccinate their people resulting large scale infection and the loss of lives. When the number of deaths rises to 7 million from the present 3.5 million, the world will have lost 1 per 1,000 of its population; a tremendous cost. Our government needs to sit back and re-consider its own policies. Silly heroic stands of ‘ I do not change my mind’ will do us all in.

From that point of view, the debate on the epidemic in Parliament on April 6, was a grave disappointment. Neither the Opposition nor the government gained any stature in the course of the debate. The Opposition did not present an analysis of the problems facing the country and propose alternative policies to solve them and their own preferred choice. The government did not articulate its policies and seek justification for them. A minister of government, who is also a professor of medicine, and who wound up the debate for the government, at the end of a combative response, issued a report card with a load of F’s to the Opposition. That debate in Parliament, as is usual, generated ‘a foul and pestilent congregation of vapours’. The public of this country deserve better.