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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

Form-ation of Higher Education in Sri Lanka

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By Hasini Lecamwasam

Improving higher education in Sri Lanka is not only important, but essential and long overdue. However, seeking to achieve higher ‘quality’ by ‘form-ising’ the performance of teachers (or the practice of forcing the entire teaching-learning exercise into forms designed to communicate exactly what and what transpires in a classroom) may not be able to bring about the desired change. A new set of four forms introduced recently to this end requires, among other things, drawing up a minutely detailed plan of each and every lesson to be delivered in class, aligned with the Course Learning Outcomes (CLOs), in turn, to be aligned with the Programme Learning Outcomes (PLOs), which should all then be tied to the graduate profile, or the kind of graduate we seek to ‘produce’ at the end of it all. This may, on the surface of it, sound reasonable enough and not encourage serious debate or resistance because, after all, it is only some forms that need to be filled.

Form by tedious form, however, the teaching-learning process at state universities is becoming increasingly constricted, fragmented, monitored, controlled. In this piece, I wish to briefly ponder on the implications of these requirements and the larger trends they signal, while also attempting to reflect on what instead we may do to ensure ‘quality’ in the delivery of higher education.

The problem with form-ation

The larger ‘Quality Assurance’ (QA) landscape in which these developments take place was discussed in detail in an earlier Kuppi Talk by Kaushalya Perera. In a nutshell, QA seeks to standardise education such that study programmes can be assessed against each other, assigned numbers, and ranked accordingly. The deployment of overarching yardsticks for programmes with hugely varying mandates, methods, and content has been the subject of much critique lately the world over, not the least due to its rather warped understanding of ‘quality’ as something that can be objectively established through metrics and audits.

While I do not question the bona fide motives behind the initiative taken with the aforementioned forms, I do think serious reflection on where these developments push us in the longer term is needed. My primary reservation here has to do with the impact of this lesson-wise breakdown on the creative and democratic exercise that the teaching-learning process is supposed to entail. When each topic is broken down into such fine detail prior to the actual occurrence of the ‘lesson’ (for want of a better word), outcomes are foreclosed rather than collectively and organically evolving in the course of the ‘lesson’, which is particularly important to many of the subjects offered in the Arts Faculties. Exactly how many of us are actually quite so democratic in our classrooms is a valid question in this regard, and one I will return to. The point for me here, however, is that for those who do have a sincere commitment to such a democratic classroom environment, such forms and the limiting of the teaching-learning experience they constitute, may be tantamount to strangulation.

Even if the majority of us admit to being very controlling in our classrooms anyway, does that justify going one step further with these forms and institutionalising such control? Should not our commitment be to the emancipatory ideal, rather than simply what most are on board with? There should be meaningful space for creative, organic, and democratic teaching-learning processes to unfold for teachers who wish to make that choice, and for students to explore and think beyond the teacher’s frame of thinking. Micromanaging beyond the general content of a course (laid down in enough detail in the course syllabus) is inimical to even a possibility of democracy existing in the classroom and within the larger university space.

This complete subservience of the teaching-learning process to red tape signals a larger and troubling trend of corporatisation. Corporatisation may be defined as the restructuring of a publicly owned institution to be managed as a business place would be, with a view to privatising in the long term. In state universities, this shift is couched in the supposedly ‘progressive’ language of student-centered approaches and interactive classrooms, hijacked from the democratic pedagogy of the likes of Paulo Freire, but bereft of any of the emancipatory politics within which these methods assume meaning. Despite the use of these catch-phrases, however, such minutely detailed forms signal a return to an extremely teacher-centered model due to the absence of the possibility for students to meaningfully influence the outcome of a lesson, as it is predetermined for them.

The result, as the Kannangara report worried with remarkable foresight some 80 years ago, is students “with much knowledge and little understanding. They have not read books; they have “studied” texts. They cannot write, they produce essays after a set style. They can answer questions but not question answers … Their imagination has been stunted, their originality suppressed, their capacity for thought undeveloped, their emotions inhibited.”

What alternative can we propose?

A valid question countering what little resistance there is to form-ation asks how we can ensure the education we currently deliver is of an acceptable standard, and that everybody observes such. There seems to prevail tacit and widespread agreement that the ‘democratic nonsense’ within universities is what has allowed many to hide behind debates, deliberations, appeals to creative freedom, and so on, without actually doing their work.

In my view, this is an arbitrary causation to draw. Blaming internal democracy for negligence of duties fails to take into account the highly anti-democratic practices at universities that may better explain such behaviour.

Specifically, I think it is the rigidly entrenched hierarchy within universities that blocks the possibility of even dialogue, let alone debate, particularly when it comes to holding those higher-up in the ladder accountable for their actions (or the lack thereof, as the case may be). Hierarchy is why, among many other things, students cannot question the content or the methods chosen by their teachers. As previous Kuppi Talks have endeavoured to show, hierarchy is silently, and therefore very effectively, observed at every level, ensuring the trumping of students by teachers, juniors by seniors, women by men, minorities by the majority, and originality by tradition. It impedes questioning, stifles dissent, and smothers alternative thinking altogether. The problem, therefore, is not that we have too much democracy in universities, but too little of it.

We must make a sincere and sustained effort to radically democratise the university space by relaxing the classroom to allow open and honest exchange between students and teachers; changing the relations of power between seniors and juniors, starting with undoing the practice of deferential treatment; refusing to tolerate snide and not-so-subtle references to ways of dressing and similar gendered remarks; questioning the exclusive use of the majority language in official communications, as a starting point. In doing so, we would be subverting the crippling hierarchy that inhibits thought and practice within the university. Such a radical change geared towards improved quality through mutual accountability, for me, is the only acceptable way of introducing accountability to a space that, admittedly, sorely lacks it.

(Hasini Lecamwasam is attached to the Department of Political Science, University of Peradeniya)

Kuppi is a politics and pedagogy happening on the margins of the lecture hall that parodies, subverts, and simultaneously reaffirms social hierarchies.

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THE LOGIC OF PRESIDENT’S PLEDGES IN NEW YORK

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by Jehan Perera

The significance of President Gotabaya Rajapaksa’s speech at the UN General Assembly, in New York, last week, was his use of the time allocated to him to provide an outline of the government’s policies towards the main challenges besetting the country. The President covered the main issues that confront the world with his focus on Sri Lanka. These included measures to contain the Covid pandemic, the economic crisis, environmental degradation and violence. In the final section of his well-crafted speech, the President went into some depth regarding the government’s approach to national reconciliation. However, the response within the country, has been muted and for good reason. Those who voted for the government, on an entirely different platform, which emphasised ethnic majority nationalism and anti-international sentiments, are quite probably at a loss.

It is only recently that the government has started to speak in terms of reconciliation and obtaining international support for it. At the two elections that brought this government to power, the Easter Sunday bombing and the consequent threat to national security, took centre stage. The majority, who voted for the government, did so to protect it from a variety of security threats they were told of, both within and outside the country. The wretched failure of the previous government to prevent the bombing, the first terrorist act of any magnitude since the war ended a decade earlier, was attributed to the personal weakness of the then government leaders. It was also attributed to the 19th Amendment which sought to give state institutions protection from use for partisan reasons by government politicians and to consequent disintegration of the system of command and control.

A second theme, at the two elections, was depiction of ethnic and religious minorities as potential security threats. This stemmed from the country’s experience of three decades of internal warfare with the armed Tamil separatist movements. This was followed by the Easter bombings by extremists from the Muslim community, who were feared to be having a vast support base both internally within the country and also externally. In these circumstances, the re-centralisation of power within the government hierarchy and greater role given to the security forces, received public acceptance as being part of the government’s democratic mandate. At the same time, by denying the equally legitimate concerns of the ethnic and religious minorities, the electoral results demonstrated the existence of an acute polarisation, and wound, in the body politic that continues to fester to the point of bringing in involuntary and imposed international interventions.

EU MONITORING

The challenge for the government is to represent the interests of all communities and not only the majority who voted it into power. The problem is that the government’s mandate comes, by and large, from the vote of the ethnic and religious majority in a country that has been polarised on ethnic and religious lines, for many decades. An ugly part of this reality is that in the prisons are several hundreds of Tamils and Muslims for the most part who are in custody for periods ranging from a few months to many years without trial. They are being held under the Prevention of Terrorism Act, ostensibly until the security forces find adequate evidence to put them before the courts of law. This contradicts the rule of law and the presumption in our legal system that we are innocent until proven guilty can have negative consequences.

In June this year, the EU parliament passed a resolution that the GSP Plus tariff privileges, made available to Sri Lanka should be withdrawn unless the government fulfilled its obligations in regard to the upholding of human rights. The resolution, expressing “deep concern over Sri Lanka’s alarming path towards the recurrence of grave human rights violations”, and makes specific reference to the use of the Prevention of Terrorism Act (PTA). The resolution notes the “continuing discrimination” against and violence towards religious and ethnic minorities, while voicing “serious concern” about the 20th Amendment passed in 2020, and the “resulting decline in judiciary independence, the reduction of parliamentary control, and the excessive accumulation of power with the presidency”. It also highlights “accelerating militarisation” of civilian government functions in Sri Lanka.

A delegation from the EU is currently in Sri Lanka to meet with members of the government, Opposition and civil society, to ascertain whether the country is fulfilling its obligations to be a beneficiary of EU trade benefits. It is likely that the delegation will be provided with evidence of human rights violations and acts of impunity. There are hundreds of persons languishing in prisons without being put on trial, many of whom are Tamils, suspected to be LTTE members, and more of them are Muslims, suspected of having links with the Easter bombings. When questioned in parliament about the latter, the minister in charge justified those detentions on the grounds that Muslim youth, including the Muslim parliamentarian who had questioned him, could contain Islamic State ideology in their heads and therefore be security threats.

NEW DIRECTION

At the last elections, the most potent theme was the failure of the then government to act effectively to protect the country from the Easter suicide bombings and the pressures from human rights actors in Geneva. Among the issues that loomed large at the last election was also the charge that the previous government was giving in too much to the Muslim community within the country. The fact that the Easter attacks were by Muslim suicide bombers added force to this charge. The prioritisation of national security in the election campaign had popular support. The influential religious clergy, associations of professionals and mass media also joined the battle in earnest and their messages reinforced one another. The recent debate in Parliament suggests the government’s thinking continues to be in sync with the mandate it received at those elections.

However, in his speech in New York, President Gotabaya Rajapaksa has shown signs of diverging from the politics of the past. The President said “Fostering greater accountability, restorative justice, and meaningful reconciliation through domestic institutions is essential to achieve lasting peace. So too is ensuring more equitable participation in the fruits of economic development. It is my Government’s firm intention to build a prosperous, stable and secure future for all Sri Lankans, regardless of ethnicity, religion, or gender. We are ready to engage with all domestic stakeholders, and to obtain the support of our international partners and the United Nations, in this process.” However, the President’s speech continues to be at variance with the ground realities at the present time and the general manner of governance since the President took office in November 2019.

So far the pledge of a new direction is articulated in words. The time for the government to make the President’s words real and act accordingly is now. This will help to overcome the deep and dark cynicism that has enveloped the country regarding promises made by politicians. The first step would be to apply the logic of the Justice Minister in Parliament. Replying to an Opposition Parliamentarian who called for the arrest of Minister Lohan Ratwatte who stands accused of entering a prison and threatening prisoners with his gun, the justice minister said that everyone is entitled to the presumption of innocence until proven guilty. This also applies to the hundreds of Tamils and Muslims in jail without evidence to charge them in a court of law. The better way to deal with the threats to national security is to win the confidence of all the communities in the Sri Lanka by treating them without discrimination, as children of one mother, as our national anthem proclaims.

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Face shields, sans masks, on TV shows!

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Face shield ONLY does not provide protection from Covid-19

Covid-19 has claimed many lives, in our part of the world. Quite a few musicians, too, have had to face the music, where this deadly virus is concerned.

However, one is perturbed with the setup seen on some of our TV shows, especially where musicians are concerned.

The Covid-19 guidelines are never adhered to – no masks, no social distancing, etc.

There were reality shows held, post pandemic, where judges were seen even hugging their favourite contestants – with no masks.

With the virus turning deadly, some of the judges took to only wearing face shields. And, we now know the results of their stupidity.

By their irresponsible behaviour (wearing only face shields), they seem to be setting a trend for others to follow.

The question being asked is what are the health authorities doing? Why haven’t such folks been taken to task!

If the man on the street is arrested for not wearing a mask, how come these law-breakers go scot-free!

If wearing a mask is a hassle in an air conditioned setup, then such shows should be put on hold, or held virtual…live stream, zoom, from home, etc., and not with the participation of several artistes, in a studio.

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