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Consequences of using poor quality PCR test kits, and misinterpretation of data

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By Sunil J. Wimalawansa,

Professor of Medicine

From March 2020, the current administration had multiple golden opportunities to prevent and better manage COVID-19 in Sri Lanka. Several learned Sri Lankans with expertise, including the author, suggested different options: the administration rejected them and opted for curfew. If strategic, proactive preventative actions, as suggested by the author, were implemented in March/April 2020, it could have prevented the community spread of COVID-19, without resorting to the ineffective and draconian curfews that caused the loss of livelihoods and despair, and ruined the economy.

 

Why ARE PCR testing kits failing?

The currently used PCR test kits in some countries including Sri Lanka, especially the cheaper kits sold or donated by China, are of inferior quality, and therefore the resulting data is unreliable. These test kits are less sensitive and less specific. So, the results can be misleading. This creates an serious injustice, labelling people who are not COVID-19 infected as ‘patients’ (false positive; similar to falsely labelling people as HIV positive) and the failure to diagnose those who are infected (false negative), both creating bad situations that eroded the trust of people.

 

Concerns related to PCR data:

Just because a PCR test is positive, it does not necessarily mean that the person is infectious or infected with COVID-19. The PCR test only detects a small viral fragment, and thus a positive test does not confirm that the person is having the virus or he/she is infectious. Besides inferior quality products, there are other scientific reasons why PCR test kits fail. Some of the common reasons are (1) faulty diagnosis (technological issues, including over-amplification of PCR cycles than recommended), (2) contamination and/or sample mixed-up, (3) previous infections with other coronaviruses, (4) patients’ recovery from COVID-19 infection irrespective of symptomatic or asymptomatic, and (5) maintaining the positivity, after full recovery (incidental detection of viral particles that yet have not been eliminated).

Similarly, a person found negative for PCR (e. g. false-negative results or during the early incubation period), can become positive in a few days. PCR is not the gold standard for diagnosing COVID-19, and new methods are emerging to overcome this issue. Importantly, the PCR test does not confirm that a person is having an active COVID-19 infection.

 

Lack of transparency and PCR scandals:

In most cases, the military runs the quarantine centres like ‘prisons’, detaining people without their consent. It was reported that some were kept extra days in hotels (apparently not in free quarantine centres) due to a delay in getting a second PCR test results. Such actions forced persons to pay for the extended stay and PCR testing by the private sector, for no fault of theirs, before being allowed to go home

The actual cost of a PCR test is a fraction of what private hospitals are charging and claimed by the Health Department. The ongoing trend suggests that the COVID-19 tragic situation has been turned into a lucrative business by some unscrupulous people. Making it mandatory for companies to have PCR tests done at private hospitals is an example.

 

Who should conduct PCR testing?

It is commonsense that the Health Department should carry out such testing as a part of COVID-19 public health management and proactive surveillance programme. It is unethical to place an additional burden on businesses that are already struggling to survive due to the mismanagement of the COVID-19 transmission and the resultant economic crisis.

Most of the delays in receiving PCR test results are apparently due to administrative and logistical failures, and a few have been attributed to dysfunctional PCR testing equipment. Nevertheless, responsibility comes with accountability. Since the army claims to be fully responsible for managing the quarantine centres, they are not only accountable but also have ethical and fiduciary responsibilities for obtaining the PCR test results without delay and releasing people they are holding. If there are any additional costs to people resulting from delays, the army must bear that.

 

Wrongly labelling people with COVID unethical:

It is unfair to label people as having COVID-19 wrongly; senior health administrators must take full responsibility for this. They must understand and acknowledge their limitations, and take affirmative steps to prevent it. They have not done so. When they are unsure, they should repeat the PCR and say “possible or probable” PCR positive, but no one can guarantee a person is infectious. As per the law of the country, getting unintentionally infected with COVID-19 is not a crime: it is just like getting the common cold or a heart attack. Then why are PCR positive innocent persons treated like criminals? It is time to change the stigmatizing attitude of anti-COVID task force and the law enforcement authorities towards the PCR positive persons: they are also our fellow citizens.

 

Presidential action needed:

The President should instruct the law-enforcement agencies immediately to stop harassing people who might have been exposed to the virus, and locking up those who are found PCR positive, their families and neighbours for 14 days. This amounts to discrimination. If the President or a current government minister is found to be a COVID-19 contact or becomes PCR positive, will they also be locked up in a quarantine centre? Law must apply to everyone equally.

 

Inhumane treatment of people continues:

Contact tracing and quarantining, in Sri Lanka in particular, are being implemented in an inhumane and punitive manner. Those engaged in such practices are violating the laws of Sri Lanka (e. g. harassment and/or unlawful arrests). Sri Lankans do not deserve such treatment.

1897, Quarantine & Prevention of Diseases Ordinance (with a few amendments) in Sri Lanka does not authorise law-enforcement officers forceful detention—arresting and imprisoning people—or intimidating, harassing, and harming citizens, in the absence of a crime. Such actions are unfortunately taken for granted though illegal. Those who are engaged in them may think they have immunity, but they can be held liable.

 

Community spread is not a myth:

Despite denials, Sri Lanka has had community COVID-19 spread since April 2020. In recent days, when the daily PCR testing is increased to more than twenty-fold (see below), it was not surprising to see an increased number of PCR positivity. With the presence of community spread, increased PCR positivity detected is proportionate to the number of PCR tests conducted. For example, if the Health Department had carried out PCR testing in the community from May through August 2020, as the author and others have urged it to do since April 2020, it would have detected 10-40 times the number of PCR positive cases in the community it has reported to the World Health Organization (WHO). Therefore, the incidence and prevalence of COVID-19 reported to the WHO was misleading and grossly underestimated.

 

The Rate of PCR positivity has not changed significantly

The ‘rate’ of PCR positivity (the number of PCR positive persons divided by the number of PCR tests carried out), has not changed significantly from May/June to October/November. The detection rate has only changed from 2% to 3%. This 1% change was fully accounted for by the twenty-fold increase in the numbers of PCR testes on “high-risk” groups that began in mid-October. It was not due to an exponential dissemination of COVID-19.

Therefore, contrary to the claims by spokespersons for the COVID task force and the Health Department, there was no new COVID crisis in October. The crisis was self-created because of misunderstanding and misinterpretation of the PCR data. The resulting curfew in late October was another major mistake that further harmed the country and its economy. The Sri Lankan government was misled to authorise an inappropriate curfew yet again in October: this time around, due to the misinterpretation of PCR data and the inability to understand basic statistics. This is unfortunate for Sri Lankans.

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Features

Govt.’s choice is dialogue over confrontation

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By Jehan Perera

Preparing for the forthcoming UN Human Rights Council cannot be easy for a government elected on a nationalist platform that was very critical of international intervention. When the government declared its intention to withdraw from Sri Lanka’s co-sponsorship of the October 2015 resolution No. 30/1 last February, it may have been hoping that this would be the end of the matter. However, this is not to be. The UN Human Rights High Commissioner’s report that will be taken up at the forthcoming UNHRC session in March contains a slate of proposals that are severely punitive in nature and will need to be mitigated. These include targeted economic sanctions, travel bans and even the involvement of the International Criminal Court.

Since UN Secretary General Ban Ki-Moon’s visit in May 2009 just a few days after the three-decade long war came to its bloody termination, Sri Lanka has been a regular part of the UNHRC’s formal discussion and sometimes even taking the centre stage. Three resolutions were passed on Sri Lanka under acrimonious circumstances, with Sri Lanka winning the very first one, but losing the next two. As the country became internationally known for its opposition to revisiting the past, sanctions and hostile propaganda against it began to mount. It was only after the then Sri Lankan government in 2015 agreed to co-sponsor a fresh resolution did the clouds begin to dispel.

Clearly in preparation for the forthcoming UNHRC session in Geneva in March, the government has finally delivered on a promise it made a year ago at the same venue. In February 2020 Foreign Minister Dinesh Gunawardena sought to prepare the ground for Sri Lanka’s withdrawal from co-sponsorship of UN Human Rights Council resolution No 30/1 of 2015. His speech in Geneva highlighted two important issues. The first, and most important to Sri Lanka’s future, was that the government did not wish to break its relationships with the UN system and its mechanisms. He said, “Sri Lanka will continue to remain engaged with, and seek as required, the assistance of the UN and its agencies including the regular human rights mandates/bodies and mechanisms in capacity building and technical assistance, in keeping with domestic priorities and policies.”

Second, the Foreign Minister concluding his speech at the UNHRC session in Geneva saying “No one has the well-being of the multi-ethnic, multi-lingual, multi-religious and multi-cultural people of Sri Lanka closer to their heart, than the Government of Sri Lanka. It is this motivation that guides our commitment and resolve to move towards comprehensive reconciliation and an era of stable peace and prosperity for our people.” On that occasion the government pledged to set up a commission of inquiry to inquire into the findings of previous commissions of inquiry. The government’s action of appointing a sitting Supreme Court judge as the chairperson of a three-member presidential commission of inquiry into the findings and recommendations of earlier commissions and official bodies can be seen as the start point of its response to the UNHRC.

 

 

NEGATIVE RESPONSE

 

The government’s setting up of a Commission of Inquiry has yet to find a positive response from the international and national human rights community and may not find it at all. The national legal commentator Kishali Pinto Jayawardene has written that “the tasks encompassed within its mandate have already been performed by the Lessons Learnt and Reconciliation Commission (LLRC, 2011) under the term of this President’s brother, himself the country’s Executive President at the time, Mahinda Rajapaksa.” Amnesty International has stated that “Sri Lanka has a litany of such failed COIs that Amnesty International has extensively documented.” It goes on to quote from the UN High Commissioner for Human Rights that “Domestic processes have consistently failed to deliver accountability in the past and I am not convinced the appointment of yet another Commission of Inquiry will advance this agenda. As a result, victims remain denied justice and Sri Lankans from all communities have no guarantee that past patterns of human rights violations will not recur.”

It appears that the government intends its appointment of the COI to meet the demand for accountability in regard to past human rights violations. Its mandate includes to “Find out whether preceding Commissions of Inquiry and Committees which have been appointed to investigate into human rights violations, have revealed any human rights violations, serious violations of the international humanitarian law and other such serious offences.” In the past the government has not been prepared to accept that such violations took place in a way that is deserving of so much of international scrutiny. Time and again the point has been made in Sri Lanka that there are no clean wars fought anywhere in the world.

International organisations that stands for the principles of international human rights will necessarily be acting according to their mandates. These include seeking the intervention of international judicial mechanisms or seeking to promote hybrid international and national joint mechanisms within countries in which the legal structures have not been successful in ensuring justice. The latter was on the cards in regard to Resolution 30/1 from which the government withdrew its co-sponsorship. The previous government leaders who agreed to this resolution had to publicly deny any such intention in view of overwhelming political and public opposition to such a hybrid mechanism. The present government has made it clear that it will not accept international or hybrid mechanisms.

 

 

SEQUENTIAL IMPLEMENATION

 

In the preamble to the establishment of the COI the government has made some very constructive statements that open up the space for dialogue on issues of accountability, human rights and reconciliation. It states that “the policy of the Government of Sri Lanka is to continue to work with the United Nations and its Agencies to achieve accountability and human resource development for achieving sustainable peace and reconciliation, even though Sri Lanka withdrew from the co-sponsorship of the aforesaid resolutions” and further goes on to say that “the Government of Sri Lanka is committed to ensure that, other issues remain to be resolved through democratic and legal processes and to make institutional reforms where necessary to ensure justice and reconciliation.”

As the representative of a sovereign state, the government cannot be compelled to either accept international mechanisms or to prosecute those it does not wish to prosecute. At the same time its willingness to discuss the issues of accountability, justice and reconciliation as outlined in the preamble can be considered positively. The concept of transitional justice on which Resolution No 30/1 was built consists of the four pillars of truth, accountability, reparations and institutional reform. There is international debate on whether these four pillars should be implemented simultaneously or whether it is acceptable that they be implemented sequentially depending on the country context.

The government has already commenced the reparations process by establishing the Office for Reparations and to allocate a monthly sum of Rs 6000 to all those who have obtained Certificates of Absence (of their relatives) from the Office of Missing Persons. This process of compensation can be speeded up, widened and improved. It is also reported that the government is willing to consider the plight of suspected members of the LTTE who have been in detention without trial, and in some cases without even being indicted, for more than 10 years. The sooner action is taken the better. The government can also seek the assistance of the international community, and India in particular, to develop the war affected parts of the country on the lines of the Marshall Plan that the United States utilized to rebuild war destroyed parts of Europe. Member countries of the UNHRC need to be convinced that the government’s actions will take forward the national reconciliation process to vote to close the chapter on UNHRC resolution 30/1 in March 2021.

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Features

Album to celebrate 30 years

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Rajiv Sebastian had mega plans to celebrate 30 years, in showbiz, and the plans included concerts, both local and foreign. But, with the pandemic, the singer had to put everything on hold.

However, in order to remember this great occasion, the singer has done an album, made up of 12 songs, featuring several well known artistes, including Sunil of the Gypsies.

All the songs have been composed, very specially for this album.

Among the highlights will be a duet, featuring Rajiv and the Derena DreamStar winner, Andrea Fallen.

Andrea, I’m told, will also be featured, doing a solo spot, on the album.

Rajiv and his band The Clan handle the Friday night scene at The Cinnamon Grand Breeze Bar, from 07.30 pm, onwards.

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Features

LET’S DO IT … in the new normal

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The local showbiz scene is certainly brightening up – of course, in the ‘new normal’ format (and we hope so!)

Going back to the old format would be disastrous, especially as the country is experiencing a surge in Covid-19 cases, and the Western Province is said to be high on the list of new cases.

But…life has to go on, and with the necessary precautions taken, we can certainly enjoy what the ‘new normal’ has to offer us…by way of entertainment.

Bassist Benjy, who leads the band Aquarius, is happy that is hard work is finally bringing the band the desired results – where work is concerned.

Although new to the entertainment scene, Aquarius had lots of good things coming their way, but the pandemic ruined it all – not only for Aquarius but also for everyone connected with showbiz.

However, there are positive signs, on the horizon, and Benjy indicated to us that he is enthusiastically looking forward to making it a happening scene – wherever they perform.

And, this Friday night (January 29th), Aquarius will be doing their thing at The Show By O, Mount Lavinia – a beach front venue.

Benjy says he is planning out something extra special for this particular night.

“This is our very first outing, as a band, at The Show By O, so we want to make it memorable for all those who turn up this Friday.”

The legendary bassist, who lights up the stage, whenever he booms into action, is looking forward to seeing music lovers, and all those who missed out on being entertained for quite a while, at the Mount Lavinia venue, this Friday.

“I assure you, it will be a night to be remembered.”

Benjy and Aquarius will also be doing their thing, every Saturday evening, at the Darley rd. Pub & Restaurant, Colombo 10.

In fact, they were featured at this particular venue, late last year, but the second wave of Covid-19 ended their gigs.

Also new to the scene – very new, I would say – is Ishini and her band, The Branch.

Of course, Ishini is a singer of repute, having performed with Mirage, but as Ishini and The Branch, they are brand new!

Nevertheless, they were featured at certain five-star venues, during the past few weeks…of their existence.

 

 

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