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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

Strong on vocals

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The group Mirage is very much alive, and kicking, as one would say!

Their lineup did undergo a few changes and now they have decided to present themselves as an all male group – operating without a female vocalist.

At the helm is Donald Pieries (drums and vocals), Trevin Joseph (percussion and vocals), Dilipa Deshan (bass and vocals), Toosha Rajarathna (keyboards and vocals), and Sudam Nanayakkara (lead guitar and vocals).

The plus factor, where the new lineup is concerned, is that all five members sing.

However, leader Donald did mention that if it’s a function, where a female vocalist is required, they would then feature a guest performer.

Mirage is a very experience outfit and they now do the Friday night scene at the Irish Pub, in Colombo, as well as private gigs.

 

 

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Dichotomy of an urban-suburban New Year

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Ushered in by the ‘coo-ee’ of the Koel and the swaying of Erabadu bunches, the Sinhala and Tamil New Year will dawn in the wee hours of April 14. With houses to clean, preparation of sweetmeats and last-minute shopping, times are hectic…. and the streets congested.

It is believed that New Year traditions predated the advent of Buddhism in the 3rd century BC. But Buddhism resulted in a re-interpretation of the existing New Year activities in a Buddhist light. Hinduism has co-existed with Buddhism over millennia and no serious contradiction in New Year rituals are observed among Buddhists and Hindus.

The local New Year is a complex mix of Indigenous, Astrological, Hindu, and Buddhist traditions. Hindu literature provides the New Year with its mythological backdrop. The Prince of Peace called Indradeva is said to descend upon the earth to ensure peace and happiness, in a white carriage wearing on his head a white floral crown seven cubits high. He first plunges, into a sea of milk, breaking earth’s gravity.

The timing of the Sinhala New Year coincides with the New Year celebrations of many traditional calendars of South and Southeast Asia. Astrologically, the New Year begins when the sun moves from the House of Pisces (Meena Rashiya) to the House of Aries (Mesha Rashiya) in the celestial sphere.

The New Year marks the end of the harvest season and spring. Consequently, for farming communities, the traditional New Year doubles as a harvest as well. It also coincides with one of two instances when the sun is directly above Sri Lanka. The month of Bak, which coincides with April, according to the Gregorian calendar, represents prosperity. Astrologers decide the modern day rituals based on auspicious times, which coincides with the transit of the Sun between ‘House of Pisces’ and ‘House of Aries’.

Consequently, the ending of the old year, and the beginning of the new year occur several hours apart, during the time of transit. This period is considered Nonegathe, which roughly translates to ‘neutral period’ or a period in which there are no auspicious times. During the Nonegathe, traditionally, people are encouraged to engage themselves in meritorious and religious activities, refraining from material pursuits. This year the Nonegathe begin at 8.09 pm on Tuesday, April 13, and continues till 8.57 am on 14. New Year dawns at the halfway point of the transit, ushered in bythe sound of fire crackers, to the woe of many a dog and cat of the neighbourhood. Cracker related accidents are a common occurrence during new year celebrations. Environmental and safety concerns aside, lighting crackers remain an integral part of the celebrations throughout Sri Lanka.

This year the Sinhala and Tamil New Year dawns on Wednesday, April 14, at 2.33 am. But ‘spring cleaning’ starts days before the dawn of the new year. Before the new year the floor of houses are washed clean, polished, walls are lime-washed or painted, drapes are washed, dried and rehang. The well of the house is drained either manually or using an electric water pump and would not be used until such time the water is drawn for first transaction. Sweetmeats are prepared, often at homes, although commercialization of the new year has encouraged most urbanites to buy such food items. Shopping is a big part of the new year. Crowds throng to clothing retailers by the thousands. Relatives, specially the kids, are bought clothes as presents.

Bathing for the old year takes place before the dawn of the new year. This year this particular auspicious time falls on April 12, to bathe in the essence of wood apple leaves. Abiding by the relevant auspicious times the hearth and an oil lamp are lit and pot of milk is set to boil upon the hearth. Milk rice, the first meal of the year, is prepared separate. Entering into the first business transaction and partaking of the first meal are also observed according to the given auspicious times. This year, the auspicious time for preparing of meals, milk rice and sweets using mung beans, falls on Wednesday, April 14 at 6.17 am, and is to be carried out dressed in light green, while facing east. Commencement of work, transactions and consumption of the first meal falls on Wednesday, April 14 at 7.41 am, to be observed while wearing light green and facing east.

The first transaction was traditionally done with the well. The woman of the house would draw water from the well and in exchange drop a few pieces of charcoal, flowers, coins, salt and dried chillies into the well, in certain regions a handful of paddy or rice is also thrown in for good measure. But this ritual is also dying out as few urban homes have wells within their premises. This is not a mere ritual and was traditionally carried out with the purification properties of charcoal in mind. The first water is preferably collected into an airtight container, and kept till the dawn of the next new year. It is believed that if the water in the container does not go down it would be a prosperous year. The rituals vary slightly based on the region. However, the essence of the celebrations remains the same.

Anointing of oil is another major ritual of the New Year celebrations. It falls on Saturday, April 17 at 7.16 am, and is done wearing blue, facing south, with nuga leaves placed on the head and Karada leaves at the feet. Oil is to be applied mixed with extracts of Nuga leaves. The auspicious time for setting out for professional occupations falls on Monday, April 19 at 6.39 am, while dressed in white, by consuming a meal of milk rice mixed with ghee, while facing South.

Traditionally, women played Raban during this time, but such practices are slowly being weaned out by urbanization and commercialisation of the New Year. Neighbours are visited with platters of sweetmeats, bananas, Kevum (oil cake) and Kokis (a crispy sweetmeat) usually delivered by children. The dichotomy of the urban and village life is obvious here too, where in the suburbs and the village outdoor celebrations are preferred and the city opts for more private parties.

 

 

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Features

New Year games: Integral part of New Year Celebrations

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Food, games and rituals make a better part of New Year celebrations. One major perk of Avurudu is the festivals that are organised in each neighbourhood in its celebration. Observing all the rituals, like boiling milk, partaking of the first meal, anointing of oil, setting off to work, are, no doubt exciting, but much looked-forward-to is the local Avurudu Uthsawaya.

Avurudu Krida or New Year games are categorised as indoor and outdoor games. All indoor games are played on the floor and outdoor games played during the Avurudu Uthsava or New Year festival, with the whole neighbourhood taking part. Some of the indoor games are Pancha Dameema, Olinda Keliya and Cadju Dameema. Outdoor games include Kotta pora, Onchili pedeema, Raban geseema, Kana mutti bindeema, Placing the eye on the elephant, Coconut grating competition, Bun-eating competition, Lime-on-spoon race, Kamba adeema (Tug-o-War) and Lissana gaha nageema (climbing the greased pole). And what’s an Avurudhu Uthsava sans an Avurudu Kumari pageant, minus the usual drama that high profile beauty pageants of the day entail, of course.

A salient point of New Year games is that there are no age categories. Although there are games reserved for children such as blowing of balloons, races and soft drinks drinking contests, most other games are not age based.

Kotta pora aka pillow fights are not the kind the average teenagers fight out with their siblings, on plush beds. This is a serious game, wherein players have to balance themselves on a horizontal log in a seated position. With one hand tied behind their back and wielding the pillow with the other, players have to knock the opponent off balance. Whoever knocks the opponent off the log first, wins. The game is usually played over a muddy pit, so the loser goes home with a mud bath.

Climbing the greased pole is fun to watch, but cannot be fun to take part in. A flag is tied to the end of a timber pole-fixed to the ground and greased along the whole length. The objective of the players is to climb the pole, referred to as the ‘tree’, and bring down the flag. Retrieving the flag is never achieved on the first climb. It takes multiple climbers removing some of the grease at a time, so someone could finally retrieve the flag.

Who knew that scraping coconut could be made into an interesting game? During the Avurudu coconut scraping competition, women sit on coconut scraper stools and try to scrape a coconut as fast as possible. The one who finishes first wins. These maybe Avurudu games, but they are taken quite seriously. The grated coconut is inspected for clumps and those with ungrated clumps are disqualified.

Coconut palm weaving is another interesting contest that is exclusive to women. However men are by no means discouraged from entering such contests and, in fact, few men do. Participants are given equally measured coconut fronds and the one who finishes first wins.

Kana Mutti Bindima involves breaking one of many water filled clay pots hung overhead, using a long wooden beam. Placing the eye on the elephant is another game played while blindfolded. An elephant is drawn on a black or white board and the blindfolded person has to spot the eye of the elephant. Another competition involves feeding the partner yoghurt or curd while blindfolded.

The Banis-eating contest involves eating tea buns tied to a string. Contestants run to the buns with their hands tied behind their backs and have to eat buns hanging from a string, on their knees. The one who finishes his or her bun first, wins. Kamba adeema or Tug-o-War pits two teams against each other in a test of strength. Teams pull on opposite ends of a rope, with the goal being to bring the rope a certain distance in one direction against the force of the opposing team’s pull.

Participants of the lime-on-spoon race have to run a certain distance while balancing a lime on a spoon, with the handle in their mouths. The first person to cross the finish line without dropping the lime wins. The sack race and the three-legged race are equally fun to watch and to take part in. In the sack race, participants get into jute sacks and hop for the finish line. The first one over, wins. In the three-legged race one leg of each pair of participants are tied together and the duo must reach the finish line by synchronising their running, else they would trip over their own feet.

Pancha Dameema is an indoor game played in two groups, using five small shells, a coconut shell and a game board. Olinda is another indoor board game, normally played by two players. The board has nine holes, four beads each. The player who collects the most number of seeds win.

This is the verse sung while playing the game:

“Olinda thibenne koi koi dese,

Olinda thibenne bangali dese…

Genath hadanne koi koi dese,

Genath hadanne Sinhala dese…”

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