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Covid-19: Some long-term effects

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Many are quite familiar with the acute-stage phenomena in COVID-19. These include the features of any viral infection, together with specific involvement of the respiratory system, as well as other organs. Yet for all that, it was assumed during the initial stages of the pandemic that if one managed to survive an attack by the SARS-CoV-2 virus, one would bounce back into good health fairly soon. This was thought to apply to the entire spectrum of COVID-19, ranging from asymptomatic persons to those who were very severely affected.

However, with the continuous flow of research information during the last 18 months, we have had to change our perspectives. Early on in the pandemic, Chinese and Italian research delineated the prevalence of long-lasting symptoms following apparent recovery among patients admitted to hospital with COVID-19. Following that, a wide variety of sources have contributed to our understanding of persistent health problems experienced by some COVID-19 survivors. Even patients categorised as having mild COVID-19 and were not hospitalized, have had ongoing long-term health effects. They have even formed online groups, such as the Body Politic COVID-19 Support Group, and have also launched patient-led research ventures. These have undoubtedly facilitated scientific recognition of the phenomenon of persistent health problems among COVID-19 survivors and led to recognition of the newly-coined term ‘Long COVID’.

In fact, a plethora of health problems have been reported as sequelae of COVID-19. The specific health effects people experience and composite names for those effects are still being defined. In addition to “Long COVID”, other names given are “Post-COVID-19 Syndrome”, “Long-term COVID” and “Chronic COVID Syndrome”. Furthermore, people who experience ongoing health problems after COVID-19 have been referred to as “Long haulers”. The National Institutes of Health of the US has funded research on health effects that persist after COVID-19 and suggested that while these effects are still being defined, they may collectively be referred to as “Post-Acute Sequelae of SARS-CoV-2 infection” (PASC).

Before describing what PASC covers, it is useful to review the goings-on during acute infection with SARS-CoV-2 in COVID-19. At the onset, the virus vigorously replicates leading to increasing numbers of viral particles in the body. Then onwards and particularly during the latter stages of the infection, the immune system of the body clears the virus. Symptoms can be caused both by direct effects of the virus as well as an overactive immune response. The virus typically infects the respiratory tract and causes respiratory symptoms such as cough and difficulties in breathing. The term “Severe COVID-19” is used to delineate cases of acute infection when lung function has been compromised. However, many other organs too can be affected by the virus and the range of symptoms people with COVID-19 experience varies widely. Many of those who are infected may be asymptomatic, but now it is known that they too can develop PASC.

A very large percentage of people recover from acute COVID-19 within weeks. The time taken for recovery may be longer in more severe cases. There is no consensus, at least not as yet, on where to draw the line between when COVID-19 ends and PASC begins. Various time progressions have been proposed but none of them are finite and written in stone. Simply stated, many guidelines define “Acute COVID-19” as lasting up to four weeks after diagnosis; “On-going COVID-19” as lasting from 4 to 12 weeks after diagnosis, and “Post-COVID-19 Syndrome” as lasting for more than 12 weeks. However, there is increasing recognition that progression of PASC may be non-linear and new symptoms arise after acute illness has resolved or even when other symptoms dissipate. The variable timelines, together with the relatively shorter duration of many research studies have restricted our understanding of PASC.

Long-term symptoms in COVID-19 survivors may be similar or different to what was experienced during the acute illness. Symptoms affecting nearly every part of the body have been reported. One research endeavour identified as many as 55 long-term effects associated with COVID-19. The five most commonly reported symptoms were fatigue (58%), headache (44%), difficulty concentrating; sometimes called “brain fog” (27%), hair loss (25%), and shortness of breath (24%). The long-term effects reported use some medical terms such as “ageusia” (loss of taste), “dyspnoea” (shortness of breath) and “polypnoea” (rapid breathing). To compound matters further, reported symptoms are not just physical. In a study of more than 230,000 COVID-19 survivors, 13% received a new neurologic or psychiatric diagnosis within the first six months after diagnosis.

As doctors and scientists learn more, an early step taken to help better define PASC has been to group together the wide range of symptoms experienced by COVID-19 survivors into distinct syndromes; a syndrome being a collection of symptoms that tend to occur together. At least one definitive syndrome has been defined under the PASC umbrella.

Investigation into cases of children who were hospitalized with an overactive immune-inflammatory or hyperinflammatory syndrome which presented sometime later after the acute infection led to the recognition of what was named as the Multisystem Inflammatory Syndrome or MIS-C. People with this syndrome are under 21 years of age and have multiple organs affected and require hospitalization, some being critically ill. There is now recognition of a similar syndrome among adults; Multisystem Inflammatory Syndrome in Adults or MIS-A. The incidence of both MIS-C and MIS-A are very low. From March 1 through March 10, 2020, the incidence of MIS-C in New York State among people younger than 21 years was 2 per 100,000 individuals, whereas the incidence of COVID-19 was 322 per 100,000 individuals. As of 3rd May 2021, 3,742 cases of MIS-C had been reported in the United States.

While scientists and researchers are trying to define PASC better, they are also trying hard to understand what may be causing the symptoms. Many theories on causation have been put forward. The two leading hypotheses are that symptoms arise from direct tissue damage due to the SARS-CoV-2 virus or from the immune response during acute infection. Another one is that health effects are caused by an ongoing immune response that is practically going inappropriately berserk.

It is difficult to quantify and characterize risk factors for a condition that is not yet all that well defined. It is likely that the risk factors for specific sequelae under the PASC umbrella vary, especially if different sequelae have different causes. Studies conducted to date suggest that four groups of people may be more likely to experience PASC: people with more severe acute illness, those who have underlying unrelated diseases or comorbidities, older adults, and women.

In a nut-shell, most people with COVID-19 fully recover within weeks of the onset of their illness. But for some, the resolution of the acute infection is not the end of their COVID-19 voyage. Some COVID-19 survivors have experienced new, returning, or ongoing, health problems, that persist long after the acute illness. As of 1st of June 2021, there have been more than 170 million cases of COVID-19 reported worldwide. The true number of infections is much higher, possibly more than one billion. If even only a small proportion of those infected develop long-term sequelae, it would create a major public health challenge. We need to better understand how many people experience long-lasting symptoms in order to prepare for and address potential public health and societal impacts.

Currently, we are well aware of the fact that COVID-19 is a complex disease that can have profound effects on nearly every part of the body during acute infection as well as over the longer term. We know that even if a small proportion of those infected with SARS-CoV-2 globally, go on to experience PASC, the societal impacts could be profound. The importance of preventing the long-term health effects of COVID-19 cannot be overstated. Perhaps, the currently available vaccines may help in mitigating the effects of PASC. This is just one of many reasons why universal access to COVID-19 vaccines should be a global priority. There should be no argument whatsoever about it.



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The battle against KNDU: Renewing our contract with the people

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By Sivamohan Sumathy

The KNDU Bill is designed to single-handedly change the face of education in Sri Lanka. Since the ‘90s, successive governments have tried to roll back the gains of the Free Education Poliicy of 1945. The history of free education is not linear, nor is it without contradictions. It is implicated in the hierarchies of class, ethnicity, gender and the multiple vectors of violence of state and civil society. Despite and because of these very contradictions Free Education has come to represent and symbolise the often contradictory but powerful assemblage of social aspirations and social desires of the general body of citizenry, particularly the vast majority situated on the margins or near margins of society. Free education does not serve everybody equally, but over the years and across decades, it has come to represent the hope of a vast majority for a better place in society. For a populace that is increasingly disempowered, it opens up opportunities toward social mobility, limited as they are; and as or more importantly, becomes the ideological and political weapon of the vast majority in the struggle for justice, social justice and bid for a democratic pact with the state.

Privatisation, Corporatisation, Militarisation

The State university system is an integral part of the state apparatus. Successive governments, have attempted and, to some degree, succeeded in undermining its integrity from within, creating parallel systems of higher education that would be on par with it. Privatisation of higher education follows a two pronged plan; the creation of fee levying centres and bodies of education and the degradation of state universities through under funding and sub-standardization. The fortnightly Kuppi Talk column in The Island has consistently foregrounded the pressures exerted upon the state university compelling it to carry out multiple reforms that compromise on standards and force it to privatise itself. From the ‘90s onwards (if not before), spending on university education has steadily deteriorated and in the post war years spending on education has stayed under 2% of the GDP (Niyanthini Kadirgamar, “Funding Fallacies,” https://island.lk/funding-fallacies-in-education/). The Humanities and Social Sciences are the most affected as highlighted in the various contributions of the Kuppi Talk column. It is no accident that the most recent move toward privatisation from within and without takes place by fiat and through militarisation. Much has been written about the principles of militarised authority that the KNDU bill enshrines. I do not have to reinvent the wheel here, but want to note that by rolling back the gains of free education and its potential to empower people, the KNDU bill points toward a future of repressive technocratic governance and repressive exclusions of those who most desire education as the path to mobility.

While the ‘80s and ‘90s saw a few stuttering steps toward privatisation of education, at the turn of the new millennium one is witness to the onset of an aggressive campaign toward the the dismantling of the long cherished free education apparatus as we know it. I trace this historical trajectory in “SAITM: Continuities and Discontinuities” looking at the different impetuses behind the establishment of NCMC and SAITM, the ideological similarities notwithstanding (http://www.island.lk/index.php?page_cat=article-details&page=article-details&code_title=161915

Certain forms of privatised tertiary education have existed for a long time and have expanded in recent years, but to this day, the establishment of a fully-fledged private university has run into problems. Popular will stood in its way. But it is also a fact that the country simply does not have the infrastructural, intellectual and investment-capacity for a viable private university to take off. Private sector in fact is weak in Sri Lanka. In the post war years, the then Mahinda Rajapaksa Government, with S. B. Dissanayake as Minister of Higher Education spear headed a move to formalise private universities through an umbrella organization that would act as an accreditation council, bringing private and state universities on par and under the same purview and placing this purview within the ambit of corporate interests. In their eyes, Sri Lanka is to become an education hub, attracting foreign investment (“Education and its discontents,” ). The Yahapalana government is no better and blindly follows through on the privatisation plans of the previous regime with its Private Public Partnership policies, SAITM, and the degrading of Arts Education to some vague notion of soft skills development. The KNDU Bill was gazetted in April 2018 and was opposed by the academic communities and members of civil society. As with most corruption ridden neo liberal moves that render all aspects of life commodified, in this instance too, the state becomes an investor in privatised education. We hear that Bank of Ceylon and NSB have been ordered to pledge 36.54 billion rupees to KDU. (https://www.sundaytimes.lk/210725/business-times/kotelawala-uni-gets-over-rs-36-bn-from-boc-nsb-449828.html) If the rationale for privatising education is to ease the burden on the state, why does the state continue to subsidize these institutions? The logic boggles the mind.

The Democracy Call

From 2011-2012 the Federation of University Teachers’ Association (FUTA) launched the greatest challenge that the teachers had ever made to an incumbent government and in the post war era brought together diverse disgruntled forces under its slogan of Save State Education and the 6% GDP campaign. It brought together different groups and a wide range of actors together to formulate a response to the neo liberal forces that were riding rough shod over the needs of an anxious working and professional class. Its call for action was framed by the call to save democracy. However, in the Yahapalana years and after, the struggle for education lost its momentum. FUTA itself was riven from within, preoccupied by its members’ narrower preoccupations, diverse aspirations, and loyalties. Other disparate groups took up the mantle to fight against privatisation, some of which may not have developed in desirable directions.

Today, the bill threatens to become a dangerous reality. It is not just Universities that are threatened by the KNDU. School teachers led by their unions have jumped into the fray. Beaten by the crippling conditions of COVID 19, teachers and students are facing the dire consequences of years of underfunding in education. FUTA is joining the protest as a key player, a mighty powerful player, but not as the only player. As Shamala Kumar eloquently put it at a press conference called against the KNDU bill on 24 July, 2021, the struggle against the authoritarian bill is a struggle against the PTA, a struggle for working people’s rights, guaranteeing safety of working conditions in the informal sector, particularly women, and a struggle for democracy within the university, including raising one’s voice against ragging. University teachers, rallying forces under FUTA, are once again on the cusp of a decisive moment of the history of education in the country. Let’s defeat the KNDU bill together!

 

Sivamohan Sumathy is attached to the Department of English at the Univ. of Peradeniya

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Condolences, warnings and admonition never to forget

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Two great Sri Lankans have died and we as a country are much the poorer, and mourn their deaths. Manouri de Silva Muttetuwegama has vacated her long held position as a wise, consistent, fearless combatant for women and particularly those underprivileged, discriminated against, and helpless against forces of war and ethnicity that caused them suffering. Another noteworthy trait of the woman and characteristic of her work-ethic was quiet efficiency in going about her remedying, healing work with no fanfare and never seeking of publicity and praise. She was a lovely friendly person, always with a sincere smile lighting her face. Manouri served the country well and her daughter carries the torch.

Business magnate and media moghul R Rajamahendran, who used his money, influence and power to help the country is mourned, more so as he could have served his company Capital Maharaja Organisation and Sri Lankan media longer. The appreciation of him by Rex Clementine in The Island, Monday July 26, detailed the great good he did for Sri Lankan cricket. Teaming up with Gamini Dissanayake he literally fought for test status for our country, amply justified by teams of yore, one of which won the World Cup and another nearly did.

(Note: Cass uses the verb ‘died’ and the noun ‘death’ in preference to the softer, gentler ‘passing’, ‘passing away’ et al as she prefers the more real though stark word to euphemisms. Death is death.)

 

Never forget crimes committed

This is the thought that came to mind when coincidentally Cassandra, on 22 July watched the movie 22 July, almost a documentary on the 32 year old Anders Behring Breivik, who parked his bomb-laden van outside the PM’s office in Oslo; it killed eight people and caused utter damage, and then crossed to a summer camp on an island where he shot, point blank, the manager who welcomed him as a police officer but then wanted to see his ID, and a woman in authority. He embarked on a killing spree, which left 69 Youth League workers dead and many more injured. When the police arrived he tamely surrendered. At his trial he said he wanted to save Norway and Europe itself from multiculturalism, particularly naming Muslims, and that the killing of innocents was a wakeup call. His defence attorney attempted pleading schizophrenia but on hearing the awfully heartrending testimony of some of the young campers who escaped death but were injured grievously, he was found guilty on all counts and jailed in solitary confinement for more than two decades.

We, most fortunately have had no single mass murderer like Breivik and American school killers but murder most foul continues and may surface any time.

Cass’ thought was never forget terrible crimes committed on persons who were innocent or who were doing their duty. Yes, we as a nation must never forget these grievous crimes. The death of Richard de Zoysa stands out stark, but the police person who took him away from his home and his mother ‘for questioning’, tortured and killed him and dropped him far out at sea died gruesomely along with Prez Premadasa on May 1. Richard’s body washed ashore though weighted and dropped far out at sea. The person who probably ordered his demise too was killed by the same LTTE bomb. Thus, they paid for their heinous crime.

Others who murdered or ordered murders seem to live on powerfully and mightily. The gruesome murder of Lasantha Wickrematunge is kept alive by his daughter, but to no avail. Never to be forgotten or forgiven is the killing of the young, harmless ruggerite whose only ‘crime’ was cocking a snook at those who thought they were superior. What the telling vine conveyed was that the rugger captaincy almost going to him had him tortured and killed. Again a coincidence or overconfidence brought to light the crime: Thajudeen’s body was placed next to the driving seat and his car pushed against a wall to fake an accident. It was all covered up. But people remember this murder, though no one shouts for justice for Thajudeen’s grieving parents.

When you question how come murderers and torturers seem to thrive, the answer is karma, Cass supposes. Maybe, the perpetrators suffer in the midst of utter luxury and in power. Maybe, even slightly, they are overcome with shivers of fright, but never remorse, we surmise.

Unanimously, we are all triumphant that the 15 year old Tamil girl’s death by immolation after prolonged rape in an ex-Minister’s home is being investigated. We hope it will move to correct, just conclusion.

 

Notes on news items

Highly commended is the article ‘Whither the Sangha and Buddha Sasana?’ by S M Sumanadasa in The Island of July 26. If you have not read it, and are a Buddhist, please retrieve the article and read it. It is spot on though gently written, very timely with so many protests going on, most headed by yellow robes. He starts by saying “As a keen observer …, I feel confident and justified in what I say…” Perfectly justified and every point made is valid. The majority of our Sangha strictly follow the 200 odd vinaya rules and render invaluable service to Buddhist lay people, to Buddhism, and the country, but the yellow robed bad eggs are truly rotten. The Sangha may only advise leaders and from a back seat. Sumanadasa queries why the Buddha Sasana Ministry and the Nayaka Theros do not stem the growing tide of indiscipline and reprehensible behaviour of men in Sangha robes. We ask the same. He states a truth that the death of Buddhism in Sri Lanka is really caused by the Buddhists themselves and some members of the Sangha.

An agreeing opinion by Piyasena Athukorale is in The Island, Wednesday July 29.

Proposed Plantation University and its economic benefits by Dr L M K Tillekeratne appears in the same newspaper. Cassandra retorts: Oh goodness! Enough universities! What benefit when sane advice by university dons and experts in agriculture and related subjects have been completely ignored by the President, the PM, the Cabinet and others in power. They have still not rescinded or withdrawn the overnight ban on import and use of inorganic fertilisers. When famine stares us in the face after the demise of the farmer (the country’s so called backbone) through suicide or utter disgusted exasperation and loss of livelihood, we Ordinaries will have to suffer hunger pangs and malnourishment while those who ordered the very ill-advised and too sudden ban, will live on happily. Maybe, exotic food from around the world will be helicoptered to them!

Professor Channa Jayasumana, I was told, has said that the long awaited and longed for Astra Zeneca vaccine was delayed in transport to our land by the Olympic Games. Cass really did not know that these Games blocked air routes or interfered with air travel. Maybe, the Prof meant that the vaccine gifted (we seem never able to buy this absolute requisite) by Japan was stymied by the Games in Tokyo. He should know as he is a professor.

Why Cass mentioned this tale is because thanks to Professor Jayasumana, she increased her life span by ten years, rolling around choking with laughter (bitter though) at the explanation of why the A-Z Vaccine is so delayed.

 

Enough is absolutely enough

Please, whoever the authority is, stop that telephone message that comes in the three languages exhorting us to act with care during this period. I have forgotten the terms used in

Sinhala and English as I don’t listen when the message comes through, but they are synonyms of urgencies, calamities, crises; which last short spells of time, not months and months as the telephone message has been. This is parallel to the Sri Lankan habit of hanging bunting, posting posters but never bothering to remove them.

It is better the government just calls up protesters for meetings (even though it intends doing nothing) so that spreader of the C19 will cease or at least decrease. We stay home – telephoners – so why have we to suffer a double whammy – eternal message and risk contracting C19. We completely disapprove of teachers protesting en masse all over the country for salary hikes. Not done, not done at all during a country’s economic crisis.

Will we ever learn to put the country’s good and people’s wellbeing before our acts of self-seeking and selfishness?

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Organic fertiliser

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Doing the right thing the wrong way

By Jayasri Priyalal

Nurturing nature is the right thing to do when mother nature is struggling to adjust to the manufactured damages taking their toll and challenging the mutual cohabitation of all living beings on earth. Feeding seven billion people with depleted natural resources and a degraded environment is a mammoth task for humanity. During the past ten millennia, homo sapiens have evolved to adjust and move ahead with their advanced cognitive abilities. However, at the beginning of the twenty-first century, there is ample evidence and warning signs to suggest that human beings have crossed the line in harming nature. Maintaining balanced biodiversity is advised by experts to mitigate natural disasters triggered by climate change.

Research in 2020 by the World Economic Forum found that $44 trillion of economic value generation – more than half of the world’s total GDP – was moderately or highly dependent on nature and its services and is therefore exposed to ‘nature loss’, including tropical forests.

This article was prompted by the presentation delivered by Senior Professor Buddhi Marambe, Department of the Crop Science, University of Peradeniya, yesterday (24 July 2021). My special thanks go to the Peradeniya Engineering Faculty Alumni Association [PEFAA] for organising the timely event.

The learned Professor presented his arguments with facts and figures from authentic sources and clarified many myths about synthetic fertiliser and pesticides use in Sri Lanka. All Sri Lankans are truly indebted to all these professionals dedicated to improving our agricultural productivity in a scientifically sound manner, causing minimum impact on biodiversity. Sri Lanka’s ranking in the use of synthetic fertiliser and pesticides, and emergence above our competitors in the region on maintaining food security was an alarming highlight of the lecture.

The discussion heightened the public awareness of the proposed move by President Gotabaya Rajapaksa, to ban the import of synthetic fertiliser and agrochemicals and switch to organic fertiliser. Professor Marambe dealt with points and forewarned the dangers of these short sighted policy directives that appear to have been formulated without sufficient consultations with experts dealing with agriculture, instead relying on ill-advised opinion makers, based on assumptions instead of scientific facts.

Recent developments in the country, mainly various draft bills, attempting to militarise higher education, attempting to dispose of the country’s iconic properties to attract investment, indicate the quality of advisors to the President. Those who teamed up with him as Viyath Maga experts appear to have misled President Rajapaksa.

At the webinar, Prof. Marambe revealed that he and other agricultural experts had been appealing for an audience with the President to explain the dangers of this policy directive, which entails long-term adverse repercussions to an agricultural economy. President Rajapaksa has come out with strong convictions on the benefits of using organic fertiliser and sadly lacks scientific evidence to back the perceived benefits and advantages of the proposed policy directive.

I am making a humble appeal to President Gotabhaya Rajapaksa and his team of advisors to seek expertise from the experts and decide on the policy directives instead of counting on assumptions.

Fareed Zakaria devotes a chapter on why people should listen to experts and experts should listen to people, in his book ‘Ten Lessons for a Post-Pandemic World’. He refers to President Donald Trump being questioned about experts he consults, during the 2016 Republican nomination campaign. Trump responded, “I am speaking with myself, number one because I have an excellent brain; my primary consultant is myself.” His idea to inject a cleaning solution to treat COVID-19 patients could have surfaced through this process of self-consultation. Trump ridiculed the experts in 2016 thus: “Look at the mess we’re in with all these experts that we have.” The rest is history; the mess he created during his tenure as the US President. These are useful lessons for many other political leaders.

 

 

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