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.
Antics of State Minister and Pohottu Mayor; mum on chemical fertiliser mistake; The Ganga – a link
Reams have been written in all local newspapers; much comment has traversed social media and persons have been bold to call for justice on two absolutely unrestrained and yes, evil, SLPP VIPs who have recently been dancing the devil as the saying goes. These evil doers seem to be pathologically unable to control themselves and behave as human beings: heads outsised with hubris and apparently bodies often pickled with liquor.
Very succinct comments have been made on Lohan Ratwatte, one being: “a leopard never changes his spots” referring to the many crimes supposed to have been committed by him, and the other that he is a gem of a man who may make a jewellery heist soon enough. He has the audacity to say he did nothing wrong in barging into two prisons; in one to show off to pals the gallows and in the other, to brandish a gun and place it against the heads of two shivering Tamil prisoners. All done within the week when world attention was focused on Sri Lankan human rights violations directed by the UNHRC
Cass’ comment is that Lohan Rat was committing hara-kiri (minus even a trace of the Japanese spirit of self sacrifice) and taking the entire country on a suicidal mission through his inability to hold his drinks and destructive hubris and murderous inclination. Cass particularly favoured Don Mano’s summation in his comment on the unlawful prison intrusions in the Sunday Times of September 19. “Any semblance of a shabby cover-up to enable Lohan Ratwatte to retain his position as State Minister of Gems and Jewellery will not only endanger the economy by depriving the nation’s dollar bare coffers of a GSP benefit of nearly 2.7 billion dollars, but will risk putting 21 million Lankans from the frying pan into the fire and test their tolerance to the core.”
The visit to the Welikada prison by the State Minister of Prison Reform and … was said to be with some men and one woman. Identities were kept under wraps and confusion raised by making the dame a beauty queen or cosmetician. But who she was, was soon known along the vine of gossip. One report said the person in charge of the prison or its section with the gallows, cautioned Lohan Rat and tried to dissuade his advance with friends in tow since the lady companion was in shorts and them walking through where prisoners were, would cause a commotion. But no, the State Minister advanced to show off the gallows with his short-shorts wearing woman companion and imbibing mates.
Cass is actually more censorious of this woman than even of the State Minister himself. Is she a Sri Lankan, so vagrant in her woman-ness? Doesn’t she have even an iota of the traditional lajja baya that decent women exhibit, even to minor level nowadays? Is associating with a State Minister and his drinking pals such a prized social event? Shame on her! She, if people’s assumption of identity is correct, has boasted political clout and been elevated by it too. Such our young girls! Do hope they are very few in number, though this seems to be a baseless hope as social events unroll.
Pistol packing – correction please – toy pistol packing Eraj Fernando is aiding the ex State Minister of Prison Reform to deface, debase and deteriorate Sri Lanka in the eyes of the world. He is interested in land and not in gallows or scantily clad gals. With thugs in tow he trespassed a property in Bamba and assaulted two security guards. Repetition of an incident he was embroiled in – a land dispute in Nugegoda a couple of weeks ago. He was taken in by the police and before you could say Raj, he was granted bail. What quick work of police and courts.
As the editor of The Island opined in the lead article of September 20: “The Rajapaksas have created quite a few monsters who enjoy unbridled freedom to violate the law of the land.” A convicted murderer known for his thug ways was presidentially pardoned a short while ago.
The good thing is that people talk, write, lampoon, and draw attention to these heinous crimes and do not seem scared for their necks and families. White vans have not started their rounds. And very importantly the memories of Ordinaries are not as fickle as they were. Wait and see is their immediate response.
New fad – jogging lanes on wewa bunds!
Some monks and men gathered recently on the partly torn up bund of Parakrama Samudraya and had the foolish audacity to say the bund needed a jogging lane. Tosh and balderdash! Then news revealed that other wewas too were being ‘attacked and desecrated’ to construct jogging lanes. In such remote rural areas which even tourists do not visit? Is there illicit money-making in this activity? Otherwise, no explanation is available for this sudden interest in farmers’ and toilers’ physical well being. They get enough exercise just engaging in their agriculture, so for whom are these jogging lanes?
Sharply contrasting persons
As apposite to the former two, are superb Sri Lankans up front and active and giving of their expertise, albeit unobtrusively. Consider the medical men and women and their service to contain the pandemic; farmers who protest to ensure harvests are not damaged too severely by false prophets who won the day for the banning of chemical fertilisers, pesticides and weedicides. The latest blow and justification of what so very many agriculturists, agrochemists, have been saying all along – organic is good but to be introduced very slowly; without importing compost from overseas, is the Chinese import containing evil microorganisms. Experts have categorically stated that chemical fertilisers are sorely needed for all agriculture; more so paddy and tea; and if used prudently cause no illness to humans or injurious side effects.
The four experts who comprised the panel at the MTV I Face the Nation discussion monitored by Shameer Rasooldeen on Monday September 20, agreed totally on these two facts and went on to say that it must be admitted a hasty decision was taken to stop import of chemical fertilizers. We listened to the considered wise opinions backed by true expertise of vibrantly attractive and articulate Dr Warshi Dandeniya – soil scientist, of Prof Saman Seneweera from the University of Melbourne, Prof Buddhi Marambe – crop scientist, and Dr Roshan Rajadurai – media person of the Planters Association. Listening to them, Cass swelled with pride and told herself see what sincerely-interested-in-the-country’s welfare eminent scientists we have in this land of rowdy politicians and uneducated MPs. They labeled the sudden banning of chemical fertilisers and insecticides and pesticides as “very dangerous and causing irreversible harm. It is not too late to reverse the decision, even if admitting fault is not possible.”
Oh dear! The stench! Never ending series of scams; executed or approved by politicians and all for illicit gains. Even the tragedy of the pandemic and suffering of much of the population does not seem to have curbed selfish lust for money.
Focus on the Mahaweli Ganga
Interesting and deserving of thanks. Chanaka Wickramasuriya wrote two excellent articles in the Sunday Islands of September 12 and 19 on the Mahaweli Ganga, imparting invaluable facts of the present river and its history, as for example which king built which wewa or anicut. He ended his second article by hoping the waters of the great river will feed the north of the island too: “Maybe then this island will be finally uplifted. Not just from north to south, but across class and caste, language and philosophy, and political partisanship. Hopefully driven by a newfound sanity among its denizens, yet symbolically attested to by the waters of the Mahaweli.”
These humans are Crazy!
Those of us who grew up reading the “Asterix” comics by Goscinny and Uderzo will no doubt remember the resonant words of Obelix, the menhir delivery man. So many times, he has observed the actions of characters ranging from Roman Emperors to Goths and made the statement “these humans are crazy” often accompanied by a few taps from his forefinger to his ample brow. These words remain a universal truth and valid even today when looking at what is going on around us.
Let’s start in Aotearoa – New Zealand with the continuing saga of the young man of Sri Lankan origin who went berserk in a supermarket and stabbed so many innocent people. Despite many assurances from the government and almost all the Kiwi friends and even acquaintances we have in this country that we Lankans are not responsible, we feel deep down inside us that we are in some way, shape or form, responsible for this person’s behaviour. Articles not only from people of my (archaic) generation but young upstanding millennials and those even younger have expressed this emotion in their own characteristic fashion. Also, we feel responsible that our network of ex citizens of the Pearl living in Aotearoa have been unable to offer any support or counselling to this person or others of his ilk.
Just as we start clawing our way out of this mire of guilt somewhat reduced by finding out just how greatly the immigration and refugee systems of New Zealand have been duped, we are now told how a currency smuggler has been granted refugee status. Now currency smuggling happens all the time, mainly due to the punitive profits taken from customers by those licenced daylight robbers the banks, but more on that later. Apparently, a currency smuggler who arrived on a forged passport, evading arrest by the authorities in the Pearl has been granted refugee status! REFUGEE seems to be the magic word as far as the NZ authorities go. Those of us who have gone through the legal immigration channels and filled reams of forms and waited years for replies are left gasping at how those worthies in the government departments of Aotearoa have one set of rules and standards for us and another completely if one puts the word REFUGEE on one’s documents.
We move on to the pearl, if I were to attempt to apologise for the “offensive actions” of members of my family (bearing my “sir” name and direct relatives) that would take up a series of tomes resembling the encyclopaedia Britannica! It may also feature my name in a few volumes as well! The current antics of a kinsman with regard to using his position and power calls for a level of responsibility, on my part. The only caveat being a request to the fourth estate to use the person’s first name. Frequent displays of a family name which some have treasured and tried to bring enhancement to, associated with behaviour of this kind, brings dismay at a level that can only be understood by those who have tried to live up to the standards set by ancestors who held high office with honour in the past. There have been many articles some ranging from biting sarcasm (unfortunately not understood by the majority) to others simply parroting what they have read on the internet. The bottom line is standby O denizens of the Pearl, this maybe just another episode in the teledrama that is Lanka under Paksa rule! There are possibilities of scripting to distract the majority and even a wider spectrum involving human rights issues in Geneva. Also, scrutinize yourselves and remember that “those who live in glass houses should not throw stones” and “let he who is without sin cast the first stone”?!
In Aotearoa, we call our Prime Minister by her first name and a PM that has gained the utmost respect of the people not to mention the world! Isn’t it time the Pearl followed suit? Of course, comments by the leader of the opposition like “Opposition Leader Premadasa said he vehemently condemned the disgraceful and illegal behaviour” reiterates the comments of Obelix. Especially when allegations and witnesses exist to “disgraceful and Illegal” behaviour by the person who uttered those very words. It may have been in a different context and “only” to do with the decimation of a national park in the Pearl but the behaviour had the same connotations. Looks like social media is the mitigating factor, as in those days, too, the fourth estate had to take care of continuing to exist and survive! Being the first party to spotlight such actions usually led to the “death of the messenger”.
As promised, back to the licenced daylight robbers of today, the banks. There is a “Robin Hood” tax in effect in some of the leading economies of Europe. The most “interesting” aspect for me being taxes on the profits of banks. The billions it could raise every year could give a vital boost to tackling poverty and climate change around the world and definitely in the Pearl. We call upon the “genius” in charge of the Central Bank as he is the “acknowledged” financial maestro of the Pearl (although he is never going to take RESPONSIBILITY for our plight) to look at this aspect if he has the cohunes to do it! But then again levels of corruption and obligations to high profit-making organisations that fund election campaigns, have to be taken into account in countries such as the Pearl.
Powerful efficient and successful economies like Germany and modern Demi-Gods like Bill Gates endorse this tax. Here is an idea for the government of the Pearl. Tax the banks on their huge profits and give some of that money back to the people without burdening an already insufferably burdened people! I fear ideas expressed in this column will meet their usual end either in the oblivion chaos and mayhem or the lack of mental fortitude that exists in the Pearl and her officials.However, one can only hope that people who wish the Pearl renewed status in the Indian Ocean region if not the world, continue to survive in these circumstances, as the village of indomitable Gauls in the face of the mighty Roman empire. We need an “Asterix” brave and quick-thinking warrior, armed with some magic portion from “Getafix” the druid. Instead, we seem to have plenty of pseudo “Getafix’s” concocting “dammika Pani” and such portions and far too many “Vitalstastix’s”- muddle-headed incompetent chiefs!
Policy quandaries set to rise for South in the wake of AUKUS
From the viewpoint of the global South, the recent coming into being of the tripartite security pact among the US, the UK and Australia or AUKUS, renders important the concept of VUCA; volatility, uncertainty, complexity and ambiguity. VUCA has its origins in the disciplines of Marketing and Business Studies, but it could best describe the current state of international politics from particularly the perspective of the middle income, lower middle income and poor countries of the world or the South.
With the implementation of the pact, Australia will be qualifying to join the select band of nuclear submarine-powered states, comprising the US, China, Russia, the UK, France and India. Essentially, the pact envisages the lending of their expertise and material assistance by the US and the UK to Australia for the development by the latter of nuclear-powered submarines.
While, officially, the pact has as one of its main aims the promotion of a ‘rules- based Indo-Pacific region’, it is no secret that the main thrust of the accord is to blunt and defuse the military presence and strength of China in the region concerned. In other words, the pact would be paving the way for an intensification of military tensions in the Asia-Pacific between the West and China.
The world ought to have prepared for a stepping-up of US efforts to bolster its presence in the Asia-Pacific when a couple of weeks ago US Vice President Kamala Harris made a wide-ranging tour of US allies in the ASEAN region. Coming in the wake of the complete US troop withdrawal from Afghanistan, the tour was essentially aimed at assuring US allies in the region of the US’s continued support for them, militarily and otherwise. Such assurances were necessitated by the general perception that following the US troop withdrawal from Afghanistan, China would be stepping in to fill the power vacuum in the country with the support of Pakistan.
From the West’s viewpoint, making Australia nuclear-capable is the thing to do against the backdrop of China being seen by a considerable number of Asia-Pacific states as being increasingly militarily assertive in the South China Sea and adjacent regions in particular. As is known, China is contending with a number of ASEAN region states over some resource rich islands in the sea area in question. These disputed territories could prove to be military flash points in the future. It only stands to reason for the West that its military strength and influence in the Asia-Pacific should be bolstered by developing a strong nuclear capability in English-speaking Australia.
As is known, Australia’s decision to enter into a pact with the US and the UK in its nuclear submarine building project has offended France in view of the fact that it amounts to a violation of an agreement entered into by Australia with France in 2016 that provides for the latter selling diesel-powered submarines manufactured by it to Australia. This decision by Australia which is seen as a ‘stab in the back’ by France has not only brought the latter’s relations with Australia to breaking point but also triggered some tensions in the EU’s ties with the US and the UK.
It should not come as a surprise if the EU opts from now on to increasingly beef-up its military presence in the ‘Indo-Pacific’ with the accent on it following a completely independent security policy trajectory, with little or no reference to Western concerns in this connection.
However, it is the economically vulnerable countries of the South that could face the biggest foreign policy quandaries against the backdrop of these developments. These dilemmas are bound to be accentuated by the fact that very many countries of the South are dependent on China’s financial and material assistance. A Non-aligned policy is likely to be strongly favoured by the majority of Southern countries in this situation but to what extent this policy could be sustained in view of their considerable dependence on China emerges as a prime foreign policy issue.
On the other hand, the majority of Southern countries cannot afford to be seen by the West as being out of step with what is seen as their vital interests. This applies in particular to matters of a security nature. Sri Lanka is in the grips of a policy crunch of this kind at present. Sri Lanka’s dependence on China is high in a number of areas but it cannot afford to be seen by the West as gravitating excessively towards China.
Besides, Sri Lanka and other small states of the northern Indian Ocean need to align themselves cordially with India, considering the latter’s dominance in the South and South West Asian regions from the economic and military points of view in particular. Given this background, tilting disproportionately towards China could be most unwise. In the mentioned regions in particular small Southern states will be compelled to maintain, if they could, an equidistance between India and China.
The AUKUS pact could be expected to aggravate these foreign policy questions for the smaller states of the South. The cleavages in international politics brought about by the pact would compel smaller states to fall in line with the West or risk being seen by the latter as pro-China and this could by no means be a happy state to be in.
The economic crisis brought about by the current pandemic could only make matters worse for the South. For example, as pointed out by the UN, there could be an increase in the number of extremely poor people by around 120 million globally amid the pandemic. Besides, as pointed out by the World Bank, “South Asia in particular is more exposed to the risk of ‘hidden debt ‘from state-owned Commercial Banks (SOCBs), state-owned enterprises (SOEs) and public-private partnerships (PPPs) because of its greater reliance on them compared to other regions.” Needless to say, such economic ills could compel small, struggling states to veer away from foreign policy stances that are in line with Non-alignment.
Accordingly, it is a world characterized by VUCA that would be confronting most Southern states. It is a world beyond their control but a coming together of Southern states on the lines of increasing South-South cooperation could be of some help.
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