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Covid-19 Vaccines:Some ethical dilemmas

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Dr B .J. C. Perera  MBBS(Cey), DCH(Cey), DCH(Eng), MD(Paed), MRCP(UK), FRCP(Edin), FRCP(Lon), FRCPCH(UK), FSLCPaed, FCCP, Hony FRCPCH(UK), Hony. FCGP(SL) 

Specialist Consultant Paediatrician and Honorary Senior Fellow, Postgraduate Institute of Medicine, University of Colombo, Sri Lanka.

There is an unprecedented interest across the globe in the currently available vaccines against SARS-CoV-2 virus that causes COVID-19 disease. There are many factors to consider in this endeavour to vaccinate the general population. The primary considerations are the effectiveness and safety of the vaccines while the costs, the adequacy of the supplies of the vaccines, ethics of selection of priority groups for vaccination, logistics of transportation as well as fair and equitable distribution of vaccines to all corners of the world are also important. This article will discuss some of the pros and cons of a few that are relevant to Sri Lanka.

The effectiveness of the currently licensed vaccines is by now well established. They do very significantly protect us against more severe symptomatic disease and thereby reduce the needs for intensive treatment in hospitals and of course by virtue of that, reduce the associated mortality. This is of major importance as this little blot of a coronavirus has killed over 2.7 million people all over the world and in Sri Lanka it has taken the lives of around 550 people at the time of writing of this article. The initial premise on which the researchers worked on, as stipulated by even the World Health Organisation (WHO), is a committed effort towards reducing more severe disease and mortality. Generally, a vaccine is formulated to prevent anyone catching the disease. However, that was not the initial principle on which the research was targeted.

Yet for all this, now there seems to be some accumulating evidence that the vaccines do play a part in protecting at least some recipients against catching the disease and thereby reducing transmission from humans to humans. In some recipients of the vaccine who contracted the virus, significantly lower viral loads have also been seen. All of these do combine to provide a real bonus and would help a great deal in our fight to defeat the virus. However, it must be stressed that it does not provide universal one hundred percent protection against infection by the virus. Vaccinated individuals should not, I repeat., should not, abandon safe physical distancing, avoidance of gatherings, washing of hands and wearing of masks. If the vaccinated people happen to catch the virus, even if they are asymptomatic, they can still transmit it, at least to some people. So it is very important to follow all health guidelines.

The safety profile of the vaccine was quite stringently looked at during all the clinical trials in humans before these vaccines were licensed for general use. It must be remembered that all types of any vaccine against infective diseases have the risk of developing allergic or sensitivity reactions. Some of the recipients of the vaccine against COVID-19 are also liable to get chills or feeling cold, fever, muscle pains, some abdominal symptoms and fatigue. All of these are quite short-lived, just only for a couple of days. Some more serious side-effects have been noted in the human trials but these were extremely rare and not thought to be of grave significance. The latest problem that was publicised are disturbances in the clotting of blood in vaccine recipients in some Western countries. Clots were detected in deep veins and some detached clots had gone into the blood vessels of the lungs. A lot of fuss was made on this issue, particularly by the media, which even led to temporary suspension of at least one brand of the corona vaccines. However, deep venous thrombosis is a well-known problem in the West and a scrupulous assessment of a cause-and-effect nature, has not been able to establish the vaccine to be directly responsible for these problems. In fact, after firm assurance of the safety of the vaccine being provided by the European Medicines Agency (EMA), many of those countries have restarted their vaccination programme with the incriminated vaccine. It is important also to highlight that even after giving around 800,000 or so vaccinations in Sri Lanka, this problem has not been seen here to a really significant extent, up to now. From an ethical perspective, there is everything to be gained by administering the currently used Oxford-AstraZenica vaccine in Sri Lanka.

The real ethical dilemma in our country is how to organise the administration of the limited supplies of the vaccines to cover the most vulnerable groups of our citizens. The administration of the vaccine to front -line health workers and the forces personnel in the front-line went off quite well, except for a couple of hitches initially in the provision of the vaccine for health personnel in the private sector. After that, for a couple of days, an ill-advised ad hoc decision to vaccinate those between 30 and 59 years caused a profound degree of mayhem and chaos at vaccination centres. At the present time there seems to be some order where the over 60-year-olds are given the vaccine. It took a considerable number of adverse scathing reports in the media and intense pressure brought on by many people, for sanity to prevail. Ethically, it is imperative that the carefully formulated ‘Priority List’ of groups of people for administration of the vaccine is strictly adhered to. Queue-jumpers, thugs and those with connections should be very firmly dealt with.

There are some other ethical aspects to the administration of the vaccine. There are some concerns regarding the second dose of the vaccine. In a previous article (The Island – 17th March 2021), I have explained the rationale for changing the timing of the second dose to three months after the first dose from the earlier recommended time period of one month from the first dose. So far around 800,000 or more first doses have been administered. It is imperative that we give the second dose to this cohort in three months or so from the first dose. The government must, I repeat MUST, ensure that sufficient stocks of the vaccine are kept for this group of people.

There have been some arguments put forward in certain quarters to say that we should use all available stocks to vaccinate as many people as possible with the first dose to provide even short-term immunity to as many people as possible. They make it out to be a human rights issue. This author believes that it is a more compelling question of human rights for ALL those who have already had the first dose to be given the second dose at the appropriate time, to provide them with the best possible and sustained protection. This contention would apply to even those between 30 and 59 years, who were given the first dose of the vaccine during those initial disordered days.

As far as ethics go, in view of the global shortage of vaccines, it is essential that the powers-that-be take steps to even get as many brands of the vaccines with PROVEN EFFICACY AND SAFETY RECORDS into the country. It really does not matter where these vaccines originate from. The only criteria that are of paramount importance are whether the vaccine is effective and whether it is safe.

As at present it is best to give both doses of the same vaccine to each recipient. However, when more scientific information is available, we may be able to mix vaccines if there is evidence that it would work equally well or even better when vaccines are mixed. All over the world, there are several scientific studies in progress to ascertain the usefulness of such a pathway. However, that decision should be a well-informed one, based on robust scientific evidence. It could only be made by the expert scientific medical community. It should not be made on economic, logistical or political grounds by non-medical people and most certainly not, by lay politicians, on their own accord.

The take home message for our people at the present time is that the authorities are trying their very best to provide the vaccines against this coronavirus that is running amok. The prioritised groups who are due to receive the vaccine should be reassured of the effectiveness and safety of this vaccination. Misinformation, especially through the social media, concocting of various stories of doubtful repute and spreading of false rumours, should not be allowed to scuttle the current vaccination procedures. A system of well-organised system of administration of the vaccines will go a long way towards ensuring success in this war against a tiny enemy that has the potential to bring all of us to our knees and make us sink to the lowest depths of despair.



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An air of discontent prevails

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We have had a series of “Avurudhu parties” here in Aotearoa. No shortage of Kavum, Kokis, Athiraha, and even Wali Thalapa. Buffalo curd available locally and of course imported treacle in abundance. Yours truly has assumed the role of a fly on the wall during these festivities and gleaned much information, worth talking about.

First to get on to the Pearl, the talk of the botched-up vaccination plan and running out of the second dose of vaccine. Bizarre permutations as to what would happen if the second dose was not available on time and to who would be press-ganged into getting the “dodgier” types of vaccine from China and Russia, etc. The possible repercussions of getting a second dose of another type of vaccine to the original, the speculations of which left me rather glad that the general populace of Aotearoa has not been vaccinated to date. The talk moved on to the Easter bombings and the recent comments by leaders of the Roman Catholic church as to the possible perpetrators of the attack. Some increasingly obvious conclusions as to those responsible for the planning and funding of same are being reached by those other than some of us who dared to voice our opinions over a year ago! This combined with the increasing and very rapid unpopularity of the person they elected to high office hoping he was genie of the magic lamp type, and the possible reverse of Hong Kong that could take shape on the reclaimed land near the Colombo port, does not bode well for an already dubious future. By reverse of Hong Kong, I mean Hong Kong is trying to hold out as a bastion for democracy, whilst the proposed port city seems to be modeled on the opposite!

Moving on to Aotearoa, the rest of the world seems to be praying for a leader such as our own Jacinda Ardern, but the fat cats of Aotearoa are getting rather sick of her. Those who own multiple houses and have been setting off their interest payments against their taxes due to a loophole in the law that has now been plugged are grumbling. The fact that most young people can’t afford to buy their first houses due to rich people and property developers snapping up all available property, happily funded by banks who are only interested in the bottom line, is of no consequence to them. The fact that this could lead to so much discontent that it could even lead to armed insurrection doesn’t bother them. They seem to have forgotten that we have had almost no deaths and hardly any Covid 19 cases in our community when they say that the lockdowns, we underwent were too excessive and how the economy and business sector has suffered. These very people throng the stadia during the rugby and cricket games and enjoy music concerts with gay abandon. Megacorporations are not happy about the restrictions that are coming on with regard to the use of Liquid Petroleum Gas (LPG) due to environmental concerns. To top it all off I had a lecture from my 13-year-old daughter about how I am being “led by the nose” by Jacinda Ardern and her propaganda! Where she got that from could only be from her elder brothers whose get rich quick schemes have seen a setback due to certain leftist policies coming in from the Labour government that is in power with an absolute majority.

I laugh to myself and think about other examples I have seen of self-proclaimed pundits never being content with their lot. My education was in a very large Government school. As a perfect and a member of some sports teams we handled the administration and some of the governance of this school. Later in life when my children were attending a private school I got involved in the Executive committee of the PTA of that school. The “problems” faced by the private school and the vast dramas that were involved in trying to solve those problems were laughable when compared to those faced by even us, senior students (a much lower level in the administration) of the Government school.

It led me to believe that people always grumble. They are never content with their lot and there is always someone plugging their case and trying to sow the seeds of discontent among the populace. If those living in Aotearoa, in the present situation and well aware of the chaos and mayhem that is prevailing in the rest of the world are dissatisfied, when will anyone be satisfied? Everything is relative and one should try to step outside the confines of one’s own situation and look at the broad picture. In the words of learned barristers, I rest my case!

This week’s missive will not be complete without a tribute to the memory of Prince Phillip, the Duke of Edinburgh. He lived through some of the best and worst times of human existence on this planet and conducted himself impeccably. He showed his humanity and his failings, with a few bloopers down the line but most of those had an undercurrent of humor and couldn’t really be construed as offensive, despite the best efforts of the media and others to make them so. He served as consort to her Majesty the Queen with loyalty and aplomb and he leaves behind an enviable legacy in the world of conservation and youth affairs. It is hoped that his heirs will be up to the task for they face a task which in cricketing terms could be classed as coming into bat after the great Sir Vivian Richards had just scored a century, in his prime. Something very difficult to surpass in skill and entertainment value. Unfortunately, the Duke made just 99. May he rest in peace!

 

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We have much to learn; and emulation is no disgrace

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“Imitation is the sincerest form of flattery that mediocrity can pay to greatness.” said Oscar Wilde who, through sharply ironic wit, often proclaimed the absolute truth.

Cassandra quotes him today as she wants to point out how much we in Sri Lanka can benefit by reaping some ideas from the recent royal funeral in Windsor. And she does not excuse herself for placing stress on our mediocrity as juxtaposed with greatness. Nationalists may shout themselves hoarse and bring down a few more majestic trees by decrying the comparison. They can justifiably claim we have a cultural heritage of two and a half millennia but have we remained cultured, following faithfully and correctly the four great religions of the world? A loud NO from Cass, echoed by millions of others. Though Britain’s development of the English language, culture, arts and science was later than our civilization, they outstripped all countries at one time and are again elevated, while we are poised on bankruptcy, with the begging bowl in hand and thugs and thieves as legislators. We in Sri Lanka are mediocre if not degraded against the greatness shown by the Brits in many spheres. This is no Anglophile speaking but a dame who was born when the Brits were leaving us to govern ourselves and grew up with our statesmen doing a jolly good job of it; Sinhalese, Tamil, Burgher, and a few Muslims taking the lead graciously and effectively with complete honesty, to serve the people. They maintained and improved our country so it was admired by others and even some desiring to imitate Ceylon as Singapore’s Lee Kwan Yew admitted. And where are we now? Except the Rajapaksa family from Medamulana, wearing rose tinted glasses or with eyes shut by arrogance, and their followers and throngs of sycophants, others see our country and our people for what it, and the people, really are. No need to elaborate.

 

The funeral of Prince Philip juxtaposed against customs here

The low-key funeral observing all Covid-19 restrictions was noteworthy for being utterly devoid of bombast and vainglory. It was dignified and moving. Cass wonders how many of her readers watched the funeral on Saturday 17, late evening here. Prince Philip had detailed all arrangements from the Navy being prominent and other Forces joining in plus the substitution of the gun carriage with a jeep he had helped design. The horse carriage he was adept at racing was stationed close by the entrance to the chapel. He has bequeathed it to the daughter of his youngest son and Sophie; the Wessexes having been very close to him and the Queen.

The entire proceedings proved first and foremost that the royal family observed strict pandemic restrictions like mask wearing and physical distancing. There was no one rule for them and another rule for us, thus proving beyond doubt that England (usually), and more so the Royal Family (definitely) are a country and an institution despising double standards. The monarch decreed and abided by the same regulations that have restricted everyone else in the UK, sharing their fate. An anecdote is relevant here. The Queen learned that lesson long ago. She was 14 when her mother said, after Buckingham Palace was bombed in September 1940, that she “could look the East End in the face now.”

Do all our people follow rules common to everyone? Oh! My heavens NO! There are differentiations according to layers in society. Shangri La would host a party for a hundred when only 30 are allowed to gather. During the height of the first wave when restrictions were strict, SLPP electioneering saw hordes thrust together and baby carrying, patting heads and hand clasping mostly by Mahinda Rajapaksha sans a mask. He has a charismatic bond with the masses but that needed to be curbed. Sajith Premadasa’s meetings were strict on physical distancing and mask wearing.

Only 30 were invited to the extremely solemn and yes, beautiful funeral service at Windsor Chapel. This meant eliminating even close relatives of the Family; but it was done. The Queen sat distanced from her daughter and sons and their spouses. Her now diminutive figure seated alone emphasized the loneliness she must be feeling after a close and successful marriage of 73 years.

This brings to mind our First Ladies. Cass steps out bravely to say that Elina Jayewardene was a gracious lady of restraint and dignity, the only perfect consort so far. Cass remembers Hema Premadasa beating her breast (true) and crying over the coffin of her late husband’s remains – in the true sense of the word – at the Prez’s funeral at Independence Square. There is dignity in restraint of even tears over a death in public. Among the women Heads of the country, the mother completely beat the daughter in dignity and ability.

We Sri Lankan women are now much more restrained in our mourning at funerals. Time was when widows even hoarsely wailed their sorrow, coiled and roiled with grief, and begged the dear departed “To look once more; say one word.” Cass in all the expressed grief of such funerals suppressed her laughter with difficulty. How would it be if the corpse obliged?

The choir at the funeral of Prince Philip was just four – one woman and three men. But their singing resounded in the high vaulted, completely majestic, centuries old church. The lone kilted piper within the Chapel evoked much. The service itself was short, just a Reading, prayers and listing of the multitude of honours bestowed on the Duke of Edinburgh, whose medals and decorations were on display beside the alter. The Archbishop of Canterbury, Justin Welby, and the Dean of Windsor, David Conner conducted the service.

To conclude, the Duke of Edinburgh had advised and laid stipulations on a simple funeral with the necessary pomp and pageantry but low key and very unostentatious. The actual funeral was even more low-key with mourners requested not to be on the streets or place flowers. The latter they did in all the residencies of the Royal Family in appreciation of a man who faithfully stood by the Queen and in his own way gave service to the nation.

Coming back to Free Sri Lanka, we seem to stress on that first word Cass inserted to the country name, even in these dire times of no crowds. And the worst is milling crowds are apparently encouraged to boost popularity of certain VVIPs by sycophants and by the preference/orders of the VVIP himself.

Consider the funeral of Minister Thondaman: crowds in Colombo and all VIPs wishing to register their presence before the body, and then the commotion at the actual cremation Up Country. Consider this year’s Sinhala New Year celebrations which were very dignified at the President’s residence but were inclusive of all traditions and a large gathering in the PM’s home, even raban playing by the Second Lady, and milling crowds outside.

 

Roller coaster ride of the country continues

Cass is relieved she had a topic to write on; namely that we should emulate the manner in which the much admired Duke of Edinburgh’s funeral was conducted, abiding by his stricture of it being low key and the country’s Covid restrictions. Our leaders especially must accept the saying I quoted at the beginning.

The country continues its roller coaster bumpy ride with some crying out the country is being sold to the Chinese, we will be a colony of theirs after they occupy the Port City; and others in remote areas sitting down for days on end, some near 100 days, drawing attention to the human elephant conflict. Much is touted about the Bill relating to the rules to govern the Port City.

Cassandra listens to all, and is somewhat warned and frightened, but cannot comment. However, one matter she speaks about loud and clear. The people must be told the status quo of the pandemic – daily numbers catching the infection and numbers dying. This is not for interest sake or ghoulish appetites; but to know how things are so we relax a wee bit or shut in more stringently. The Covid-19 Task Force, or the Health High Ups (not Pavithra please) should tell the country of the true situ of the pandemic as it holds the country in its grip. We want to know whether the grip is tightening or weakening. Please give us daily statistics. This newspaper announces total numbers. No help. Are we expected to jot down figures, subtract, and give ourselves daily infection and death statistics? No! It goes to prove that other matters – political slanted, ego boosting and economics – are more important than warning, containing the pandemic, and saving lives.

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Do you pump Octane 95 Petrol to your car to get better performance?

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If your answer is YES, this article is for you

Dr. Saliya Jayasekara.

Senior Lecturer Department of Mechanical Engineering
University of Moratuwa

Many passenger vehicles, including three-wheelers and motorcycles are fueled by octane 95 gasoline when octane 92 gasoline (petrol) is available at a lower price. 

Otto engine (petrol engine) is an internal combustion spark ignition engine invented by a German engineer Nicolaus Otto in 1876 and used in most of the light weight vehicles including cars, three wheelers and motor bicycles. Otto engines can burn most of the hydrocarbon fuels (including hydrogen and ethanol) that can mix with air by evaporation (low boiling point). But the combustion characteristics of different hydrocarbons are not the same when burned inside an engine. If an Otto engine is designed for a particular fuel, it would not perform similarly with a fuel that has a different chemical composition.

In a well-tuned Otto engine run on gasoline for which the engine is designed, the combustion of the gasoline (petrol) / air mixture will continue smoothly from the spark plug to the piston head by igniting successive layers of the mixture as shown in Figure 1 (a).

If low grade gasolines are used, the combustion of some of the air/ fuel mixture in the cylinder does not result from propagation of the flame front initiated by the spark plug, but one or more pockets of air/fuel mixture explode (Detonate) outside the envelope of the normal combustion front as shown in Figure 1 (b). This detonation can cause severe damage to the piston and the head of the engine while deteriorating thermal performance of the engine (low efficiency)

Gasoline is a petroleum-derived product comprising a mixture of different hydrocarbons ranging from 4 to 12 carbon atoms in a carbon chain with the boiling point ranging of 30–225°C. It is predominantly a mixture of paraffins, naphthenes, aromatics and olefins. Additives and blending agents are added to improve the performance and stability of gasoline. The engine designers learned that straight-chain paraffin have a much higher tendency to detonate than do branched-chain paraffin.

The tendency of a particular gasoline to detonate is expressed by its octane number (ON). Arbitrarily, tri-methyl-pentane, C8H18 (iso-octane) is assigned an ON of 100, while the straight-chain paraffin n-heptane, C7H16 is given an ON of zero. Hence, a fuel sample with the same anti-detonation quality as that of a mixture containing 90% iso-octane and 10% n-heptane is said to have an ON of 90. Gasoline is made up of a mixture of mostly branched-chain paraffin with suitable additives to give an ON in the range 90 –100. It was also learned through experiments that the ON of a gasoline blends (e.g. gasoline and ethanol) can be calculated by using weighted average ON of each compound. Most importantly, the octane number has nothing to do with the heating value (Calorific value) or the purity of the fuel.

Engine thermodynamics show that engines with a high compression ratio offer higher thermal performance than engines with a low compression ratio. These engines having high compression ratio require high octane gasoline (for example octane 95) to avoid detonation. However, using gasoline having higher octane ratings for the engines designed for a low octane rating (for example, 92 octane) would not provide an additional benefit or loss, other than increased fuel cost.

Therefore, it is important to know the designed octane number of the engine before fueling (refer owner’s manual of the vehicle). For example: the minimum ON requirement for two and three wheelers in south Asia is 87 (The World Bank). Most of the Toyota, Honda and Nissan models including hybrid engines recommend 92 octane gasoline.

Dr. Saliya Jayasekara received the B. Sc. degree in mechanical engineering from university of Moratuwa in 2001, and the M.Sc. and PhD degrees in decentralized power generation systems from Royal institute of technology Sweden and the Melbourne University Australia in 2004 and 2013 respectively. He has well over 13 years of national and international experience in design and installation of centralised/decentralised power plants, boilers (utility/package) and heat exchangers. Currently he is serving as a senior lecture at University of Moratuwa, a visiting lecturer and fellow at Deakin University Australia.

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