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Public health officials smother SARS-Cov-2 epidemic

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By A. Bystander

Public health officials have done it again: they have smothered the severe acute respiratory syndrome coronavirus 2 before it took more lives and disabled even more economic activity. This is not the first time that they have got the better of deadly and disabling pathogens. Perhaps the closest parallel is their campaign against malaria, which rampaged over most of Sri Lanka during the 1930s and early the first part of the 1940s. Then there was no WHO or OXFAM. It was then, as now, an achievement of local public health officials: PHIs, nurses, lab technician, ambulance drivers and of course the physicians. Who would dare assess the contribution each group against that of another? It is true that the anti-malaria campaign gained a powerful weapon, when DDT spraying was introduced in the 1940s. Its use was strictly limited later because of its disastrous ill effects on the environment. Not enough has been written about this heroic story. There is some account in Dr. S.A.Meegama’s recent book as there was in Dr. N. K. Sarkar’s Ph.D. thesis. I have not read Dr.Uragoda’s writings; it is most likely that he dwelt on this subject as I recall him holding forth on it. Dr.W.G.Wickremasinghe, the first Ceylonese Director of Medical And Sanitary Services (DM&SS, as was then called) wrote a booklet, an autobiography of sorts, privately distributed (I have lost my copy.), in which he described the work he did with PHIs when he was MOH of the Kalutara district. They went from house to house destroying breeding places for mosquitoes and advising people about ways of avoiding the spread of malaria. It is this remarkable dedication of public health officials and the better distribution of food, irrespective of purchasing power in the hands of consumers coupled with a better distribution of rural hospitals, that helped Ceylon to stand out in the health conditions of its people as the war (1939-45) ended. The rising standards of living and literacy, especially of women, all contributed in their own time.

Infant mortality rates dropped sharply as the malaria epidemic abated. Maternal mortality rates fell similarly with the opening of rural hospitals. Consequently, the average expectation of life at birth shot up. Sustaining all these successes was better nutrition, assured by government schemes to distribute essential commodities evenly among all people under a ration scheme and subsided prices. Japan had invaded South East Asia and the Japanese warships were present on the high seas. We were a British colony and Britain had a deep commitment to Ceylon as Singapore fell to the Japanese. It was important that they had a peaceful country from which they could operate. The people had to be kept reasonably satisfied. But food supplies became scarce. They introduced a scheme of rationing essential food supplies and fuel supplies. The colonial government appointed highly competent civilian as the Competent Authority who oversaw all this work. To do so the government introduced a rationing scheme, which ensured the supply to irrespective of high purchasing power. Each adult was entitled to a kilogram of rice, 2 kilos in the event he did hard labour, some flour, some sugar and some kerosene oil. It is this assured supply that built healthier children in those years who grew up to go to school and university and reasonably long life. (I am one of them.). In England and Wales, the lowest infant mortality rates were registered 1911-1921 because of food rationing during those years of horrible war.

In a paper that Amartya Sen wrote in 1981 in the Bulletin of the Oxford Institute Economics and Statistics he identified five poor countries which stood out on a scatter map relating GDP per capita and infant mortality rates (or average expectation of life at birth). Cota Rica, Cuba, Korea, Sri Lanka and Vietnam, though poor sported rates of infant mortality matching those of OECD countries. The secret of success lay in the fairly even distribution of food and outstanding public health policies. Costa Rica had no army and the money wasted on starched uniforms, polished brass and jack boots went into primary education and public health. Cuba under Fidel Castro spent heavily on primary education and public health. Their public health officers still work in many parts of Africa. I have mentioned some of the policies in colonial Ceylon. The free education scheme launched by Kannanangara and teaching in indigenous languages introduced by Jayawardena and Nalliah supplemented that to make the younger population more literate. There was a pronounced emphasis on primary health care in contrast to curative care of more complex sicknesses. Graduates in medicine and surgery that came out of the new faculty of medicine carried with them not only sophisticated understanding sicknesses but also an admirable commitment to common people. Professional who come here from neighbouring countries to participate in conferences in education and health express wonderment that teachers in government schools regularly teach in schools and that doctors regularly come to work in rural hospitals. It is that commitment of well trained and skilled men (and now women) that helped to hold back the epidemic, thus preventing the curative branch from being overwhelmed by the simultaneous large inflows of sick people. Of the 2,900 or so infected, some 900 were sailors from the Navy who were young and in robust health and the risk of them falling acutely ill was very small. As we do not know the age structure of those others who fell ill, one cannot assess the probability of their proceeding to being acutely need requiring breathing help. I am sure that in time an epidemiologist will look at the figures analytically.

Of course, one must not forget that the bhikkhu sangha recited the ratana sutta interminably to keep off the epidemic as had been done in Vaishali in the time of the Buddha.

 



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Opinion

Jeffrey: Cartoonist par excellence 

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If there exists a print media personality who does not receive the due recognition and appreciation he rightfully deserves, it undoubtedly is ‘Jeffrey’ of The Island newspaper. The works of many a journalist have been frequently highlighted and appreciated but the capabilities and efficiency of personnel of the calibre of ‘Jeffrey ‘ are, more or less, taken for granted.

In every sphere of life, professional or occupational, there are people who function, not necessarily from behind the scenes, but nevertheless perform an equally efficient service, which in all probability goes unnoticed.

To be frank, even before reading the headlines of the Newspaper, as is customary now, my eyes seek for the Cartoon of the day. Indeed, a sight for sore eyes each morning, the lovable ‘Jeffrey’ makes my day.

Suffice to say that a ‘Good Job done man’ type of occasional pat on the back, to a person who puts his very soul into his work, would touch the only place where it matters the most – his heart. If a smile could work wonders, then how much further would a word of appreciation go.

‘Jeffrey ‘ has, time and again through his  cartoons, aptly proven his innovative and creative skills to present factual depiction of current affairs, both local and global. His drawing pen effortlessly covers all boundaries, irrespective of whatever nature. On a previous occasion, too, I have openly commended his abilities, finding it difficult to fathom how he could convey pertinent incidents, normally requiring hundreds of words to express, with a single drawing.

To all intents and purposes, ‘Jeffrey ‘ ranks much higher and could be considered as a rare find when compared with the numerous others actively engaged in this particular field of professionalism.

In ‘Jeffrey ‘, The Island newspaper indeed has a Cartoonist par excellence!

Jeffrey, more power to your elbow!

WILLIAM PHILLIPSZ 

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Opinion

Anti-aging injection shows promise in re-growing knee cartilage

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Scientists at Stanford Medicine have reported a discovery that could change how arthritis and joint damage are treated. In experiments on animals and human tissue, researchers found that blocking a protein linked to aging can restore worn cartilage in the knee and prevent arthritis after injury. The treatment works not by adding stem cells, but by reprogramming existing cartilage cells to behave in a more youthful way.

In aging mice, an injectable drug rebuilt knee cartilage that normally thins with age. In mice with knee injuries similar to anterior cruciate ligament tears, the same treatment prevented the onset of arthritis, a condition that often follows such injuries in humans. A pill form of the drug is already being tested in early clinical trials for age-related muscle weakness, raising hopes that a similar approach could one day be used for joints.

Human knee cartilage removed during joint replacement surgery also responded to the treatment. When exposed to the drug in the laboratory, the tissue began forming new cartilage that resembled healthy, functional joint cartilage. These findings suggest that cartilage lost to aging or arthritis might eventually be restored through injections into the joint or even oral medication, potentially reducing the need for knee and hip replacements.

Osteoarthritis affects about one in five adults in the United States and costs tens of billions of dollars annually in direct health care spending. Despite its prevalence, there is no drug that can stop or reverse the disease. Current treatment focuses on pain relief, physical therapy and, in advanced cases, joint replacement surgery.

The new therapy targets a protein known as 15-PGDH, which increases in the body with age. The research team classifies it as a gerozyme, a type of enzyme that contributes to the gradual decline of tissue function over time. Previous work from the same group showed that rising levels of 15-PGDH weaken muscles with age. Blocking the protein restored muscle strength and endurance in older mice, while forcing young mice to produce it caused muscle loss.

Unlike muscle, bone or blood, cartilage does not rely on stem cells to repair itself. Instead, cartilage cells called chondrocytes can change their gene activity. By inhibiting 15-PGDH, researchers found that these cells reverted to a more youthful state and began producing healthy cartilage again.

“This is a new way of regenerating adult tissue, and it has significant clinical promise for treating arthritis due to aging or injury,” said Helen Blau, professor of microbiology and immunology at Stanford and a senior author of the study.

There are three main types of cartilage in the body. Elastic cartilage forms flexible structures like the outer ear. Fibrocartilage is tough and shock absorbing, found between spinal vertebrae. Hyaline cartilage, also called articular cartilage, is smooth and glossy and allows joints such as the knees, hips and shoulders to move with minimal friction. Osteoarthritis mainly affects this last type.

The disease develops when joints are stressed by aging, injury or excess weight. Chondrocytes begin releasing inflammatory molecules and breaking down collagen, the main structural protein of cartilage. As collagen is lost, cartilage thins and softens, leading to pain, swelling and stiffness. Articular cartilage rarely regenerates on its own, and attempts to find stem cells capable of rebuilding it have largely failed.

In the new study, researchers compared knee cartilage from young and old mice and found that levels of 15-PGDH roughly doubled with age. When older mice were treated with a drug that blocks the protein, either throughout the body or directly in the joint, their knee cartilage thickened and regained function. Importantly, the new tissue was true hyaline cartilage rather than weaker fibrocartilage.

The results were equally striking in injured joints. In mice with ligament injuries, repeated injections over four weeks sharply reduced the likelihood of developing arthritis. Untreated animals showed high levels of 15-PGDH and developed arthritis within weeks. Treated animals moved more normally and placed more weight on the injured limb.

Detailed analysis showed that the treatment shifted the balance of cartilage cells. Cells associated with inflammation and cartilage breakdown became less common, while cells responsible for producing healthy joint cartilage increased markedly. This change occurred without the involvement of stem cells.

When human osteoarthritic cartilage was treated in the laboratory for one week, similar changes were observed. Levels of harmful gene activity fell, and signs of cartilage regeneration appeared.

The findings are encouraging but still early. While safety trials of a 15-PGDH inhibitor for muscle weakness have shown promising results, clinical trials focused on cartilage regeneration have yet to begin. Even so, researchers are optimistic.

“Imagine regrowing existing cartilage and avoiding joint replacement,” Blau said. For millions living with joint pain and stiffness, that possibility now seems closer than ever.

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Opinion

Why is transparency underfunded?

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The RTI Commission has now confirmed what many suspected — although the RTI Act grants it independence to recruit staff, this authority is rendered toothless because the Treasury controls the purse strings. The Commission is left operating with inadequate manpower, limiting its institutional growth even as it struggles to meet rising public demand for information.

 This raises an uncomfortable question: if the Treasury can repeatedly allocate billions to loss-making State-Owned Enterprises — some of which continue to hemorrhage public funds without reform — why is adequate funding for the RTI Commission treated as optional?

 Strengthening transparency is not a luxury. It is the foundation of good governance. Every rupee spent on effective oversight helps prevent many more rupees being wasted through inefficiency, misuse, or opaque decision-making.

 In such a context, can one really fault those who argue that restricting the Commission’s resources conveniently limits disclosures that may prove politically inconvenient? Whether deliberate or not, the outcome is the same: weaker accountability, reduced public scrutiny, and a system where opacity is easier than openness.

 If the government is serious about reform, it must start by funding the institutions that keep it honest. Investing in RTI is not an expense — it is a safeguard for the public purse and the public trust.

A Concerned Citizen – Moratuwa

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