Features
A science-based strategy to control the current covid-19 situation
by Malik Peiris
Chair/Professor of Virology, School of Public Health, University of Hong Kong, Faculty of Medicine, Hong Kong and
Kamini Mendis
Professor Emeritus, University of Colombo, Public Health and Malaria Expert formerly at the World Health Organisation.
I. The current covid-19 situation in the country
There is a high intensity of transmission of covid-19 in the country just now. Although it became apparent with cases increasing in the last week of April, the increase in transmission began about 4 weeks before that. The incubation period of the virus (3-14 days) together with testing / reporting delays mean that the cases detected and reported now were the result of transmission that took place 1-2 weeks ago. Since deaths follow with a lag period of a further two weeks, the deaths occurring now were the result or transmission that took place around one month ago. The mortality impact of the increase in cases is only just starting to be felt now.
The B.1.1.7 variant of the virus spreading now is more transmissible, and possibly more virulent, than in previous “waves”. An even more concerning variant B.1.617 (first detected in India) has also been detected in Sri Lanka and it remains to be seen how widespread it will become. WHO has designated it a “variant of concern,” it is now spreading in the UK and is the cause of some of the recent case clusters in Singapore.
There was an exponential increase of cases from mid-April to date. Although case numbers appear to plateau in recent days, it is likely that this is a result of limitation in testing capacity. Testing numbers have remained flat, in spite of high positive rates (exceeding 10% in most laboratories), raising concerns of whether the epi-curve we now see reflects reality. ICU admissions and deaths continue to increase, as will be inevitable, from infections that have already occurred.
As a result, the capacity of the health system to manage covid-19 patients has already been exceeded, the inevitable consequences being more avoidable deaths. With increasing cases, even the implementation of the public health measures that were being implemented– i.e. testing, isolating, contact tracing and quarantining, have exceeded the capacity of the health sector. In addition, health staff in the curative and preventive sectors is becoming victims of covid-19 themselves, which makes the situation grave.
The vaccination programme, currently getting under way within the constraints of limited vaccine supply, even if targeted to those at highest risk of death, i.e. the elderly and those with co-morbidities (a policy that has NOT been consistently followed in Sri Lanka so far), will take many months to translate into an impact on mortality. Vaccines, which require two doses at least a month apart, take optimal effect >2 weeks after the second vaccine dose. As of now, only 1% of the population have received both doses of vaccine and 6% received at least one dose, that too, mainly in one province of the country. Even under the most optimistic scenarios, it will be over 6 months before most of the high-risk population receives protection from vaccine across the country.
The only available option in the short-medium term to arrest this impending catastrophe is to significantly curtail transmission through social and public health interventions.
Although a few public health interventions have been implemented in the past week, we explain below why these recent measures of small-area isolations, prohibiting inter-provincial travel, intermittent and short period lockdowns, as the one during 14 – 17 May, together with mild restrictions on human movement such as those based on identity card numbers, will not arrest this wave of the epidemic.
We explain why a nation-wide lockdown of at least 14 days (defined below) is absolutely necessary, if increasing ICU admissions and deaths from this wave are to be contained. We also comment on the likely economic impact of these different approaches.
II. Why small-area isolation, preventing inter-provincial travel, short and intermittent lockdowns and mild restraints on human movement will not work
1. The testing is not sufficient to make small area isolation have an impact.
Small area lockdowns are based on obtaining information of a cluster(s) of cases from a particular location. The detection of these clusters are based on testing a population in an area in response to detecting a few cases from that location – i.e. reactive case detection rather than proactive surveillance. Thus, by the time the cluster has been detected, multiple weeks have lapsed since the initiation of each cluster and therefore the people in that cluster would have already spread the virus through their movement, to many other areas, adjacent and distant. In other words, isolating that small area will not have much effect on the spread of the virus to other areas, because it has already happened. If small-area isolation is to work, then an extensive amount of active surveillance and testing in the population (as opposed to being based on contact tracing) is necessary, but this is currently not feasible given the laboratory system being already overloaded. Initiating these small-area lockdowns are sucking up a huge lab testing capacity at the moment, which will be more productively deployed elsewhere.
2. Since all provinces have ongoing high transmission already, stopping travel between provinces will have little effect.
By the end of April, all provinces had ongoing high transmission of the virus and therefore stopping inter-Provincial travel will be of no avail at this stage. It may have had a role in early or mid-April, soon after the B.1.1.7 variant was detected in the Western Province. But not any more, with the virus entrenched in every province.
3. Countrywide lockdowns of 3 days will not block even a single cycle of virus transmission or cover the period of infectiousness of an individual.
Intermittent countrywide lockdowns (such as the one from 14 – 17 may or the proposed one from 21 – 25 May) will only have effect during those three days. Three days is far shorter than the incubation period of the virus, i.e. from infection to manifestation of illness and transmission, which is around 5 days (range 3- 14 days). It is even shorter that the infectious period of one infected individual, which is around 8 days. For example, if an infected individual begins to be infectious on day one of a 3-day lock down, he/she will remain infectious at the end of the lockdown, at which time the person will be again moving in the community. In order to even partially interrupt transmission, one needs to cover at least two cycles of transmission, i.e. 10-14 days of intervention. That will allow an exponentially higher probability of chains of transmission being interrupted. Therefore, the minimum period of lockdown should be countrywide and at least 2 weeks in duration. The impact of 5 successive intermittent lockdowns of 3 days each (i. e. 15 days in aggregate) will therefore, be much less than that of one continuous 14 day period of lockdown. Furthermore, the former strategy will be spread out over a much longer period, when we do not have the luxury of time any more.
4. Partial restriction of human movement using ID card digits will not have much impact on virus transmission.
Limiting the movement of people and crowd-gathering through means such as restricting them to alternate days based on identity card numbers is not sufficient to prevent the congregation of people because up to half the population could be out of home at any given time. This is not sufficient for transmission is to be halted.
5. Standard preventive measures are not having optimal impact because of overcrowded living conditions
Even the strict enforcement of social distancing and mask wearing will not have its optimal impact because they are not ideally implementable under overcrowded living conditions in urban areas.
6. People working in enclosed environments e.g., office spaces will enhance virus transmission
Offices such as banks, and industrial working places such as garment factories require people to be in enclosed and confined spaces with insufficient ventilation for the entire working day. These are extremely and highly conducive to the spread of the virus.
Thus, these recent measures have impeded economic activity and sucked up huge resources and effort from the security forces for a marginal public health gain, at best. Moreover, repeated, intermittent short-duration restrictions also carry significant economic costs. The uncertainty associated with the introduction of these measures/future measures create an unstable environment for most economic activities. Most daily wage earners are not given work by employers because they travel daily from unknown risk situations at home. Most industries and offices are working within a context of uncertainty and are unable to plan even for the medium-term. This is not conducive to economic growth.
A rational, determined and convincing strategy is needed, both to get control of an impending public health disaster and also to restore economic confidence.
III. A countrywide lockdown for at least 14 continuous days is immediately necessary for the following reasons:
1. Only a degree of restriction of human movement enabled by a total countrywide lockdown of 14 days will lead to interrupting at least one (preferably two) cycles of virus transmission in the community. Such an intervention would give an opportunity for the health sector, currently at or beyond breaking point, to catch its collective breath, to face the future. Otherwise, exponential increase in the number of cases (and deaths) will lead to health staff succumbing and the consequent collapse of the health system.
2. Such an intervention can be signaled >5 days in advance so that the community, traders and businesses can make adequate preparations. It will give some level of certainty for planning and instill confidence in the population, the business community and the health sector.
3. The daily wage earners will need to be given an allowance to tide over this period. But this investment will be amply repaid by the opportunity to get faster control of an epidemic that is rapidly spiraling out of control.
4. Access to essential commodities – food, fuel, medicines, health care will not be compromised because the necessary logistical arrangements can be made. The experience of the March-April 2020 lockdown will be an asset in planning and implementing the distribution of essential goods to the people.
We recommend the following:
All persons to remain in their homes at all times for a period of at least 14 days continuously, and all schools, industries, commercial enterprises and places of worship to remain closed, with the exceptions listed below. These exempted places will be subject to social distancing, capacity restriction, wearing of face-masks, hand sanitizing and operating under conditions of optimal ventilation.
1. All essential services to be functional.
2. A minimum number of grocery stores, pharmacies, and fuel stations to remain open in every district. A limited number of vegetable, fruit and fish/meat, bakery and other food delivery vehicles permitted to operate on the basis of permits.
3. Restaurants able to prepare food for delivery on order, but not allow in-house dining.
4. Government departments deemed essential, to keep an office open for a few hours a day and function with a skeleton staff on a roster basis.
5. Any organization or enterprise may allow its employees to work from home.
6. A person can leave home only for a health need (including vaccination), any other emergency, or to purchase food supplies, but only one person can leave home at any one time for these purposes.
7. Gatherings of more than 4 people to be prohibited.
8. Outdoors agricultural work permitted to continue.
We request, in addition, that all ongoing preventive measures be enforced rigorously, including increasing vaccination coverage, and that case management and treatment interventions are greatly strengthened in the country.
by Dr Gotabhya Ranasinghe
Senior Consultant Cardiologist
National Hospital Sri Lanka
When we sought a meeting with Hon Dr. Ramesh Pathirana, Minister of Health, he graciously cleared his busy schedule to accommodate us. Renowned for his attentive listening and deep understanding, Minister Pathirana is dedicated to advancing the health sector. His openness and transparency exemplify the qualities of an exemplary politician and minister.
Dr. Palitha Mahipala, the current Health Secretary, demonstrates both commendable enthusiasm and unwavering support. This combination of attributes makes him a highly compatible colleague for the esteemed Minister of Health.
Our discussion centered on a project that has been in the works for the past 30 years, one that no other minister had managed to advance.
Minister Pathirana, however, recognized the project’s significance and its potential to revolutionize care for heart patients.
The project involves the construction of a state-of-the-art facility at the premises of the National Hospital Colombo. The project’s location within the premises of the National Hospital underscores its importance and relevance to the healthcare infrastructure of the nation.
This facility will include a cardiology building and a tertiary care center, equipped with the latest technology to handle and treat all types of heart-related conditions and surgeries.
Securing funding was a major milestone for this initiative. Minister Pathirana successfully obtained approval for a $40 billion loan from the Asian Development Bank. With the funding in place, the foundation stone is scheduled to be laid in September this year, and construction will begin in January 2025.
This project guarantees a consistent and uninterrupted supply of stents and related medications for heart patients. As a result, patients will have timely access to essential medical supplies during their treatment and recovery. By securing these critical resources, the project aims to enhance patient outcomes, minimize treatment delays, and maintain the highest standards of cardiac care.
Upon its fruition, this monumental building will serve as a beacon of hope and healing, symbolizing the unwavering dedication to improving patient outcomes and fostering a healthier society.We anticipate a future marked by significant progress and positive outcomes in Sri Lanka’s cardiovascular treatment landscape within the foreseeable timeframe.
by Fr. Emmanuel Fernando, OMI
Jesuit Fr. Aloysius Pieris (affectionately called Fr. Aloy) celebrated his 90th birthday on April 9, 2024 and I, as the editor of our Oblate Journal, THE MISSIONARY OBLATE had gone to press by that time. Immediately I decided to publish an article, appreciating the untiring selfless services he continues to offer for inter-Faith dialogue, the renewal of the Catholic Church, his concern for the poor and the suffering Sri Lankan masses and to me, the present writer.
It was in 1988, when I was appointed Director of the Oblate Scholastics at Ampitiya by the then Oblate Provincial Fr. Anselm Silva, that I came to know Fr. Aloy more closely. Knowing well his expertise in matters spiritual, theological, Indological and pastoral, and with the collaborative spirit of my companion-formators, our Oblate Scholastics were sent to Tulana, the Research and Encounter Centre, Kelaniya, of which he is the Founder-Director, for ‘exposure-programmes’ on matters spiritual, biblical, theological and pastoral. Some of these dimensions according to my view and that of my companion-formators, were not available at the National Seminary, Ampitiya.
Ever since that time, our Oblate formators/ accompaniers at the Oblate Scholasticate, Ampitiya , have continued to send our Oblate Scholastics to Tulana Centre for deepening their insights and convictions regarding matters needed to serve the people in today’s context. Fr. Aloy also had tried very enthusiastically with the Oblate team headed by Frs. Oswald Firth and Clement Waidyasekara to begin a Theologate, directed by the Religious Congregations in Sri Lanka, for the contextual formation/ accompaniment of their members. It should very well be a desired goal of the Leaders / Provincials of the Religious Congregations.
Besides being a formator/accompanier at the Oblate Scholasticate, I was entrusted also with the task of editing and publishing our Oblate journal, ‘The Missionary Oblate’. To maintain the quality of the journal I continue to depend on Fr. Aloy for his thought-provoking and stimulating articles on Biblical Spirituality, Biblical Theology and Ecclesiology. I am very grateful to him for his generous assistance. Of late, his writings on renewal of the Church, initiated by Pope St. John XX111 and continued by Pope Francis through the Synodal path, published in our Oblate journal, enable our readers to focus their attention also on the needed renewal in the Catholic Church in Sri Lanka. Fr. Aloy appreciated very much the Synodal path adopted by the Jesuit Pope Francis for the renewal of the Church, rooted very much on prayerful discernment. In my Religious and presbyteral life, Fr.Aloy continues to be my spiritual animator / guide and ongoing formator / acccompanier.
Fr. Aloysius Pieris, BA Hons (Lond), LPh (SHC, India), STL (PFT, Naples), PhD (SLU/VC), ThD (Tilburg), D.Ltt (KU), has been one of the eminent Asian theologians well recognized internationally and one who has lectured and held visiting chairs in many universities both in the West and in the East. Many members of Religious Congregations from Asian countries have benefited from his lectures and guidance in the East Asian Pastoral Institute (EAPI) in Manila, Philippines. He had been a Theologian consulted by the Federation of Asian Bishops’ Conferences for many years. During his professorship at the Gregorian University in Rome, he was called to be a member of a special group of advisers on other religions consulted by Pope Paul VI.
Fr. Aloy is the author of more than 30 books and well over 500 Research Papers. Some of his books and articles have been translated and published in several countries. Among those books, one can find the following: 1) The Genesis of an Asian Theology of Liberation (An Autobiographical Excursus on the Art of Theologising in Asia, 2) An Asian Theology of Liberation, 3) Providential Timeliness of Vatican 11 (a long-overdue halt to a scandalous millennium, 4) Give Vatican 11 a chance, 5) Leadership in the Church, 6) Relishing our faith in working for justice (Themes for study and discussion), 7) A Message meant mainly, not exclusively for Jesuits (Background information necessary for helping Francis renew the Church), 8) Lent in Lanka (Reflections and Resolutions, 9) Love meets wisdom (A Christian Experience of Buddhism, 10) Fire and Water 11) God’s Reign for God’s poor, 12) Our Unhiddden Agenda (How we Jesuits work, pray and form our men). He is also the Editor of two journals, Vagdevi, Journal of Religious Reflection and Dialogue, New Series.
Fr. Aloy has a BA in Pali and Sanskrit from the University of London and a Ph.D in Buddhist Philosophy from the University of Sri Lankan, Vidyodaya Campus. On Nov. 23, 2019, he was awarded the prestigious honorary Doctorate of Literature (D.Litt) by the Chancellor of the University of Kelaniya, the Most Venerable Welamitiyawe Dharmakirthi Sri Kusala Dhamma Thera.
Fr. Aloy continues to be a promoter of Gospel values and virtues. Justice as a constitutive dimension of love and social concern for the downtrodden masses are very much noted in his life and work. He had very much appreciated the commitment of the late Fr. Joseph (Joe) Fernando, the National Director of the Social and Economic Centre (SEDEC) for the poor.
In Sri Lanka, a few religious Congregations – the Good Shepherd Sisters, the Christian Brothers, the Marist Brothers and the Oblates – have invited him to animate their members especially during their Provincial Congresses, Chapters and International Conferences. The mainline Christian Churches also have sought his advice and followed his seminars. I, for one, regret very much, that the Sri Lankan authorities of the Catholic Church –today’s Hierarchy—- have not sought Fr.
Aloy’s expertise for the renewal of the Catholic Church in Sri Lanka and thus have not benefited from the immense store of wisdom and insight that he can offer to our local Church while the Sri Lankan bishops who governed the Catholic church in the immediate aftermath of the Second Vatican Council (Edmund Fernando OMI, Anthony de Saram, Leo Nanayakkara OSB, Frank Marcus Fernando, Paul Perera,) visited him and consulted him on many matters. Among the Tamil Bishops, Bishop Rayappu Joseph was keeping close contact with him and Bishop J. Deogupillai hosted him and his team visiting him after the horrible Black July massacre of Tamils.
Sri Lanka-Singapore Free Trade Agreement
By Gomi Senadhira
senadhiragomi@gmail.com
“You might tell fairy tales, but the progress of a country cannot be achieved through such narratives. A country cannot be developed by making false promises. The country moved backward because of the electoral promises made by political parties throughout time. We have witnessed that the ultimate result of this is the country becoming bankrupt. Unfortunately, many segments of the population have not come to realize this yet.” – President Ranil Wickremesinghe, 2024 Budget speech
Any Sri Lankan would agree with the above words of President Wickremesinghe on the false promises our politicians and officials make and the fairy tales they narrate which bankrupted this country. So, to understand this, let’s look at one such fairy tale with lots of false promises; Ranil Wickremesinghe’s greatest achievement in the area of international trade and investment promotion during the Yahapalana period, Sri Lanka-Singapore Free Trade Agreement (SLSFTA).
It is appropriate and timely to do it now as Finance Minister Wickremesinghe has just presented to parliament a bill on the National Policy on Economic Transformation which includes the establishment of an Office for International Trade and the Sri Lanka Institute of Economics and International Trade.
Was SLSFTA a “Cleverly negotiated Free Trade Agreement” as stated by the (former) Minister of Development Strategies and International Trade Malik Samarawickrama during the Parliamentary Debate on the SLSFTA in July 2018, or a colossal blunder covered up with lies, false promises, and fairy tales? After SLSFTA was signed there were a number of fairy tales published on this agreement by the Ministry of Development Strategies and International, Institute of Policy Studies, and others.
However, for this article, I would like to limit my comments to the speech by Minister Samarawickrama during the Parliamentary Debate, and the two most important areas in the agreement which were covered up with lies, fairy tales, and false promises, namely: revenue loss for Sri Lanka and Investment from Singapore. On the other important area, “Waste products dumping” I do not want to comment here as I have written extensively on the issue.
1. The revenue loss
During the Parliamentary Debate in July 2018, Minister Samarawickrama stated “…. let me reiterate that this FTA with Singapore has been very cleverly negotiated by us…. The liberalisation programme under this FTA has been carefully designed to have the least impact on domestic industry and revenue collection. We have included all revenue sensitive items in the negative list of items which will not be subject to removal of tariff. Therefore, 97.8% revenue from Customs duty is protected. Our tariff liberalisation will take place over a period of 12-15 years! In fact, the revenue earned through tariffs on goods imported from Singapore last year was Rs. 35 billion.
The revenue loss for over the next 15 years due to the FTA is only Rs. 733 million– which when annualised, on average, is just Rs. 51 million. That is just 0.14% per year! So anyone who claims the Singapore FTA causes revenue loss to the Government cannot do basic arithmetic! Mr. Speaker, in conclusion, I call on my fellow members of this House – don’t mislead the public with baseless criticism that is not grounded in facts. Don’t look at petty politics and use these issues for your own political survival.”
I was surprised to read the minister’s speech because an article published in January 2018 in “The Straits Times“, based on information released by the Singaporean Negotiators stated, “…. With the FTA, tariff savings for Singapore exports are estimated to hit $10 million annually“.
As the annual tariff savings (that is the revenue loss for Sri Lanka) calculated by the Singaporean Negotiators, Singaporean $ 10 million (Sri Lankan rupees 1,200 million in 2018) was way above the rupees’ 733 million revenue loss for 15 years estimated by the Sri Lankan negotiators, it was clear to any observer that one of the parties to the agreement had not done the basic arithmetic!
Six years later, according to a report published by “The Morning” newspaper, speaking at the Committee on Public Finance (COPF) on 7th May 2024, Mr Samarawickrama’s chief trade negotiator K.J. Weerasinghehad had admitted “…. that forecasted revenue loss for the Government of Sri Lanka through the Singapore FTA is Rs. 450 million in 2023 and Rs. 1.3 billion in 2024.”
If these numbers are correct, as tariff liberalisation under the SLSFTA has just started, we will pass Rs 2 billion very soon. Then, the question is how Sri Lanka’s trade negotiators made such a colossal blunder. Didn’t they do their basic arithmetic? If they didn’t know how to do basic arithmetic they should have at least done their basic readings. For example, the headline of the article published in The Straits Times in January 2018 was “Singapore, Sri Lanka sign FTA, annual savings of $10m expected”.
Anyway, as Sri Lanka’s chief negotiator reiterated at the COPF meeting that “…. since 99% of the tariffs in Singapore have zero rates of duty, Sri Lanka has agreed on 80% tariff liberalisation over a period of 15 years while expecting Singapore investments to address the imbalance in trade,” let’s turn towards investment.
Investment from Singapore
In July 2018, speaking during the Parliamentary Debate on the FTA this is what Minister Malik Samarawickrama stated on investment from Singapore, “Already, thanks to this FTA, in just the past two-and-a-half months since the agreement came into effect we have received a proposal from Singapore for investment amounting to $ 14.8 billion in an oil refinery for export of petroleum products. In addition, we have proposals for a steel manufacturing plant for exports ($ 1 billion investment), flour milling plant ($ 50 million), sugar refinery ($ 200 million). This adds up to more than $ 16.05 billion in the pipeline on these projects alone.
And all of these projects will create thousands of more jobs for our people. In principle approval has already been granted by the BOI and the investors are awaiting the release of land the environmental approvals to commence the project.
I request the Opposition and those with vested interests to change their narrow-minded thinking and join us to develop our country. We must always look at what is best for the whole community, not just the few who may oppose. We owe it to our people to courageously take decisions that will change their lives for the better.”
According to the media report I quoted earlier, speaking at the Committee on Public Finance (COPF) Chief Negotiator Weerasinghe has admitted that Sri Lanka was not happy with overall Singapore investments that have come in the past few years in return for the trade liberalisation under the Singapore-Sri Lanka Free Trade Agreement. He has added that between 2021 and 2023 the total investment from Singapore had been around $162 million!
What happened to those projects worth $16 billion negotiated, thanks to the SLSFTA, in just the two-and-a-half months after the agreement came into effect and approved by the BOI? I do not know about the steel manufacturing plant for exports ($ 1 billion investment), flour milling plant ($ 50 million) and sugar refinery ($ 200 million).
However, story of the multibillion-dollar investment in the Petroleum Refinery unfolded in a manner that would qualify it as the best fairy tale with false promises presented by our politicians and the officials, prior to 2019 elections.
Though many Sri Lankans got to know, through the media which repeatedly highlighted a plethora of issues surrounding the project and the questionable credentials of the Singaporean investor, the construction work on the Mirrijiwela Oil Refinery along with the cement factory began on the24th of March 2019 with a bang and Minister Ranil Wickremesinghe and his ministers along with the foreign and local dignitaries laid the foundation stones.
That was few months before the 2019 Presidential elections. Inaugurating the construction work Prime Minister Ranil Wickremesinghe said the projects will create thousands of job opportunities in the area and surrounding districts.
The oil refinery, which was to be built over 200 acres of land, with the capacity to refine 200,000 barrels of crude oil per day, was to generate US$7 billion of exports and create 1,500 direct and 3,000 indirect jobs. The construction of the refinery was to be completed in 44 months. Four years later, in August 2023 the Cabinet of Ministers approved the proposal presented by President Ranil Wickremesinghe to cancel the agreement with the investors of the refinery as the project has not been implemented! Can they explain to the country how much money was wasted to produce that fairy tale?
It is obvious that the President, ministers, and officials had made huge blunders and had deliberately misled the public and the parliament on the revenue loss and potential investment from SLSFTA with fairy tales and false promises.
As the president himself said, a country cannot be developed by making false promises or with fairy tales and these false promises and fairy tales had bankrupted the country. “Unfortunately, many segments of the population have not come to realize this yet”.
(The writer, a specialist and an activist on trade and development issues . )
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