It’s time for epidemiologists to lead battle against Covid-19

Dr. Pradeep Kariyawasam’s recent article on the pandemic prompted me to pen this letter. I met the good doctor 20 long years ago as a rookie medical rep. He was the chief MOH in the Colombo Municipal Council at the time. I was awed by the Town Hall building itself, entering it for the first time in my life. Somehow, I managed to find the MOH offices in its labyrinth, tucked away in a corner on the second floor. Dr. Kariyawasam, in his plush office, welcomed me, listened patiently to my practiced jargon about my products, which we’re expected to deliver to doctors, and soon put me at ease. His joviality was infectious and though he was not swayed by any of the marketing gimmicks the drug companies employ to sell products, he was courteous and kind enough to give me the time to deliver my monologues on my products every time I went to meet him. He was a busy man, rarely found warming his seat. He was always at some meeting or the other, returning to his office well past lunch time. At the time I didn’t realise he was an epidemiologist too. But even then, I noted he was a manager besides being a doctor. Always seeing the big picture and its problems, and finding answers to them, rather than fighting fires here and there.

Reading the contributions, he has made to the papers since the beginning of the -Covid Pandemic, especially The Island article encompassing Sri Lanka’s whole tryst with Covid from the beginning, it is very clear, its him, or people like him that is needed, to get us out of the woods. It was an eye-opener, rendered by an expert who was able to decimate data as well as grasp the situation and see how, when, and where we can get out of this nightmare. The broken up and mostly narrow angled, and sometimes even opposing views the medical fraternity has given on this pandemic has created more confusion. Everyone from union leaders, PHIs, to nurses to laboratory technicians, to medical specialists had a different take, or a partial solution to the same problem. All are divided as government, unions, individuals, associations, medical specialties, political parties etc.

Sri Lanka doesn’t need different opinions or advice. What the country needs is expert handling of the crisis. Expertise in epidemiology to be in charge of this pandemic situation. The country has become rudderless in the Covid situation, because the rudder, the Task force, has proved inefficient. This in spite of the massive effort and brave plodding on by the Army Commander and his men in the fight against Coronavirus. This is because of the lack of experienced and effective epidemiologists in the battle front, people who can see the big picture and know the trends of an epidemic. This can be only achieved by years of experience fighting different epidemic wars, not just knowing about the viruses and their behaviour.

One thing that stands out in Dr. Kariyawasam’s solution is the ‘community participation’. His care and kindness to the community is astounding. After I left my job, I lost touch with Dr. Pradeep for many years. Then he was brought to my sphere of life again about 15 years later, without him even ever knowing about it. I was looking for the Japanese Encephalitis vaccine for my 10-year-old, which at the time was out of stock everywhere in Sri Lanka. After drawing negative at almost all MOH offices in my area of Rajagiriya/Borella, and all private hospitals in Colombo, I was directed to call the CMC head office. The call from a community member like me, was directed right to the top guy, Dr. Kariyawasam. I never identified myself/or told him that he knew me. But I told him of my fruitless search to find this vaccine. He acknowledged the stock out situation and said he would let me know as soon as he can get it. That is the stock answer many of us get from most government officials. We’re so used to this stock response that we never expect to hear anything afterwards. So, rather mad and disheartened, I gave up on this mission of mine and forgot about the matter myself.

I nearly fell off my chair when a week later Dr. Kariyawasam himself called me. He said he had managed to find a single vial at an MOH office in a remote corner of Colombo, Jinthupitiya. If I could get my son over there, he could have it. I stood flabbergasted at this man’s commitment to just one mother, in his sphere of care. I never got to tell him who I was, even then. I found Jinthupitiya, and got my son the vaccine. For me that is the true spirit of an epidemiologist. We are not just numbers or statistics on paper. To him we were human beings in need of care and protection.

An epidemiologist needs to be Sherlock Holmes. Not only did Sherlock gather data, but connected them together to give the correct story as well as solve the crime. That’s what Dr Kariyawasam has done in his article in The Island of 19th August. His expertise on this matter is evident. This kind of expertise is gathered by experience rather than learning. He talks of a ‘gut feeling’. This is only achieved by experience. A rookie can fly a plane as well as a seasoned pilot. But when bad weather hits, that’s when you need the Captain, the experienced. The years count then. The ‘gut feelings’ come into play. That’s when a rookie pilot will bow out and hand over the controls to the captain. I’m an avid watcher of Air Crash Investigations and it is horrifying to see the human errors that cause a crash. 99% of the time it is lack of experience that contributes to it. Either not seeing the glaring signs of trouble or panicking and making more errors.

In Sri Lanka, many errors have been committed in the handling of the pandemic, for it to reach this horrific proportion. In spite of the brave Army Commander and his task force doing everything possible to combat it, they have lacked the guidance and expertise expected from the epidemiology personnel. We need to identify this glaring shortcoming in the Task Force, and make rapid course correction, if Sri Lanka is to avoid a nose dive into the quagmire of uncontrolled Covid deaths. We need Captains of the epidemiologists, the experienced ones to take over the controls. Who can read the clouds/trends, who have ‘gut feelings’ on when and where the virus can pop up, and knows what’s best to do when it does. They have experienced it before, handled it, failed at it, succeeded in it and seasoned by it.

I’m sure there’s many Dr. Kariyawasams in Sri Lanka. Find them and install them at the controls. If called, any captain will volunteer to save the plane if it’s crashing, even if they are sitting as passengers in an aircraft. As the saying goes, when the going gets tough, the tough gets going. Please give the controls of Sri Lanka’s Covid flight, over to the hands of these. Recall them from retirement if necessary. Fly them back, if they are abroad. Transfer them from outposts. Get these to the helm – the Task Force. They are the ones to take charge. Not the government or all parties or opposition or trade unions.

SDZ