Public health officials smother SARS-Cov-2 epidemic

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.