Statistical ruse backfires

Monday 16th August, 2021

Sri Lanka’s Covid-19 case-fatality rate (about 5%) has exceeded the global average (1.4%), according to media reports. This rate may look accurate, given the officially confirmed cases, but there is reason to believe that it is misleading; many cases have gone undetected, and if testing is stepped up, the morbidity rate will increase exponentially, bringing the case-fatality rate down. The fatality figures, however, remain undisputed, and, therefore, could be considered reliable.

The Health Ministry stands accused of trying to hide the severity of the pandemic from the public, for political reasons, by not increasing the number of PCR tests conducted a day so as to keep the number of daily cases low, but its action has made the world consider Sri Lanka an extremely dangerous place.

The process of collecting Covid-19 data and tabulating them is not that complex, though somewhat difficult, due to the geographical distribution of the pandemic and the inefficiency of the state service. Doctors and other health workers have pointed out that the number of tests conducted daily is woefully inadequate for them to get a clear picture of the spread of the pandemic; they have called for aggressive testing, which is a prerequisite for controlling Covid-19. But these calls have gone unheeded.

President of the College of Medical Laboratory Science (CMLS) Ravi Kumudesh has told this newspaper that the number of PCR tests conducted daily is insufficient, and it can be increased to 50,000 a day easily. Pointing out that the state sector labs have about 36 Rapid PCR machines capable of giving test results in less than two hours, and detecting viruses other than SARS-CoV-2, he has said the members of his association are awaiting the government’s nod to go into overdrive. The Health Ministry ought to explain why the full potential of the state sector laboratories has not been tapped to fight the pandemic effectively. Is it that some health bigwigs are colluding with their private sector cronies notorious for various rackets? They also made the government-run Covid-19 testing facility at the Bandaranaike International Airport idle so that the samples collected from foreigners and others could be sent to some private labs.

Thousands of Covid-19 patients receiving homecare are encouraged to purchase pulse oximeters to check their blood oxygen levels themselves, and the question is why the Rapid Antigen Test kits are not made available freely for the people to test themselves at home. Self-testing should have preceded homecare for pandemic patients. This will help increase the number of daily tests so that more cases could be detected, isolated and treated to curb the rapid transmission of the Delta variant. Countries such as the UK, the US, Singapore and India are promoting self-testing by making available Rapid Antigen Test kits, which cost about INR 200 a piece in India. The government can import them and sell them through the Osusala outlets to prevent the private health mudalalis from fleecing the pandemic-hit public. It should be able to do so if its leaders are not in league with the unscrupulous businessmen who thrive on the misery of the sick.

If the exiting PRC and Rapid PCR machines in the state sector are fully utilised with the people being provided with Rapid Antigen Test kits, about 100,000 persons could be tested daily, the CMLS informs us. Will the government care to do so promptly and save lives?

The task of bringing down Covid-19 deaths as well as the case-fatality rate also requires the acceleration of the vaccination drive, imposing strict movement restrictions and ensuring that the people abide by the health regulations. The government is expected to bring in new laws to enforce the existing health regulations more virtuously, we are told. The need for such stringent action cannot be overemphasised because not many people follow Covid-19 protocol voluntarily.

Ideally, the country should be closed. This is what the World Health Organization, and Sri Lankan medical experts have recommended. The government is under pressure to impose lockdowns and a quarantine curfew at least for two weeks, and vaccinate as many people as possible during that period. But one should not lose sight of the huge socio-economic costs of lockdowns.

Developed nations can afford lockdowns and therefore impose them at the first sign of trouble. If this country is closed again, there will be more job losses besides economic hardships. Many private sector institutions are already on the brink of going belly up. Having chosen to control the pandemic while keeping the country open, the government finds itself in an unenviable position. There should be funds, especially foreign exchange, for pandemic control, and what the situation would be like if the economy collapsed at this juncture is not difficult to imagine. In a worst-case scenario, the public sector employees will also face pay cuts; they may not even get paid, at all; hospitals will be without drugs and there will be shortages of all essential commodities. Such a situation will be inevitable unless everyone realises the gravity of the health crisis and fully co-operates to stop the spread of the destructive virus.

Head of the Public Health Inspectors’ Association Upul Rohana, who is au fait with the ground situation, has called upon the public to restrict their movements for their own sake. There is no reason why the people cannot do so to save their own lives as well as those of their dear ones, without waiting till the government imposes lockdowns.