Gota’s war: Are we winning this time?

Besides the Health Ministry, members of the tri forces have played a major role in keeping the infection numbers under control through numerous measures. However, the good news story of Sri Lanka has suffered a setback with the significant number of positive cases being detected in the last few days, mainly amongst Navy personnel based in the Welisara Navy camp 

    – Pic by Shehan Gunasekara

The title of the book was a bit perplexing to me at the beginning. Like many other readers most probably did, I expected to read what would prove to be an attempt to lionise a single individual out of many for something that was widely recognised as a result achieved through dedicated teamwork – Rohana R. Wasala, Island newspaper, 8 June 2012 commenting on the book ‘Gota’s War’

Sri Lanka has managed the COVID outbreak well by any international standard. Irrespective of star ratings given by different international agencies, people living in Sri Lanka knows best how it has been managed, and they are the ultimate jury on this issue, not any external agency. It has been a team effort, with the involvement of many agencies, and the ordinary people of Sri Lanka, but without doubt, under the able leadership of President Gotabaya Rajapaksa.

Besides the Health Ministry, members of the tri forces have played a major role in keeping the infection numbers under control through numerous measures. These have caused disruption to the daily lifestyle of the people, and the economy too has gone into a tail spin. Unfortunately, these measures were needed to contain the virus, and it appears that an overwhelming part of the population understood and accepted these hardships in order to stay healthy and to keep Sri Lanka safe from the virus.

However, the good news story of Sri Lanka has suffered a setback with the significant number of positive cases being detected in the last few days, mainly amongst Navy personnel based in the Welisara Navy camp.

Among the COVID-19 infected patients identified in Sri Lanka, 180 are Navy personnel, says Commander of the Army Lieutenant General Shavendra Silva. Among them 112 have been identified from the Welisara Navy Base, said Silva. The other 68 officers had been reported while on leave in different areas, he added. Accordingly, the tally of coronavirus cases reported in the country has gone up to 588 cases as of 28 April, and is poised to pass 600 today.

The number of cases on 1 April was just over 130, and the numbers were increasing at an average percentage of 3% on a daily basis. The increase however is around 8% now, and while this does not necessarily mean this rate or a higher rate will prevail in the next few weeks, there is a degree of uncertainty being felt by Sri Lankans about how the trending will occur in view of these increasing numbers.

The number of cases is likely to go past 650 by the end of this month, raising the number from just over 130 at the beginning of April, and in percentage terms, showing an increase of about 400% in one month.

The danger of the increase in the baseline figure, which is the accumulated monthly figure, is the exponential increase that can happen if the daily numbers keep increasing at the current 8%, or more, and it does not go down to a much lower percentage. The increasing trend can only be arrested if the daily positive rate drops and reaches zero and stays consistently at zero.

A depiction of the current rate of increase and the impact on the total number of cases accumulating on a daily basis may be illustrated as shown in the graph below. 

The graph illustrates this steep increase. If it is plotted for the month of May, with the increase even around 5% per day, the number at the end of May could be as many as 3,000 cases. If an exponential increase continues, the resulting numbers will be of great concern to the country’s ability to manage the health crisis that will follow, and also to manage a worsened economic crisis.

While it is acknowledged that the case numbers that have contributed to the significant increase in the overall number of infected cases are mainly Navy personnel, the issue is not about who has been infected, but how many, and also how many others those affected may have infected in turn that matters. Although there is no doubt the government is monitoring these affected Navy personnel and others who they would have come in contact with, one can never draw an easy line between these categories. In the circumstances, it is not easy to be assured that all potential candidates for COVID-19 infection have been taken care of unless confirmed by tests.

An intensive testing program will have to be undertaken to eliminate any potential chain infections. 

This increase, in a sense from an unexpected source like Navy personnel, does create some concern amongst the public as the tri forces are in the thick of the containment program, and a very worrying prospect should other Forces personnel also contract the virus. 

While the President has appointed a special Presidential Task Force to ensure the health safety within camps of the tri-forces, hopefully this task force will also introduce strict social distancing and where necessary, quarantine requirements, not just for the Forces personnel, but to those who come in close contact with the Forces personnel including their family members.

It would be in the interest of the public who are being told on the one hand that restrictions are to be phased out gradually, and on the other hand, to hear about this spike in numbers, 180 of them from the Navy with a large number of fellow Navy men and women and their families said to be quarantined in Welisara, for the Government, hopefully the President or the Prime Minister to make a public statement on the status of the pandemic in Sri Lanka.

There are conflicting reports on the testing regime being conducted by the Ministry of Health. The GMOA appears to be at odds with another group of medical personnel who are reportedly advising the Government. The status of how the testing is being done, who is being tested, how many in fact have been tested, how many more are anticipated to be tested and whether the Health Ministry has adequate stocks of test kits and reagents, is another factor that needs clarification from the highest levels of the Government. Mass-scale testing is the only answer to identifying who might or might not have contracted the virus.

It is good for the Government and the many task forces appointed so far to keep abreast of developments in countries like Singapore, which now have in excess of 12,000 positive cases from a relatively small number just a few weeks ago. The experience of the horrors going on in the USA, UK, many European countries, and the resurgence reported in China and in Japan, are lessons that need to be learnt about how this virus containment and/or a resurgence needs to be managed. Alongside these, the positives in countries like South Korea, Australia and New Zealand also need to be learnt as they have, through the policies they adopted, have brought the number of daily occurrence of positive cases to less than 10 in Australia and zero in New Zealand.

One thing common these countries had and still have, is that the political administration has relied on a single voice of medical opinion, based on the research and studies done in other countries, with such an opinion being given primarily by epidemiologists and not by doctors who have no specialised learning or experience in this discipline. 

A divided medical opinion is the last thing the country and its political leaders need. Doctors may argue and debate amongst themselves, but they need to take a consensus position and present that to the President who is leading this battle against COVID-19. They need to be guided by research studies done in other countries however limited such studies are. They need to learn lessons from debacles experienced by other countries, as well as what they had done to contain the spread.

Australia, which has a Federal system of governance, with its States and Territories, has managed the virus spread in an effective manner. Prime Minister Morrison decided to set up a National Cabinet comprising all State Premiers and Chief Ministers of Territories, to make policy decisions which were uniform across its Federal system. A Medical Expert body headed by the Chief Medical Officer of the Federal government provided a one voice medical advice to the Government on measures that needed to be taken to contain the virus spread. 

This strategy worked in Australia, and the daily increase of around 300 cases experienced during the second half of March, has dropped to less than 10 per day now.

The political leadership with President Gotabaya Rajapaksa at the helm have taken and still are taking methodical measures to contain the spread of this virus and at the same time exploring and planning how the economy of the country may be revived. Both tasks are daunting not just to the President and the Government but to the entire country. This is not a war led by one person. It is and has to be a war led by all Sri Lankans.