The oversold virus

Tell people, ‘Go out and live! Be careful, follow guidelines, take your temperature, sanitise, keep sane distance, monitor symptoms, and look after each other, and let’s rebuild our country, and educate our children, and pave a future that will make us resilient enough that we can tackle pathogens and tsunamis and whatever else may be headed our way that we don’t control, can’t ‘police’ and order around – Pic by Shehan Gunasekara

Well, we are in a curious ‘twilight zone’ between having decided, sanely, salvifically, to move forward in Sri Lanka rather than staying economically comatose and moribund as a society indefinitely, quaking over a viral strain, with currently far more demonstrated ‘bark’ than ‘bite’ on these shores. 

If we’re not careful though, the mismatch between our ‘strategy’ and our ‘rhetoric’ may have us clutching defeat from the jaws of victory, undermining the very laudable and necessary initiatives being taken.

Presidential perspective

Overall, the President has stressed the need to keep the country open. As I wrote in ‘a tale of two prescriptions,’ if you compare the alternative, it’s not really a choice. The President suggested the ‘easiest’ thing is to keep the country shut. Well, yes, if self-destruction over a virus is the aim. Clearly, it’s not his aim, and happily he has led us beyond that ‘false’ choice. 

I would also just suggest though, that if there were a spike, necessitating more ‘control,’ we needn’t immediately relapse to ‘curfew,’ which has not been used on a 24/7 sustained basis anywhere in the world, and certainly not in any of the exemplar countries we would wish to emulate. It is certainly not a WHO recommendation either.  

Hence, the tiered circuit breaker model being presented (still incomplete, as each tier needs some ‘numbers’ or sense of magnitude attached as triggers to make sense, more below), which at worst allows industry to function, schools to operate (as in France, Germany), people to go out briefly to buy groceries and medicine, and get fresh air and take some suitably, physically distanced exercise, is compelling. 

Locking people up inside, the sick with the well, is both psychologically tormenting, and completely, medically unnecessary. At most it ‘delays’ what we encounter later. Either our ‘guidelines’ work or they don’t. Most of the super-spreader ‘sparks’ we are told (including from recent research out of Princeton from Indian researchers reported in The Economist) come from indoors, and from family dwellings, and then yes hospitals, markets and other highly bustling situations. Virtually none come from outdoors (literally three out of 1,600 studied). 

The President rightly points out, in making the case that just shutting down doesn’t work, that even in places isolated for over 40 days, infected persons are reported daily. Yes, ‘eradication’ unless you forever seal yourself off from the planet and reap the economic and developmental whirlwind as a result, is not a viable aim. For years we have attacked various colds and influenzas and pneumonia strains with medicine, vaccines and more. They mutate and evolve, and in heavy influenza seasons, take 650,000 to 750,000 lives globally on a recurring basis. TB takes 1.6 million lives per annum with a vaccine. 

So medical guidelines, getting out and living and gaining greater immunological experience with the ‘novel’ coronavirus, and when we have it, a vaccine (which the FDA says may have at best 50% efficacy, and usually not for the most at-risk above 75 demographic) to fortify our efforts, is the only rational game-plan. 

Perhaps though, the President is being slightly harsh in blaming the public. Whatever transpired this time, some combination of a ‘Black Swan’ event via a Brandix factory and then contacts and then fish markets, whether truly unpredictable, or flowing from some human negligence, can certainly take place again. 

And so we have to keep our sanity and learn to distinguish, as we’ve kept saying, between ‘positive test results’ (not 100% reliable by any means), ‘cases’ (symptoms needing treatment, a far smaller percentage) and ‘deaths’ (each to be deeply mourned, but infitesimal by comparison, ranging from .14% to .3% of those infected). We otherwise don’t have a ‘pandemic,’ or even a ‘case-demic’ but a ‘test-demic.’ 

But let us rally behind the President’s call to economic and developmental revitalisation while supporting our medical professionals with our own care and prudence. But this now gets us to more worrisome ‘mixed messaging.’

The dreaded ‘community transmission’ scare

This is where numbers matter. Definitions are easy. ‘Local’ transmission contrasts with ‘imported,’ readily. ‘Clusters’ which are geographically centred, and where virtually all infections can be contact traced back to the cluster or clusters is conceptually easy to absorb. 

‘Community transmission’ is meant to be that which we all wish to avoid, when cases are popping up sporadically across a country, or even parts of a country, with no known connection to a clear spark or cluster. We are now being told we may be on the ‘verge’ of this, if we are not careful.

I think we have to stop this ‘communication terror’ campaign, as otherwise we will instil a ‘behavioural curfew’ as devastating as a ‘legal’ one. And businesses will not get the kindling they need from our conducting our lives. 

Globally speaking, community transmission concerns are triggered, both as per the CDC, and in some of the leading exemplar European countries, when we have five to 10 per 100,000 cases that are unrelated, sustained for 10-14 days. So if we started seeing 1,600 to 2,100 or more daily unconnected cases popping up around Lanka, and it was more than a few day anomaly, then as per the global thresholds, we would have tipped over, and would need to take more extreme circuit breaker action (please no curfew as it is the worst of all worlds, as a whole network to provide basic subsistence has to be put in place, when people can prudently address that themselves, and community transmission or not, ‘transmissibility’ of the virus follows the same laws, and so the ‘guidelines’ would have the same safeguarding effect).

Fifty or so stray cases could just be that, or where not having web access for everyone, we just can’t track contacts down. And the real number, to keep an eye on, is people actually requiring hospital admissions and ICU attention, not ‘positive test results’ per se. But yes, that sustained quantum of positive test results would certainly be cause for concern. 

But, outside of the identified clusters we are nowhere close to that, nor have we been over this ‘surge’ period, and presumably no one is suggesting slavishly shutting down if say 200 unknown, across the island, ‘positive tests’ emerged, with no pattern, but also no sustainability, and no increasing sustained trend-line either.

We must stay sane, and understand, it is both ‘types’ of cases as well as ‘number’ of cases that together paint an emerging portrait.

Recent news: It was announced on 10th November that “nearly” 4% of total PCR tests performed on the Minuwangoda and Peliyagoda clusters from October 5th to November 9th tested positive for the virus, specifically (and this matters) 3.63% on average.

This is good news! 

Re community spread and impact, the higher the percent positive, the more concerning it is. Leave aside the likely “false positives” in the above, but even if every test was accurate, the WHO threshold recommended in May was to stay “below 5% and that could trigger “relaxing measures.” 

Notice those measures are anyway NOT curfew! But however you may have “closed,” WHO guideline was two weeks below 5% and we could “consider reopening.”

 Notice in our case for over a month we’ve averaged “well below” that threshold, which argues there was no reason for outright shutdown and curfew anyway. The conclusion as medically stated by Johns Hopkins is “a low percent positive simply means the level of coronavirus transmission, relative to the amount of testing, is low at this point in time.”

Please note these weren’t even stats from the general public, but from the epicenter of the most likely infected and affected, the clusters and their direct contacts, and even there we demonstrated low C-19 infection rates, which indicates “low transmission in the community.”  

And as I said above, these were not “cluster” threshold guidelines from WHO, but overall community population thresholds -- back to my point about “type” and “number” cases needing to be assessed in concert before “community transmission” alarm bells go off.

The strange ‘erotica’ of lockdown

Our fetish for recurring waves of ‘curfew’ posing as ‘lockdown’ must be thrilling at some level, as it makes no sense. Imagine now, another pathogen, a few years down the road. Barely recovering from the economic disruption and devastation this time, if we evolve no saner playbook, we once more take a bungee jump without an economic and social bungee?  We have heard bizarre declarations from ‘experts’ and epidemiologists here saying the areas relieved from curfew are still ‘not safe.’ Blaring, absurd headlines.

First, what the devil is ‘safe?’ We have infectious diseases galore, dengue, rat fever, then diseases of lifestyle like smoking, drinking, diabetes (to which we contribute), hypertension, heart disease and more. If ‘safety’ was a benchmark, Sri Lanka would have shrivelled during 30+ years of civil war, the entire world would have been routed by measles and polio and mumps and more. What is this new tragically silly benchmark we are inflicting on ourselves of a ‘fantasy safety’ that goes out the window, when you simply ride a tuk-tuk or cross a busy Colombo street?

So, the hell with it. Tell people, ‘Go out and live! Be careful, follow guidelines, take your temperature, sanitise, keep sane distance, monitor symptoms, and look after each other, and let’s rebuild our country, and educate our children, and pave a future that will make us resilient enough that we can tackle pathogens and tsunamis and whatever else may be headed our way that we don’t control, can’t ‘police’ and order around.

Otherwise, telling people there are ‘asymptomatic’ carriers everywhere, and we should all stay home, and only one person dare head out at a time, gives us what? Asymptomatic or otherwise, the guidelines are there to protect us against even raging infection, as this is not radioactivity, and it does not seep in through our pores. 

Are we suggesting we ‘open’ and tell people to stay cowering and so effectively stay ‘closed?’ Where is the sanity in that? How do we ever recover or get economic ignition that way? 

Again, why does Asia with 60% of the world’s population, have about 20% of the world’s indicated C-19 fatalities? Our immune systems are hardier, we deal with vaccines for more illnesses that may provide a level of protection as well, but infantilising our capacity to integrate C-19 into our recurring epidemiology as we ultimately must, unless it just opts to sputter out into irrelevance as it may, is again, the worst of worlds.

So ‘lock yourself’ up if it provides a frisson of excitement, some modicum of thrills, but it’s retarding both economic and medical recovery which require engagement. And as the vast majority of the populace is not at risk, and 99% under 70 recover even if infected, remember to focus on the infection fatality rate as what really matters (we have added 10,000 new ‘positive tests’ from these clusters and 31 deaths and not all of these seem strictly ‘from’ COVID as earlier outlined…hardly a reason to suspend life and liberty).

The danger grows (or not)!

Next up is further manic panic  from ‘experts’ whose jobs are not on the line, are insulated from the shocks experienced by wage earners, SMEs, businesses, students, parents, and more, and who can academically ‘theorise’ as if this one scourge, this one source of danger, this one ‘possible’ source of extremely mild mortality is somehow ‘more important’ than all the deferred medical care, vaccinations, screenings, suicides, destruction of livelihoods, undermining of national vitality. Why? What makes this matter more? Just because there is a chorus of global hysteria?

And again, countries with largely open economies have flourished in Asia, with only targeted interventions: Taiwan, Hong Kong, Japan, South Korea, Singapore, Vietnam, Cambodia, elsewhere Belarus, the strange outlier Sweden, but also Norway and Finland. Why don’t we emulate these? We are instead opting for prescriptions no one is suggesting (curfew), applying panic thresholds that would not apply anywhere else (mortality is the final and only really relevant metric here, as we are trying to avoid ‘deaths’ surely not asymptomatic ‘cases’), and why? With no bullshit, and without inserting the words ‘medical experts’ in a sentence, using facts, data, logic, could anyone anywhere kindly explain?

We are told this is a new strain, and a ‘simple sneeze’ can spread ‘billions’ of particles compared to ‘100,000 particles’ seen earlier? What is the medical basis for this claim? Measured how? Demonstrated where? And if you have the right distance, and the person sneezes into their elbow, and most people are not susceptible anyway, who cares? 

If it’s ‘more dangerous’ then why the very tame correlation to date between mortality and these cases? 12,000 again die in Lanka each month from various recurring causes. Also, COVID-19 compared to its SARS predecessor is far more contagious, and mercifully, far ‘less’ lethal. So when we say ‘dangerous’ we mean ‘more contagious?’ If so, if the lethality doesn’t really change it doesn’t really matter. SARS was many times more lethal (9% IFR, along with MERS with a whopping 37% fatality rate) but the combined number of global infections was 10,617 as best we know.

And some sobering global costs

We really must beware lest we emerge with a chronic intolerance for the nature of biology, as we cannot survive that confusion going forward.

An older friend advises that when she was a kid, there was no MMR vaccine, and children were expected to get measles, mumps, chickenpox, and rubella as a matter of course. They obligingly did, not without danger, and immunologically we moved forwards, until vaccines stepped in to lighten the load.

Most of us have had recurring flus, we know we can contract whooping cough, meningitis, TB from others. I never recall being advised to wrap ourselves in cling film, lock ourselves in a closet with towels across our faces. We now find the ‘rigours’ of human interaction, which carry joys as well as some risks, intolerable. We look at each other first now, not as a source of inspiration or engagement for example, but as a source of potential infection. 

So ‘zero’ cases or positive tests are all that will do? Then we’re done. For that delusion we would have to ‘only’ sacrifice our work, our lives, our friends, live performances, plays, restaurants, weddings, funerals, birthdays, family celebrations, and convert our cultural zones into surreal ghost towns (already happening). No festivals, beware dentistry, or a massage, no travel. Really, is that even worth it? Can we call it ‘life?’

‘Lockdown’ was never a part of any public health playbook until now, it applied to prisons, and if that is officialdom’s kneejerk response to any contagion or emergency, perhaps we should all take to the hills, and create our own communes.

Cost-wise we have spent trillions globally, literal trillions on shutdowns, quarantine measures, distancing, sheer business cataclysms. One more like this, and we literally could not feed ourselves, or have money for healthcare. And this ongoing expense, dwarfs any healthcare ‘danger,’ our crazy intemperate spending for a mildly lethal pathogen that has rendered us deranged.

So, Lanka should heed the President’s warning, and should remove the panic porn from our prognostications. There will be a new contagion, and one after that. We cannot keep sending national debt soaring, devastating small businesses, paralysing Government, ultimately undermining healthcare (which requires economic resources), and cancel indefinitely the civil liberties and human dignities of a free, democratic people. Bombs, tsunamis, wars, none of them ever did this. It would be truly tragic if our misguided fears inflicted what actual horrors never could.

Let us vote for the future, let us underwrite it with our resilience. And let’s let this pathogen find a more balanced place in the inventory of our challenges.