Debating the Progress of Covid-19: Vibrant Viewpoints

                                

While the Email Discussions below have developed from Malik Magdon Ismail’s modelling of the likely chart for Sri Lanka, the items beyond ÖNE” have been responses to that article viz, https://thuppahi.wordpress.com/2020/04/24/prediction-covid-19-in-sri-lanka-heading-for-peak-in-august/#more-41891….

ONE: A Comment from “Fair Brit,” mid-April 2020

Do you get emails from Information Clearing House? Interesting article below (click on the

relinkto subscribe) …. http://www.informationclearinghouse.info/55075.htm. As I

mentioned to you,many countries are including deaths from other diseases, (e.g. coronary

heart disease, cancer) in thefigures for corona deaths. So: they are included in the corona

death figures if a person died WITH corona (in their body), rather than died OF corona.

How can we possibly know the truth about this?

TWO:  Visit Chandre Dharmawardana: “Is complacency marring Sri Lanka’s

Covid-19 effort?Fatality figures and the number of “confirmed cases” =

https://thuppahi.wordpress.com/2020/04/25/sri-lankas-problematic-covid-data/#more-41951 …… AND  Gerald H Peiris: “The Problem with Spatial Diffusion Models,” https://thuppahi.wordpress.com/2020/04/25/the-problem-with-spatial-diffusion-models/#more-41914

THREE: A Comment from “Fair Brit,” 25 April 2020

I have just read Dr Chandre Dharmawardana’s interesting article on Thuppahi.1

Put this together with other articles, and the only conclusion I can come to is that we

can’t really take seriously any of the figures being bandied around. Not only in Sri

Lanka (SL), but worldwide. Dr Dharmawardana referred to articles by Prof. Prasanna

Cooray and Prof. Marc Lipsitch.2, 3

Since then, you will see that cases in SL did indeed rise, and, I believe, for the moment

will keep on rising. As of 25 April 2020, we have 452 cases, and 7 deaths, from Covid-19,

that makes the death rate 1.55% (no longer 3.2%) so that’s already halved.

It’s an ever changing situation, but, more importantly, the situation is not being reported

accurately. I can’t comment on how deaths are identified and recorded as a fatality from

Covid in SL, but in many countries (eg Australia, the UK and the US) they are recording

anyone who died WITH Covid, as a Covid death, rather than those who died OF Covid.

That is to say people who went into hospital with pre-existing medical conditions and

died are included in these figures. So if people die of Ischaemic Heart Disease, Diabetes,

Lung Disease, Cancer, Hypertension, Asthma, Kidney Disease, and Liver Disease, etc,

they are being included in the number of fatalities from Covid, whereas realistically

they most likely would have died anyway from those conditions. But because they

happened to be Covid positive, they are counted in the numbers of fatalities from

Covid.4 You can see why we therefore can’t know the correct numbers.

The SL authorities seem to be dealing extremely well with a difficult situation. It is,

however, a little concerning the way people are being quarantined. “In quarantine”

should mean “in isolation”, in order to prevent a disease from spreading. You saw

from your previous article about Dr Lucien Jayasuriya’s experience5, that the people

being quarantined were in a dormitory type room, in bunk beds, breathing the same

air, (though he and his wife were in a separate room) where the virus could have

easily spread to all of them, if anyone had it (fortunately they didn’t). The isolated

people were asked how they were feeling and temperatures were recorded twice a

day, they were not actually tested for Covid! In fact evidence from other articles

suggest monitoring people’s oxygen saturation is a better indicator than measuring

temperatures, since many patients appeared normal and were having a normal

 

cases as low as 20-30%)6, 7. Normal oxygen saturation in a healthy person should be

around 95-98%. It was evident that the quarantined people were treated very well,

albeit not in isolation, which was the reason for them being detained.

Then let’s throw into all of this, the batch of testing kits which were headed to the UK that

were found to be contaminated with corona virus.8

Then we have a country leader allegedly proposing injecting disinfectant into people to kill

the virus!9

The articles and videos are out there, you only have to search for them.
So much to consider, how can we ever know the truth….

Bibliography:

  1. https://thuppahi.wordpress.com/2020/04/25/sri-lankas-problematic-covid-data/
  2. https://www.thelancet.com/journals/laninf/article/PIIS1473-3099(20)30245-0/fulltext
  3. http://www.island.lk/index.php?page_cat=article-details&page=article-details&code_title=221296

4.https://www.realclearpolitics.com/video/2020/04/08/dr_birx_unlike_some_countries_if_someone_dies_with_covid-19_we_are_counting_that_as_a_covid-19_death.html

  1. https://thuppahi.wordpress.com/2020/04/17/experiencing-a-quarantine-camp-in-sri-lanka-an-incoming-doctor/
  2. https://www.nytimes.com/2020/04/20/opinion/coronavirus-testing-pneumonia.html
  3. https://www.medscape.com/viewarticle/928156
  4. https://myfox8.com/news/coronavirus-test-kits-meant-for-the-uk-found-to-be-contaminated-with-covid-19/
  5. https://www.bbc.com/news/world-us-canada-52399464

A COMMENT from Lakshman F. B. Gunasekara, 26 April 2020

Most interesting discussion. Some quick thoughts by a veteran journo and

commentator after years of reporting disasters, riots, wars, racism and

authoritarianism (have also advised/taught disaster communications) :-

1) Need for Pro-active testing as well as reactive testing (i.e. on symptom

): Pro-active testing would be done on selected human cohorts designed to identify

current numbers of infected people, their geophysical locations, their potential

geophysical directions their physiological vulnerability to COVID-19, and their social

transmission directions and frequency. I believe the GMOA and other medical

specialists are advocating pro-active testing. I am sure they have their scientifically

formulated objectives for such testing which would be far more precise than those

I have listed above.

2) Issue of correctly identifying direct COVID-19-caused fatalitiesUnless all

human deaths are examined for COVID-19 infection and examination (either while

alive or post-mortem), we can NEVER have a full quantifying of actual COVID-caused

fatalities. At present the COVID fatalities in SL only those found COVID-positive and

whose deaths were medically monitored. Also, there is inadequate information

being provided to the local news media industry (Web, electronic, print etc) on the

COVID tally – e.g. when positive cases are identified only occasionally are the locations provided and their circumstances (e.g. whether the new cases are part of existing ‘contact’ circles or entirely new ones).

3) Ideological challenge :- Valuation of COVID-19’s impact on society (social,

economic, political) :  Different country political leadership are making their own

valuations when assessing depths of societal impact and devising both counter-measures as

well as long term recovery measures. I have impression that the more socially

collectivised nation-states (collectivised for whatever reason) seem to be handling

the epidemic better than the classically individualist-capitalist-modernist

nation-states/regional groups (i.e. EU).

See China, S. Korea, Vietnam. I think part of the reason for Sri Lanka’s own partial

success so far is also this socio-political element.  Thus, we have the classical ‘advanced capitalist’

societies (EU., US, Japan) preferring to take enforced state regulatory measures (as

opposed to be ‘advice’ and ‘guidance’) ONLY after relatively large numbers (in the

100s) of actual COVID fatalities. The London FT newspaper over a month ago

published a graph showing when countries began to go into various types of  lockdown – China began such measures

after just 30 fatalities! SL began controls even before a single fatality. The political

and technocratic discourse in the media in the advanced capitalist Western powers

has been dominated by the weighing of the number of fatalities against the

importance of keeping the economy running. In SL there was at least one serious

columnist commentator (from the economics side) who argued strongly for continuing

economic ‘normalcy’ despite the death rate arguing that the deaths PER POPULATION

should be the criteria for economic strategy decisions and that SL need NOT go into

full curfew and suspension of normal life. Just yesterday, the Mayor of an American

mid-West American city  (Las Vegas??) argued on CNN TV that given the ratio of

fatalities PER POPULATION fatalities, she was right to revive normal socio-economic

life and re-open pubs, casinos, salons etc etc as the size of the population hit by the

lockdown  did not justify continued economic disruption. Sadly, Sri Lanka seems caught in-between these two approaches. While, true to our yet partially traditional collectivised socio-cultural formation, the

country instinctively went into lockdown relatively early in the COVID cycle, and we

can see its benefits, subsequently, for some reason/s (I could guess), there has been a

failure to sustain

counter-measures and take them to the next  levels despite much

advocacy/lobbying by the technical experts (including the GMOA!). I

am perplexed by this failure by a regime that to date has seemingly pursued (even if

partially) a more technocracy-based governance (even the military is a technocracy)

approach especially in relation to epidemic response.

Of course, although a longtime observer and reporter, in this area of a massive epidemic

disaster-crisis, I am a novice and await comments.

Lakshman.

2 Comments

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2 responses to “Debating the Progress of Covid-19: Vibrant Viewpoints

  1. arthur duff

    Dear Dr Roberts

    I hope this finds you safe and well in these difficult times. I am writing to you from Ireland where we are all in “lock-down”. By way of a distraction I have been delving into family matters. In the early part of the 20th century it was very common for Irish people to enter the colonial service and our family, on both sides had numerous members who served in some capacity in India or Ceylon. How I found your blog was in reference to my grand uncle James Devane – my mother’s uncle from Limerick – who was the author of a report on the 1915 riots which you referred to in one of your works.

    I understand he was stationed in Ceylon for some years, perhaps as a judge? He later returned to Ireland and took up another profession, becoming a dispensary doctor in the poorest part of Dublin.

    Do you happen to know anything else about him?

    When I am not in Ireland I am attached to CEPT University in Ahmedabad — where I qualified as an architect in the 1980’s – in Gujarat, India. I have great admiration for the wonderful architects of the 20th century from Sri Lanka and had planned to have a photographic exhibition on the work of Geoffrey Bawa which did not materialise unfortunately.

    With kind regards

    Arthur Duff

  2. chandre Dharmawardana

    Regarding fair-brits ‘s comment.
    1. It is true that confirmed fatalities include co-morbity effects. But this is not too hard to correct (to first order). Thus INSEE in France publishes figures for “all deaths” in France from 1 March – with a 10 day publication delay. The latest data are up to 13 April. Compared to the 2018-2019 average, they show an “excess mortality” of 14,735. The French govt estimate for Covid-19 deaths on 13 April was 14,697 – so a minor correction. We also have usual death trends for age groups etc., and corrections can be applied. One usually finds that these corrections are smaller than the error bars on CFR. See my note 3 below.
    2. The life expectancy of a healthy person over 78 is zero in North America. So, from an actuarial point of view, a fatality can occur from any cause after 78 and the cause of death is taken as the immediate “straw that broke the Camel’s back”.
    3. To make a remark on the uncertainty in evaluating CFR (e.g., using different definitions, see American Journal of Epidemiology, 2005; 162: 479-486) I think a more realistic value for the CFR today in Sri lanka is 7/250=2.8% because although the reported “confirmed deaths” stand at 460, one must remove from this number those found in dedicated quarantine centers, because such finds are not active sources of infection to the populace. These are what I call confirmed PUBLIC cases. So, there is room for many more discoveries of hidden infected people among the PUBLIC, without reaching the canonical CFR value (which is what ever your favourite number is, in the range 1-2%). Perhaps the number 7 for fatalities is wrong. As “fair-brit” has stated, it may be affected by co-morbidity effects, but 7 is too small a number to correct for co-morbidities using statistical trends.