Appraising the Corona Pandemic in Kandy District: A Critical Survey

Gerald H.  Peiris, whose chosen title was “The Corona Pandemic in Kandy District: A Critique of Responses”

This article presents a grass-roots perspective, empirical in content, on the efforts to counteract the Covid-19 in the highland District of Kandy, set against information extracted from several published sources. As a guide to the sequence in this narrative I should explain that it begins with some introductory notes on the Corona pandemic and on Kandy District, proceeds to sketch the edifying experiences such as the guidance bestowed on people by their religious leadership, the priority accorded by the government on the management of affairs from perspectives of health-care, the selfless commitment of those on whom arduous responsibilities of implementing policy decisions and prescribed strategies, and, in general, the commendable level of successes achieved through the related efforts. Thereafter I focus on the disappointments and the occasional errors of judgement, the sporadic scenarios of prejudice and confusion, and the looming uncertainties. There are significant lessons that could be drawn from both these sets of experiences.

Covid-19 Pandemic: Sri Lanka in the Global Context

The phrase ‘Corona Virus’ refers to a group of viruses that infect humans and animals. The label ‘COVID-19’ is attached to a recently identified and relatively more contagious pathogen in that group. There is a widely held (but persuasively refuted) belief that COVID-19 epidemic was first publicly reported in Wuhan (capital city of the Province of Hubei in the Republic of China) on 31 December 2019. Alternative interpretations of the origin (venue and time) and spatial diffusion of Covid-19, formulated on the basis of both serious research outcomes as well as reasoned speculation, include the works by microbiologists with impeccable scholarly credentials like Quijano, 2020 and Forster et. al. 2020. Regardless of the eventual outcome of such disputes at the plane of research, it might eventually be possible to trace the origin of the present calamity to the relentless pursuit by the main global powers to acquire diabolical weapons of mass destruction.

The first victim of Covid-19 in Sri Lanka – a young woman from China on holiday– was reported on 27 January 2020. She was promptly admitted to the National Infectious Diseases Hospital (NIDH), and effectively treated. Her departure for China was preceded by a poignant farewell ceremony that involved a charming display of maternal affection by the Minister of Health in the presence of the National Infectious Diseases (NIDH) nursing staff which was, more than all else, a reiteration of the close and cordial relations that had prevailed between Sri Lanka and the People’s Republic of China since the early 1950s.

In 2020 the Covid-19 intrusion happened during the “honeymoon phase” (first-one-hundred days) of Gotabhaya Rajapaksa’s presidential incumbency. He had been elected to office in mid-November the previous year, generating among those comprising his support-base hopes for prosperity, stability and peace in the years ahead. Meanwhile the Corona epidemic in China was emerging in importance as a disconcerting item of news in Sri Lanka, gradually replacing other media concerns such as malpractices of the previous regime, search for perpetrators of mass murder on Easter Sunday last year, arrogant disregard by the Swiss Embassy in Colombo of diplomatic norms between friendly countries, and the intensifying United States’ pressures for acceptance by the GR-led government several draft agreements which, if ratified, could jeopardise Sri Lanka’s rights as a sovereign nation-state.

The national parliament, then in the final phase of its stipulated five-year tenure, remained under the control of political parties arrayed against the new president. Accordingly there prevailed severe constitutional restrictions on presidential powers and functions in the executive branch of government. But, with the formidable opposition alliance (led by the United National Party) disgruntled after its defeat in the presidential race, and in disarray due to internal machinations, there were expectations among many in the Sinhalese segment of the electorate that the impending parliamentary elections (scheduled for late April 2020) will facilitate a consolidation of the new government with a substantial majority in the legislature. Meanwhile, there was a contrary hope among the leaders of the opposition that if they unite, forming a ‘national front’ consisting of all parties opposed to the GR regime, they could secure parliamentary control at the polls, and thus lay claim to the post of Prime Minister and to a large segment of real executive power.

 

 

It was in this state of conflicting expectations in electoral politics that President GR and his inner circle of loyalists (including his uniquely charismatic brother, the former president Mahinda Rajapaksa), and his appointees to other key posts at the apex of government had to turn their attention to the Corona epidemic which by early April had assumed the form of a deadly global pandemic (Figure 1). In this they also had to face a series of other overlapping impediments among which the most intractable were: (a) a debt-ridden economy more dependent than ever before on foreign trade and aid, and on tourism and remittances of earnings by the expatriate workforce, (b) a plundered treasury, (c) the barely concealed hostility of the more formidable NATO powers and their satellites, and (d) the economic havoc caused by the Covid-19 pandemic to Sri Lanka’s genuine ‘friends-in-need’ – especially China.

Sri Lanka on the 10th of February, there were only 14 suspected ‘Corona’ patients  in quarantine, and only one confirmed case, against the backdrop of 37,558 quarantined, and 813 deaths worldwide. Despite those at the apex of government being concerned with their electoral aspirations, the authorities of the health services, acting on presidential instructions, were getting their act together to meet the Covid challenge. They established eleven hospitals especially manned and equipped to admit and treat suspected Corona patients. At the Colombo International Airport, thermal scanners and a 24 X 7 help-desk were installed. Data on all in-coming passengers were systematically documented. The realisation also dawned that in the weeks ahead arrangements need to be made for many thousands of our citizens living abroad (as migrant workers or engaged in higher studies in countries) to be brought back to Sri Lanka, and for the country’s visitors to return home.

It was in the second week of March that the perilous upsurge of Covid-19 really begin. It indicated that Sri Lanka might plunge into a dreadful  abyss similar to some of the most economically advanced and culturally alluring nation-states such as Italy, Spain and France, unless measures far more drastic than those already in place were soon adopted. Thus, acting with a sense of urgency, the government ordered the closure of universities, schools of all types, and state-sector institutions except those performing essential services. Gatherings were prohibited. Private entrepreneurs in retail trade were advised and, a few days later, ordered, to engage in business only if and when the all-island curfew is stringently lifted. Immigration and emigration via air ports and harbours were reduced in stages leading to an almost total ban on incoming and outgoing air traffic by 5 April.

For conveying to the people the government’s advisory services aimed at curtaining the corona infection, there is, since early March, a parade of diverse professionals repeating the same litany of advice on individual and collective safety measure that need to be adopted. The responses of the government through its medical and sanitary services, when contextualised in the prevailing resource scarcity, were quite impressive. Mini teaching and training sessions were held for emergency staff, and hospital space was made available to isolate suspected patients until they were transferred to quarantine centres. Twenty-six among the larger hospitals were made ready to treat Corona-infected patients Sinks with taps, soap/disinfectants were installed outside every hospital and supermarkets. Large teams of sanitary workers were mobilised for fumigating/decontaminating places at which the public needs to congregate for purposed of travel, shopping and obtaining essential services.

The Security Services were functionally reoriented towards implementing a multitude of government decisions relating to the pandemic such as: (a) curfew restrictions, (b) bans on inter-district travel, (c) community-level isolations (by early April there were in all 5 such localities),  and (d) the arrest and incarceration of curfew violators. More burdensome than all else were their functions relating to the setting up Quarantine Centres to accommodate 15,000 immigrants during the first fortnight of the month (and more arrivals in the weeks ahead), as well as the ongoing increase within the country suspected of exposure to Covid-19 infection. These centres were required to provide their inmates all services (food, lodging, medical care) at a satisfactory level of comfort and well-being. Self-imposed quarantine of entire households was selectively resorted to as determined by security and sanitary services officialdom.

Edifying Experiences and Achievements

Epitomising a prominent feature of the unique cultural heritage of Sri Lanka, the  venerated prelates of all the main religious faiths in the country made profound efforts to enhance amity and concord among the people, especially in the nation’s combat against the Covic-19 invasion. Moreover, the most venerable chief incumbents of the three Buddhist Nikāya (sects) issued a joint statement advising people to refrain from congregating at any of their shrines for performing rituals as long-established traditions of worship demand. The prelates of Malwatta and Asgiriya conducted a series of exemplary devotional ceremonies, chanting the Rathana Sūtra at the ‘Temple of the Tooth Relic’ to invoke the blessings and protection of the people from the virulent pandemic, thus following a primordial Buddhist traditions dating back to the time of the Buddha. His Eminence, Cardinal Malcolm Ranjith, who, over several years had been at the vanguard of efforts at promoting inter-religious unity, announced a decision to suspend church gatherings not only for Sunday worship, but for any other purpose, prioritising the need for safety of the people above all else. Prelates and leaders of other Christian denominations, the Muslims and the Hindus advocated similar precautionary measures.

Sri Lanka has a longer tradition of commitment to government-sponsored social welfare, especially those of health-care, education and poverty alleviation, even at the expanse of retarding economic growth. Thus it was no surprise that the government promptly channelled the bulk of resources at its disposal to protect the people from the deadly pandemic. In implementing the related measures it encountered (apart from the general impediments referred to at the outset of this study) other formidable problems such as: (a) the presence in Sri Lanka of a large number of tourists from a variety of sources, this being the height of the country’s tourist, and (b) manpower limitations to handle the unprecedented crisis which the pandemic represented.

In statistical tables and graphs such as those presented above as Figures 1 (above) and Table 1 that depict Covid-19 morbidity and mortality rates, Sri Lanka has hitherto been placed among the countries least affected by the pandemic. The inter-country comparisons based on raw aggregate enumerations, however, contain distortions of the real intensity of impact of Covid-19. Overlooking unknown distortions due to under-reporting especially in remote and poverty stricken parts of large countries like India, Pakistan and Indonesia about which nothing could be done in statistical analysis, it is possible to adjust national totals to per capita values for the necessary comparisons, as done in compiling the following Table.

Table 1 – Selected estimates of Corona-related morbidity & mortality

 

World/selected country  

Total Population (in millions)

 

Reported Infections

per one million

of population

Reported Deaths

per one million

of population

World 7,776 193.61 11.49
India 1,390 4.23 0.12
Pakistan 221 19.48 0.28
Bangladesh 165 1.24 0.10
Indonesia 274 10.89 0.85
Thailand 70 32.41 1.16
Malaysia 32 129.16 0.53
Sri Lanka 21 9.14 0.29
Source: These estimates are based on data extracted from https://www.worldometers.info. which publishes daily updated values as published on for 8 April 2020.

Note:     There is a likelihood of the estimates on the large countries being adversely affected by under-reporting. Sri Lanka values are probably the least distorted among these estimates.

 

When set against the backdrop of my earlier observations on Sri Lanka’s excessive locational, economic and cultural exposure to the world outside, the low per capita rate (see the data tabulated above) that has hitherto been maintained through the country’s efforts to counteract the pandemic must be considered highly satisfactory. It has, indeed, been commended by those at the highest levels of the World Health Organisation, and the European Community Covid-19 monitoring agency.

There is reason to state that those responsible at all levels of government for the aforesaid achievement (policy makers, implementing agencies, especially the truly heroic and selfless healthcare staff of the Ministry of Health) deserve our utmost gratitude. From such a perspective we need to note that Sri Lanka has avoided the type of public pandemonium and collective despair witnessed in some of the most affluent countries of the West despite their possessing an abundance of resources including those of health-care technology. In addition, the performance by our security forces demonstrate to us and to the world at large how and why they won the “unwinnable war” against the LTTE (as it had been described by military experts) within the framework of the same humane paradigms as their co-workers in health-care.

According to a recent World Bank estimate the Corona pandemic will push at least about 500 million people worldwide (i. e. roughly 7% of the global population) into a state of acute poverty and destitution. It is hardly likely that Sri Lanka will be spared a process of impoverishment of proportionately similar magnitude, given the essential features of the economy and the predicted economic recession in our foreign markets and sources of aid. It is with these considerations in mind that we need to evaluate the relief measures of the government targeted at the low-income segments of the population.

Initially, the various macroeconomic fiscal concessions granted by the government in order to reduce the spiralling cost of living and to ease the burden of those indebted to banks and finance companies had, at best, only a marginal impact. Imposing price controls of essential consumer goods, distribution of dry rations among the poor, Samurdhi Programme payments etc. did not appear sufficiently effective. But, in the recent weeks, there have been signs of improvement in some of these direct poverty-alleviation efforts. More about this, later in this study.

To turn now to Sri Lanka’s comparative level of success in controlling the pandemic, there is the ‘flip side of the coin’ of utmost relevance that must also be borne in mind. In many of the more contagious viral infections, past trends and international comparisons thereof fail to provide an adequate basis for predictions. Nevertheless they receive wide media publicity  and serve at times as ‘expert inputs’ for policy-making in matters such as the imposition of curfew restrictions or organising relief measures. What should hence be emphasised is that Sri Lanka, along with other nation-states, will be venturing into the unknown in the weeks and months ahead, at least until a proven system of immunisation is found, produced in adequate amounts, and distributed worldwide at an affordable price.

The foregoing observations do not constitute a denial of the fact that there have been, at least from about the mid-19th century, several theoretical postulates (‘Statistical Models’) applied to the study of diffusion of disease-causing pathogens that engender epidemics. The more recent among the studies of this genre have involved computerised analysis of a mass of empirical information of the type which, unfortunately, is just not available for any country, leave alone Sri Lanka, on the prevailing pandemic.

It is mainly with the foregoing consideration in mind that decision-making pertaining to restoration of norms in our daily lives be made. Following my return to the Peradeniya University Council since being evicted in the aftermath of the presidential election of January 2015, I am particularly concerned about the decision to reopen the university in a staggered process during mid-May, according priority to students in their final year. Even is the bringing in of other undergraduates is delayed beyond may, the consequences of the likely overcrowding in the halls of residence (rooms, dining halls, latrines, canteens) should not be ignored, even if it is possible to ensure total compliance with all ‘preventive practices’. We also know that ‘joint-cramming’ and informal “kuppiya” discussions are a very common feature in the periods leading up to examinations.

There could hardly be any doubt or dispute on restrictions that have been imposed on inter-district travel and transport of goods within the country and in the form of selectively imposed curfews from about mid-March 2020 in the early stages of the Covid-19 menace in the island have had the desired impact of retarding the rate of increase of the pandemic. That they represent measures reluctantly adopted in the interest of the people is also universally accepted. Yet there are certain questionable features in their specific modalities – those relating to the use of the district spatial frame, the intervals in the curfew calendar, and other specificities of the related regulations– that need to be raised, and on which clarifications must be sought.

Observations on Kandy District

To illustrate, Kandy District (7% of the country’s population & 1,940 km2) was placed in the category of “high risk districts” when two persons living in the bustling township of Akurana (about 8-9 km to the north of Kandy City) tested Covid-19 positive. The dispatch of 114 to the Quarantine Camp at Punani those who had associated with the infected persons, and the total closedown of several Grama Niladhari (GN/village officer) extending over the urbanised parts of the Akurana ‘Divisional Secretary Area were measures immediately implemented. Meanwhile the district total of corona-infected persons increased to 7.

Detailed information obtained from the “locked down and isolated” parts of Akurana indicate that all 7 infected persons were inhabitants of two localities within the GN areas of Bulukhotenna and Kasawatta (named in Figure 4), each of which has a resident population of about 2,500.

 

Figure 4 – Bulukohotenna & Kasawatta GN areas are located to the east of

the Kandy-Matale highway, less than 1/2 km from the Akurana ‘Grand Mosque’

The questionable (but not necessarily disputable) aspects of the aforesaid official responses to the Akurana calamity may be rendered as follows:

  • The eviction at short notice of a large number of persons – men women and children – from their homes and dispatched to unknown destinations, following what could have been no more than a hastily conducted survey on their inter-personal associations over the 2 previous weeks (supposedly the incubation period of Covid-19) –please ask yourself how many and whom you associated with during the past fortnight; this survey, remember, was conducted before the clamp-down occurred– was undoubtedly a traumatic experience at an individual plane that could remain for long a collective grievance in the community at large.* It must also be remembered that those so evicted in military fashion were not comparable to the rescue of many thousands of civilians in the concluding phase of the Eelam War from untold hardships they had suffered under the jackboot of the ‘Tigers’. Were there alternative modalities that could have been adopted at the township of Akurana where a total shutdown and isolation were already in force?

* This is not mere armchair guesswork. With my field studies that culminated in the gook published last year, and with my very long association with the university, I have a fairly large network of personal contact (mainly by ‘phone in the past few weeks).

  • In the context of the fact that sealing-off and isolating Akurana was to remain indefinitely, was there a genuine need to clamp down a never ending curfew over the entire district of Kandy, placing it among the “high risk” parts of the island? In doing so, did the authorities take a close look at the spatial configuration of Akurana vis-a-vis ‘non-high risk’ adjacent districts such as Kurunegala and Matale, and compare the same in relation to, say, Ganga Ihala Korale or Pasbage Korale tea plantation Divisions of Kandy District before making such a drastic decision?
  • It is true that there are several fairly large Muslim communities around the city of Kandy among which Akurana is the largest. Was that the reason for the belief that the entire district is at “high risk”? If it actually was the reason, did the decision-makers overlook the fact that they had sealed off Akurana, presumably in a manner which Covid-19 cannot breach?
  • Likewise, in the wider context, there is reason to question (using Kandy as an illustration) the rationale of enforcing a ban on inter-district travel and conveyance of goods. Satellite imagery and recently published maps indicate that there are 6 inter-district highways, at least about 18 other roads of the ‘B’ category, and innumerable minor roads that are motorable, traversing the boundaries of this district. If the transport ban referred to is to be genuinely enforced round-the-clock, all over the country, it requires the services of a large contingent of security personnel distributed placed at a very large number of points along inter-district boundaries. This, in turn, raises several issues, the most significant among which is whether the security manpower employed for the inter-district transport ban could be mobilised for more effective action to isolate and to provide various essential services in and around the sealed-off communities such as these Akurana, Atalogama (Kalutara Dt.), Kadayankulam (Puttalam Dt.), Suduwella (Gampaha Dt.), and several localities in Ratnapura Dt. and Beruwala? Such an alternative strategy, adopted as an option to installing the patently futile inter-district barriers, might have been more effective, less costly and, above all, far less burdensome for the people at large. The authorities, especially those at the highest levels, must realise two basic realities – one, that there is seething anger among the people for the hardships they suffer during any major hazard, and a tendency among them to hold the government responsible for their suffering; and the other, the repeated mass media incantation that everything is done in utmost benevolence in order to protect the people from the pestilential Corona virus is fast becoming less and less effective. Given the present circumstances, they must also take into account the likely electoral consequences of what they do.

There is, in my understanding, a serious error of judgement in the hasty removal of the interdiction of the two police officers who administered their version of corporal punishment to the youth, an act of brutality and a violation of the law. These have received wide media publicity. Moreover, the official spokesman for the police made an absurd announcement (also widely publicised) that their interdiction was lifted because the violence they unleashed was not premeditated! This is certainly a serious blemish of the otherwise norm of benevolence and firmness that features the performance of police functions during this calamitous time. Ordinary people have begun to refer to the contrast in the action of the two police officers and the way they have been reacting acting to the tragicomedy of Ranjan Ramanayake on more than one occasion.

Direct poverty alleviation has hardly ever been comprehensively effective anywhere in the world. In calamitous circumstances such as those prevailing at present, the inadequacy of the offers, the targeting errors, and malpractices such as favouritism and discrimination in the chains of implementation tend to nullify preventive and corrective measures which the ultra-poor observe, but are compelled to suffer in silence.

The restriction of the people’s access to retail sales outlets of medicines in the early stages of the government’s anti-Covid-19 drive, and the blatant disregard of the patients’ needs by the state-sector Osu Sala network of drugs and pharmaceuticals, were tantamount to criminal callousness. Was this deliberate sabotage? Redeemingly, the blunder of compelling private pharmacies to close down has been somewhat belatedly rectified. The announced system of postal delivery of medicines could be no more than a massive farce in the well-known context of the fact that even in ‘middle class’ residential localities of towns like Kandy, postal delivery is excessively erratic even at normal times. Do you know why? As the Post-Master in Kandy himself told me, many of these fellows cannot read!

The restriction of patients’ direct access to curative health-care outlets was an unavoidable measure that had to be adopted taking into account both excessive overcrowding of ‘outpatients’ at the hospital premises as well as the virulence of Covid-19. Yet, there was the possibility of installing (at the vacant school and university premises, for instance) temporary screening procedures manned by relatively junior doctors and interns (which is often what really happens to ‘First Visit’ clinical patients at hospitals), and intensively supervised by security personnel to ensure prevention of the usual scramble – a duty which the police perform quite efficiently at urban supermarkets.

Finally there are the massive inadequacies in certain responses of our people to the government’s efforts to improve safety precautions in their behaviour, avoiding scramble at the large open-market venues such as those of the Central Market in Kandy, of the Manning Market in Colombo. What we need to remember in this context is that voluntary formation of queues at, say, passengers boarding trains and buses, clients engaging in administrative transaction, or bargain-hunters at ‘clearance sales’, survival-of-the-fittest is the behavioural norm (not confined to Sri Lanka). Thus, the inculcation of practices such as maintenance of the prescribed minimum of one-metre interpersonal distances, wearing protective masks and coughing and sneezing towards one’s own breast and armpit, need to be ‘policed’. Moreover, the defiance of curfew restrictions in the form of outdoor frolics and partying or daredevil one-upmanship at highway checkpoints, though infrequent, have not been eliminated, despite well over 26,000 arrests and incarcerations of the culprits within about 3 weeks. A management-level employee of a Cooperative Wholesale Establishment who had pilfered a large stock of consumer items from the supermarket of which he was apprehended by the police. A few instances of hoarding and profiteering by tradesmen have been detected and exposed. These retail market malpractices, however, seem less frequent in occurrence now than they were in certain spells of natural disasters of the past probably due to greater police vigilance.

ATTACHMENT 1

Reported Cases of Covid-19 Infected Patients as on 11 April 2020

Compiled by Dr. A. S. M. Nawfhal

ALSO NOTE

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