Sri Lanka and the Pandemic

by Michael Patrick O'Leary

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One reads a lot in the western press about how badly the UK and US governments are coping with the Covid19 pandemic. One of the UK’s diplomatic strengths has long been its international advocacy for global health, and its current poor domestic performance may cause other nations to think again about the prestige accorded to Britain. Britain’s embarrassing failures undermine its soft power in the international arena and ‘less-developed’ nations may be even less willing to listen to British ‘advice’ on health and, indeed, other matters.

A few weeks ago, Sarah Hulton OBE, UK High Commissioner to Sri Lanka, went on Facebook to advise any British citizens still loitering about in Sr Lanka to hie them hence smartish. She noted that some British passport holders were in Sri Lanka visiting family. She reiterated the UK Government advice that all British nationals who normally live in the UK should return to the UK now. She wrote: “Serious outbreaks of coronavirus are placing a significant strain on health services globally. In the event of a serious outbreak in Sri Lanka, consular services and flights out of the country could be seriously affected. We cannot guarantee what flight options might be available if people choose to leave at a later date.” I well remember that after the tsunami, UK “consular services” were as helpful as the proverbial chocolate teapot.  If these lingerers, who probably see themselves as Sri Lankans, want to stay with their families in Sri Lanka in this difficult time, why tell them to go to the UK to add to the UK’s burden? One person wryly asked why the High Commissioner was sending fellow citizens to the UK to a death sentence.

 

Imperial Arrogance

Was the High Commissioner really saying “get back to Blighty soon because when it really hits the fan these damned colonials won’t be able to cope with it”? It should be noted that many of those doing their best to cope with the crisis in the UK are immigrants. Most of the NHS staff who have died, including a Sri Lankan, Dr Anton Sebastianpillai, were immigrants, immigrants who survived the “hostile environment” created by Theresa May but perished trying to save others. One nurse who died had been photographed with Boris Johnson. He has been highly irresponsible in spreading the virus and has the Galle Face to praise the NHS for saving his life.

Exploitation of Immigrants

Foreign staff working for the NHS actually have to pay the UK government for the privilege of working. This surcharge is £400 a year and was due to increase to £624 until Keir Starmer raised the issue at Prime Minister’s Questions on May 20. NHS and care staff already ‘contribute’ to the cost of the NHS through their taxes, and this surcharge effectively taxes them twice. According to Paul Waugh of Huffington Post, some NHS trusts are so incensed by the iniquity of the surcharge that they actually pay it on behalf of their staff. Johnson bumblingly admitted at PMQs that foreign NHS staff saved his life but insisted that the £900 million the surcharge brings in was indispensable to the nation. A spokesman admitted to Huffington Post that he didn’t know how much NHS and care workers actually do pay, let alone the healthcare costs of foreign worker. A spokesman later said: “The PM has asked the Home Office and Department of Health and Social Care to remove NHS and care workers from the NHS surcharge as soon as possible”.

Confusion Rule the Waves

As I write (May 22) people in the UK are totally confused by the government’s latest guidance. Boris Johnson is coming under increasing criticism for the missteps he has taken in dealing with the crisis from the outset. He now has a formidable opponent in the new leader of the opposition Labour Party, Sir Keir Starmer. Starmer has had a distinguished career as a human rights barrister and served five years as the UK’s Director of Public Prosecutions. He brings incisive forensic skills to his questioning of inept government ministers who have never done a proper job in their lives. Johnson and his possible successor, Gove, were journalists (not very good ones). It is depressing to contemplate what a better job Starmer would be doing as prime minister, depressing to contemplate the missed opportunities, the lives needlessly lost.

Despite the difficulties, the situation in Sri Lanka is encouraging. Health Review Global did a thorough analysis and concluded: “We have studied the responses of many countries to the coronavirus pandemic. We at healthreviewglobal.com decided to select Sri Lanka for its swift and impressive response to the global epidemic despite being a second world economy. On top of it, we learned the importance of investing in public health”.

Lack of Recognition

Nevertheless, it is surprising how little coverage there is world-wide of Sri Lanka’s battle against the virus. The London Sunday Times published an article entitled Lifting Lockdown: What Britain can learn from the rest of the world. The article draws on a report by the Blavatnik School of Government at Oxford University. Readers are invited to: “Select any of the 109 countries tracked to see their lockdown journey.” I scrolled down the list and discovered a strange gap between Spain and Sudan. Shouldn’t Sri Lanka be in there?

The London Times: “by early March, it was clear that transmission was being restricted in parts of Asia through testing and tracing. South Korea has yet to have a single day with more than nine deaths, and has kept offices, restaurants and shops open.” Sri Lanka has locked down and there have only been nine deaths IN TOTAL.

On May 21, the New York Times published a map of the global spread of the virus. Sri Lanka was not on the map but our junior neighbours, the Maldive Islands, were. The Maldives has a population of 540,544 and there have been four deaths

New Zealand, which locked down before it had a single death, has seen its stringency score fall by nearly ten points. New Zealand and its prime minister have justly been praised for a successful approach to the crisis. New Zealand’s population is 4.88 million; there have been 21 deaths.

I hope you don’t get bored with me repeating this. Sri Lanka has a population of 21.4 million. There have been nine deaths from the virus.

Nepal reported its what was claimed to be its first coronavirus death on May 16 — a 29-year-old woman had who recently given birth — as the total number of people infected in the country reached 281. Nepal’s population is 28 million. In January, Nepal was the first south Asian country to report a case of coronavirus. The country has been under lockdown since March 24 after a second case was confirmed. Epidemiologist Lhamo Sherpa said, “I don’t think this is the first death. There have been cases of deaths where similar symptoms were seen, but the cause was unclear”.

Sri Lanka’s Action

 

The Sri Lankan government deserves praise for the way it has handled the crisis. Sri Lanka reacted rapidly to early warnings while most Western countries complacently carried on as normal. The world was put on notice on 31 December 2019, when the Wuhan Municipal Health Commission reported an unusual cluster of cases of pneumonia. Our president, Gotabhaya Rajapaksa, elected by a decisive majority last November, followed up his advice to people to stay at home and keep a safe social distance by imposing a curfew from Friday 20 March at 6.00 p.m. The first reported case involving a Sri Lankan national, a 52-year-old tour guide, was declared recovered and released from quarantine on March 26. On 28 March, the first death from the virus was announced. The victim was 60-year-old diabetic who had had a heart transplant. As of May 16, the total number of confirmed cases is 935 and 477 patients have completely recovered so far. There have been nine deaths.

Odious Comparisons

When I initially compared the total number of deaths in Sri Lanka and UK, I was told such comparisons could not be made. The UK government is also arguing that international comparisons are odious. Odious to them, perhaps, because deaths in the UK are, at 36,550 (May 23) the worst in Europe (According to the Financial Times, it’s probably nearer 63,000). The UK population is 67.83 million. Sri Lanka’s population is 21.67 million. The UK accounts for less than one per cent of the global population but accounts for 12 per cent of reported Covid deaths.

It is very strange that Sri Lanka is never mentioned when comparative responses to the virus are being discussed. Ireland is held up as a good example. The population of the Republic of Ireland is 4.94 million. As of 23 May, the Irish Department of Health has confirmed a total of 1,592 deaths. Sri Lanka’s population is 21.4 million and there have been nine deaths. There is of course the danger of complacency but let’s give ourselves a little encouragement in these dark days.

A well-informed Irish friend, a former diplomat, tentatively suggested that Ireland might have special circumstances which made it more difficult for it to cope with the pandemic than it is for Sri Lanka. “Small or medium-sized highly globalised countries located within the main highway of the globalised economy and with high volumes of diverse migrant and visitor population flows (Ireland, Sweden, UK) may have a greater exposure”.

Sri Lanka is not exempt from globalisation. Sri Lanka’s land mass is roughly the same as the island of Ireland but the population is 5.25 times that of the Republic. Like Ireland, Sri Lanka does not have huge cities and there is a lot of open nature and mountains. Ireland has long had a problem with rural depopulation. However, it is obvious that Sri Lanka has a greater density of population in urban areas than Ireland.  Ireland only started attracting immigrants in recent times but Sri Lanka has long had a very diverse ethnic mix. Even today, there are communal frictions because of the government’s insistence on cremation of Covid victims.

Sri Lanka’s geographical position makes it a global hub for maritime traffic. It has attracted a vast amount of Chinese investment and personnel which makes India take a keen geopolitical interest. Chinese collaborative projects with Sri Lanka developed a working population of Chinese and Sri Lankans that moved between the two countries. The Department of Immigration and Emigration informed all construction sites to restrict their Chinese employees to their respective workplaces and lodgings

Migrant Labour

Among the many factors severely damaging the Sri Lankan economy during the pandemic is the effect on migrant labour. Way back in 2008, I wrote: “remittances from migrant workers represent more than nine per cent of GDP. Sri Lanka receives US$ 526 million more in remittances than it does from foreign aid and foreign direct investment combined. These remittances are now a greater source of revenue than our tea exports.”  It long ago became the norm for remittances from migrant workers to bear the main burden of containing Sri Lanka’s fiscal deficit. According to the 2012 Annual Statistics of the Sri Lanka Bureau of Foreign Employment, approximately 1.8 million Sri Lankans were working abroad of which 51% were men and 49% were women. These people are having to come home. A considerable number of returnees are from badly affected countries and this causes problems. Some of the clusters of confirmed cases arose because migrant workers returning from Italy were disappearing into their local communities without registering with the police or being tested.

Sri Lankan National Health Services, headed by Director General Anil Jasinghe, established 46 quarantine centres.  In the early stages, repatriated migrant workers from Italy and South Korea, were placed in quarantine facilities close to their hometowns They were transported by Government and military to prevent contact between family members, and all vehicles and contaminants were duly sanitized.  The military provided beds and bedding for the quarantine units.

Sri Lanka is fortunate in that it is an island nation which accepts most of its visitors through one international airport, Bandaranaike International Airport (BIA). In January, (when the UK was doing nothing) travellers reported that they were subjected to thermal screening at BIA.  Quarantine facilities were quickly established and expanded. Facilities for treating Corona patients were quickly made available in 16 major hospitals with IDH (Infectious Diseases Hospital) at Angoda as the key institution. Foreign tourists from 14 countries were among those quarantined.  When they were released many of them applauded in the media the efficient and courteous treatment they received.

Well-Established Health Service

One of the advantages that Sri Lanka enjoys is a free healthcare network of state hospitals nationwide supplemented by a thriving well-equipped private system. Sri Lanka’s state-funded universal health care service has considerable experience in managing deadly diseases.  Malaria and polio were eliminated and AIDS, SARS, H1N1, Chikungunya and MERS were successfully tackled. In 2005, Sri Lanka did not suffer the much-anticipated epidemics following the Indian Ocean tsunami.  In the IDP camps at the end of the war against the LTTE in 2009, there was not the predicted outbreak of deadly disease.

MOH (Medical Officer of Health) geographical areas were established across the island in 1926 to provide preventive health services at a community level, through a team of medical officers, public health nurses, health inspectors and midwives.

Dr. Anil Jasinghe, Director General of Health Services in Sri Lanka said: ““We have no issue whatsoever with our treatment capacities. We have been incrementally strengthening capacities. We don’t want to say how many ICU beds or how many hospitals are available, but I assure you we are ready for any number of cases”. The objective is mainly to minimize the number of patients at the outset, instead of allowing the disease to progress and having to treat patients at hospitals. Contrast this with the UK’s early flirtation with herd immunity. “We have been able to minimize the number of patients and even with the present-day clusters, we believe that with our strong public health system, we will soon be able to curtail the numbers.”

“Beggars have also been taken to certain residential facilities where they are taken care of. Notwithstanding the socio-economic level, I think they have been treated well and they are given clothes and meals, their requirements have been well looked after. Even the special segments of society are well looked after.”

Lockdown

All flights to BIA were stopped from March 19. High risk areas in the Negombo and Puttalam districts were locked down. Schools closed indefinitely. Government offices closed and working from home was encouraged.  Large gatherings were banned and the planned parliamentary election was postponed. An island-wide curfew was monitored by the police and the armed forces. To date (May 20) over 60,000 people have been arrested for curfew violation and will be prosecuted. Over 13,500 vehicles have been impounded.

Industry

The garment export industry stepped in to retool and provide PPE supplies for medical personnel and the general public. The state-owned Sugar Corporation and the private distillery companies provided alcohol-based sanitizers.

Industries with the ability to change their production lines and retool supported the government with making Personal Protective Equipment (PPE) including gowns and masks for medical personnel and other needs as required.

Religious organizations are donating to keep people and the front-line workers supported.  The Government is helping with financial and other relief for those who have lost earnings.

Tracing

Systems were set up to facilitate the exchange of medical information. Police were involved at an early stage in tracking down people likely to have been exposed to the virus and to deal with those who were uncooperative in following government guidelines. the Police Media Commissioner Ajith Rohana is an important member of the team.

Sri Lanka’s defence secretary, Major General Kamal Gunaratne, announced on April 19 that army intelligence officers will obtain the assistance of telecommunication service providers to trace contacts and places visited by COVID-19 patients.

As soon as the Epidemiology Unit of the Ministry of Health hears from a designated laboratory of a positive case, its staff activate “case search” among the infected person’s close contacts. The “activation” essentially involves informing the military and State Intelligence Service immediately, who then proceed to trace those who had been in contact with the patient, and direct them to quarantine.

“Contact tracing of the affected personnel remains the most important factor for containment. The intelligence services of the armed forces and the Police, with health authorities, were tasked to conduct contact tracing into first, second and third tiers of the confirmed, suspected and exposed cases. Therefore, the quarantine process and the conduct of PCR testing were followed up as and when required. “

In the UK, on 18 May, it was revealed that applicants to become contact tracers for the NHS were told recruitment was on hold while the government considered an alternative app. The shadow health secretary, Jon Ashworth, said: “Test, trace and isolate is fundamental to managing and controlling this virus and safely easing lockdown – yet the government’s approach has been increasingly chaotic, with misstep after misstep.” But the app is working against constraints in modern smartphones that only Google and Apple can work around, as well as arriving burdened with privacy concerns that could deter some members of the public from using it. Wide-ranging security flaws have been flagged in the Covid-19 contact-tracing app being piloted in the Isle of Wight.

Armed Forces

President Gotabaya Rajapaksa set up a ‘National Operation Center for Prevention of COVID- 19 Outbreak’ led by Army Commander Shavendra Silva.

The army, navy and air force have played a huge role in the success of Sri Lanka’s anti-Covid programme. Gotabaya Rajapaksa won the presidency of Sri Lanka in November 2019 by a convincing majority. He is possibly the first president of Sri Lanka to have done a proper job. He was a Colonel in the Sri Lankan Army and saw action against the JVP and the Tamil Tigers. He emigrated to the USA in 1998 but returned to Sri Lanka to support his brother Mahinda’s presidential campaign in 2005. When Mahinda decided to take on the LTTE militarily, Gotabaya became his defence secretary. The LTTE were soundly beaten in 2009 and there have been no incidents since. In a fairly short time, Gotabaya Rajapaksa turned a shambolic army into an effective and reliable force for wartime or peacetime. The army that Gotabaya Rajapaksa created is, essentially, still with us although the personnel has changed. The current Army Commander and Chief of Defence Staff, Shavendra Silva, played a crucial role in the ultimate victory over the LTTE. Although Sri Lanka has no external enemies (to fight by force, anyway), the Tri-Forces have proved their worth in peacetime.

The Navy handled shipments of food supplies from ports and delivered them to the public.  They also sanitized the streets and public places to prevent infection. Because navy personnel were engaged in front-line activities, they were vulnerable to infection. New cases of infection are being described as the ‘Navy cluster’.  All 35 cases reported on May 19 were sailors. Sailors were deployed to hunt down a group of drug addicts who had contact with a COVID-19 patient and were evading quarantine. Sailors at a Sri Lankan naval base became the biggest cluster of coronavirus infections with 480 being tested positive. The virus spread when sailors went on home leave. About 4,000 navy troops were quarantined while 242 relatives were taken to quarantine centers run by the navy. As of May 17, 151 naval personnel have recovered and discharged from hospitals.

Symposium

Professor Indika Karunathilake, President of the Sri Lanka Medical Association, chaired a discussion at Wijerama House on April 30 as part of the Asia-Pacific Academic Consortium for Public Health international webinar on Covid-19. Attending were Head of the National Operation Centre for Prevention of COVID-19 Outbreak (NOCPCO), Army Commander Lieutenant General Shavendra Silva, Director General Health Services Dr Anil Jasinghe and Chief Physician at the National Infectious Diseases Institute Dr Ananda Wijewickrama discussed Sri Lanka’s unique approach to tackling the disease and made important notes on challenges ahead.

Dr Wijewickrama said. “At present, the Health Ministry’s policy is to admit all the positive cases irrespective of their symptomatology (Symptoms characteristic of a medical condition exhibited by a patient) We can do that at the moment because we only have close to 700 patients in the country. That is an incidence of about 3 per 100,000,”

Donald Trump might be interested to learn that Covid-19 positive patients in Sri Lanka are currently being treated with Hydroxychloroquine, a drug used in the successful treatment of malaria. Dr Wijewickrama said that they were aware of the controversy over the drug but had decided to use it and were “analysing the response of the patients, the physical symptoms as well as the viral clearance of the patients who were given this drug”. In three severe instances, patients were treated with convalescent plasma.

Human Rights

There are many who are worried about militarization. “Placing an army General at the helm of the campaign against the epidemic is as inane as asking a medical doctor with zero-military training to lead a war,” wrote columnist Tisaranee Gunasekara. Although many applaud the role of the navy, she thinks it was a foolish error to involve sailors and their role was mishandled when it discovered that they were the cause of most new infections.

Human Rights Watch (HRW) expressed concern because Sri Lanka’s inspector general of police ordered police to arrest those who “criticize” officials involved in the coronavirus response, or share “fake” or “malicious” messages about the pandemic. HRW also put out a statement: “Gen. Shavendra Silva, who heads the National Operation Centre for Prevention of COVID-19 Outbreak, faces credible allegations of war crimes during the final months of Sri Lanka’s long civil war. Ethnic Tamils, Muslims, and critics of the government, who have long borne the brunt of security force abuses, will be especially concerned that their civil and political rights will not be respected.”

Note those weasel words “credible allegations”. The Darusman Panel used that phrase when disseminating inflated figures about the number of civilians killed at the end of the war. The real meaning of the words soon became lost with repetition and “credible allegations’ elided into “proven fact”. On May 19 2020, most Sri Lankans celebrated the 11th anniversary of the end of the war. In that long time, the “credible allegations” have not been proved but General Silva is banned from entering the USA.

I do not have the space here to go into all the arguments about war crimes and human rights abuses that have been circulating for a dozen years without any resolution. One can find plenty of articles dealing with this on the websites of Groundviews and Colombo Telegraph. Here are a few examples:

https://groundviews.org/2020/05/12/ramzy-razeek-an-extraordinary-struggle-for-an-ordinary-life-of-service-upended-by-an-arrest/

https://groundviews.org/2020/05/10/election-against-democracy/

https://www.colombotelegraph.com/index.php/lanka-may-cease-to-be-a-democracy-by-june-1-if-court-does-not-resolve-constitutional-deadlock-counsel-suren-fernando/

When Mahinda Rajapaksa was defeated in the 2015 presidential election, the victorious coalition promised yahapalanagood governance, an end to corruption and cronyism. They did not bring any miscreants to book and perpetrated their own corruption. They introduced chronic incompetence which was symbolized by the lethal inertia with which they dealt with the Easter bombings. Even opponents of the Rajapaksas rejoice that we did not have the Yahapalana crowd dealing with the pandemic.

If you read the comments on Colombo Telegraph you might think that the overwhelming majority of Sri Lankans think the government is fascist and in the process of using the military to undermine democracy. The website is run from London and none of the commenters reveal their true identity. They could be anybody, they could be nobody. Groundviews depends for its existence on foreign funding.

Democracy

Democracy has not been doing too well lately. Trump is busy wrecking the USA and its reputation and causing unnecessary deaths after winning three million votes fewer than Hillary Clinton in 2016. In the UK, Boris Johnson struggled to “get Brexit done” with a majority of minus 43 and now struggles to cope with a pandemic with a secure majority of 80. The authority of the Irish Cabinet is diminished by the fact that three of its members were voted out of the Dáil (parliament) in the general election on February 8 but remain in Government. It could be argued that Sinn Féin won the election, but they are being kept out of power by the two parties who normally take to turns to govern.The Taoiseach (prime minister) Leo Varadkar is getting good world press for the way he is handling the crisis (and working one day a week as doctor – medical, not political science) but his party was defeated in the election. The Dáil hardly exists at present and its committees are in abeyance. The most influential body in the management of the crisis, is the NPHET (National Public Health Emergency Team). Neither elected representatives nor the media have access to its meetings.

In Russia, Putin was re-elected in 2018 with nearly 80 percent of the vote and faces no serious threats to his power. He has not been having a good pandemic. According to Andrew Higgins in the New York Times, “the pandemic has only highlighted what has always been Mr Putin’s biggest vulnerability: a pronounced lack of interest or success in tackling intractable domestic problems like dilapidated hospitals, pockets of entrenched poverty and years of falling real incomes.”  Putin has been sheltering at his country villa and has not been pictured in public for nearly a month. Higgins described his Orthodox Easter message to the nation as “what, me worry?” Russia has had 1,537 deaths out of a population of 144.5 million.

Gotabaya Rajapaksa won the presidential election only last November by a comfortable margin. There are calls to reconvene the parliament that he dissolved on March 3 with an expectation of a parliamentary election on April 25. Because of the pandemic, the election had been postponed indefinitely. In the parliament that was elected in 2015 the UNP had 106 seats, not a clear majority. The Sri Lankan Freedom Party, which had once been powerful enough to rule the country, in the 2015 parliament was part of the United People’s Freedom Alliance (UPFA) which won 95 seats. The SLFP barely exists any more having been usurped by the SLPP (Sri Lanka Podujana Peramuna – Sri Lanka People’s Front) which won a landslide victory in the much-delayed local elections in February 2018. The UNP were only able to secure 34 councils out of 340, whereas the SLPP won 231.

Many people detest Gota but many more admire him and think he is doing a good job. The following comment is probably more representative than any of the opinions expressed by the anonymous sages of Colombo Telegraph. “Our President is forging ahead in brilliance, with innovative decisions, gaining the confidence of more and more people. This is the very reason for all the Opposition bull shit every day! They have no credibility after yahapalana period!”