- The authorities have to prospectively study and see if Ayurveda and traditional medicine would be beneficial
- Govt. wanted to take credit when first COVID wave ended
- Current viral strain is more infectious, but isn’t severe
- Outcomes of vaccine uncertain as of now
- Bulk of the budget should have been allocated for COVID-19 relief
- If we are going to use the vaccine we can rely on what is recommended by WHO
- So it’s the duty of the Government to ensure that economic activities are sustained at the maximum possible level
- So far, the coronavirus doesn’t show a big shift, but a gradual drift
- We have experts in the field, but none of them has been called for discussions
- Our capacity for PCR testing is inadequate and we aren’t doing sufficient tests
Sri Lanka Podujana Peramuna (SLPP) National List MP Prof. Tissa Vitharana recently said that COVID-19 is now in the community and nobody has immunity against it since it’s a new virus. He made these observations in his capacity as a specialist in the fields of bacteriology and virology. Having obtained a Diploma in Bacteriology from the London School of Hygiene & Tropical Medicine and a Ph.D. in virology from the University of London, he also served as the Director of the Medical Research Institute in Colombo. He headed MRI’s virology department and apart from that he was a consultant virologist at the Edinburgh City Hospital’s Regional Virus Laboratory and deputy director of the Victoria Infectious Diseases Reference Laboratory in Melbourne. He was the leader of the Lanka Samasamaja Party prior to joining the SLPP.
Following are excerpts of an interview Prof. Vitharana had with the Daily Mirror:
" The PHIs, midwives can do this health education programme, but the decision has to be taken from the top. This will be the lasting and cheapest solution rather than getting vaccines from abroad which are questionable"
Q Many are not aware that prior to being a leftist politician, you have had an extensive career as a medical expert specialized in virology and bacteriology. What should have been our plans to fight a global pandemic like COVID-19?
This is a global pandemic from a virus that probably originated from an animal source and it is completely new to the world. Therefore there’s no immunity against the virus and it’s like an open field. It’s a virus which spreads like the common cold, but the difference is that it goes right down to the chest and presses the lungs. Other viruses are confined to the nasal area. Around 80% are asymptomatic and therefore the infection can easily spread within the society. Therefore it has a so-called second wave which itself may extend further and become a big wave or drop off a bit if human behaviour is conditioned properly. Or it may reappear as a third wave. It’s not only easily spread, but would affect elderly people and those with chronic conditions, tipping the balance between life and death. Therefore it’s a novel problem and in every country there was no possibility of being prepared for it till it actually hit the society. Though people are finding fault with governments and various people I call it unfair. By and large the Government reacted quite quickly.
Q What is the alternative in that case?
What I have recommended is that at this particular stage we need an intensive health education programme where we make it known to every individual in the country that now it is a point of us not knowing whether we have it or not. We need to follow health precautions as a habit. Now there’s an element of fear and it is the authorities who are communicating the message and people are reacting to the authoritative approach. We see people wearing the mask on the neck and wearing it properly when they see the police. By this health education system it will be digested mentally and every person will realise that there’s a danger to one’s life out of self-interest. If we protect ourselves by observing these three rules then the virus itself will die out of the country and we will be free of the epidemic. The PHIs, midwives can do this health education programme, but the decision has to be taken from the top. This will be the lasting and cheapest solution rather than getting vaccines from abroad which are questionable.
Q Do you observe any loopholes in the way Sri Lanka attempted to stop the spread of the virus?
During the cluster stage everything was efficient. Both the service personnel as well as the health personnel who participated in it from the highest level down did a great job. Now in this new stage necessary action is not being taken. It maybe taken here and there, but not like a definite programme. Earlier in my medical career the main cause of death was diarrhoea especially among children. Therefore the health ministry setup a diarrhoea eradication committee. We had a lot of discussions on causes, treatments etc. But before we did all those we said we’ll take some simple public health measures. These include washing hands with soap and water once they use the washroom, doing the same before sitting down to a meal and the water should be boiled prior to consuming. That health education was introduced at school level and incorporated into the curriculum. As a result everybody developed it into a habit. So we can do the same with regard to COVID-19 as well. But this has to be accepted from the top.
Q One key concern was getting technical expertise. What are your views/concerns about keeping aside experienced individuals like you and allowing the military to take control of the matters?
It started as a military exercise for the simple reason that the military was ready at hand, organised, quick to get into action and enforce restrictions initially. But now it is entirely a matter for the health personnel to handle which should be supported by the army and the police.
Q Prior to the second wave, Sri Lanka maintained a lesser number of cases and retained number of deaths to 10. Why was it impossible during the second wave? Was it due to the heavy viral load in this strain or because patient zero was unknown or the authorities didn’t take matters seriously?
The Government also wanted to take credit and said we have controlled the situation. If there’s a particular cluster, say in Borella for example, people living outside that area thought that there’s no cluster there. But we would have been intermingling with people having the virus. Especially when the occurrence of cases and deaths came to a standstill, people thought the problem was over. From there it flared up again and that led to the so-called second wave. It’s clearly a matter of human behaviour. We have to have a real understanding and follow health guidelines for our own survival, incorporating them into our normal behaviour patterns.
"More than 20-30 companies are now claiming over 90% positivity. Since fear has been generated, people are being rushed to buy it. But we shouldn’t fall for that trap. If we are going to use the vaccine we can rely on what is recommended by WHO"
Q Although you mentioned that the spread has gone beyond clusters towards a community spread, statements by the authorities such as Epidemiology Unit repeatedly deny such claims. They were referring to the definitions given by WHO thereby claiming that we haven’t reached community transmission stage. Is this a situation where people can go by such definitions?
The WHO guidelines have been based on available knowledge. These are only guidelines. They don’t lay down the rules, but we have to decide on how we will tackle it. They only point out possibilities and guidelines to protect the community. But we have to use our judgements to decide what is best for the people. There may be social practices that facilitate the spread and after all people’s behaviours differ from country to country.
Q Let’s talk about PCR and Rapid Antigen testing. Does Sri Lanka have the capacity to conduct them and what are your thoughts on the results?
In the case of PCR tests, they have been used for diagnosing so many illnesses. But for each virus you need to develop a special test. For instance, the efficacy of the test itself is about 70% and around 30% are being missed. Our capacity for PCR testing is inadequate and we aren’t doing sufficient tests. Therefore more research needs to be done to improve the quality of tests. At the Medical Research Institute and Sri Jayawardenapura University, we have trained people to improve tests to obtain 100% results. This needs continuous research where you need to change conditions such as acidity, alkalinity, quantity of different reagents and experiment. PCR tests are done widely for different conditions and generally the positivity rate is over 90%. But what is now available in Sri Lanka and around the world is below par. We have experts in the field, but none of them has been called for discussions. On the other hand, this is a virus, but as far as I know, there were no virologists in the committees that were set up. When you’re trained in a particular discipline you get to know all aspects of it and be able to adapt it to suit the problem. We should have made use of the trained personnel we have, but the idea that it should be done by people with connections is the kind of thinking we have.
Q Are Rapid Antigen Tests any better?
The Rapid Test is very much cheaper, the test itself is quick and results are produced quickly. But the number of positive cases it picks up is around 60%, which is less than that produced by PCR tests. I suggest that both tests should be used.
Q This global pandemic said to have spread from Wuhan in China is also seen through a geopolitical perspective. Even there are allegations that the pandemic is being used as a biological weapon. In a way there is evidence to support this as some economies, specially in the Europe, have failed while other economies have managed to survive or thrive. Your comments?
In China, when you have a population of 1.5 billion, it is not a surprise to see a virus emerging. It cannot start from a population of 20 million like that in Sri Lanka. When it comes to viruses, there are stable viruses that don’t undergo genetic changes. For instance the small pox virus is stable and the vaccine that was prepared was effective and stayed effective till the end, so we could eliminate it altogether. But there are other viruses that change their genetic configuration and could be of two varieties; there could be a gradual change that takes place once or once in two years, which causes minor outbreaks which is called an antigenic drift. Once in about five to ten years there is a big change, which is called an antigenic shift. Therefore the body faces a different virus from what it faced earlier and the immune system is also not recognising the virus. Then you find that it spreads like wildlife and turns into a pandemic. So far, the coronavirus doesn’t show a big shift, but a gradual drift. What I heard from my virology contacts is that the strain of virus that is now circulating is more infectious, but isn’t severe. So we have to watch how it evolves and respond proactively.
Q The pandemic also highlighted a stark contrast among social classes. In a way, the rich can survive through it while the poor are left to die. How do you see this as a leftist political leader?
This is where we are facing a challenge like facing a foreign invasion and we have to protect our people. The most vulnerable individuals need to be safeguarded. The requirement to maintain distancing means that many companies have cut down on staff or closed them down and small businesses too will be badly affected. So it’s the duty of the Government to ensure that economic activities are sustained at the maximum possible level. People should receive livelihood support and if there’s a shortfall the Government should top it up. Measures also have to be taken to take care of people getting displaced and those having to go home with no source of income need to be financially assisted. It may then be possible to get alternative sources of income, new ventures can be developed and the Government should play the leading role. The Government can obtain assistance from private sector if the need arises.
Q But there were discrepancies in distributing the Rs.5000 relief and the budget didn’t address a relief system for those affected. Do you think it should be revised?
Definitely. There should have been a much bigger allocation for COVID-19 and its consequences. In fact the bulk of the budget should have been for that. I would have put long-term ventures on hold and given priority to the immediate needs of the people. We need to workout on priorities and address them accordingly. Those who are affected now are suffering. That should be given priority.
Q As an expert in this subject don’t you think that a vaccine against a viral infection should have been tested for a number of years?
It’s a new type of vaccine called mRNA and it’s a new illness. Even during natural infections what has emerged from laboratories is that antibody formation is short lived. Therefore the vaccine itself may not offer protection for very long and therefore people may have to be prescribed repeated doses. As such it’s uncertain how effective it will be. In order to get a sufficient vaccine to effectively break the transmission you need to immunise at least 70-80% of the population. This is going to be costly and the outcomes are uncertain.
Q The availability of a life saving vaccine will depend on the capitalistic market system. Would there be any possibility to avoid it?
I’m sorry to say this, but after the armaments industry the second biggest source of profits is the medicinal drug industry. One aspect of it is the production of vaccines. There has to be investment and so on, but when they come up with a vaccine, they try to cash-in on the fear to sell the product and may even come up with bogus data. Those should be tested by accepted reference and laboratories linked to WHO and the outcomes must be confirmed. Then they maybe used. More than 20-30 companies are now claiming over 90% positivity. Since fear has been generated, people are being rushed to buy it. But we shouldn’t fall for that trap. If we are going to use the vaccine we can rely on what is recommended by WHO. This is because they always ensure that the best laboratories test them out, carry out population studies and results are examined carefully. Once they establish that its efficacy is over 90% then they give the go-ahead to use it. In that case we can act on it.
Q Another division of social class will be seen once the vaccine is made available to the populace. How should governments such as those in developing nations look at ensuring the equal distribution and accessibility to the vaccine?
If the WHO gives it free for 20% of the population, that would be adequate to protect the vulnerable groups. This means those who are liable to get severe diseases and die. Once you get that, people will still get infected but those who are healthy to withstand the infection may not succumb to it.
Q Ayurveda and traditional medicine have become a trending topic today. Can traditional medicine cure a mutating viral strain such as COVID-19?
Traditional medicine has been used widely in our country. They have been used over a period of time and people continue to use it if they feel they have benefits. But this is a new problem. There’s no past history which we can fall back on. So we have to prospectively study and see if it will be beneficial or not. There are traditional medicines which have been attributed to increase one’s immune ability and people take them for a long period on that premise. If there are responsible scientists who have verified and tested outcomes they can establish whether it is beneficial or not. They could check if the medicine could prevent the infection or make it milder or whether they have any curative effect. There are medicines available that were effective against other viral infections, so they can try it out against COVID-19 and see if they’re effective. Antivirals tend to be specific for some viruses and the range is smaller. All these need to be tried out. We can only draw conclusions in the future when we compare the outcomes.
Q We are approaching a new year and it looks like we will have to live with the virus for sometime. What are the immediate measures the Government should execute at this point?
We don’t need to harbour an unnecessary fear. We know that the percentage mortality is less than 5%. So there’s no major degree of threat and in our country the count has been less. That doesn’t mean that we have to be overconfident and careless. But we need to realise that we are in a position to protect ourselves and in the process get rid of the virus. Therefore Sri Lankans who return should be carefully isolated minutely, so that they don’t infect anybody. If we can act in that way I’m sure we can minimise the risk to ourselves. We must get back to normal economic life while taking necessary preventive measures.