Forwarded by Lakshman Karalliedde
Even as the government brings the outbreak of C19 under control, we need to bear in mind that the virus will probably remain endemic in reservoirs around the world. There will be periodic epidemics until a vaccine is found. Remember that up to now, despite billions of dollars and multiple decades of effort having been invested, no vaccines have emerged for HIV or even the common cold. It would be foolish, in the near term, to pin our hopes on a vaccine: that is at least two years away. We cannot keep our borders closed forever. Travel will have to begin, risking the spawning of new outbreaks. Also, what of the tourism industry and the million Sri Lankans dependent on it? We need tourists, but we don’t want C19. The only way we can open our borders and minimize the risk of new outbreaks is to test on a mass scale. With 20,000 people being tested daily, South Korea leads the world in testing1. Only epidemiological modelling will tell, but I would guess that Sri Lanka will have to test up to 50,000-100,000 people daily (as will other countries) over the coming year, to ensure that new outbreaks are detected and contained early. Tests take two forms2. The gold standard is the RT-PCR3, which is what the government is using now. This can detect even minute samples of the virus taken from the mucous membranes of the respiratory tract (nose or throat). RT-PCR can detect the virus very shortly after someone is infected, even before they show symptoms. Its drawback is that it is expensive and slow (the test costs about $75, and results take a few hours, though real-time PCR is now becoming a reality). Also, because they no longer carry the virus, this method doesn’t work for those who have recovered from C19. However, people who have recovered from the disease are likely to have immunity for some months or perhaps years. We still don’t know for how long, and will not know for—well, some months or years. The way around that is to test blood for antibodies4. Your body begins producing antibodies to the virus shortly after you’re infected, and these become detectable 3-10 days afterwards. Antibodies will also be detectable for months or years after your recovery. Thus, although antibody tests are of limited value in detecting people with the virus early, they are really useful in identifying people who have immunity and can safely be allowed to mingle with the general population. Most people who catch C19 don’t even know they’re sick: they just get over it in a few days. But once they recover, they’re immunized and pose no risk to the rest of us. So, it is good to know who they are. And the advantage of antibody tests is that they are cheap, quick and easy5. They need only a drop of blood, and take less than 15 minutes for a result. They are (or soon will be) cheap: of the order of $1 per test. So, it is not impractical to test millions of people, because the test can be safely administered by public health workers with minimal training, like the phlebotomists who take blood samples in hospitals. How will this help? Well, for one thing, international travellers can be required compulsorily to undergo both PCR and antibody tests as a condition of travel, with the tests administered in the 24 hours prior to boarding, or even at the airport. The test outcome could be part of an electronic travel authorization, which doubles as a health certificate on arrival at your destination. People who have positive antibody tests taken 3 weeks apart, for example, would
1 https://foreignpolicy.com/2020/03/23/coronavirus-pandemic-south-korea-italy-mass-testing-covid19-will-keep-spreading/ 2 https://www.nature.com/articles/d41587-020-00010-2 3 Reverse-transcriptase polymerase chain reaction, which searches for strands of RNA unique to the virus. 4 Known as immunoglobulin tests. 5 https://theconversation.com/covid-19-tests-how-they-work-and-whats-in-development-134479
be safe travellers, and therefore exempt from frequent PCR testing. With such a testing regime6 in place, Sri Lanka could open its doors to foreign visitors once more. And, like the airport tax, the cost could be included in the airfare. Even so, it would be foolish to think that the virus will not re-emerge in Sri Lanka. Many people with only mild symptoms, or no symptoms at all, may be carriers for a long time. No test shows positive or negative with 100% accuracy, so a few false-negatives will slip through, and we will need to be geared to catch the resulting outbreaks early. There’s also the risk of the virus mutating and infecting people all over again, as the flu virus does every year. This means continued testing of the population, especially in high-risk groups such as factory workers and those who use public transport. Given the scale of demand, the cost of PCR testing will probably decline substantially: $10 tests are being trialled already7. For effective monitoring, test results must be available centrally via a smartphone app, so people aren’t unnecessarily retested. Alongside this, we must continue to minimize disease transmission through better behaviours. Washing hands frequently, not touching the face, not coughing or sneezing where others are present, staying home when sick, and disinfecting frequently-touched surfaces8: these must be the new norm. Feel a sneeze coming? Leave the room, just as you would if you had to pass wind. Architects have their part to play by designing spaces to reduce crossinfection: electric or foot-operated doors in public buildings, hotels and toilets, for example. Staggered working hours in offices and factories will also ease congestion on public transport. The government’s response to this crisis so far, has been swift and effective, especially given that the more ‘proportionate’ public-order measures failed. However, we cannot have curfews forever. Besides, when the curfew is lifted, the melee that ensues lays waste to all the socialdistancing measures. But there are ways to get around this, as we have done for decades, for example, by ending the school day three hours ahead of the office day. Here, our NICs have value. To make sure not everyone hits the shops at the same time, the NIC could serve as a curfew pass, with weekly slots being allocated for people to get about, depending on the last digit of their NIC. That reduces people in public spaces at any one time by 90%, increasing social distance. In Australia, for example, supermarkets allow only people over the age of 60 to enter between 7-8 a.m. As we enter the endemic stage of this disease, government must relax its monopoly on treatment and control, and engage the private health sector, too, in treating C19. Remember: every doctor in Sri Lanka has at one time been a government doctor—they know the rules. The present system, which involves ‘reporting’ patients to the authorities and mandatorily sequestering them in government hospitals will soon be found to be ineffective, because many non-critical patients will simply not self-report. We have to learn from the HIV-AIDS epidemic of the 1990s that stigmatizing and criminalising those who are unfortunate enough to get infected results in a public-health failure. Unless people who think they have the virus feel comfortable about reporting it and seeking treatment, we will continue to harbour reservoirs of infection. This is especially so because the vast majority of those with C19 symptoms in fact have only a flu or a common cold: abducting them to a state hospital makes no sense unless they test positive and need hospital care. Our challenge is to return the economy to normalcy as soon as possible. Without that, there is no future for anyone. And the only way forward seems to lie in mass testing. The scale on
6 As at today (29 March), for example, Australia has approved 16 different test kits; see https://www.tga.gov.au/covid-19-diagnostic-testsincluded-artg-legal-supply-australia
7 https://www.bloomberg.com/news/articles/2020-03-25/virus-test-in-hours-for-under-11-eyed-by-atomic-scientists 8 I’ve seen images of buildings being fumigated in Sri Lanka, but can find no evidence that this is effective. Fumigation works well against insect vectors, but against viruses, it could in fact lead to false security.
which tests must be done is so vast that we should manufacture at least the antibody tests in Sri Lanka (this is eminently feasible). Additionally, an effective testing regime calls for complex monitoring software, integrating, for example, our NICs, driver’s licenses, passports and mobile phones. Development of this technology must start now. But for this to be effective, people need to trust government not to misuse their data, as happened in the early HIV days. C19 has been a leveller across the world’s nations. Countries with the best economic recovery plans will make huge gains as others fumble. We can turn the present adversity to our competitive advantage and spring back to full production. The policing stage of managing this crisis, which is where we are now, is relatively easy. That has happened. The next phase, however, calls for policy innovations on a grand and unprecedented scale. If we muster our wits and get this right, we may succeed not only in undoing the damage C19 has caused, but also the setback of the separatist war. This is a time for opportunity, not despair. Sri Lanka after C19: Policy Prescriptions
Even as the government brings the outbreak of C19 under control, we need to bear in mind that the virus will probably remain endemic in reservoirs around the world. There will be periodic epidemics until a vaccine is found. Remember that up to now, despite billions of dollars and multiple decades of effort having been invested, no vaccines have emerged for HIV or even the common cold. It would be foolish, in the near term, to pin our hopes on a vaccine: that is at least two years away. We cannot keep our borders closed forever. Travel will have to begin, risking the spawning of new outbreaks. Also, what of the tourism industry and the million Sri Lankans dependent on it? We need tourists, but we don’t want C19. The only way we can open our borders and minimize the risk of new outbreaks is to test on a mass scale. With 20,000 people being tested daily, South Korea leads the world in testing1. Only epidemiological modelling will tell, but I would guess that Sri Lanka will have to test up to 50,000-100,000 people daily (as will other countries) over the coming year, to ensure that new outbreaks are detected and contained early. Tests take two forms2. The gold standard is the RT-PCR3, which is what the government is using now. This can detect even minute samples of the virus taken from the mucous membranes of the respiratory tract (nose or throat). RT-PCR can detect the virus very shortly after someone is infected, even before they show symptoms. Its drawback is that it is expensive and slow (the test costs about $75, and results take a few hours, though real-time PCR is now becoming a reality). Also, because they no longer carry the virus, this method doesn’t work for those who have recovered from C19. However, people who have recovered from the disease are likely to have immunity for some months or perhaps years. We still don’t know for how long, and will not know for—well, some months or years. The way around that is to test blood for antibodies4. Your body begins producing antibodies to the virus shortly after you’re infected, and these become detectable 3-10 days afterwards. Antibodies will also be detectable for months or years after your recovery. Thus, although antibody tests are of limited value in detecting people with the virus early, they are really useful in identifying people who have immunity and can safely be allowed to mingle with the general population. Most people who catch C19 don’t even know they’re sick: they just get over it in a few days. But once they recover, they’re immunized and pose no risk to the rest of us. So, it is good to know who they are. And the advantage of antibody tests is that they are cheap, quick and easy5. They need only a drop of blood, and take less than 15 minutes for a result. They are (or soon will be) cheap: of the order of $1 per test. So, it is not impractical to test millions of people, because the test can be safely administered by public health workers with minimal training, like the phlebotomists who take blood samples in hospitals. How will this help? Well, for one thing, international travellers can be required compulsorily to undergo both PCR and antibody tests as a condition of travel, with the tests administered in the 24 hours prior to boarding, or even at the airport. The test outcome could be part of an electronic travel authorization, which doubles as a health certificate on arrival at your destination. People who have positive antibody tests taken 3 weeks apart, for example, would
1 https://foreignpolicy.com/2020/03/23/coronavirus-pandemic-south-korea-italy-mass-testing-covid19-will-keep-spreading/ 2 https://www.nature.com/articles/d41587-020-00010-2 3 Reverse-transcriptase polymerase chain reaction, which searches for strands of RNA unique to the virus. 4 Known as immunoglobulin tests. 5 https://theconversation.com/covid-19-tests-how-they-work-and-whats-in-development-134479
be safe travellers, and therefore exempt from frequent PCR testing. With such a testing regime6 in place, Sri Lanka could open its doors to foreign visitors once more. And, like the airport tax, the cost could be included in the airfare. Even so, it would be foolish to think that the virus will not re-emerge in Sri Lanka. Many people with only mild symptoms, or no symptoms at all, may be carriers for a long time. No test shows positive or negative with 100% accuracy, so a few false-negatives will slip through, and we will need to be geared to catch the resulting outbreaks early. There’s also the risk of the virus mutating and infecting people all over again, as the flu virus does every year. This means continued testing of the population, especially in high-risk groups such as factory workers and those who use public transport. Given the scale of demand, the cost of PCR testing will probably decline substantially: $10 tests are being trialled already7. For effective monitoring, test results must be available centrally via a smartphone app, so people aren’t unnecessarily retested. Alongside this, we must continue to minimize disease transmission through better behaviours. Washing hands frequently, not touching the face, not coughing or sneezing where others are present, staying home when sick, and disinfecting frequently-touched surfaces8: these must be the new norm. Feel a sneeze coming? Leave the room, just as you would if you had to pass wind. Architects have their part to play by designing spaces to reduce crossinfection: electric or foot-operated doors in public buildings, hotels and toilets, for example. Staggered working hours in offices and factories will also ease congestion on public transport. The government’s response to this crisis so far, has been swift and effective, especially given that the more ‘proportionate’ public-order measures failed. However, we cannot have curfews forever. Besides, when the curfew is lifted, the melee that ensues lays waste to all the socialdistancing measures. But there are ways to get around this, as we have done for decades, for example, by ending the school day three hours ahead of the office day. Here, our NICs have value. To make sure not everyone hits the shops at the same time, the NIC could serve as a curfew pass, with weekly slots being allocated for people to get about, depending on the last digit of their NIC. That reduces people in public spaces at any one time by 90%, increasing social distance. In Australia, for example, supermarkets allow only people over the age of 60 to enter between 7-8 a.m. As we enter the endemic stage of this disease, government must relax its monopoly on treatment and control, and engage the private health sector, too, in treating C19. Remember: every doctor in Sri Lanka has at one time been a government doctor—they know the rules. The present system, which involves ‘reporting’ patients to the authorities and mandatorily sequestering them in government hospitals will soon be found to be ineffective, because many non-critical patients will simply not self-report. We have to learn from the HIV-AIDS epidemic of the 1990s that stigmatizing and criminalising those who are unfortunate enough to get infected results in a public-health failure. Unless people who think they have the virus feel comfortable about reporting it and seeking treatment, we will continue to harbour reservoirs of infection. This is especially so because the vast majority of those with C19 symptoms in fact have only a flu or a common cold: abducting them to a state hospital makes no sense unless they test positive and need hospital care. Our challenge is to return the economy to normalcy as soon as possible. Without that, there is no future for anyone. And the only way forward seems to lie in mass testing. The scale on
6 As at today (29 March), for example, Australia has approved 16 different test kits; see https://www.tga.gov.au/covid-19-diagnostic-testsincluded-artg-legal-supply-australia
7 https://www.bloomberg.com/news/articles/2020-03-25/virus-test-in-hours-for-under-11-eyed-by-atomic-scientists 8 I’ve seen images of buildings being fumigated in Sri Lanka, but can find no evidence that this is effective. Fumigation works well against insect vectors, but against viruses, it could in fact lead to false security.
which tests must be done is so vast that we should manufacture at least the antibody tests in Sri Lanka (this is eminently feasible). Additionally, an effective testing regime calls for complex monitoring software, integrating, for example, our NICs, driver’s licenses, passports and mobile phones. Development of this technology must start now. But for this to be effective, people need to trust government not to misuse their data, as happened in the early HIV days. C19 has been a leveller across the world’s nations. Countries with the best economic recovery plans will make huge gains as others fumble. We can turn the present adversity to our competitive advantage and spring back to full production. The policing stage of managing this crisis, which is where we are now, is relatively easy. That has happened. The next phase, however, calls for policy innovations on a grand and unprecedented scale. If we muster our wits and get this right, we may succeed not only in undoing the damage C19 has caused, but also the setback of the separatist war. This is a time for opportunity, not despair.
Even as the government brings the outbreak of C19 under control, we need to bear in mind that the virus will probably remain endemic in reservoirs around the world. There will be periodic epidemics until a vaccine is found. Remember that up to now, despite billions of dollars and multiple decades of effort having been invested, no vaccines have emerged for HIV or even the common cold. It would be foolish, in the near term, to pin our hopes on a vaccine: that is at least two years away. We cannot keep our borders closed forever. Travel will have to begin, risking the spawning of new outbreaks. Also, what of the tourism industry and the million Sri Lankans dependent on it? We need tourists, but we don’t want C19. The only way we can open our borders and minimize the risk of new outbreaks is to test on a mass scale. With 20,000 people being tested daily, South Korea leads the world in testing1. Only epidemiological modelling will tell, but I would guess that Sri Lanka will have to test up to 50,000-100,000 people daily (as will other countries) over the coming year, to ensure that new outbreaks are detected and contained early. Tests take two forms2. The gold standard is the RT-PCR3, which is what the government is using now. This can detect even minute samples of the virus taken from the mucous membranes of the respiratory tract (nose or throat). RT-PCR can detect the virus very shortly after someone is infected, even before they show symptoms. Its drawback is that it is expensive and slow (the test costs about $75, and results take a few hours, though real-time PCR is now becoming a reality). Also, because they no longer carry the virus, this method doesn’t work for those who have recovered from C19. However, people who have recovered from the disease are likely to have immunity for some months or perhaps years. We still don’t know for how long, and will not know for—well, some months or years. The way around that is to test blood for antibodies4. Your body begins producing antibodies to the virus shortly after you’re infected, and these become detectable 3-10 days afterwards. Antibodies will also be detectable for months or years after your recovery. Thus, although antibody tests are of limited value in detecting people with the virus early, they are really useful in identifying people who have immunity and can safely be allowed to mingle with the general population. Most people who catch C19 don’t even know they’re sick: they just get over it in a few days. But once they recover, they’re immunized and pose no risk to the rest of us. So, it is good to know who they are. And the advantage of antibody tests is that they are cheap, quick and easy5. They need only a drop of blood, and take less than 15 minutes for a result. They are (or soon will be) cheap: of the order of $1 per test. So, it is not impractical to test millions of people, because the test can be safely administered by public health workers with minimal training, like the phlebotomists who take blood samples in hospitals. How will this help? Well, for one thing, international travellers can be required compulsorily to undergo both PCR and antibody tests as a condition of travel, with the tests administered in the 24 hours prior to boarding, or even at the airport. The test outcome could be part of an electronic travel authorization, which doubles as a health certificate on arrival at your destination. People who have positive antibody tests taken 3 weeks apart, for example, would
1 https://foreignpolicy.com/2020/03/23/coronavirus-pandemic-south-korea-italy-mass-testing-covid19-will-keep-spreading/ 2 https://www.nature.com/articles/d41587-020-00010-2 3 Reverse-transcriptase polymerase chain reaction, which searches for strands of RNA unique to the virus. 4 Known as immunoglobulin tests. 5 https://theconversation.com/covid-19-tests-how-they-work-and-whats-in-development-134479
be safe travellers, and therefore exempt from frequent PCR testing. With such a testing regime6 in place, Sri Lanka could open its doors to foreign visitors once more. And, like the airport tax, the cost could be included in the airfare. Even so, it would be foolish to think that the virus will not re-emerge in Sri Lanka. Many people with only mild symptoms, or no symptoms at all, may be carriers for a long time. No test shows positive or negative with 100% accuracy, so a few false-negatives will slip through, and we will need to be geared to catch the resulting outbreaks early. There’s also the risk of the virus mutating and infecting people all over again, as the flu virus does every year. This means continued testing of the population, especially in high-risk groups such as factory workers and those who use public transport. Given the scale of demand, the cost of PCR testing will probably decline substantially: $10 tests are being trialled already7. For effective monitoring, test results must be available centrally via a smartphone app, so people aren’t unnecessarily retested. Alongside this, we must continue to minimize disease transmission through better behaviours. Washing hands frequently, not touching the face, not coughing or sneezing where others are present, staying home when sick, and disinfecting frequently-touched surfaces8: these must be the new norm. Feel a sneeze coming? Leave the room, just as you would if you had to pass wind. Architects have their part to play by designing spaces to reduce crossinfection: electric or foot-operated doors in public buildings, hotels and toilets, for example. Staggered working hours in offices and factories will also ease congestion on public transport. The government’s response to this crisis so far, has been swift and effective, especially given that the more ‘proportionate’ public-order measures failed. However, we cannot have curfews forever. Besides, when the curfew is lifted, the melee that ensues lays waste to all the socialdistancing measures. But there are ways to get around this, as we have done for decades, for example, by ending the school day three hours ahead of the office day. Here, our NICs have value. To make sure not everyone hits the shops at the same time, the NIC could serve as a curfew pass, with weekly slots being allocated for people to get about, depending on the last digit of their NIC. That reduces people in public spaces at any one time by 90%, increasing social distance. In Australia, for example, supermarkets allow only people over the age of 60 to enter between 7-8 a.m. As we enter the endemic stage of this disease, government must relax its monopoly on treatment and control, and engage the private health sector, too, in treating C19. Remember: every doctor in Sri Lanka has at one time been a government doctor—they know the rules. The present system, which involves ‘reporting’ patients to the authorities and mandatorily sequestering them in government hospitals will soon be found to be ineffective, because many non-critical patients will simply not self-report. We have to learn from the HIV-AIDS epidemic of the 1990s that stigmatizing and criminalising those who are unfortunate enough to get infected results in a public-health failure. Unless people who think they have the virus feel comfortable about reporting it and seeking treatment, we will continue to harbour reservoirs of infection. This is especially so because the vast majority of those with C19 symptoms in fact have only a flu or a common cold: abducting them to a state hospital makes no sense unless they test positive and need hospital care. Our challenge is to return the economy to normalcy as soon as possible. Without that, there is no future for anyone. And the only way forward seems to lie in mass testing. The scale on
6 As at today (29 March), for example, Australia has approved 16 different test kits; see https://www.tga.gov.au/covid-19-diagnostic-testsincluded-artg-legal-supply-australia
7 https://www.bloomberg.com/news/articles/2020-03-25/virus-test-in-hours-for-under-11-eyed-by-atomic-scientists 8 I’ve seen images of buildings being fumigated in Sri Lanka, but can find no evidence that this is effective. Fumigation works well against insect vectors, but against viruses, it could in fact lead to false security.
which tests must be done is so vast that we should manufacture at least the antibody tests in Sri Lanka (this is eminently feasible). Additionally, an effective testing regime calls for complex monitoring software, integrating, for example, our NICs, driver’s licenses, passports and mobile phones. Development of this technology must start now. But for this to be effective, people need to trust government not to misuse their data, as happened in the early HIV days. C19 has been a leveller across the world’s nations. Countries with the best economic recovery plans will make huge gains as others fumble. We can turn the present adversity to our competitive advantage and spring back to full production. The policing stage of managing this crisis, which is where we are now, is relatively easy. That has happened. The next phase, however, calls for policy innovations on a grand and unprecedented scale. If we muster our wits and get this right, we may succeed not only in undoing the damage C19 has caused, but also the setback of the separatist war. This is a time for opportunity, not despair. Sri Lanka after C19: Policy Prescriptions
Even as the government brings the outbreak of C19 under control, we need to bear in mind that the virus will probably remain endemic in reservoirs around the world. There will be periodic epidemics until a vaccine is found. Remember that up to now, despite billions of dollars and multiple decades of effort having been invested, no vaccines have emerged for HIV or even the common cold. It would be foolish, in the near term, to pin our hopes on a vaccine: that is at least two years away. We cannot keep our borders closed forever. Travel will have to begin, risking the spawning of new outbreaks. Also, what of the tourism industry and the million Sri Lankans dependent on it? We need tourists, but we don’t want C19. The only way we can open our borders and minimize the risk of new outbreaks is to test on a mass scale. With 20,000 people being tested daily, South Korea leads the world in testing1. Only epidemiological modelling will tell, but I would guess that Sri Lanka will have to test up to 50,000-100,000 people daily (as will other countries) over the coming year, to ensure that new outbreaks are detected and contained early. Tests take two forms2. The gold standard is the RT-PCR3, which is what the government is using now. This can detect even minute samples of the virus taken from the mucous membranes of the respiratory tract (nose or throat). RT-PCR can detect the virus very shortly after someone is infected, even before they show symptoms. Its drawback is that it is expensive and slow (the test costs about $75, and results take a few hours, though real-time PCR is now becoming a reality). Also, because they no longer carry the virus, this method doesn’t work for those who have recovered from C19. However, people who have recovered from the disease are likely to have immunity for some months or perhaps years. We still don’t know for how long, and will not know for—well, some months or years. The way around that is to test blood for antibodies4. Your body begins producing antibodies to the virus shortly after you’re infected, and these become detectable 3-10 days afterwards. Antibodies will also be detectable for months or years after your recovery. Thus, although antibody tests are of limited value in detecting people with the virus early, they are really useful in identifying people who have immunity and can safely be allowed to mingle with the general population. Most people who catch C19 don’t even know they’re sick: they just get over it in a few days. But once they recover, they’re immunized and pose no risk to the rest of us. So, it is good to know who they are. And the advantage of antibody tests is that they are cheap, quick and easy5. They need only a drop of blood, and take less than 15 minutes for a result. They are (or soon will be) cheap: of the order of $1 per test. So, it is not impractical to test millions of people, because the test can be safely administered by public health workers with minimal training, like the phlebotomists who take blood samples in hospitals. How will this help? Well, for one thing, international travellers can be required compulsorily to undergo both PCR and antibody tests as a condition of travel, with the tests administered in the 24 hours prior to boarding, or even at the airport. The test outcome could be part of an electronic travel authorization, which doubles as a health certificate on arrival at your destination. People who have positive antibody tests taken 3 weeks apart, for example, would
1 https://foreignpolicy.com/2020/03/23/coronavirus-pandemic-south-korea-italy-mass-testing-covid19-will-keep-spreading/ 2 https://www.nature.com/articles/d41587-020-00010-2 3 Reverse-transcriptase polymerase chain reaction, which searches for strands of RNA unique to the virus. 4 Known as immunoglobulin tests. 5 https://theconversation.com/covid-19-tests-how-they-work-and-whats-in-development-134479
be safe travellers, and therefore exempt from frequent PCR testing. With such a testing regime6 in place, Sri Lanka could open its doors to foreign visitors once more. And, like the airport tax, the cost could be included in the airfare. Even so, it would be foolish to think that the virus will not re-emerge in Sri Lanka. Many people with only mild symptoms, or no symptoms at all, may be carriers for a long time. No test shows positive or negative with 100% accuracy, so a few false-negatives will slip through, and we will need to be geared to catch the resulting outbreaks early. There’s also the risk of the virus mutating and infecting people all over again, as the flu virus does every year. This means continued testing of the population, especially in high-risk groups such as factory workers and those who use public transport. Given the scale of demand, the cost of PCR testing will probably decline substantially: $10 tests are being trialled already7. For effective monitoring, test results must be available centrally via a smartphone app, so people aren’t unnecessarily retested. Alongside this, we must continue to minimize disease transmission through better behaviours. Washing hands frequently, not touching the face, not coughing or sneezing where others are present, staying home when sick, and disinfecting frequently-touched surfaces8: these must be the new norm. Feel a sneeze coming? Leave the room, just as you would if you had to pass wind. Architects have their part to play by designing spaces to reduce crossinfection: electric or foot-operated doors in public buildings, hotels and toilets, for example. Staggered working hours in offices and factories will also ease congestion on public transport. The government’s response to this crisis so far, has been swift and effective, especially given that the more ‘proportionate’ public-order measures failed. However, we cannot have curfews forever. Besides, when the curfew is lifted, the melee that ensues lays waste to all the socialdistancing measures. But there are ways to get around this, as we have done for decades, for example, by ending the school day three hours ahead of the office day. Here, our NICs have value. To make sure not everyone hits the shops at the same time, the NIC could serve as a curfew pass, with weekly slots being allocated for people to get about, depending on the last digit of their NIC. That reduces people in public spaces at any one time by 90%, increasing social distance. In Australia, for example, supermarkets allow only people over the age of 60 to enter between 7-8 a.m. As we enter the endemic stage of this disease, government must relax its monopoly on treatment and control, and engage the private health sector, too, in treating C19. Remember: every doctor in Sri Lanka has at one time been a government doctor—they know the rules. The present system, which involves ‘reporting’ patients to the authorities and mandatorily sequestering them in government hospitals will soon be found to be ineffective, because many non-critical patients will simply not self-report. We have to learn from the HIV-AIDS epidemic of the 1990s that stigmatizing and criminalising those who are unfortunate enough to get infected results in a public-health failure. Unless people who think they have the virus feel comfortable about reporting it and seeking treatment, we will continue to harbour reservoirs of infection. This is especially so because the vast majority of those with C19 symptoms in fact have only a flu or a common cold: abducting them to a state hospital makes no sense unless they test positive and need hospital care. Our challenge is to return the economy to normalcy as soon as possible. Without that, there is no future for anyone. And the only way forward seems to lie in mass testing. The scale on
6 As at today (29 March), for example, Australia has approved 16 different test kits; see https://www.tga.gov.au/covid-19-diagnostic-testsincluded-artg-legal-supply-australia
7 https://www.bloomberg.com/news/articles/2020-03-25/virus-test-in-hours-for-under-11-eyed-by-atomic-scientists 8 I’ve seen images of buildings being fumigated in Sri Lanka, but can find no evidence that this is effective. Fumigation works well against insect vectors, but against viruses, it could in fact lead to false security.
which tests must be done is so vast that we should manufacture at least the antibody tests in Sri Lanka (this is eminently feasible). Additionally, an effective testing regime calls for complex monitoring software, integrating, for example, our NICs, driver’s licenses, passports and mobile phones. Development of this technology must start now. But for this to be effective, people need to trust government not to misuse their data, as happened in the early HIV days. C19 has been a leveller across the world’s nations. Countries with the best economic recovery plans will make huge gains as others fumble. We can turn the present adversity to our competitive advantage and spring back to full production. The policing stage of managing this crisis, which is where we are now, is relatively easy. That has happened. The next phase, however, calls for policy innovations on a grand and unprecedented scale. If we muster our wits and get this right, we may succeed not only in undoing the damage C19 has caused, but also the setback of the separatist war. This is a time for opportunity, not despair.
