parafox
Friday, September 4, 2026
When an Examiner/Invigilator sit at the Back Bench and answer the MCQ Paper with the students - Outcome
නිවනට යන්න පුළුවන්ද, ගිහිල්ලා ඉන්න පුළුවන්ද?
Break the Backbone of Ceylon
Break the Backbone of Ceylon
Multi Prong Attempt to Break the Backbone of Ceylon
There is 4 or 5 prong attack to strangle Economy of Ceylon
Doctor DRUNK on a Highway
Saturday, December 27, 2014
This extends from streetwise pickpocket to a computer hacker.
When one is under the weather, I mean alcohol, he loses his inhibitions.
The other day, I met an old doctor drunk to his under belly and was trying to behave like a policeman.
I did not know he was a doctor who had lost his senses.
He wanted to push me to the middle and sit (in a seat for three).
Besides, I was reading a local paper (not kind to the ruling party) and was fully engrossed in it.
I refused to move and curtly told him go and sit in the middle.
There was another guy in the other corner.
I am reading the paper, please do not disturb me in English and asked him whether he needs a Sinhala translation.
This is my original sin and the defense.
In Sri-Lanka, presently 95% cannot speak in proper English (Sinhala superiority complex has originated form this basic flaw in line of communication) except the minority community.
The idea was to CUT SHORT my conversation.
There is basic weakness, no healthy conversation or alternative views.
I repeated my statement without waiting in Sinhala and pretended to be reading the paper but visibly angry inside.
That is where, the old guy older than me made his cardinal sin/s.
He said;
You should go and read the paper at home.
I saw you refusing other passengers, rudely.
Three
I am a doctor.
The third quip was an invitation for WAR.
I hit the roof top of the bus instantly, without any jolt from the driver.
I blasted him with all the words that I could gather in English, in one second.
When, he was leaving and getting down I warned him, never to CROSS my path again.
He was drunk.
I said; I pity the patients who is consulting this DRUNK DOCTOR.
I am particularly RASH on doctors.
One day, I blasted a young Lady Doctor who broke the queue, in a not so busy pharmacy door.
This is Sri-Lanka and how an average Buddhist shows his/her custom is primitive.
We see an ultra-violent election campaign, NOW.
Either, we are completely PASSIVE or overtly AGGRESSIVE.
What my bone of contention is, (in a working democracy) the very existence of democracy cannot survive, if we are at two extreme opposing poles.
I tried to take the middle ground and do a bit of reform, even in a mundane affair like commuting in a public conveyance.
But I am failing miserably.
The above story is for an average web browser, to take note.
There are no rules (I hate social media now) like in a public transport.
There are no guardian angels.
Everybody including me is at risk.
This is the time of the year hackers THRIVE taking your liberties specially if under the influence of alcohol.
ENJOY your SPIRITS.
Do not drive especially, the super Electronic HIGHWAY.
Give your computer a holiday.
Please DO NOT RESPOND to POP UPS.
I of course do a full upgrade of my very OLD computer towards the end of the year.
I just finished it.
Good Luck till I see you next year.
Thank you to all those who browsed my Linux Tit Bits.
Please ignore my political aberrations, even though I try to be neutral.
There is nothing called neutrality in politics.
It is always SELFISH DESIRE.
Wednesday, September 2, 2026
Debian the clear winner
Tuesday, July 26, 2011
Debian the clear winner
The Gold for Light and Heavy Weight Championship
Now that the industrial action is over, we brought the Hero to Gyro (not giro and we could not be bought by money circulating on illegal hands or corruption) except perhaps few individual who had vested interests and wanted to be heroes at the expense of the general body politics of our action perpetuated by sheer needs and not aspirations (fell far short of aspirations of accountability, transparency, fairness).
These instant Heroes had unassailable lead and they had to be pulled down to base level and gyrate them on the correct path lest all of us would be heading for disaster.
We never had the political will to bring Heroes to Zeros but the vision to come to the base level we reached way back in 2008 and gyrate in correct orbit instead of asking for miracles which we will never achieve the way we sink into dirty tricks and manipulations by undesirables.
I hope senses will come to body politics of the country, unless of course the voters will bring the Heroes to Zeroes in double quick time at the correct gyroscopic orbit and time and they are not stupid or donkeys who carry burden.
We are of course in the minority in that context and what we can provide is wisdom if not vision.
We came to equilibrium position neither zero nor hero but a position of comfort from where we can gyrate to greater heights if correct recognition is extended.
Otherwise history will take us backward (like in cricket) instead of forward.
Debian
Coming to IT industry where there are commercial heroes but the clear winner which gyrate at the correct orbit is Debian.
It was no surprise.
Score of above 3000 and well above the Gold Standard of 2500 for the standard CD.
For the heavy weight category it is within the Gold Mark where no other distribution has all the components at hand with over 30,000 package well tested.
It has gParted which is around 100 MiB with partition and security features.
It has Blender, Scribus and Inkscape.
Only missing component was O.E.M. component.
It did not have a printed book but thanks to French and the English translation is due soon and available on line as open source.
It has all the versions from Mini to KDE to Server.
It has multi-language support including Sinhala.
It does not pretend to be a (commercial) hero but the wise counsel to all the other distributions which include Ubuntu and extending a hand to Linux Mint currently.
Additionally it is forging with FreeBSD too.
It is the clear winner.
If I said without my marking scheme everybody will say I am biased. Now it is vindicated and flame wars are not the necessity but a feature of Linux and its multi-faceted distributions..
Now I can say with or without bias it is the one that guides us and the Gyroscope for years to come.
If you need a solid, stable and secure enhanced Linux, there is only one and only one.
It is called Debian.
It is not for the lazy souls and it is the one who wants to dig a lot, sweat a bit and enjoy a lot of the hard labour.
Nothing is easy in the IT World.
One has to go into simple command line and give commanding orders till midnight commander sleeps like a sleeping beauty!
Real Polities and WAR
Real Polities and WAR
War and Peace
Let me be forthright from the very outset.
I am writing this as a simple Buddhist who is totally against any war anywhere on this Planet Earth.
Hatred begets hatred.
Loving kindness brings harmony.
In Ceylon we had over 35 years of political hatred under JRJ (UNP) and Sirimovo (SLFP).
These two parties and their collateral, ruined Ceylon.
The breakaway offshoot parties from these two parties still carry hatred in Ceylon including LSSP, CP, MEP and JVP.
There are 80 odd registered parties in Ceylon and one is headed by a monk.
According to Buddha monks should not take part in politics or should not give advice to Kings, Queens and Presidents.
The latest in this development are Wira Wansa Associate Conglomerate and Champaka's new party of descent (Hate).
These two are offshoots of the old JVP lead by Wije (Wira) Weera who started a armed revolution in this country when there was no need for such action
Then there was no racial animosity in existence.
He started hating India to begin with.
It is believed North Korea was instrumental in creating this party of descent who used killing opponents in broad day light, as a political stunt and tool.
Now, I believe, India created both JVP and DJVP.
Less I talk about LTTE is better and it was a party of HATE from its origin and it systematically exterminated, all the other Moderate Tamil Parties.
TNA is the remnant collateral.
I have nothing but admiration for Mr.Sampanthan for his political stamina.
He is no more.
By the way, I do not understand how the Tamil political parties evolved in the North. They were obviously created in India to begin with.
Muslim parties analogy is simple.
When two dogs fight, the small dog steals the flesh of politics.
Here is the entry point for CIA.
CIA used Indian RAW as its collateral in creating descent in Ceylon just like in Ukraine
India hated Ceylon and feared Ceylon would supersede Singapore as a power keg of the Indian Ocean.
USA was eyeing Ceylon as a military base.
I know it as the first hand information by coincidence since, I protected the satellite in the surgical theater as a piece of surgical equipment not willingly but unknowingly.
It was hidden as a surgical equipment when the previous doctor in charge was the head of the clinical unit.
This doctor fled to United Kingdom fearing recrimination from the DJVP.
I was hanging around without a job during trouble times and I gladly filled his place.
India created DJVP (second RAW creation and the earlier creation was LTTE) in 1988-89 to scuttle the launch of this satellite.
Indira Gandhi was the architect of the first but I am not sure of the second, may be Rajiv Gandhi.
Only difference in Ukraine was it armed the Neo Nazis and Bandera in Ukraine for over a decade (equivalents to JVP and DJVP).
Both Republicans and Democrats without exception helped to create Russophobia.
CIA and MIC (Military industrial Complex) were direct beneficiary but they have now met their nemesis called Russians who withstood Nazis, during the World War II.
I have sympathy for average Ukrainians who are refugees in Poland and EU countries.
Of course, historically Poland had to stomach spill overs.
Coming to India and Indians they did not provide refugee status to Ceylonese Tamils.
In fact, there is step brotherly treatment of Tamils of Ceylon but Indians gladly take their dollars.
The typical Political Duplicity of Indians.
Currently, India while buying cheap Russian fuels and selling them back to EU countries 3 times the stock price is asking for a seat in the Security Council.
It is the real Geopolitical Duplicity.
Pakistan and the rest of the neutral countries should oppose double dealing Indians, and there should NOT be a place in the Security Council for India.
China obliterated Tibet.
Dalai Lama is a lame duck.
China fought two wars with India for a narrow stretch of land and should not be given a seat in the Security Council.
Instead South Africa deserves a place in the Security Council.
WHO is a colossal waste and should be abolished for the reason, allowing CIA to operate lethal viral laboratories in Ukraine to kill President Putin. There would have been over 22 experimental laboratories over there. When war broke out, the first thing Russians did was to take over these facilities with tell tale evidence and WHO is numb and dumb about these experimental laboratories which they have probably authorized, in the first instance.
One need not do anything to resurrect USA and UK personnel who suffer from radioactive injuries that they may have acquired while handling the Depleted Uranium.
Let the guys/girls who masterminded these operations die of lethal cancers.
France should be allowed to have Nuclear Plants in every city but they should not be allowed to buy Uranium from outside sources, at all.
They should dig and mine Uranium in France.
Not in West Africa.
No gas and fuel from Russia or any other country to France and UK until all the Depleted Uranium is utilized in the War Zone of their choice.
Above points are raised to show not only India but all except a few EU countries are Duplicity Giants.
This piece is not complete unless I make some references to Israel and Muslim conflict.
Both religions are essentially similar,
God based.
One branch arise from a legitimate child and other branch from an illegitimate child from same father.
The father was called Abraham.
Their God, I think was an intermediary by creating another hybrid child for humans and gods.
I am a guy who believes in, that the God has no relationship to human evolution.
If there was a hybrid child it would have been from an alien species who visited this planet millions of years ago having had sex with an evolving primate species.
By the way, the age of this planet is not 7000 years as according to the Bible and Quran but this planet is much more ancient and revising these texts according to at least the Sumerian artifacts, if not scientific is mandatory.
By the way, these two texts have many editions and are constantly changing with time.
Archaeologists and writers are born liars except for a few.
This comment applies to Bagawath Geetha, too.
I have a request for President Putin.
We took 35 years to end our war of attrition and we are totally bankrupt.
He should end the War (attrition till next Presidential Election in USA is prudent) soon, on his own accord with a Strategic Bomb (ideally no Nuclear and that is how we finished the World War II in Japan).
But here it is to avoid the World War III which is annihilation of all and sundry, near the border of Poland or on the head quarters of the Military Alliance of the EU, lest Russia too, go bankrupt with Esoteric Missiles of mass destruction.
Otherwise, MAD or Mutually Assured Destruction!
Postscript
Please note, I am not in Ceylon currently and if I post this post in a local post I will be categorized as a terrorist.
All Ceylonese are by default born terrorists thanks to our robust constitution.
I think Ceylon should not have a constitution but let our monks deliberate Security Council Debates, on monthly basis in every village in Ceylon and the UNO should fund these rabid monks.
By doing so, (debating security) as rabid dogs, fighting each other, they will exhaust their inbuilt anger and spent up steam, while the rest of the citizens can exercise their free and democratic rights only in their residential domains, if they possess any of their own but not rented out.
According to proposed amendments to the constitution tenants are terrorists with no legal rights.
In the alternative each monk should be provided with a Steam Deck and Drive with a big overhead TV to play "War Games" in preparation of the Security Council Debates.
By the way, Steam Deck iso was out just today.
It cannot be installed on a PC.
I have another proposal!
The rent for University Students should be raised by three times the local prices.
By doing so, we can reduce the number entering the Universities drastically and then having more dons than undergraduates in every university that fails to function with perennial strikes.
These perpetual strikes were created by NPP/JVP
The dons themselves can create creativity perpetually without students asking valid questions.
Reflection of my Life at Panideniya
Tuesday, September 1, 2026
U.S.B. Multi Booting
This is the Final Update on preparing a Multi-booting USB.
YUMI
In spite of warning, by Peppermint, I installed YUMI Version One (using Debian Installer) on Ubuntu 14.04.
With lot of fiddling, I managed to Install few distributions on a 8 GB USB.
It installed everything including writing the boot menu.
This was written in Gambas programming language.
I did not investigate the reasons and what were the missing files.
Multi-booting USB (the follow up of YUMI)
Then from source-forge I got version 7 of multi-booting USB and installed it using Debian Installer and both attempts at launching it on Ubuntu 14.04 and Pinguy 14.04 failed due possibly to a missing dependency.
Sudo and root does not work and program crashes and disappears, never to be activated again.
This is a very dicey situation.
Multi-Sysytem from France works nicely on Peppermint, Pinguy and and Ubuntu.
It does not let you delete a distribution.
This is something available on Debian Multiboot-USB
I did not test it on Debian (I was bit lazy and Debian on 7 version is bit high and advanced for me) and it is probably a result of the distribution variability.
I have a request from both developer teams.
1. Multi-System should add the functionality to delete a distribution/s.
2. Multiboot-USB should work on the dependency and the distribution variation and specially the root and sudo administration.
3. UnetBootIn should work on both of the above issues and produce the third viable option (multi-booting and deletion of distributions) which is available for KDE desktops unlike Multi-System and Multiboot-USB.
I want both packages to succeed in the long run.
Both are pretty good.
Mind you we only had UnetBootIn, my favorite for different reasons.
It can be used on KDE desktops.
KDE guys and girls still cannot figure out and produce (Gnome the winner) a good USB Multi-Boot Utility.
Magnetic Equator, Kandy and Ravana and the Linux Revival
Wednesday, September 3, 2025
Magnetic Equator, Kandy and Ravana and the Linux Revival
Chinese Haircut
I dream a lot nowadays, simply because we are on industrial action and that gave me a liberal choice to dream whenever it pleases me and also to avoid dreams related to our action on day time.
Now I even dream on an armchair or a baby chair and I can be considered a armchair dreamer with a paltry pension to support myself in twilight years.
I can tell you dreaming is good for your soul and your brain and it invigorates you and make you more creative.
I hope the industrial action would go on for ever, so that I can develop a good relationship with Maha Brahma and who knows he might give me a new lease of life next time round.
Again the dream is aeriel type related to flying but not interplanetary episode.
The Dream
I was staying with one of my friends who was top class civilian pilot.
He too, was a good dreamer not on flight unlike the present day pilots with autopilot who drop to sleep in the cockpit for no reason.
He has seen my dreams and their interpretations on the Web
We were chatting and it was big double bed with my head on his foot side and his head on my foot side.
His first question was how can you dream so easily, my the interplanetary stuff, so outstanding.
I said; No he was too boring without even dry humor I never read his books.
How come?
Second time in my life I joined an industrial action and at the beginning I was dreaming of fat salary hike, like you are getting as a pilot
Then without any effort I got an especial part of my brain charged, the part I never used when I was working and the secret is the industrial action.
You mean to say if I want to have good dreams, I should go on strike.
Have I got to wear a beard?
NO, but the salary one gets is not enough even for a good shave and that is why we do not shave or take a haircut.
Then suddenly I went into deep sleep mode.
My friend like a fire Fighter in 3 minutes was ready and he was reading his flight schedule.
I woke up but went to sleep again. Again, I was in my dream state.
Then when I was looking for a pair of shoes I did not fine my pair of shoes.
I usually buy two pairs of the same type since when one shoe is damaged, I take one from the other.
What happens is when I use my creative (right) side of the brain the shoe on the opposite side of the brain wears off faster and when I use the logical brain (left) the shoes on the right side wears off.
I never use both sides of the brain at the same time for my own sanity, simply because I can get one shoe at a time repaired from the salary we get but never both shoes are taken to the cobbler.
If I use both sides of the brain I deserve twice the salary anyway.
By this method I can use both pairs of shoes as long as possible until my dog decides that, it is time for a good and smelly chew.
I was trying to pick a proper pair for half an hour and I could not and my friend's size was twice my size and he was of no help.
Afterall it was a dream.
Actually I got up because of the nasty smell of his shoes.
I quickly put his shoes on his head end my shoes on my head end.
So, if you share a room with your friends please make sure that you put shoes outside.
Interpretation.
Maha was excited about the dream but he always exchange some pleasantries and that is the way the heaven works.
He asked me have you ever missed a flight?
Only once nearly so I told him.
How come?
I was saying with one (really two-husband and wife) of my friends and they had a domestic fight before we left home and the fight continued up to the airport lounge.
I thought people do not fight when visitors are there.
Not like in heaven, we make sure that we start a fight so that the third party also can join in and make it worse.
Did you join in?
No.
If I did that I would have missed the flight.
I joined the queue and made a request to pay for the extra luggage to have some leeway to catch up with the lost time.
I quickly paid and luggage was in transit.
Because, I had gone to pay for extra luggage they knew, "I had checked in" and she came in search of me.
So we finally (she was in front in the latter stages) reached the gate and all doors were closed except the rear emergency entry from which we got in.
I must say I had a lovely flight home and the flight attendant kept the big teddy in her cabin.
Mind you I was the first to get out of the plane with the courtesy of the flight attendants.
That is a very nice true story and he was about to dish out his explanation, I asked him, I am going to miss a ride / a flight to heaven isn't it?
Do not be impatient old man.
This is about future.
This has nothing to do with flying.
In time to come there will be food shortages, the shoes represent the scarcity of food and people eating from filthy dustbins, like dogs.
Missed flight represent the hunger.
Yes no paraya (stray) dogs, too.
They have eaten all cats and dogs and bird of feather, too.
They are on the verge of cannibalism.
I think I should not go any further.
My Comments
I have made adequate entries on this virus (not the epidemic) at this site!
Our failure to "nip in the bud" were obvious even though government doctors (not GMOA, who bum-sucks politicians) did a creditable job.
We were lucky that we were not a tourist destination for many except Chinese and Indians (that is also for commercial exploitation) after Church Bomb and Wahabis activities which Sirisena ans Ranil failed to address (includes Mahinda too, he did not suppress its activities emerging way back in 2008 fearing loss of Muslim vote).
Cash struck we relied on Chinese and allowed Visa Office for Chinese to operate without supervision.
Very stupid political action.
I have a saying, "Never trust a Chinaman" that includes SOHO in London.
The only difference between Indians (RAW and Gandhis) and Chinese is very simple.
Indians get caught lying but Chinese never get caught with the HELP of WHO with an Ethiopian heading it shamefully.
When India and Africa get affected there is no stop of it spreading like a wildfire (poor sanitation, lack of water, malnutrition, poverty and joblessness compounding).
We may have to go back to hand to mouth existence (with unbearable debts and nobody giving a free lunch- an euphemism of mine) and NM and Sirima Era of Pan Poling-Bread queues and Manioc and Batala.
History repeats itself and SLFP/SLPP (I call it Pathala Party) unlike the UNP cannot feed the masses, especially in the North!
It is like Un SuKi of Myanmar taming the Army.
Very soon we won't be able to tame the emerging army influence on politics.
Thankfully our Police Force kept them at bay!
Above are SAD realities (only a few mentioned).
COVID-19: Ceylonese Response
Emerging Questions, Testing Times
Reproduction
Rajan Philips
It is now one month after the WHO declared Covid-19 a global pandemic. Some clarity is emerging through the viral cloud about what happened, what went wrong and what might have been done differently. It is legitimate to ask if Wuhan had to be isolated from the rest of China, why could not China have been isolated from the rest of the world. Had that twin isolation been undertaken, China would have got reconnected with the world in 67 days at most, the time it took China to end the isolation of Wuhan. In fact, China’s external isolation would have ended a lot sooner. Trade connections and supply chains would have survived an immediate isolation with minimum disruptions, and would not have been catastrophically broken as they are now.
This is all now hindsight, but the questions to China and the WHO are not going to go away.
There is plenty of blame to go around the world for general government inertia as well as sinister political calculations. Early warnings were ignored in the US and pandemic emergency plans meticulously prepared in western countries after the SARS crisis were not even looked at this time.
The exceptions are the few East Asian countries, perhaps Australia and New Zealand down under, and Iceland and Denmark up north. There are broader questions as well – from the direct connections between the growth of global agri-business and the release of pathogens from their harmless natural settings to hit and harm human hosts, and the diminishing global investment in the study of and preparedness for communicable diseases relative to lifestyle illnesses. But the questions and the debates will have to wait for another day until the current fight against the virus is brought under control.
There is no primeval fight or flight option. But fight and feed. Fight the virus, feed the people. That is the task of every government and it cannot get more basic for any government. And the task should not be made more difficult by the all too familiar lapses into never ending spats over race, region and religion. When nothing works, blame the unreliable Chinese or the ugly American. If neither works, blame the Muslims, especially in South Asia. The European Union that was created to end its recurrent internal wars is warring again over supplies and subsidies in the fight against the virus. And for the great NATO, it is business as usual. They will get paid for doing nothing as usual, or for desk-top testing of non-existent pandemic scenarios, unlike everyone else in the world.
Oh, yes, “April is the cruelest month.” T.S. Eliot would never have imagined that the famous opening line of his melancholy poem, The Waste Land, would turn out to be a morbid prophesy not only for the country of his birth, but also for the country of his adoption. The United State of America, where Eliot was born, is now the epicentre of a global pandemic. And the United Kingdom, of which he became a citizen after renouncing his American citizenship, is faring proportionately the same, if not worse. Prime Minister Boris Johnson himself has become a prime patient of Covid-19. Mr. Johnson is reportedly recovering well, after being in intensive care unit but without needing ventilator support, and much to the relief of a Brexit-battered and virus-hit nation. In general, however, and as usually alarmingly in the US, marginalized people are faring the worst.
The number of Covid-19 cases and deaths worldwide keep rising relentlessly. There are different lights in different tunnels. Europe seems to be on the mend finally, but only through a mountain of the dead. In the US the virus is surging in one state after another, but the curve appears to be flattening in general. Africa is no longer immune as it appeared to be at the start, and the worst is yet to come both for the continent’s health and its economy. East Asia is relatively stable, including China the origin of the viral quake. South Asia is sitting somewhat precariously in the middle, with India looming as the huge known unknown. That is the current picture and also the context for ongoing decision making.
Decision Making
Decisions are now being made in three interlocking planes, the science about the virus, the public action to contain its transmission, and governmental efforts to cushion the economic fall outs. The practical side of the science about the virus is all about testing. It is the paucity of testing and the lack of sufficient knowledge about the virus that has made contact tracing and physical distancing – from simple home isolation, to centralized quarantines, to total lock downs - the only way to break the chain of transmission and stop the viral spread.
It is the same paucity that has given rise to two, rather crude but the only available, universal metrics in the tracking of the virus and the fighting of its transmission: the number of days it takes to double the number of Covid-19 cases; and the number of tests per million population. The former helps in plotting the curve and the latter to assess the extent of the virus spread and to see if and how containment measures are working. For comparison, in the pandemic hot spots like China, Italy, Spain and the US, the number of days during which cases doubled, shrank from six to seven days at the start to three to four days during the surge.
Sufficient testing is needed to decide how and when the current isolation and distancing could be relaxed, and in what stages. Until then, there are economic fall outs to be taken care of. Unlike any of the past economic upheavals, the current shutdown is the worst supply side crisis ever, and writ large over the world like never before. While during the 2008 Great Recession, the western countries were hit hard and the peripheral economies were relatively spared, it is the global periphery that will be hit harder than the economic centres in the current showdown. Global initiatives have been either promised or called for by G20 leaders ($5-trillion), the UN ($9-trillion) and a large group of former world leaders ($5-billion) – that includes President Chandrika Kumaratunga. If any or all of them were to materialize, that would ensure a significant cash flow to peripheral countries. But how soon and how much are indeterminate, and the current beggar-thy-neighbour attitude to one another among the western countries does not augur well for much global certainty.
Testing delays have been universal, except again for the few East Asian countries. Even the US got tied up in regulatory knots and wasted precious time in the beginning before ramping up its testing program. The countries that are doing better in containing the virus are also doing larger number of tests than others. South Korea and Singapore are at 9,000 and 12,000 tests per million people, respectively. Australia is at 13,000 tests per million people, while Bahrain and Iceland are off the charts at 35,000 and 89,000 (multiple) tests per million. Timing is important. Germany and Italy are doing 15,000 tests per million, but they started late, especially Italy. France and England are under 5,000 tests per million, while the US and Canada are hitting close to 7,000 and 10,000 tests, respectively, but with significant regional variations.
Testing time for Sri Lanka
By all accounts, Sri Lanka has done phenomenally well in contact tracing and supervised quarantining. The record on testing, however, is nowhere near as good. Currently, the tests are reportedly limited to patients only, and about 3500 tests have been carried out so far according to recent news reports. That would place Sri Lanka at about 175 tests per million people, and in the same South Asian camp as Bangladesh at 36 tests per million (with 6,000 tests), India at 107 (145,000 tests), and Pakistan at 212 (45,000 tests). Sri Lanka has been conducting 150 to 300 tests daily, although it is said to have the capacity to go up to 1500 tests a day. At this rate, it will take just over two months to reach a reasonable target of 5000 tests per million (i.e. 100,000 tests). There have also been suggestions that the daily test rate can go up to 12,000 tests a day, but there has been no follow up regarding an aggressive testing program
There is then the debate, including in Sri Lanka, about what tests to perform and who should be targeted for tests. The primary test type is the diagnostic laboratory PCR (Polymerase Chain Reaction) test that detects the virus and confirms infection in a person. Multiple tests are needed in some cases before infection is confirmed. In many jurisdictions, this test and confirmation are required for ‘treating’ patients, even though, as some epidemiologists and physicians have pointed out, there is no accredited therapy for Covid-19.
The WHO definition of a confirmed case as “a person with laboratory confirmation of COVID-19 infection”, gives PCR test a special imprimatur. Dr. Jayaruwan Bandara, Director of the Medical Research Institute, has called it “the gold standard test” for diagnosing Covid-19. Understandably so, and the same token entails many restrictive guidelines for carrying out the test. The lab work invariably takes time and it has taken too much time even in western countries to increase the laboratory throughput of test results.
In addition, the PCR test is not a mass surveillance test to assess the spread of infection in a community. Hence the call for a second test, the serology test, that detects the antibodies that are produced to fight the virus infection. This can be used for both diagnosis and for population surveillance that will show the number of people who have been infected, including those with minor symptoms and those who are asymptomatic. Detecting asymptomatic cases is the special advantage of the serology test, knowing that asymptomatic transmission of the coronavirus is what renders it intractable.
As against these merits of serological testing, there is conventional reluctance in (government) medical and health regulatory circles to implement a serological testing program at the early stages of an epidemic. The reluctance might be because the regulatory agencies are not prepared to apply the serology test for diagnostic purposes insofar as the test does not detect the virus or early infection. Serology tests are typically used after an epidemic to assess the levels of infection and immunity in the community to prepare for the next outbreak. This point has also been made by the Director General of Health, Dr. Anil Jasinghe, who has indicated that “PCR is the test that was used by China and South Korea, at the initial stage of Covid-19, and that tests, like blood antibody testing, were used later.” The Sri Lanka Medical Association (SLMA) has also called for expanding PCR testing instead of shifting to serology testing.
On the other hand, the GMOA, in my understanding from news reports, has been pressing for implementing a rapid (serology) test program, and to carry out tests among 45,000 or so ‘contact traces’, who are in quarantine and are yet to be tested. In between, Chair Professors of Medicine (and specialist Physicians) from six of the island’s medical faculties, in their letter to Lt. Gen. Shavendra Silva, Chairman of the Covid-19 National Task Force and Dr Anil Jasinghe, Director General of Health Services, recommending next steps, have called for increasing test capacity and to “seek advice from virologists regarding what tests are most appropriate for use in specific scenarios.”
Across the world, a Canadian epidemiologist, Prof. Dawn Bowdish of McMaster University, has said that serology tests “are absolutely the gold standard for understanding the spread of this infection.” So, if both the PCR and serology tests are gold standard tests according to medical experts, albeit for different purposes, why not use both – from a simple and practical policy standpoint, to serve both purposes in Sri Lanka, and since both are needed. That is, both to diagnose patients and to track the virus spread. New serology tests are already being used in a number of countries, each priced at $10 (Rs. 2000, less than the PCR test cost of Rs. 6000), and able to give results in 20 minutes.
One more viewpoint on the matter of testing might be of particular relevance in the Sri Lankan context, with a tradition of doctors providing exceptionally good diagnosis in spite of limited resources for laboratory testing. Prof. David Fisman, Infectious Disease Epidemiologist and Physician at the University of Toronto, has suggested that given the newness of and the lack of information on Covid-19, ‘clinical case definitions’ should be used to identify Covid-19 cases where formal testing facilities are not sufficiently available. According to Dr. Fisman, clinical definitions were used during the SARS outbreak in Canada, and at the height of the current crisis in China, CT-scans were used in diagnosing Covid-19. Dr. Fisman has also suggested that in a pandemic situation such as this, every patient admitted to a hospital should be tested for Covid-19, along with healthcare providers. Testing of inmates in prisons, and other high-density dwellings and institutions would also make sense.
At this early stage of an epidemic caused by an etiologically little-known virus, the sampling for testing is invariably not random. Optimal sampling strategies have been developed for other disease epidemics that are both time-dependent and independent, and target both the vector (virus) and the host (human) populations. For now, in the case of the coronavirus, the rather crude metric of ‘tests per million’ appears to be the only guidance everywhere. Random sampling has been reported in Iceland, but the randomness assumption there is also being contested. In the light of all this and to get to practical matters, what could be the next steps in Sri Lanka?
Next Steps and Potential Slips
There is no further need to belabour the case, which is to implement both the PCR and the serological tests as rapidly as possible and as in many numbers as possible. Sri Lanka could learn from Vietnam, which has a low testing rate, about 1,200 tests per million people (and a total of 115,000 tests), but has aggressively carried out contact tracing and targeted ring-testing among the traced contacts to break the chain of transmission. The Sri Lankan government should support medical and health professionals to devise testing programs specific to each district, based on the experience so far and district-specific infection information, and implement them aggressively. There are medical faculties practically in every province and their resources should be leveraged to maximum benefit through co-ordination with the MRI and the Director General of Health Services.
It would also be helpful if the government could set up a proper professional forum where all the medical voices and opinions could be channeled and consulted without their having to find independent media outlets to express themselves. There is some media muttering that some medical voices are closer to the political powers than others. But that is inevitable and in itself should not be much of a concern, provided the scientific independence of the MRI and the administrative independence of the Director General of Health Services are not compromised.
To strike a personal note, I have found the silence of Dr. Tissa Vitarana in all of this somewhat puzzling. As onetime Director of the MRI, he was a highly respected medical scientist and was universally liked as a person, as some UNP Doctors used to say, in spite of his affiliations to the LSSP. His age should not be a factor, because everybody who is somebody in the current Administration is old. Dr. Vitarana is the only medical scientist who is politically associated with the current Administration. He is the Governor for the North Central Province and is also on the SLPP National List for the parliamentary election. And he could be a source of experience and wisdom in linking medical-scientific thinking and political decision making.
A ramped-up testing program and informed consultations based on test results will be critical in determining the next steps in coming out of the current curfew situations in the country. The virus is not going to disappear any time soon any where in the world, until an effective therapy or a successful vaccine is found. So, there cannot be a total relaxation of the current restrictive measures. In fact, it would be prudent to expect and prepare for restrictions and relaxation to alternatingly continue for rather long periods of time. And there are good practices to follow – from Vietnam, South Korea, Singapore and Taiwan.
Singapore is currently implementing a series of “stepping up measures” to deal with a second spike in the local transmission of the virus. Singapore calls the measures a “circuit breaker”, not a lockdown or a curfew, and they are being implemented with due preparation and prior notice to avoid public confusion and transport stampedes. The measures will initially last a period of one month, which is calculated to cover two cycles of viral incubation. Additionally, modern supermarkets and traditional ‘wet markets’ will remain open and people will be allowed shop in orderly manner while maintaining minimum physical separation. These are not difficult measures and similar measures can be easily implemented in Sri Lanka. In Colombo, and other main cities, it should not be difficult to keep markets open and designate separate days of the week for households from different areas (e.g. by streets or ward) to do their shopping.
Overall, the government faces three challenges: containing the virus; cushioning the economic fallouts; and ensuring the survival of constitutional politics. On the first, the government deserves all the credit that has been extended to it. Hopefully, it will keep up the good work, informed by sufficient test data and appropriately adopting good practices from East Asian countries. It is too soon to pass verdict on the second challenge. Even without the virus the government was in a deep hole and the virus has made it infinitely worse. Its first responsibility is to support employees and businesses who are involuntarily locked out of work, and this goes far beyond fulfilling the already established subsidy practices.
To that end, the government should look for immediate funding opportunities anywhere and everywhere, bilateral or multilateral. It could even send Chandrika Kumaratunga and Ranil Wickremesinghe as urgent emissaries to scour the world and not to return without foreign exchange. They could be more useful to the country from the outside than from within. Of course, they cannot emplane immediately, nor is physical travel really necessary with the new virus making virtual connections the new reality. Desperate times call for desperate measures, and no one is going to lose by working together in this crisis. Hopefully, I am not jinxing the possibility of a positive outcome for the country by publicly suggesting it.
The government should also forcefully nix lamebrained ideas emanating from within its ranks. Two have surfaced so far – one on (ab)using the EPF savings as a stimulus source, and the other to bring back import substitution from the long-ago dead. Neither seems to have found any traction, and hopefully both are still born, or dead on arrival. This is not to say that there is no room for new ideas, only they should not be lamebrained.
Worldwide food scarcity has been talked about even before the arrival of the virus, and its arrival makes it all the more urgent. Sri Lanka can and must re-energize its food production, but without raising barriers. It is a fact of Sri Lankan economic history that local food production has thrived only when there was no barrier at the customs, or checkpoints at district boundaries. One can be a socialist and doesn’t have to feel shy about saying this. As for new ideas, it would be worth for some in the government and the industry to explore the possibility of retooling the island’s industrial knowhow and technology in medical glove making and the garment industry to cater to the rising global demand for hospital gowns and other Personal Protection Equipment (PPE) for front line healthcare providers.
The third challenge is also the government’s Achilles’ heel, and where it can slip. The success here will be marked not by the extent of the SLPP’s victory at the next parliamentary election, whenever it comes, but by the extent to which President Gotabaya Rajapaksa and his Administration abide by constitutional norms in exercising executive power. A curfew without declaring emergency, avoiding emergency rule to avoid recalling parliament, and bankrolling off the national coffers, no matter how empty, without parliamentary approvals – are all jointly and severally beyond the pale in every direction. The President has the power and the option not to do any of this. And those who advise him to the contrary are not serving the President or the country well.
The latest in this vein is the missive by Presidential Secretary,