A big wave is coming. We need to move

You can read this article in English, සිංහල, or தமிழ்.

When the tsunami came to Sri Lanka it came slowly, then all at once. We had hours between the earthquake and impact. We even had time as the wave swept around the island. We just didn’t know, and over 30,000 of us died.

Now we know. When there’s a warning we need to run, we need to get away from the beach, prepare and take care of each other. So this is a warning. This is now. Today a wave of coronavirus is sweeping around the world, and it’s coming here. Sri Lanka still has time to act, but we must act aggressively, and we must act now.

2 cases… wait no 5 cases… no 10… sorry, 18

As I write this we have two cases, transmitted person to person on this island. Sorry, since I’ve been writing this it’s grown to five/10/18. You can see what’s happening.

If you double a grain of rice on a chessboard, you end up with 2 billion before getting halfway across the board. We’re not wired to understand exponential growth, but understand this. It’s like a tsunami coming from a thousand kilometers away. For a long time, it’s just a ripple on the ocean, then it’s waves 10m high. By the time you realize something is wrong, it’s far, far too late.

In the tsunami, Indonesia was hit first but we didn’t know. Today, multiple countries have been hit and we do know. Let’s look at Italy.

Italy had two cases for a week, just like us. Then three for another two weeks. No problem. In the fourth work, suddenly nine. Still manageable. Then, the next day, 76. Then it was over.

Within two weeks they had nearly 12,500 cases and 200 deaths. The nation was at war, under complete quarantine and doing triage in hospital halls.

Coronavirus was just a ripple, then an enormous wave. Italy has an excellent health system and it broke. What do you think will happen to us?

Italy has 12.5 ICU beds per 100,000 people. Sri Lanka has 2.3, and Sri Lanka is not North Italy. We have two patients per bed in wards, and ICUs are 100% full right now. When this wave hits our hospitals we are going to drown, unless we batten down the hatches right now.

Italy’s experience has now underscored the need to act decisively — quickly and early — well before case numbers even appear to reach crisis levels. By that point, it may already be too late to prevent a spike in cases that stretches systems beyond their limits. (NYTimes)

We must act now

The benefits of acting early are enormous.

“The graph that really grabbed my attention was the one showing a model of daily new cases of Covid-19 with social-distancing measures starting just one day apart,” Dr. Britta Jewell said. “It only takes a one-day difference in action to see a 40 percent reduction in cases — that’s enormous. It really conveys the urgency of the situation.” (NYTimes)

Look, I had a lot more written on this point but I think events should have shown you this by now. If you’re not feeling the actual fear in your heart right now then I don’t know what you’re feeling. This is not panic, this is your body telling you to act and you need to use your brain to figure out what to do. Thousands of people have suffered and died to get us that information. We can listen, and we can learn.

What to do?

First, who? Who does what? In Sri Lanka is comes down the President, the public health authorities, and eventually the military. We have a government I didn’t vote for but they are listening to scientists and it is thankfully stable. Gotabaya Rajapaksa has some competence at this and I think he’s listening to the right people. Right now have to support them 100% and listen to them. The government needs to be supporting our public health officials and getting everything else out of their way.

What any country like ours should be doing is listening to the WHO and learning from countries like China, South Korea and Taiwan that have successfully managed this. If at all possible, we should get experts and resources from them.

What the WHO Director-General says is:

“Not testing alone. Not contact tracing alone. Not quarantine alone. Not social distancing alone. Do it all.”

What China and other countries did is actually herculean. I’d recommend watching this video for a full report. China had temperature scanners everywhere. Anyone with a fever was taken to a fever clinic and tested. If positive they were quarantined, away from their families.

Sri Lanka is now in the containment phase, finding every case, testing, quarantining and tracing contacts. We can only do this for so long but it is vital work and needs to be given every support. That means making public health officials jobs easier by shutting as much as possible down. As the wave is coming, we must move inland. That essentially means staying home.

Move away from the beach

Once they finally stopped covering up, China completely shut down entire provinces and limited freedom of movement for nearly 1 billion people. Their are more surgical controls, but I think we lack the technology for those. We must do what we can.

The simplest thing we can do with limited resources is extreme social distancing. Canceling big matches, limiting mass migrations like Avurudu, canceling weddings, conferences, parties, whatever. We have already closed schools because parents are extra paranoid but we all need to be parents to each other right now. We need to cancel everything.

We do this to give public health officials a fighting chance. Every activity we do creates more work for them in the containment phase. We cannot stop the coronavirus but we can slow it down. We can flatten the curve.

The less contact we have with each other, the less contact tracing public health officials have to do. This isn’t forever and it isn’t perfect. If we have better technology we could do something more surgical, like Taiwan or Hong Kong, but I don’t think we do. The wave is coming now and we just need to buy time.

This also means international travel restrictions. Essentially shutting down our tourism industry, and impacting every aspect of island life. In a month or so this will be counterproductive but again, we are just buying time. We desperately need that time to prepare.

Prepare for recovery

We cannot contain the coronavirus forever. This is just happening. What we can do is prepare our health system as best as possible. This means protective equipment for our doctors and nurses, testing kits, etc. No one can do this better than China and I think we honestly need their help. They sent a lot but we will need more. Someone needs to be living at the Chinese Ambassador’s house.

We also need to rapidly build quarantine centers (which the government has done), field hospitals and to train up as many staff as humanly possible. We don’t have enough ICU beds, ventilators, breathing machines. We will need these. This is a war and we are going to need huge amounts of ammunition. Luckily we have a wartime President, with a tendency to militarize things. That tendency is useful right now.

Recovery

This is all going to be incredibly hard. Because what we are talking about is shutting down the economy, and that kills people too. People will certainly go hungry. Our tourism industry has taken a 1–2 and now 3 punch. It’s down. Guys down south were barely making their van payments. That’s all gone now.

Daily wage earners, with social distancing, where does that go? The poor, hell, the middle class, everyone is going to get hit because we will increasingly have to shut down the entire economy.

Note that the UK is not doing this, they are simply letting the virus spread and preserving economic activity. They have stopped testing and essentially given up. Neither the WHO or anyone else recommends this, and I don’t think we should do it either. China managed to save millions of lives and is now restarting. I think this is the only moral path forward and I hope the government takes it. I think they are.

At some point, the travel restrictions should be lifted. The wave will have come and we will be underwater no matter what we do. At that point, we will need to open up our borders again.

At some point, everything will be less effective because the virus will just be here. Flattening the curve doesn’t mean you get fewer cases, it just means you spread them out over time so your health system doesn’t collapse. I don’t know where this point is or what happens next. I don’t know if the virus comes back when social distancing is relaxed. We’ll have to keep watching truly developed countries like China and South Korea and avoiding whatever the US and UK are doing in the new third world.

Then what?

I don’t know. We can only see as far as the most advanced countries and they’re still not back to normal. I don’t think normal will be the same. We have to seriously rethink how we live. We have to stop ignoring long-term threats that experts are warning about. We need to be more cautious, more prepared, and take better care of each other because we are quite obviously all connected.

And then, I fear, we will all have to grieve. We can fight the wave — we can move away, we can prepare and we can recover — but we cannot avoid it. It will take some of us away. I’m sorry. I’m sorry to me, I’m sorry to you. We’ve been through this every generation but it never gets better. But please hear this now. Every action we take now is worth ten tomorrow and a hundred in a week. Every inconvenience and caution today will save hundreds if not thousands of lives. So please Sri Lanka, act now.

You can read this article in English, සිංහල, or தமிழ்.