Features
How can Sri Lanka benefit? Insights & Solutions…
Vaccines against Covid-19:
By Dr LakKumar Fernando.
MD, DCH, MRCP(UK), MRCPCH (UK), FRCP (Lond), FSLCP
Background
It is almost one year since the world started battling the Covid-19 pandemic; there are over 80 million confirmed cases and 1.8 million deaths. WHO estimates that 10% of the world’s 7.8 billion population is already infected with Covid-19, and if that is the case the true case number is ten times higher. However, we are still without a proper treatment that can cure all the patients. Sri Lanka has recorded more than 200 Covid deaths and 40,000 cases by now. Fortunately, there is a light at the end of the tunnel with the positive news that several vaccines are getting lined up, shaping to end the pandemic before the end of 2021.
Vaccines have become the best solution against nearly all the important infections that threatened the human existence and Covid-19 is the most recent threat that demanded the biggest ever ‘vaccine solution’ in the history of mankind.
Normally, a vaccine takes 5-15 years of serious medical research before it is delivered for licensing and marketing. However, with all the tools ready with several vaccine makers to bring in a vaccine for similar infections, the race for Covid-19 vaccine became fast and efficient and researchers worked round the clock to fast track the solutions. The result is vaccinations against Covid-19 have started in several parts of the world already, even before the end of 2020.
With WHO declaring Covid-19 a global pandemic, close to 200 vaccine developers started research with huge investments and after completing pre-clinical animal studies, 44 vaccine candidates are currently in phase 1, 21 in phase 2, 18 are in phase 3. Five vaccines have approvals for limited use and three have emergency approval for full use., The fourth was approved on the 30th which can be a turning point with regard to cost and storage temperature of vaccines. About 85 vaccines are still in animal testing and just one vaccine was abandoned after the trials. Most Covid vaccines need two doses for complete immunity. However, trials have also shown significant immunity protection (70%) after a few weeks of the first dose itself. As a result, now the UK government is going to delay the second dose to 12 weeks instead of threeweeks so that more people could be vaccinated with the first dose protecting many while giving manufacturer more time to produce more doses.
Pfizer BioNTech’s BNT162b2 is the first vaccine against Covid-19 that got approval in most countries, that included the USA, Canada, the UK, and EU with more being added to the list almost daily. Moderna was the next that got approved in the USA and Canada. The Russian manufacturer Gamaley’s Sputnik V vaccine is in early use in Russia and it’s also approved in Belarus and Argentina. The Chinese vaccine Sinopharm Beijing is approved in the UAE and Bahrain and there is limited use in China too. CanSino and Sinovac are two other Chinese vaccines that are in limited use in China already.
The British-Swiss Oxford University combined Astra-Zeneca (AZ) vaccine AZD1222 which also has its biggest manufacturing site in the Serum Institute of our neighbouring India just got approval from the UK regulatory authority MHRA (Medicine and Health Regulatory Authority) and its possibly going to be the cheapest with cost being as low as two USD per dose with the storage capability of being within on 2-8 centigrade under normal refrigeration. Serum Institute also has over 50 million doses ready for dispatch after approval. AZ with about 30 manufacturing sites has the capacity to produce bigger quantities of the vaccine than most others.
Another Indian vaccine by Bharat Biotech is also in Phase 3 and will complete trials early next year.
With all these vaccines getting lined up and with more than a couple of million people in the world getting their doses already, Sri Lanka too should move fast to get the best use of the opportunity.
HOW CAN SRI LANKA GET THE VACCINE?
There is a group called COVAX set up with WHO’s help with funding from rich countries organized to give access for Covid-19 vaccines to populations in over 90 poorer countries. Covax has already ordered 2 billion of Covid vaccines from different manufacturers and they have already secured 1 billion doses from this order. It has agreed to give Sri Lanka too vaccines for 4.1 million or 20% of our population free.
No Covid vaccine is still intended for the under 16 age group as the trials were in populations older than this age limit. Fortunately, in this younger age group Covid has so far remained largely an asymptomatic disease with minimal deaths or need for hospitalisation.
WHEN CAN SRI LANKA GET THE VACCINE?
If we get ready with all logistical requirements, and communicate with COVAX and WHO efficiently and professionally, we can start having it from as early as next February itself but how many doses we can have and over what period of time will depend on many factors which also include the degree of our local effort and commitment.
WHOM SHOULD WE
VACCINATE FIRST?
We will have to have a priority order which should include our elderly population and those with co-existing illnesses like diabetes, heart and kidney disease and other chronic illnesses as well as the healthcare workers (HCW) and security forces involved in Covid control activities who are high risk groups to contact the disease.
Vaccinating healthcare workers are important for several reasons and they include…
1. We cannot afford to lose HCW having to isolate them or quarantine them with infection or exposure as they are needed in numbers to look after the Covid cases and other patients
2. Due to the fear of contacting Covid there is breakdown in the necessary routine medical and surgical care for patients in most healthcare institutions at present and this is responsible for most parallel deaths and morbidity even in non-Covid patients. Some of the Covid deaths specially home deaths are also a result of the malfunctioning of routine standard follow up and care for those with co-morbidities.
3. If the case numbers increase HCW will need more PPE for everyday use and we will not be able to face it if the situation escalate further.
WHAT ABOUT VACCINATING THE OTHERS? CAN WE AFFORD IT?
When it comes to immunisation coverage for routine vaccines, Sri Lanka is outstanding in the world where our strong public health set up and the infrastructure has beaten even many developed countries.
Our vaccination acceptance rates are remarkably high with the literacy rates and public health network, mass vaccination is nothing new to our setup. Being an island with secure borders and the limited population of only 21 million compared to eg. India’s 1.3 billion, we are a country where vaccinating the entire population is a realistic feasible option if you can find the money and the doses to cover the entire population. With about 25% (6 million) below 16 years of age, where there is no vaccine for this age group, we need vaccines only for less than 15 million people. Our over 65 population in the country is just about 10% (2 million). We will get at least 4 million doses free from COVAX. We must spend money only for 11 million doses.
If we buy at 2 USD per dose, (Indonesia is possibly getting the AZ vaccine from serum institute for USD 1.64 per dose) we will need less than Rs. 5-8 billion to buy the vaccine and there will be a little more logistical cost. This will also be over many months. Sri Lanka has already spent close to 10 billion rupees on PCR testing alone since March and compared to that the vaccine expenditure is a remarkably worthwhile investment. It is also not essential that we give the vaccine free to everybody.
With good motivation and awareness campaign there will be many who will not mind paying for their vaccine which can be as little as 500-800 rupees for both doses. We can start a public campaign to raise funding for the vaccine without overburdening the Treasury and if handled properly this can have an excellent response. We have 1.8 million Samurdhi recipients and it is believed that only about 1 million of them are in the extremely poor category. In this country we can also easily find over 1 million people who will not mind sponsoring a vaccine for someone else who is poor and cannot afford it. This is a time we have to get-together to face this pandemic.
No one should try to take political advantage of the situation. Together we can end up a proud nation that has vaccinated all its people ahead of many other countries. It is also essential that we strengthen the vaccination system by allowing the private sector too, to be very much a part of the vaccination program. This not only ease the burden to the government, it will also help to reduce unwanted unrest among people.
It is also worth noting that many rich countries have already placed orders far in excess of their true requirement. For example, UK has placed orders for 350 million doses though they need only 120 million doses for its less than 60 million eligible population. There are many examples like Canada pre-ordering almost 9 doses per person very much more than they need and countries needing more doses can take advantage of these situations, by being proactive. Its unlikely that the cost of the vaccines will go up or the availability of doses will become a huge issue. With time most will be solved. Already 18 vaccines are in phase 3, and they too will be competing in the market soon. The early successors have no room for monopoly and when vaccines like by Johnson & Johnson which is single dose also come into the market the competition will be even more. Serum Institute in India can produce 2 billion doses of AZ vaccine in 2021 and the Russian Gamaleya can produce 500 million more doses to be used outside Russia. WHO and NMRA will do the regulatory evaluations for each vaccine fast. However, if we do not actively look for avenues, we will be end up at the back end of waiting list.
With above explained feasibility and reality, Sri Lankan can be one of the first countries in this part of the world to vaccinate its entire population. It is never an impossible task. This will place us in a unique situation, with our ability to fully open the country where factories and tourism and our economy can jump ahead of many others, making Sri Lanka one of the safest countries in the world to travel and to deal with. We being a smaller country with a smaller population, it’s best that we take advantage of our unique circumstances. For the best out come extreme efficiency is a must and we will need top officials with a proven track record handing our vaccine effort.
WHAT ARE THE VACCINES WE CAN BUY OR GET?
With the huge global demand, it is unlikely that any country(possible exception of Singapore and Canada) can vaccinate the entire population with only one type of vaccine. We will have to keep shopping for different vaccines, while the COVAX also will be giving the countries their free quota from different makes. They have already offered as 200,000 doses of Pfizer vaccine to Sri Lanka last week through a proposal, as they believe, Sri Lanka is an ideal example in this part of the world to successfully execute distribution of an ultra-cold vaccine to a limited population like the healthcare workers. Though -70C appeared not practical at the beginning Pfizer has already found good transport solution where vaccine doses can be taken in a separate storage unit filled with dry ice (liquid carbon dioxide), and there are reputed local logistics companies (eg. Akbar Brothers) that can handle it up to the delivery to the hospital. The Pfizer’s storage units can maintain ultra-cold temperature for 10 days if unopened and can be kept for 30 days if re-filled with dry ice every 5 days. Once taken out of these storage unit the vaccine can be kept in normal refrigerator temperature of 2-8C up to a further 5 days. If we commit to take this free offer, (has to be a firm commitment done fast enough in time) we can vaccinate our HCW front liners incredibly early, and the same Pfizer vaccine can be made available also for the private sector later in the future. Our preparedness to complete our vaccinations using different vaccines for Covid will be the best way to achieve the ‘not-impossible target’ of vaccinating our entire population early.
WHAT ABOUT SIDE EFFECTS OF THE VACCINE AND DURATION OF IMMUNITY? WHAT ABOUT NEW STRAINS THAT WILL APPEAR?
Any vaccine or drug can have side effects, like allergy in people known for severe allergy. With over millions of vaccinations now completed after recent approval the safety of the approved vaccines appear very good and comparable to the vaccines we have already taken from childhood. This has been systematically tested in phase 2 and 3 of the trials.
About efficacy and long-lasting immunity, we can be only be hopeful as compared to influenza virus that fast mutate, SARS Covid-2 is a relatively stable virus where mutations are slower, and indications are that even the new variant of Covid-19 that emerged in UK and South Africa will still be prevented by the vaccine. There are interesting reports about the survivors of 2002- 2004 SARS epidemic infected by SARS Covid-01 still showing protection against the current Covid-2. If the immunity does not last long a booster will be needed. Initially like children we will have few exclusions for vaccinations like for any new vaccine for eg. pregnancy. Vaccinating a large number will bring in a major change into our lifestyle and take us towards herd immunity. With so many restrictions affecting our day-to-day life the vaccine option is THE best available solution we have now.
In summary we need to use a multi-pronged effort to vaccinate everybody which will be a noticeably big useful investment towards economic development, even more than a health solution. We will have to secure and use
1. The free vaccine we will get from COVAX for 20% of our population
2. Negotiate with various sources, and countries to obtain or buy more doses to cover the balance population.
3. Permit the private sector also to import, distribute and vaccinate, with state monitoring to facilitate effective coverage of the population who could afford the vaccine privately.
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Features
Islamophobia and the threat to democratic development
There’s an ill more dangerous and pervasive than the Coronavirus that’s currently sweeping Sri Lanka. That is the fear to express one’s convictions. Across the public sector of the country in particular many persons holding high office are stringently regulating and controlling the voices of their consciences and this bodes ill for all and the country.
The corrupting impact of fear was discussed in this column a couple of weeks ago when dealing with the military coup in Myanmar. It stands to the enduring credit of ousted Myanmarese Head of Government Aung San Suu Kyi that she, perhaps for the first time in the history of modern political thought, singled out fear, and not power, as the principal cause of corruption within the individual; powerful or otherwise.
To be sure, power corrupts but the corrupting impact of fear is graver and more devastating. For instance, the fear in a person holding ministerial office or in a senior public sector official, that he would lose position and power as a result of speaking out his convictions and sincere beliefs on matters of the first importance, would lead to a country’s ills going unaddressed and uncorrected.
Besides, the individual concerned would be devaluing himself in the eyes of all irrevocably and revealing himself to be a person who would be willing to compromise his moral integrity for petty worldly gain or a ‘mess of pottage’. This happens all the while in Lankan public life. Some of those who have wielded and are wielding immense power in Sri Lanka leave very much to be desired from these standards.
It could be said that fear has prevented Sri Lanka from growing in every vital respect over the decades and has earned for itself the notoriety of being a directionless country.
All these ills and more are contained in the current controversy in Sri Lanka over the disposal of the bodies of Covid victims, for example. The Sri Lankan polity has no choice but to abide by scientific advice on this question. Since authorities of the standing of even the WHO have declared that the burial of the bodies of those dying of Covid could not prove to be injurious to the wider public, the Sri Lankan health authorities could go ahead and sanction the burying of the bodies concerned. What’s preventing the local authorities from taking this course since they claim to be on the side of science? Who or what are they fearing? This is the issue that’s crying out to be probed and answered.
Considering the need for absolute truthfulness and honesty on the part of all relevant persons and quarters in matters such as these, the latter have no choice but to resign from their positions if they are prevented from following the dictates of their consciences. If they are firmly convinced that burials could bring no harm, they are obliged to take up the position that burials should be allowed.
If any ‘higher authority’ is preventing them from allowing burials, our ministers and officials are conscience-bound to renounce their positions in protest, rather than behave compromisingly and engage in ‘double think’ and ‘double talk’. By adopting the latter course they are helping none but keeping the country in a state of chronic uncertainty, which is a handy recipe for social instabiliy and division.
In the Sri Lankan context, the failure on the part of the quarters that matter to follow scientific advice on the burials question could result in the aggravation of Islamophobia, or hatred of the practitioners of Islam, in the country. Sri Lanka could do without this latter phobia and hatred on account of its implications for national stability and development. The 30 year war against separatist forces was all about the prevention by military means of ‘nation-breaking’. The disastrous results for Sri Lanka from this war are continuing to weigh it down and are part of the international offensive against Sri Lanka in the UNHCR.
However, Islamophobia is an almost world wide phenomenon. It was greatly strengthened during Donald Trump’s presidential tenure in the US. While in office Trump resorted to the divisive ruling strategy of quite a few populist authoritarian rulers of the South. Essentially, the manoeuvre is to divide and rule by pandering to the racial prejudices of majority communities.
It has happened continually in Sri Lanka. In the initial post-independence years and for several decades after, it was a case of some populist politicians of the South whipping-up anti-Tamil sentiments. Some Tamil politicians did likewise in respect of the majority community. No doubt, both such quarters have done Sri Lanka immeasurable harm. By failing to follow scientific advice on the burial question and by not doing what is right, Sri Lanka’s current authorities are opening themselves to the charge that they are pandering to religious extremists among the majority community.
The murderous, destructive course of action adopted by some extremist sections among Muslim communities world wide, including of course Sri Lanka, has not earned the condemnation it deserves from moderate Muslims who make-up the preponderant majority in the Muslim community. It is up to moderate opinion in the latter collectivity to come out more strongly and persuasively against religious extremists in their midst. It will prove to have a cementing and unifying impact among communities.
It is not sufficiently appreciated by governments in the global South in particular that by voicing for religious and racial unity and by working consistently towards it, they would be strengthening democratic development, which is an essential condition for a country’s growth in all senses.
A ‘divided house’ is doomed to fall; this is the lesson of history. ‘National security’ cannot be had without human security and peaceful living among communities is central to the latter. There cannot be any ‘double talk’ or ‘politically correct’ opinions on this question. Truth and falsehood are the only valid categories of thought and speech.
Those in authority everywhere claiming to be democratic need to adopt a scientific outlook on this issue as well. Studies conducted on plural societies in South Asia, for example, reveal that the promotion of friendly, cordial ties among communities invariably brings about healing among estranged groups and produces social peace. This is the truth that is waiting to be acted upon.
Features
Pakistan’s love of Sri Lanka
By Sanjeewa Jayaweera
It was on 3rd January 1972 that our family arrived in Karachi from Moscow. Our departure from Moscow had been delayed for a few weeks due to the military confrontation between Pakistan and India. It ended on 16th December 1971. After that, international flights were not permitted for some time.
The contrast between Moscow and Karachi was unbelievable. First and foremost, Moscow’s temperature was near minus 40 degrees centigrade, while in Karachi, it was sunny and a warm 28 degrees centigrade. However, what struck us most was the extreme warmth with which the airport authorities greeted our family. As my father was a diplomat, we were quickly ushered to the airport’s VIP Lounge. We were in transit on our way to Rawalpindi, the airport serving the capital of Islamabad.
We quickly realized that the word “we are from Sri Lanka” opened all doors just as saying “open sesame” gained entry to Aladdin’s cave! The broad smile, extreme courtesy, and genuine warmth we received from the Pakistani people were unbelievable.
This was all to do with Mrs Sirima Bandaranaike’s decision to allow Pakistani aircraft to land in Colombo to refuel on the way to Dhaka in East Pakistan during the military confrontation between Pakistan and India. It was a brave decision by Mrs Bandaranaike (Mrs B), and the successive governments and Sri Lanka people are still enjoying the fruits of it. Pakistan has been a steadfast and loyal supporter of our country. They have come to our assistance time and again in times of great need when many have turned their back on us. They have indeed been an “all-weather” friend of our country.
Getting back to 1972, I was an early beneficiary of Pakistani people’s love for Sri Lankans. I failed the entrance exam to gain entry to the only English medium school in Islamabad! However, when I met the Principal, along with my father, he said, “Sanjeewa, although you failed the entrance exam, I will this time make an exception as Sri Lankans are our dear friends.” After that, the joke around the family dinner table was that I owed my education in Pakistan to Mrs B!
At school, my brother and I were extended a warm welcome and always greeted “our good friends from Sri Lanka.” I felt when playing cricket for our college; our runs were cheered more loudly than of others.
One particular incident that I remember well was when the Embassy received a telex from the Foreign inistry. It requested that our High Commissioner seek an immediate meeting with the Prime Minister of Pakistan, Mr Zulifikar Ali Bhutto (ZB), and convey a message from Mrs B. The message requested that an urgent shipment of rice be dispatched to Sri Lanka as there would be an imminent rice shortage. As the Ambassador was not in the station, the responsibility devolved on my father.
It usually takes about a week or more to get an audience with the Prime Minister (PM) of a foreign country due to their busy schedule. However, given the urgency, my father spoke to the Foreign Ministry’s Permanent Sectary, who fortunately was our neighbour and sought an urgent appointment. My father received a call from the PM’s secretary around 10 P.M asking him to come over to the PM’s residence. My father met ZB around midnight. ZB was about to retire to bed and, as such, was in his pyjamas and gown enjoying a cigar! He had greeted my father and had asked, “Mr Jayaweera, what can we do for great friend Madam Bandaranaike?. My father conveyed the message from Colombo and quietly mentioned that there would be riots in the country if there is no rice!
ZB had immediately got the Food Commissioner of Pakistan on the line and said, “I want a shipload of rice to be in Colombo within the next 72 hours!” The Food Commissioner reverted within a few minutes, saying that nothing was available and the last export shipment had left the port only a few hours ago to another country. ZB had instructed to turn the ship around and send it to Colombo. This despite protests from the Food Commissioner about terms and conditions of the Letter of Credit prohibiting non-delivery. Sri Lanka got its delivery of rice!
The next was the visit of Mrs B to Pakistan. On arrival in Rawalpindi airport, she was given a hero’s welcome, which Pakistan had previously only offered to President Gaddafi of Libya, who financially backed Pakistan with his oil money. That day, I missed school and accompanied my parents to the airport. On our way, we witnessed thousands of people had gathered by the roadside to welcome Mrs B.
When we walked to the airport’s tarmac, thousands of people were standing in temporary stands waving Sri Lanka and Pakistan flags and chanting “Sri Lanka Pakistan Zindabad.” The noise emanating from the crowd was as loud and passionate as the cheering that the Pakistani cricket team received during a test match. It was electric!
I believe she was only the second head of state given the privilege of addressing both assemblies of Parliament. The other being Gaddafi. There was genuine affection from Mrs B amongst the people of Pakistan.
I always remember the indefatigable efforts of Mr Abdul Haffez Kardar, a cabinet minister and the President of the Pakistan Cricket Board. From around 1973 onwards, he passionately championed Sri Lanka’s cause to be admitted as a full member of the International Cricket Council (ICC) and granted test status. Every year, he would propose at the ICC’s annual meeting, but England and Australia’s veto kept us out until 1981.
I always felt that our Cricket Board made a mistake by not inviting Pakistan to play our inaugural test match. We should have appreciated Mr Kardar and Pakistan’s efforts. In 1974 the Pakistan board invited our team for a tour involving three test matches and a few first-class games. Most of those who played in our first test match was part of that tour, and no doubt gained significant exposure playing against a highly talented Pakistani team.
Several Pakistani greats were part of the Pakistan and India team that played a match soon after the Central Bank bomb in Colombo to prove that it was safe to play cricket in Colombo. It was a magnificent gesture by both Pakistan and India. Our greatest cricket triumph was in Pakistan when we won the World Cup in 1996. I am sure the players and those who watched the match on TV will remember the passionate support our team received that night from the Pakistani crowd. It was like playing at home!
I also recall reading about how the Pakistani government air freighted several Multi Barrell artillery guns and ammunition to Sri Lanka when the A rmy camp in Jaffna was under severe threat from the LTTE. This was even more important than the shipload of rice that ZB sent. This was crucial as most other countries refused to sell arms to our country during the war.
Time and again, Pakistan has steadfastly supported our country’s cause at the UNHCR. No doubt this year, too, their diplomats will work tirelessly to assist our country.
We extend a warm welcome to Mr Imran Khan, the Prime Minister of Pakistan. He is a truly inspirational individual who was undoubtedly an excellent cricketer. Since retirement from cricket, he has decided to get involved in politics, and after several years of patiently building up his support base, he won the last parliamentary elections. I hope that just as much as he galvanized Sri Lankan cricketers, his political journey would act as a catalyst for people like Kumar Sangakkara and Mahela Jayawardene to get involved in politics. Cricket has been called a “gentleman’s game.” Whilst politics is far from it!.
Features
Covid-19 health rules disregarded at entertainment venues?
Believe me, seeing certain videos, on social media, depicting action, on the dance floor, at some of these entertainment venues, got me wondering whether this Coronavirus pandemic is REAL!
To those having a good time, at these particular venues, and, I guess, the management, as well, what the world is experiencing now doesn’t seem to be their concerned.
Obviously, such irresponsible behaviour could create more problems for those who are battling to halt the spread of Covid-19, and the new viriant of Covid, in our part of the world.
The videos, on display, on social media, show certain venues, packed to capacity – with hardly anyone wearing a mask, and social distancing…only a dream..
How can one think of social distancing while gyrating, on a dance floor, that is over crowded!
If this trend continues, it wouldn’t be a surprise if Coronavirus makes its presence felt…at such venues.
And, then, what happens to the entertainment scene, and those involved in this field, especially the musicians? No work, whatsoever!
Lots of countries have closed nightclubs, and venues, where people gather, in order to curtail the spread of this deadly virus that has already claimed the lives of thousands.
Thailand did it and the country is still having lots of restrictions, where entertainment is concerned, and that is probably the reason why Thailand has been able to control the spread of the Coronavirus.
With a population of over 69 million, they have had (so far), a little over 25,000 cases, and 83 deaths, while we, with a population of around 21 million, have over 80,000 cases, and more than 450 deaths.
I’m not saying we should do away with entertainment – totally – but we need to follow a format, connected with the ‘new normal,’ where masks and social distancing are mandatory requirements at these venues. And, dancing, I believe, should be banned, at least temporarily, as one can’t maintain the required social distance, while on the dance floor, especially after drinks.
Police spokesman DIG Ajith Rohana keeps emphasising, on TV, radio, and in the newspapers, the need to adhere to the health regulations, now in force, and that those who fail to do so would be penalised.
He has also stated that plainclothes officers would move around to apprehend such offenders.
Perhaps, he should instruct his officers to pay surprise visits to some of these entertainment venues.
He would certainly have more than a bus load of offenders to be whisked off for PCR/Rapid Antigen tests!
I need to quote what Dr. H.T. Wickremasinghe said in his article, published in The Island of Tuesday, February 16th, 2021:
“…let me conclude, while emphasising the need to continue our general public health measures, such as wearing masks, social distancing, and avoiding crowded gatherings, to reduce the risk of contact with an infected person.
“There is no science to beat common sense.”
But…do some of our folks have this thing called COMMON SENSE!