Govt, people must act together

Professor Sayedur Rahman, chairman, Department of Pharmacology, BSMMU

We have to restrict people’s movements first to flatten the current rising infection curve in Bangladesh. The standard practice around the world to stop the virus spread is to get people in their houses. Each country has done the job in different ways.

However, in the context of our country, we cannot go for a blanket lockdown. Instead, we should adopt area-wise measures in the four or five cities with higher infection rates. If people of these areas can be placed under a 21-day home quarantine – 14-day virus incubation period plus seven days extra – the spread of Covid-19 can be contained.

Then, people who have been infected in the cities will have to be diagnosed. There will have to be mobile units that will identify individuals with virus symptoms and isolate those who have come in contact with the infected.

Besides, the infected will have to be brought under treatment. And for that, existing health infrastructure in major cities will have to be expanded. If necessary, the health facilities of the army or other forces should be expanded to field hospitals.

These are the tasks we should perform immediately.

On top of this, we need to speed up vaccination. The required doses need to be collected fast and more people need to be immunised through mass awareness campaigns. Policymakers now need to quickly bring in the Sputnik V and the Johnson & Johnson vaccines.

But, vaccines are never the main weapon in preventing infection. Face masks and social distancing are the main tools to stop the virus spread. If you are away from the virus and have your face covered, you will not contract Covid-19.

Mutations can occur in any viral infection and the vaccine has to be changed accordingly every year.

With the vaccines we are trying to reduce pressure on the hospitals and fatalities. But no vaccine guarantees complete protection so one can dump away the face mask and roam around. Even after being inoculated, we cannot take off the mask until the world reaches herd immunity when the virus spread stops.

The point of vaccination is to survive. The shots should be taken to avert severe and critical infections. The Oxford vaccine is still expected to be effective in reducing the severity and mortality of patients infected with the South African variant of Covid-19.

People are not responding to the stay-at-home order owing to misconceptions and flawed lockdown enforcement approaches.

We have several misconceptions about the infection such as the elderly are being affected more, middle and upper-class families are more susceptive to the virus, or the poor have some kind of an immunity against the virus.

These conceptions stemmed from higher media coverage of certain classes and age groups.

Another misconception suggests there is no infection in rural areas. But if you run a mass antibody test in the villages, the results would show rural areas also have city-like infection rates.

Cities and villages have a difference in infection severity as the rural areas have more open spaces.

The rich in cities are being infected because they live in closed air-conditioned rooms. The closed indoors result in more virus load and exposure to the virus for a long time. In contrast, though village people got infected, they did not become seriously ill due to the open spaces and their lifestyle.

But we are assuming the virus lives in cities and infects the rich people, which gives a wrong message. People are not responding to the preventive measures due to such assumptions.

In western countries, the poor are getting infected more than the rich as the low-income people live in squalid houses in cramped neighbourhoods while the rich live in big houses.

With hospitals already overwhelmed, now there will be many deaths that could be averted with treatments. The lockdown is enforced so that the infection does not jump further and deaths reduce.

But the government has been failing in lockdown enforcement since it could not engage the mass people in following the preventive measures. The government could have engaged the youths – who have been sitting idle due to school closure – to raise mass awareness. If we could train them on awareness raising, they were enough to enforce the stay-at-home order.

We saw the Red Crescent volunteers performed excellent in the vaccination drive. Apart from them, there are about 98% of youths who could have helped the government keep people at home, arrange food for them, ensure face mask wearing and immunisation.

You will not get the same performance from the law enforcers that a university student can do easily by convincing their neighbours. In addition to the police and the army patrol, the educated youths must be engaged in the fight against the pandemic. We have to utilise the youths irrespective of their political, social or religious identities to control the pandemic.

Prof Sayedur Rahman spoke to Tawsia Tajmim of TBS over the phone

Prof Muzaherul Huq, former adviser, South East Asia, WHO

Like the government, the citizens are aware of the fact that Covid-19 is spreading fast in the country. Therefore, initiatives must be taken from both sides to tame infections.

However, since the government has a responsibility towards the citizens, it has to take the first initiative. The people need to be informed about the strategy that the government wants to adopt in battling the coronavirus.

If citizens come to know the government’s strategic plan in advance, they will understand what they have to do. In order to engage the people, the government should bring change to its strategy if it finds it necessary.

The World Health Organization advises that both public awareness and public participation are needed to prevent infection. We have created public awareness but we are not involving the people. As long as the people are not involved, it is not possible for the government alone to control the coronavirus.

In order to ensure people’s participation, the government should engage all people at the ward level with the process. They will motivate themselves to do everything from creating awareness to wearing masks to receiving vaccines.

The government alone will not be able to convince the people by merely issuing instructions. If the people of every ward across the country become involved in the battle against Covid-19, the infection can be brought under control.

Lockdown is a scientific method of confining people to their homes. The people, however, have to be given prior knowledge about situations when the government may impose a lockdown.

If people know in advance that there may be a lockdown, they will be prepared for that. But, if they do not know the purpose of the lockdown, they will not respond. The proof of which we saw last week – people took to the streets protesting the lockdown.

Now a question has arisen: What comes first, life or livelihood? But, we have to bear in mind that livelihood is for a living.

We have to set our priority – whether to save life or think of livelihood. We will think about life in the first place.

The government’s first responsibility will be to save lives and then think of livelihoods. There are examples of this in different countries. In a developing country like Indonesia, food is left on the streets and in the open when lockdowns are in force for people to collect.

Ward members in our country will prepare a list of people who are living from hand to mouth. The government will provide them with foodstuffs. Only then will the government succeed by imposing a lockdown.

Every country in the world knows that death from Covid-19 is on the rise and may rise further.

Our neighbouring countries Nepal and Sri Lanka enforced curfews at the outset and successfully controlled the coronavirus. Bhutan has taken good steps to save both lives and livelihoods.

Vietnam – a developing country – is among the most successful in the world in terms of safeguarding both lives and livelihoods. Factories in the country have never been shuttered.

We have examples before us of what strategies different countries have adopted to bring the coronavirus under control. People do not know if the Bangladesh government has any strategic plan.

Now the government must focus on saving lives and preventing the spread of the pandemic. We had to prepare in advance to deal with the second wave. We were not ready for the first wave, not even this time. The prime minister asked for creating ICUs in every district hospital. But that did not happen.

Now, in order to treat people, every district stadium has to be turned into a field hospital with an ICU unit under the supervision of the army. After that, first aid will have to be arranged at the upazila health complexes. ICUs should be set up in district hospitals as soon as possible, and doctors and nurses should be trained.

Prof Muzaherul Huq spoke to Tawsia Tajmim of TBS over the phone

Prof Nazrul Islam, virologist and member, Technical Committee on Covid-19

Now we have to go back to the basics: social distancing must be followed; one cannot move without a mask; and one must wash hands repeatedly. We have to think that we are dealing with the pandemic as if from the very beginning.

We must remember that one year has passed since the beginning of the pandemic which has reduced people’s sensitivity to some extent. At present, we just cannot afford to close down all daily activities and sit at home, even if we want to. There is the issue of livelihood here.

We have shut down our inter-district communication, but for the livelihood of the people, city buses and shopping malls have to be kept open.

Considering the present situation, this decision cannot be termed bad. But, now there is no way to ignore the hygiene rules anymore.

I think that to bring the situation under control, it is necessary to deploy the army to make the people comply with the hygiene rules. As a result of rigorous mandatory practice, people will then become accustomed to it. Once upon a time, everyone used to ride motorbikes without a helmet; but now everyone abides by the rule as the traffic authorities have been strict about it.

For the health guidelines, you have to do the same. The army must be kept on the streets for at least three weeks to ensure hygiene everywhere. Besides, local people’s representatives should come forward to cooperate with the law enforcers in ensuring the implementation of the health guidelines. In order to stem the spread of infection, there is no alternative now to abiding by the hygiene rules by every citizen of the country.

Three weeks ago I came to know that there are ICUs in 28 districts while the remaining 36 districts have none. But in June last year, the prime minister instructed the health ministry to address the need. Now patients from districts without ICU are rushing to Dhaka for treatment, which is not only time-consuming but also contributing to the alarmingly increasing death toll.

Another thing is that the government, at the beginning of the pandemic last year, initiated a project to set up central oxygen facilities in 79 hospitals and clinics. But only 29 of them have been set up while the remaining 50 are yet to be completed.

Why did this happen? We must get the answer.

If the project could have been fully implemented, there would be fewer problems. But now, first of all, we have to take a concerted effort to manage the crisis.

A problem has arisen about importing vaccines from India. But the government is not sitting idle. Initiatives are being taken to bring vaccines from other sources. This is a good step. The issue needs to be addressed more quickly.

The people of our country already dislike vaccines. I remember giving the smallpox vaccine. Once I went to Tangail to administer vaccines. Hearing the news of our arrival, people of the village climbed on trees. It happened in around 1968-69.

I have the experience of giving polio vaccines also. People do not want to get vaccinated easily. Although people are more educated nowadays, many superstitions are still in place. So, the media has to be careful in giving information about this.

It is not totally right that the Oxford vaccine is not working against the South African variant, because it did not work in 10% cases only. But the vaccine is still more than 80% effective. People should be encouraged to get vaccinated.

The government needs to be more cautious about adopting the strategy. Before enforcing the lockdown, the media raises a hue and cry over the imminent restrictions which ultimately triggers people’s anger, increasing the possibility of increased infection.

The lack of coordination between different government agencies and departments, which was evident in last week’s Covid management policies, ultimately contributes to further deterioration of the situation. This incoherence can be noticed in almost all government decisions taken to tackle the pandemic.

It is clear that it happens as a result of not paying attention. This cannot happen if everyone works with due sincerity and attention. But now there is not much to do. Even if we cannot but let everything continue as usual, no compromise can be made in the case of following hygiene rules.

I would say it has now become essential to strictly enforce mask-wearing for at least three weeks in all city corporations and municipalities. Otherwise, I fear, the situation will get out of control and no matter how much we try, nothing could be done then. If wearing masks can be ensured fully, there would be no big problem to carry on all other daily and social activities.

In this case, if we carry on daily activities maintaining social distance, it might take a little more time, but would ensure safety also.

The country will be saved from a major large-scale damage. So, now there is only one thing – do all the work, but wear the mask.

One thing we have to keep in mind is that the people should be encouraged to maintain the health guidelines, they even should be forced to do so, but in no way they should be punished.

Now there is only one thing to say: do everything as usual, but wear the mask.

Prof Nazrul Islam spoke to TBS’ Faijullah Wasif over the phone

Dr Mohammad Mushtuq Husain, Adviser, IEDCR. Sketch: TBS

Dr Mohammad Mushtuq Husain, Adviser, IEDCR

Covid-19 infections will be spreading fast for another week. If the situation does not improve after that, I see no way out except for shutting everything down.

The situation has reached a point that warrants restrictions on people’s movement for several months.

No fear stays among people for long. Everyone has now become indifferent to the Covid-19 situation.

Again, it cannot be expected that everyone will comply with every instruction now – one year after the outbreak.

In such a situation, policymakers must make changes to their strategy. Besides, they must ensure people’s participation.

Instead of closing everything abruptly, they can consider identifying the most risky areas and impose lockdowns there.

Coronavirus control measures have to be taken in phases. This has to be done by involving people based on organisations and areas.

The government alone cannot do this. Socio-political organisations also have to come forward to this end.

Questions are being raised about the effectiveness of the vaccine on the South African variant of Covid-19. But, I think more research is needed in this regard. This is because the effectiveness of this vaccine was found to be low even during clinical trials.

However, we need more vigorous measures regarding vaccination in the country. People need to be assisted especially in the registration process for vaccination. The interest that people still have in receiving the jab must be put to good use. Besides, everyone should be encouraged to receive the vaccine.

It must be remembered that vaccines are the best treatment. Therefore, a balance has to be struck between the demand and supply of vaccines. Vaccination is being discontinued when people are showing interest in getting vaccinated – which should not be the case.

Our medical capacity has increased, but the infection is growing several times faster than that. Therefore, no matter how much healthcare capacity you have, it will not come to use if you cannot control the infection.

This is why we have to build field hospitals for the isolation and treatment of identified patients. Less risky patients should be kept there. Even if there are not experienced doctors there, the patients should be kept under the supervision of medical students or nurses.

This will help curb the spreading of the disease.

We are always talking about hygiene but giving less importance to isolation. This strategy will not work. It is important to adopt this method to control infections from direct contact. And public indoor gatherings cannot be allowed in any way.

Social and cultural events cannot be allowed to happen either. Political programmes must be stopped.

Crowds at markets have decreased. But, strict hygiene rules must be followed on public transports and at shops. Alongside the government, traders and shop owners have to take the responsibility.

The infection has risen rapidly but it will not fall in the same manner. It will go down slowly. When the situation got a little better after the first wave peak, everyone did whatever they wanted, flouting health guidelines. In doing so, what was suspected has happened.

Now, there should be no negligence in following the health guidelines if we do not want to see the situation get graver.

Dr Mohammad Mushtuq Husain spoke to Faijullah Wasif of TBS over the phone