Lockdown eases worry deepens

Professor Be-Nazir Ahmed

Bangladesh is at a stage when the virus transmits rapidly, and if the lockdown is relaxed or withdrawn now, we basically lose the most effective intervention to contain the pandemic. 

Our frontline fighters against Covid-19 – healthcare providers and policemen – are contracting the virus in increasing numbers, raising the alarm. In a situation like this, it is unprecedented for a nation to decide to remove restrictions on movement and businesses. 

The curve of the infection has been going up over the last one week. We face the risk of being trapped in a prolonged vicious cycle of virus transmission without a strict enforcement of lockdown. So, in the end, the outcome is that the nation gets the coronavirus as a new burden on the list of endemics like tuberculosis, malaria and typhoid. 

If we analyse the cases that tested positive, we understand that the virus has reached almost all the districts, with Dhaka and its adjacent areas identified as the hotspots. There are many asymptomatic people as well who are carrying the virus. 

With the restriction loosened, people will be transmitting the virus even to those areas that have remained unaffected. 

There will be a catastrophic impact on public health and on the economy. People in society’s lowest tier will bear the brunt of such a widespread transmission of the disease because they suffer from a lack of nutrition and access to healthcare. 

It is wise to lift the lockdown in phases, and the government should begin the measure when the infection rate comes down, flattening the curve. By that time, the healthcare system should be strengthened with more testing facilities, isolation beds and ICU facilities so that all infected people can be isolated and given care, and virus transmission can be avoided.  

Professor Be-Nazir Ahmed, former director, Communicable Disease Control, DGHS

Dr Mohammad Mushtuq Husain

The reopening of shops and business enterprises, that we deem necessary to revive the economy may boomerang on us.It may usher in so disastrous a situation which the nation will not be able to deal with.

There is no scientific, epidemiological rationale behind relaxing the lockdown at a time when we see the number ofinfectionsis rising. Rather, a strict enforcement of social distancing should be in place now.

To continue essential social and economic activities, some organisationsmight be allowed to resume their operations on a limited scale andin compliance with the health safety guidelines. But those should not include shops reopening ahead of Eid-ul-Fitr. The move might give a wrong message to the public.

In times of a pandemic like this one, directives should come on the basis of a consensus of different agencies of the government. If what the health directorate suggests contradicts the withdrawal of the restriction, people will tend to do what fits into their own explanations.

The cases are in small clusters spread-out across the country. According to an epidemiological estimation, the number of infected people will be 10-40 times.

From the number of patients that the healthcare system is handling, we can say that critical cases are still less in number. This gives us time to prepare the hospitals but we should be cautious enough so that the situation does not go beyond control.Because, our resources are limited.

The issue of laying the highest priority is supporting the marginalised people living in pockets of crammed settlements in urban areas and in villages so that they can follow safety protocols.

Those who are young and able to work among them can be deployed as volunteers to keep vigilance in bazaars and other areas to prevent gatherings and deliver goods to houses. In that way, they will earn some money in allowances and help to contain a further spread of the coronavirus.

Dr Mohammad Mushtuq Husain, adviser, Institute of Epidemiology, Disease Control and Research

Dr Jahidur Rahman

The World Health Organisation (WHO) has issued guidelines for Covid-19 affected countries to follow before they end their shutdowns. 

The directives include extensive contact tracing for suspected novel coronavirus cases, increasing testing capacity, and ensuring the isolation and treatment of Covid-19 patients. 

Easing or lifting the lockdown without implementing the WHO’s guidelines would be a suicidal decision. Since the Covid-19 outbreak started in Bangladesh, testing for the novel coronavirus has been neglected. 

At the beginning, only one facility was used to perform Covid-19 tests. However, now, many labs across the country are carrying them out. However, we are not even performing one-tenth of the tests that are necessary. 

It is not difficult to ramp up the number of tests. Several departments in our public universities have PCR lab setups, and trained personnel.  If we can prepare public universities and private hospitals, it will be possible to carry out around 20,000 tests per day.

Aside from increasing the number of tests, maintaining quality control is essential. We must ensure contact tracing so that every suspected Covid-19 case can be tracked down. Contact tracing is the backbone of any viral epidemic control system.

The primary reason behind countries such as South Korea, Taiwan, Hong Kong, Malaysia, and Singapore successfully managing to curb the Covid-19 outbreak is aggressive testing and contact tracing.

Countries such as America, Britain, Spain, and Italy did not initially attach much importance to the matter. However, now they are emphasising the importance of contact tracing. Some countries are even using the support of their armed forces and mobile apps on the issue.

Companies such as Google and Apple are working together to develop apps with better cross-platform support. In Bangladesh, the infection is spreading because contact tracing is not being carried out properly.

If the Institute of Epidemiology Disease Control and Research is busy with other matters, it could employ the help of other organisations to perform contact tracing on their behalf. 

Hundreds of epidemiologists graduate every year from the Bangabandhu Sheikh Mujib Medical University’s Public Health Department, National Institute of Preventive and Social Medicine plus the Institute of Public Health.

They can carry out contact tracing in the country. With effort, it is possible to track down every suspected novel coronavirus case. More doctors, nurses and technologists must be trained to tackle the Covid-19 crisis. Directors of all public hospitals can provide this training online. 

There is confusion regarding what kind of hospital a Covid-19 patient needs. Dedicated hospitals and novel coronavirus isolation centres are different matters.

A dedicated hospital for Covid-19 patients must provide all necessary facilities at the medical college level. The number of such dedicated facilities must be increased. 

The responsibilities of tackling a pandemic do not fall solely on the shoulders of any one department or ministry. We must tackle the crisis with a concerted effort. 

Dr Jahidur Rahman, assistant professor, Department of Virology, Shaheed Suhrawardy Medical College and Hospital

Prof Muzaherul Huq

Every country is following the World Health Organisation’s (WHO) pandemic control recommendations in addition to their strategies to tackle the Covid-19 crisis. 

Even though no country’s healthcare system was prepared to deal with the crisis, many countries made preparations for it in advance. Bangladesh made limited preparations – with public awareness as the main focus. 

Testing was limited to only one centre and the people across the country have yet to come under the umbrella of testing. In this situation, I cannot predict when infections will reach their peak. 

In all countries, infections fell after reaching their peak. Italy reached its peak in 45 days, and Spain in 55, but our transmission is still rising at this time when testing remains limited. We cannot predict when we will reach the peak of infections as long as we cannot test people countrywide. 

We announced general holidays from March 26 after the first case was reported on March 8. We did not make the shutdown successful the way it should have been done. 

The shutdown was imposed in a scattered fashion. We announced general holidays instead of shutting down several hotspots, resulting in a nationwide spread of the virus and community transmission from those hotspots. 

Now we have opened garment factories and markets for the sake of the economy, and the result will be very risky. This is because the WHO’s directive was that shutdowns cannot be lifted or relaxed until virus transmission is brought under control. Nevertheless, every country will have an exit plan to end their shutdowns – to be implemented in a slow and strategic way. 

For instance, small local stores should be allowed to open first – where the health guidelines will be followed and not more than 10 people may gather at a time. Restaurants and offices will then be reopened for a maximum of 10 people. Later, the number will be increased to 20. 

This is how we can detect who has been infected and do contact tracing. A separate shutdown strategy has to be followed for every neighbourhood. Now the whole country must be divided into three zones – green, yellow and red. 

The areas containing fewer than 10 patients must be shut down, but businesses will remain open in the green zone. The yellow zone is a district or upazila where the number of patients is below 100. They will not be completely shut down, and businesses will run. Meanwhile, the red zone will remain completely shut down, for as long as infections do not fall, and all businesses will be closed.

Prof Muzaherul Huq, former adviser of WHO’s Southeast Asia region

Professor Nazrul Islam

Now, markets, apparel factories and different other organisations have reopened to keep the economy afloat. But all have to comply with health safety guidelines. Wearing of face masks properly and handwashing have to be ensured which will lower infection to a great extent. There have to be hand washing arrangements at every intersection.  

The fall in the number of Covid-19 patients depends on measures to contain the contagion.  The community transmission in our country is on the rise for not being able to implement the lockdown properly. 

All business establishments including shopping malls and readymade garment (RMG) factories are reopening which might lead to a stark rise in coronavirus cases. The May 12 will mark 14thday since the RMG factories resumed operations, then the impact of their reopening will be felt. Which way the pattern of transmission is going to, will be understood after five to seven more days. 

The number of Covid-19 cases has been witnessing rise and fall. People are not abiding by lockdown norms properly. It is because of locking down an entire locality rather than putting an individual house with coronavirus patients under lockdown.  

There are now many patients with no visible symptoms roaming around their neighbourhoods and transmitting coronavirus.  There is a great worry about asymptomatic patients. So, there is no alternative to testing. The extent of tests has to be enhanced all the more. We need to test 10,000 samples a day so that Covid-19 patients can be promptly identified and isolated. 

Now, our testing capacity has increased significantly.  The number of tests has reached 6,000 per day from mere 41 at the beginning. The government has already appointed nurses and imparting training to them. The government has also taken various measures such as improving the quality of hospitals and increasing intensive care facilities.  As a result, the healthcare system has improved to some extent.
Professor Nazrul Islam, Virologist and former vice-chancellor of BSMMU