Running behind the virus

We have entered the crucial fifth week since the coronavirus was first detected in Bangladesh and the rate of infection curve has started to move up sharply as was predicted from the experiences of the other pandemic affected countries.

The very low numbers of testing of suspected patients are still not producing the real picture of the situation but it is clear, as the number of tests increases so does the number of newly detected patients.

In this critical situation, the most worrisome issue is that the government has not been able to ensure a proper lockdown as suggested by epidemiologists.

It now looks like Bangladesh has been running behind the runaway pestilence rather than ahead of it as health experts have been urging.

In fact, the government has not officially said the country is going through a lockdown, but announced holidays for private and public offices.

In a holiday mood, people flocked to the mosques and offered prayers, especially the Friday prayer. And only on Monday did the government limit offering prayers in mosques. By this time, thousands more might have been infected.

Decision of garment owners was damaging

The situation in the capital took a turn for the worst when thousands of garment workers first went home in hordes as soon as the holiday began and then the tide of workers returned in similar fashion because the garment owners refused to keep their factories closed after a certain period.

Only when thousands had already entered the city, possibly carrying the virus, the police have closed the entry and exit points of Dhaka city.

Finally, the government has ordered closure of all garment factories until April 14. But by this time maximum damage may have been inflicted.

Monday's order to close the shopping malls by 6pm also came late.

And finally, the decision for "complete lockdown" came on Monday, but that too only for those areas where the virus patients have been detected.

Bangladesh also trailed behind the virus in deciding to shut down its airports and send incoming passengers to compulsory quarantine.

The airport still remains open, though, partially. Most flights were suspended only at the end of March and no compulsory quarantine was ever practiced for all passengers.

The lockdown (or rather the holiday) was also very arbitrarily imposed not following the epidemiological practice and recommendations.

 

Need to follow the mathematical model of lockdown

An Indian internal medicine consultant Dr Sibabrata Banerjee has explained on an Indian TV channel ABP about the procedures to be followed for enforcing lockdowns using the mathematical model of pandemic.

The mathematical model can predict how infectious diseases progress to show the likely outcome of epidemics and help inform public health intervention.

There are two ways to do it.

In the first method, lockdowns are enforced in three phases. The first phase starts for a period of 21 days when the infection curve starts picking. After that a five-day recess is allowed as the curve starts falling.

In five days, the number of infections again starts climbing as a second wave of infections begins and the curve lifts again. It is then a 28-day lockdown is imposed. During these 28 days, the number of new cases fall significantly and the curve stays low.

It is then another five-day recess is allowed. During these five days, a third wave of attack, sometimes virulent, but often mild, begins.

It is then another 18 days of lockdown is enforced. During this time, the new cases come down significantly which is less than ten cases a day.

In the second method, a continuous four-day lockdown is enforced and the curve comes down close to the base line which is less than ten new cases a day.

However, in Bangladesh, the lockdown (or rather the holiday) was first declared for ten days. Then it was extended by another seven days and then another three days. This practically stretched the period of lockdown to 21 days.

Italy, the first worst-hit country in Europe, belatedly ordered on March 10 a national lockdown for 21 days before extending it because the country was still reporting thousands of new infections daily.

Spain, the second worst-hit country in Europe, has been enforcing strict lockdown from March 14 for 45 days.

China imposed a lockdown in Wuhan and other cities in Hubei on January 23 and the restrictions were gradually lifted only in March.

The original practice of quarantine began during the 14th century when ships arriving in Venice from ports suffering from the plague would have to wait for 40 days at docks.

During the Spanish flu pandemic of 1918, the lockdown stretched more than two months in some countries.

But because of the confusion of lockdown and holiday, people actually came out of their houses and the decision of the BGMEA not to request further closure of factories led to mass return of workers, many of whom must have been infected, to Dhaka.

So with the fifth week of coronavirus infection setting in, the number of detected cases is also rising and Health Minister Zahid Maleque on Monday rightly warned that April is very critical, especially the next 10 to 15 days.

Physicians have also started advocating for total lockdown in view of the situation.

Bangladesh Medicine Society General Secretary Professor Ahmedul Kabir has said a complete countrywide lockdown must be enforced right now in a meeting with the health minister on Monday. He said, otherwise, the situation would go out of control.

The Director of the National Institute of Neuromedicine Dr Deen Mohammad also urged strict measures at once. Other doctors present at the meeting also expressed their concerns.

Is a lockdown possible?

A lockdown needs a foolproof plan and its harsh enforcement.

So far, Bangladesh's efforts are piecemeal at best – right from whether to call it a lockdown to the duration of the lockdown.

Only on Monday, the government has ordered a complete lockdown but that too only in areas where coronavirus has been detected.

The weak economic condition of a large part of the people also makes a complete countrywide lockdown for the duration, as suggested by epidemiologists, almost impossible. Although the government has started a massive food distribution programme, a large number of people are yet to get its benefit.

So they are coming out in search of work or to run their small mobile businesses, further intensifying the spread of the pandemic.

The slums are critical flash points where people live in such high density in such squalor that social distancing and other precautions are almost impossible to follow.

Take the garment workers as an example. In the shadow of the over $30 billion industry, these workers share small rooms where four to six persons pack in to spend the night.  It is very easy for community transmission to occur in such condition.

In fact, IEDCR has said that 'limited' community transmission is already assumed to have happened in at least two areas of the country.

Nobel Laureates Esther Duflo and Abhijit Banerjee have advocated for bolder social transfers to fight the Covid-19 infection.

In an article published in The Indian Express last week, they wrote that to keep the poor at home, a larger amount of benefits must be sent to them directly or the poor would have no alternative but to come out in search of livelihood. They advocated for electronic transfer of such funds to them.

They have underscored the fact that containing the spread of the disease will be very difficult once it reaches urban slums since social distancing is hard to observe in such places.