Health authorities let Bangladesh down in fight against Coronavirus

On January 27 when coronavirus began ravaging China and had already affected Japan and South Korea, Bangladesh's Health Minister Zahid Maleque assured his countrymen that there was nothing to worry about as no such virus patient had yet been detected in Bangladesh.

"We are working so that the virus cannot enter Bangladesh," he said. "The government is fully ready to face the situation even if the virus infects anyone."

The minister told an inter-ministerial meeting that airports, land ports and sea ports had been directed to take "necessary measures".

About two months later, on March 21, the same minister said it was now a war-like situation.

So, how did the tables turn on the authorities' fight against coronavirus?

If we go through the chronology of events and check the statements that IEDCR Director Meerjady Sabrina Flora had been making every day at her press briefings, it becomes clear that words and actions did not match. In fact, the authorities failed to grasp the gravity of the situation, the speed at which the virus would travel and the level of impact it would have.

The IEDCR was mostly full of empty words.

And so here we are, caught unprepared in the corona cauldron today.

In this report, we have quoted some selected statements by the IEDCR director and the health minister since January to show how they miscalculated everything and took things with the usual complacency that many of the high-ups of the administration harbour.

But before we go there, we can review what steps we had missed and how we could have handled things better.

As the virus raged in China, we did not close our borders with China. We let flights operate and thousands of people, many of them from Wuhan – we have met one such Chinese national who had come to Dhaka from Wuhan in January – had flown in.

Russia, a country that has beaten back the coronavirus invasion, can credit its success on closing its vast border with China as soon as the virus broke out.

And we just sat there open and remain so to date. The IEDCR or the health ministry failed to advise the government to impose a ban on all flights.

Even when the flights were open, there was no initiative to take the returnees to mandatory quarantine. We were happy to just tell them to go home and stay in self-quarantine. It was anybody's guess what these people would do and that is exactly what they did. They roamed around the bazaars, mixed with neighbours and spread the disease. There was no effort to monitor them and when the police were told to lock them down, it was too late.

The authorities repeatedly claimed that all passengers were being 'tested' at the airport. That was a misleading statement. They had set up five temperature scanners of which only one worked. That 'testing' was basically checking body temperature. And one may be infected with the virus and yet not show any temperature because the germ has a gestation period prior to showing symptoms.

But anyway, most passengers even bypassed the scanners and walked to the immigration desks unhindered.

And whatever has happened when it came to real testing has been abysmally low.

The World Health Organisaiton had been insisting that carrying out more tests was the only way to detect and isolate the patients. "Test, test, test," the WHO chief had urged. The more people you test the better picture of infection one gets.

Even in the middle of the pandemic, Bangladesh had no or few test kits. But once again the IEDCR director misled us by saying her organization had enough kits. That was on January 29. And again on February 26 she said the government had enough kits in hand.

She never revealed the number of kits though, because that would have been truly embarrassing as to what the word adequacy means to her in the time of pandemic.

Days later on February 25, China sent us 500 testing kits and then more. Based on these Chinese kits we are still being able to detect some patients. But the detection rate is way below the real picture because of the extremely limited scale of testing.

But all this while, the ICDDRB, a world-renowned organization, was never brought into the scene. At least one American doctor had told us that they wanted the ICDDRB to be involved but the permission never came.

When all these facts are considered, one finds an eerie similarity with what happened in Italy in its failed fight against the virus.

The tragedy of Italy is a glaring warning for all. It shows that measures to isolate affected areas and limit movement of people have to be taken as early as possible through ensuring strict enforcement. Here in Bangladesh we still have public transports carting thousands of people on the roads and highways every day in a crammed and anti-social distancing mode.

"Italy's piecemeal attempts to cut it off – isolating towns first, then regions, then shutting down the country in an internationally porous lockdown – always lagged behind the virus's lethal trajectory," The New York Times reported on March 21. And the virus gained on complacency.

"Now we are running after it," said Sandra Zampa, the undersecretary at Italy's health ministry.

Italian officials had claimed they had moved swiftly and drastically on the pandemic 'but their action shows missed opportunities and critical missteps' just like ours.

But those missteps are costly. Bangladesh may still say it has only 27 people tested positive for coronavirus, a number anyone can consider too low.

But this "low" does not mean anything because we had tested only a very few people, 565 so far, which means nothing about the scale of infection now.

What they told us in last two months

Jan 28

The IEDCR in a press release signed by its director Meerjady Sabrina Flora says the health ministry has been observing the total situation regarding the coronavirus outbreak and has taken 'necessary steps'.

A meeting is held [on Jan 27] with the director general of the health directorate on coronavirus with all the top bosses in the government's health programme.

A press release by the IEDCR the next day says all civil surgeons have been directed to take necessary steps. The district administrations, civil surgeons and police have been asked to draw up a list of all the people who have come from China in the last 14 days.

Feb 8

The IEDCR says those returning from China have to go for self-quarantine for 14 days. Prof Meerjady Sabrina Flora in her daily briefing asked all committees in hospitals to prevent infection in order to be more active. She also advised the public at large to wash hands.

Not only those coming from China, but all passengers will be screened at the airports from now on, the Institute of Epidemiology, Disease Control and Research (IEDCR) has stated.

No passenger will be allowed to enter Bangladesh without clearance from doctors at the airports, IEDCR Director Prof Meerjady Sabrina Flora said at a press conference in the capital.

"Earlier, only travelers from China were being screened but from now on, all inbound passengers will have to go through the thermal health screenings at all the international entry points," she said.

Feb 16

There is no need to keep all the China and Singapore returnees in hospital quarantine, Prof Meerjady Sabrina Flora said.

"We see pressure from people and departments concerned to keep China and Singapore-returnees in hospital isolation. If someone comes from these countries, it doesn't mean that they are COVID-19 infected," she said at a press conference at the IEDCR auditorium in the city.

"COVID-19 hasn't broken out in all provinces of China. So, there's no need to keep all China or Singapore-returnees in hospital quarantine," she said.

Drawing attention to the administration outside Dhaka, Flora said, "We'll keep people in quarantine upon suggestions from the Health Directorate only when the returnee has any symptom."

Meerjady Flora urged district and upazila officials not to take any decision over coronavirus infection, but to instead cooperate with and inform the local health authorities in this regard.

"We're keeping China and Singapore-returnees suffering from fever and cough isolated, testing them and suggesting that others stay in self-quarantine," she added.

Feb 19

Prof Meerjady Flora in her briefing said rumours were being spread on the social media on coronavirus. She said her organization had been assessing the validity of such rumours and also checking various mass media. She said responses to such rumours were being readied which would be properly publicized. She also gave the usual health advisory.

Feb 23

"It [avoiding non-mandatory foreign visit] is not any directive; an advice only. We are advising this considering the latest spread pattern across many parts of the world where source of infection is unknown," Prof Meerjady Sabrina Flora told The Daily Star.

Feb 26

With screening systems installed at all the ports of entry, Bangladesh is prepared to prevent the spread of the virus.

Isolation centres were also opened at all the medical college hospitals and districts hospitals.

The epidemiological surveillance sites across the country have been activated.

The IEDCR also installed facilities at every district for collecting samples from suspected patients and testing those by the IEDCR.

March 1

The health ministry sends a circular to the district and upazila administrations, asking them to raise awareness and ensure quarantine for the targeted people and provide logistics support for this purpose.

March 7

The IEDCR director said at the Saturday news briefing that the government's strategy focused on early detection and isolation of the patients to prevent a spread of the novel coronavirus.

"Our plan is to isolate the suspected patients as quickly as possible to prevent its spread," said Meerjady Flora.

She said the virus might enter Bangladesh anytime through people coming from abroad.

March 8

First case found as three people were tested positive for coronavirus.

Amid growing concern over the outbreak of the novel coronavirus in different parts of the world and the detection of three patients in Bangladesh, Health Minister Zahid Maleque said the government was fully ready to tackle the situation.

"The government has deployed medical teams in the country's airports and land ports. Those coming from abroad are undergoing tests."

March 9

The national committee to prevent and face coronavirus met with the health minister in the chair.

The health secretary first explained how this virus had spread to 102 countries affecting over a lakh people, with 3,584 of them dead.

Then he very firmly said Bangladesh had all preparations to face coronavirus and Kuwait-Bangladesh Friendship Hospital had been readied for quarantine. Three committees have been set up at national, district and upazila levels to resolve any problem relating to coronavirus prevention.

Mar 10

The IEDCR has requested all returnees from coronavirus-hit countries to self-quarantine for two weeks from the date of their arrival to prevent the spread of the virus in Bangladesh.

The IEDCR also discourages people from travelling abroad.

People, be it local and foreigner, of the sixty out of 102 countries that are affected by coronavirus have been requested to be in self-quarantine mandatorily after entering Bangladesh.

Mar 12

A public notice by the health directorate says preparations by Bangladesh were consistent with the global declaration of coronavirus as a pandemic. It said the people need not panic.

It also acknowledged that many of the returnees are not abiding by the quarantine protocol and warned that anyone not complying with the quarantine guidelines would be punished.

March 15

At a press briefing Meerjady Sabrina Flora urged all suspected coronavirus patients not to come to the IEDCR directly for getting tested.

"If you suspect you're infected, inform us over phone first. We would instruct on the next step. But please don't come to the IEDCR directly," she said.

March 16

The cabinet issued a set of directives, including sending returnees from abroad to a 14-day compulsory quarantine as part of precautionary measures against the coronavirus.

"If anyone of them develops COVID-19 symptoms, they have been asked to communicate with the IEDCR immediately," said its director Prof Meerjady Sabrina Flora.

March 17

Meerjady Flora also confirms that the returnees are not complying with self-quarantine rules.

March 18 

At a daily press briefing Meerjady Flora said: "We have sad news. An elderly person infected with coronavirus has died."

Bangladesh reports the first death from the deadly virus.

March 21

Bangladesh confirms a second death.

March 22

At a daily briefing, Meerjady Flora said three more people were had been with the virus, raising the number to 27.

"Among the 27 infected persons in the country, two have died and five got cured of the virus. 40 patients have been taken to isolation at different hospitals and the IEDCR collected 65 samples in the last 24 hours," she added.

She also said, "It is too early to say the virus has reached the community transmission level as we need more information regarding it."

Health Secretary Asadul Islam assured that "We have made arrangements to quarantine 10 lakh patients and we have 13,000 testing kits. Ventilator service is currently available at Kuwait-Bangladesh Friendship Hospital. We will add 100 more ventilators very soon."