Fight against Covid-19: A proposal to engage at the community level

To many, it is already too late to act. Yet, as long as there is a future, it is never too late to begin.

The pace of transmission of SARS-CoV2 virus is believed to be way above unity, meaning the infection is growing exponentially. The number of tests administered is inadequate and as the tests get selective, proportion of Covid-19 positive will be on the rise.

It has been hovering at around 22%, and with slow daily growth in number of tests (falling below 3% in the recent past), that proportion will soon be 25% (meaning, a quarter of those tested will be Covid19-positive).

The death rate (measured in terms of reported deaths and the average number infected 7 to 15 days before) has recently gone below 2%. If one is confined to the daily official reporting, at a constant 16,000 tests, 22% infection and 2% death among those infected, the daily death figure would be 70 persons.

There is another side to the story. If only 10% of those infected needed hospital care (while rest chose to get treated at home), 352 persons would be demanding such care every day.

Even if 50% of them had to be accommodated, daily provisions have to be made for 176 patients. If the average stay period is 15 days, we would need 2,640 seats for Covid19 patients — to address only 5% of the Covid19-positives! There would still be long queues remaining unattended.

It does not require rocket science to recognize that, as long as the virus stays, and till herd immunity is developed either through immunization (oral therapy, blood plasma or vaccination) or via infection, the only feasible way to reduce death is by controlling the pace of infection.

In the above numerical sketch, which excludes the consequences faced by the untested many, the percentage of tested showing positive should be reduced. Since the health care provisions, particularly qualified medical personnel, are unlikely to increase (and improve) over the short term, lower death rates (actual) may not be achieved. The problem may aggravate if poverty due to disruptions in livelihoods act as co-morbidity.

It has taken quite a while to recognize the role of community (and CBOs) in reducing the pace of virus-spread. Within the broad guideline put forward here, it is hoped that communities may organize themselves and contribute towards government initiatives to contain the spread of virus infection.

It is also recognized that coordination across multiple agencies often take long time, which may not be conducive for actions in emergency situations. The situation thus calls for independent community initiatives that may be aligned with the programs organized by the City Corporation under the broader national-level programs.

Where community-level activities have largely remained dormant or partial, the following sketches the entry point for engagements have been outlined.

Short-term objective:

Create condition so that there is no purpose-less loitering in the streets or sidewalks within a demarcated area, nor does anyone have to beg on the streets for survival during the on-going pandemic.

The broad interventions:

There are essentially three interventions.

(1) Identify people who are either loitering in the streets and sidewalks without any purpose or for seeking food or financial assistance from those carrying out normal activities and take them to predesignated area. The latter could be enclosed field/park, a school compound or a community place currently not in use, or a vacant unfinished building compound.

(2) Register each of these individuals with photos, names, address, phone contacts, origin, etc., and issue a photo ID card with a unique number. A preliminary health checkup will be done to separate the symptomatic ones from the rest.

(3) Provide food and/or cash support for the day registration is done, as well as a food plan for a month or more, which may be implemented. The latter will, hopefully, involve either (i) delivery of cash using MFS, or, (ii) delivery of meals to the cluster (or nearby) where they live.

Issues/activities to be addressed:

There are several issues to be addressed in realizing the interventions.

The law enforcing authority needs to be consulted to ensure that loitering in the streets does not take place, and genuine needs of those seeking food and financial assistance should be attended. Ideally, a regular staff from the local thana with a police van may be needed to take groups of (say) ten persons to the designated location. The purpose should be made clear before they are boarded. The choice is to leave the place or get registered for assured food and some cash assistance over a month or more. The main task will however have to be performed by volunteers and/or paid temporary employees.

A daily mandatory task will be to disinfect the designated areas before registration, as well as after each day's activities.

While boarding the van, body temperature will be read using infrared thermometer and a visual check on symptoms. Those with Covid-19 symptoms and/or high body temperature should be immediately isolated and taken to a separate place for further inquiry. While strict measures for isolation of the latter group will be needed, the details may have to be worked out in consultation with the DGH and the communities should be relieved of such responsibilities.

Awareness: All beneficiaries will have to wash their hands with soap, and they should be given masks to wear (if they need). Volunteers should be able to brief on how loitering in the streets make them, as well as their family members, vulnerable to infections and how fatal COVID-19 is.

It is also important to explain why staying among close family members and friends, known not to have the infection, is important for remaining safe. In addition, it may be emphasized that the purpose of food assistance is to ensure their health safety. Organization can share phone numbers with the beneficiaries so that they may call to for consultation or conveying information. Ideally, such contact numbers may connect several volunteers working from home.

Those taken for registration will stand in queues while the service providers work from inside few enclosures. Each enclosure will have microphones and speakers on both sides, as well as a camera fitted outside to take photos of the person being registered. A template will be used to collect information and digitally store those as well as the photo. This will be done using software so that the information may be shared via cloud (or, pre-designated domain) with other collaborating agencies.

During the time of registration, each will be asked to share their mobile numbers and as an incentive, a given amount of cash will be loaded to their credit or MFS account. Both telecom (Grameen and Robi) and MFS (including bKash and Rocket) can be approached to come forward with assistance.

Upon completion of registration, the dos and don'ts have to be spelled out to the beneficiaries, along with a plan for food distribution while they stay indoor for one month.

Subsequent activities will involve enforcing the food/cash distribution plan and ensuring that none of those registered is allowed to loiter on the streets in the given area. In addition, there will be needs to develop the templates/apps, mobilizing workforce and mobilizing fund (cash and food).

Organizational issues:

Local residents and owners of the establishments may organize themselves if they can agree on the objectives and the ways to engage. It can be a club or a zonal committee of a Society or any other neighborhood group.

The geographic perimeter may be defined to include a road, a block with several lanes, or any larger segment where the activities may be coordinated. Where larger segments are identified, groups representing smaller segments may be coordinated.

Alternatively, several groups covering areas adjacent to each other may collaborate under the umbrella of a coordination committee. Most important of all, these activities are unlikely to be achieved under one-person's initiative and making room for many is critical to fight the virus.

Coordination with various organs of establishments will be necessary to have their blessings. It will however be unfair to expect substantive support from an already depleted force, both within law-enforcing agencies and in other service-providing organs of the government.

The community, be it an elected body of the Society or a group of committed individuals having contacts with right nodes (persons who have contacts with the administration, corporate entities within the area and belong to social network groups having the potential to ensure sustained supply of food and fund).

It will be a win-win for all. The only caveat, and a major one, is to find people who will take the risk of providing service on ground and expose themselves to the virus. Mixing high degree of protection measures (distance, coverings, etc.) with hiring of several able-bodied (who have high potential to acquire anti-body) persons may be one likely option.

Sajjad Zohir, is the Executive Director of Economic Research Group. While some of ERG's researchers are willing to extend their assistance in designing templates, collection and processing of data, the proposal is author's own and may not be shared by all ERG members