‘Consider teachers as frontliners and open schools immediately’

Previously, Dr Anis Siddique was the Head of Immunisation in UNICEF Nigeria, Chief of Communication for Development and Polio in Nigeria, Officer In-charge Polio in UNICEF Afghanistan, Program Manager – Polio in India, and WHO Divisional Coordinator of EPI in Dhaka Division, Bangladesh.

And currently, Dr Anis Siddique holds the position of Team Lead, Immunisation Coverage and Equity at the UNICEF Headquarter in New York.

In conversation with The Business Standard, Dr Anis stressed on immediately opening schools in Bangladesh, advised to consider teachers as frontline medical officers, and answered, based on his expertise, the question of going back to regular lives with proper evaluation of the pandemic behaviours.

The Business Standard: The icddr,b says that 69 percent of the Covid-19 patients in Dhaka are suffering from Omicron. However, according to a recent report, more hospitalised patients are actually suffering from Delta. Why is that? Should we fear Omicron as much as we fear Delta?

Anis Siddique: Globally, we see a higher number of Omicron patients because it infects faster. And Bangladesh is no exception.

However, Delta has been dominating for a while, and in terms of hospitalisation, it is still the dominant variant. 

When a person is exposed to Omicron, it infects the upper respiratory tracts, which start from our nose down to the lung; and we experience symptoms such as headache, runny nose, unwellness, common cold type symptoms, etc. It is not affecting the lungs. 

But Delta infects the lower respiratory tracts (lungs). Consequently, the patients show severe symptoms, including reduction of oxygen [level in the blood], resulting in more hospitalisation. 

In the case of Omicron, the lungs function normally, hence it doesn't require oxygenation. So even though Delta patients are smaller in number, they compete with Omicron in terms of hospitalisation.

Omicron is as fatal as the other variants for elderly patients who are around 60s, and suffering from comorbidity (for example cancer/asthma/severe heart or kidney issues). If these people become infected with Omicron, they are equally susceptible to hospitalisations. In such cases, Omicron is as frightening as other variants.

TBS: Europe is getting 'back to normal' by dropping Covid-19 rules despite surging cases of Omicron. Bangladesh, on the other hand, is stepping back to former restrictions with regards to public movement. Is it time for us to get 'back to normal'? 

AS: Partly yes, and partly no. 

You know it is not only Europe. Some other countries like Canada or the United States are shifting the protocols and changing the technical guidelines, like how to manage the quarantines and other public health measures. 

I will give you an example. Think about the first Covid-19 virus that gripped the world, and then came the Delta and now the Omicron variant. We have seen three major scenarios in Bangladesh as well.

Now, a recent study by the Centres for Disease Control and Prevention (CDC) said that initially, the virus had taken five days in the incubation period - from the day a person is exposed to the virus to the day the symptoms are revealed.

When the Delta variant came, the incubation period decreased to around four days. And in the case of Omicron, the incubation period is now three days or less. Evidently, now, the patient is not suffering for a long time, for various reasons. For example, it could be that your body already created an antibody for coronavirus. 

So, many countries are reducing the isolation period. For instance, what previously was two weeks, now is around five to seven days. The countries are adjusting the protocols and guidelines. 

But these countries are easing the regulations based on virus epidemiology, not for their own interest. At the same time, they are ensuring that the vaccination rate and non-pharmaceutical interventions are scaled up. 

The virus itself is saying how you can readjust your guidelines and protocols. I will not say they are going back to normality, it is about adjustment. 

We don't know the future of Covid-19. There are many hypotheses around it. Many say Covid-19 will remain as a normal flu in the future, but we never know how it will continue to evolve. 

So, we must adjust to the situation in order to ensure our normal life, continue business and sustain the economy.

TBS: Schools have been shut for more than a year and a half in Bangladesh. The students already lost months of education. Online education is not affordable for most students. And again, we have shut down the schools. What is the smart solution to education?

AS: I strongly believe that online education is creating a divide between the rich and poor – among the haves and have-nots. When it comes to education for all, it is completely defeating the purpose. 

Majority of the population cannot avail facilities like the internet. Similarly, it is not good for the mental health of those who can avail this as well. The kids need to be in the classrooms, exchange views, play and participate in other activities. 

So online classes are obviously not a solution for universal education.

I will give you statistics from Uganda. The schools were shut for two years in Uganda. After reopening, almost one-third of the Ugandan students did not return to school. I don't have Bangladesh's statistics. But this is about a generation being impacted. 

The closure of the school is not a correct decision. Around the globe, only a handful of countries are shutting down schools. 

According to the organisation I work for, and if you ask me personally, the schools should be opened immediately. Also, it should be ensured that public health measures are available there, and the school teachers should be considered front liners, like health workers, and given priority in vaccination. 

Besides, the infection rate among the children is low and there is no evidence that the virus spreads through children. Then why are we shutting down schools especially when fairs, sports, and many other public gatherings are open? What are we achieving from this? 

The schools should be opened as soon as possible, without any delay or excuse.

TBS: During the last wave in Bangladesh, the death rates were much higher than what we see today, although the recorded infection rate is very high. How do you evaluate this?

AS: By now, in Bangladesh, almost 34 percent of the population have received two doses of the vaccine, while around 20 percent of others received at least one dose. More or less 54 percent of the population got at least one shot of the vaccine or more. So, there is a presence of antibodies due to the vaccines. 

Also thanks to Omicron not affecting the lower respiratory tract, the severity is less. On the other hand, public awareness is much better, and non-pharmaceutical interventions are also helping. 

TBS: One after another variant keeps coming up. When do you see an end to this pandemic? 

AS: It is very difficult to predict the end. You will see that the Omicron itself has at least 50 mutations. 

The virus is mutating in a natural process and different variants are emerging. Hopefully, this is weakening the effect of the virus. 

With antibodies, natural resistance against the virus is also increasing. At the same time, the non-pharmaceutical interventions are increasing. 

If you consider the Spanish Flu, there was no vaccine back then. Almost 50 crores of the world's 150 crore people were infected. Tens of thousands died. That pandemic too ended at some point. 

A natural immunity grew among the people against that flu. There is cell-mediated immunity resulting from T Cell. It creates its own immunity [an immune response that does not involve antibodies]. There are many scientific theories around it. 

After the Spanish flu, the first vaccine was invented in 1953, which was an influenza vaccine. So the vaccine itself didn't limit the Spanish flu. It had its natural evolution. 

Meanwhile, one small study suggests that after Omicron infection, chances of Delta infection are lower. But after the Delta infection, Omicron can still infect, suggesting that Omicron infection results in better immunity.

But this is only a hypothesis. We should approach Omicron like other variants or else we may risk our elderly, high risk groups and patients with comorbidity.

There is a ray of hope. In my opinion, it may not be a long haul of a wait to see the end of the pandemic. But no one can give you a timeline of exactly when this pandemic will come to an end.