As Bangladesh announced its first death from coronavirus infection on Wednesday, the health ministry now says the pandemic has spread to the level of community transmission, meaning it will spread quite rapidly.
The person who died on Wednesday at a large private hospital, a 70-year-old male, had contracted the disease locally when he came in contact with someone who had returned from abroad.
Meantime, four new patients were identified on Wednesday even though a very limited-scale testing is being done, raising the total number of infected persons to 14. However, it definitely is not the real picture as experts say with such small testing samples, the number is bound to be much higher.
Belatedly, the government has now decided to allow coronavirus testing in a few more government laboratories by next week.
New coronavirus units will be established in eight divisional headquarters and the Biswa Ijtema ground will be prepared to quarantine patients, a move that experts have been urging for quite some time.
The health ministry has asked for Tk200 crore to meet the evolving situation now. A ministry official has told The Business Standard that there is a crisis of fund for the big challenge ahead.
Briefing the media on Wednesday, Road Transport and Bridges Minister Obaidul Quader said the government may put some places under lockdown and even road transport services would be suspended.
Such lockdowns are also being suggested by experts for quite some time.
Finance Minister AHM Mustafa Kamal told reporters the government was ready to provide as much fund as needed for treatment of patients and control of the virus.
He added that the government would provide funds if the health ministry took an initiative to set up special hospitals like China.
"The number of patients may rise in the future. Many Bangladeshis who work abroad have returned. They should be in home quarantine," said Health Minister Zahid Maleque.
He once again told a ministry meeting that all passenger coming from abroad must undergo a 14-day home quarantine.
Otherwise, strict actions will be taken against them, he said.
The directive has been sent to field-level administration.
However, so far, one lakh expatriates have entered Bangladesh over the last one month and they have dispersed throughout the country without being screened, which raises the risk of infection.
The person who died came in contact with one of these infected expatriates.
Cases from recent countries with community spread show, when it has hit those countries, it has moved quite rapidly.
The US Center for Disease Control and Prevention is warning its citizens of just such situations.
"We want to make sure the American public is prepared," Nancy Messonnier, director of CDC's National Centre for Immunisation and Respiratory Diseases told reporters.
"As more and more countries experience community spread, successful containment at our borders becomes harder and harder," she said.
First victim had diabetes, kidney problems
The Institute of Epidemiology, Disease Control and Research (IEDCR) said appropriate measures would be taken according to protocol for the burial of the first coronavirus victim.
IEDCR officials will be at the burial site and steps will also be taken to check the spread of the virus, said the institute's Director Professor Dr Meerjady Sabrina Flora.
The victim tested positive for the virus on March 17. He was suffering from comorbidity or one or more additional health conditions. He had chronic obstructive pulmonary disease, diabetes, high blood pressure and kidney problems, the IEDCR said.
Stents were also inserted in his heart as he had cardiac problems.
He was at high risk of contracting the virus, Flora said.
At present, 16 suspected people remain in isolation while 42 are in institutional quarantine, she said.
Of the 14 cases detected so far, seven were infected through local transmission, and had not traveled abroad. They came in contact with infected returnees and thus contracted the virus.
At present, only the returnees and those coming in contact with them are being tested for the virus. No one is being tested even if someone displays the symptoms common to Covid-19 infection.
Experts fear community transmission of the virus as returnees are not properly following home quarantine guidelines.
However, Flora said there was no evidence of community transmission of the virus in the country yet.
"We are maintaining constant surveillance. We are testing pneumonia samples collected from hospitals. So far, we have got no positive report," she explained.
"Epidemiologically, I shall never say there have been community transmissions until I get positive reports," added Flora.
She said there had been transmissions only locally and via family members so far.
The IEDCR chief said community transmission would pose a high risk.
We need to change our plans if local transmissions lead to community transmissions, she said.
"So far, we have identified an area where the highest number of cases were detected. We have taken very strong measures there," said Flora.
Tests in more labs next week
She said the government was changing its decision to conduct tests only in the IEDCR lab.
Tests will be done in several other labs and measures are underway to arrange tests outside Dhaka, she said.
Epidemiologically speaking, cases are increasing and will rise further, said Flora.
That is why we are preparing several other labs where tests will be conducted in a week, she said.
"This will be done under overall supervision of the IEDCR. If a single case is detected, it is our responsibility to gather information about that person and trace his history to understand who he or she came in contact with," explained the professor.
She said hospitals were refusing to admit patients showing coronavirus symptoms and this might emerge as a bigger challenge in the days to come.
"At present, our biggest challenge is to arrange treatment of patients in hospitals," said Flora.
We are facing this problem not only in public hospitals but in private ones too, she said.
"Hopefully, we will get over it soon," added Flora.