Emulating best practices: Part 3: Testing, medical management & tracing
More than 18 million people around the world are infected with the novel coronavirus and over 7,00,000 people have lost their life to the virus. According to the World Health Organization's Situation Report 22, around 11,24,417 tests were conducted in Bangladesh till July 27, 2020, and 17.6 million calls were made to the Covid-19 helplines.
The screening at every port of entry, supply of masks, PPE, and testing kits have had a positive outcome on containing the spread of the virus. Currently, 81 laboratories responsible for collecting samples and test are active in Bangladesh.
In the third part of this series of looking at the global best practices in containing coronavirus that we can emulate, we can take a look at how some countries have successfully employed testing, tracing and medical management to contain the virus.
Test & medical management
Vietnam primarily bought 200,000 tests from South Korea, then developed its successful test kits replicating the Korean ones. The Vietnamese health ministry set up testing booths in major urban areas and provided free tests.
South Korea introduced - 3T formula- Test, trace, and treat – the key to success according to the country's deputy foreign minister. South Korea received a huge response in drive-in facilities where a patient does not need to get off the car for the test.
The government advised all medical companies to develop their coronavirus test kits and told manufacturers to prepare for mass production. When US President was giving a speech on "no test = no Covid" and Brazil's PM stated that- "Corona is like rain", South Korea completed testing almost 1,45,000 people -- which is more than total tests of US, UK., France, Italy, and Japan altogether through 600 testing centres.
Singapore has made a record of testing nearly 3,000 migrant workers per day. The Singapore City State has turned the community convention centres and other public buildings into isolation facilities and hospitals by setting up "community care beds".
According to US magazine CEOWORLD - Thailand not only spread the coronavirus protection amenities at the public and private healthcare facilities but also villages, towns and slums too. For example - Thailand's largest slum named Khlong Toei, which is home to 1,00,000 people has no scope of physical distancing. The Thai authorities tested each of them and those who tested positive were transferred to a nearby temple that served as quarantine centre.
Let us check the table below before analyzing Bangladesh.
The media and international data hubs reported that Covid-19 infection and death rates were initially relatively low in Bangladesh. It might be the effect of numerous variables including – fewer people going for tests due to bad weather, people are following the physical distancing rules more carefully than before, or mass people's immunity increased - the actual reason is yet to be discovered.
Bangladesh had its first coronavirus death on 18 March 2020. By the last week of April, new cases in Bangladesh grew to be the highest in Asia, according to Wikipedia. Bangladesh had 1,169 ICU beds- means 0.72 beds per 100,000 citizens.
There were only 550 ventilators in the country initially. The IEDCR announced installing 150 Covid-19 dedicated ICU beds in Dhaka. With Basundhara group and other private hospitals, we now have nearly 1500 ICU beds dedicated for Covid-19 along with 7,693 isolated beds around the country.
Till June, there were nearly seven lakh samples tested in Bangladesh and around four lakh tests have been done in July. But there is a huge confusion regarding the latest number as Ekattor TV reported that the IECDR, DGHS failed to publish total numbers in front of media.
Around March, we all saw cases of poor hospital management, unfed nurse and doctors, which was later handled through allocating hotels for health caregivers. But it proves our unpreparedness.
In private hospitals, a Covid-19 test costs 3500/5000TK whereas initially, the service was free for all citizen. But the long queue for days, presence of a middleman, people asking for bribes and even instances of deaths standing in the queue – made it quite difficult for people to go for a free test.
One good example is the introduction of an online appointment for tests and IECDR also started home service. The news of the recent incidents on fake Covid-19 reports has spread wordwide. The Rapid Action Battalion did a commendable job by capturing the Covid-19 negative certificate seller gangs who sold thousands of fake papers to people willing to travel overseas or join their workplaces for Tk5,000-Tk7,000.
Japan, Italy and even Kolkata have sent back Bangladeshi passengers carrying fake certificates. Additionally, on 28th June, news channels aired a report that the Corona testing will not be free anymore.
On 27 July 2020, the World Health Organization published a guideline for all to observe Eid-ul-Azha safely amid the Covid-19 pandemic, and advised all to maintain the guidelines during all religious practices and gatherings. Following that, the railway ministry declared that only those who will purchase tickets online will be able to travel by train during the holiday season.
In the season of rain and flood, the DGHS health emergency should activate a Covid-19 monitoring unit in the flood areas too. Meanwhile, authorities have asked all the government-owned hospitals outside Dhaka to have flu corners.
Before that, it is mandatory to review the medical management of the hospitals. In the orientation program of Covid-19 Unit of BSMMU, doctors were assured that they will receive original1860 N95 masks as well as standard PPE.
The first two groups of duty doctors received 8210 N95 good masks, but the third group received fake N95 masks which had spelling mistakes and wrong lot numbers. The administration answered that there were fake masks mixed with original ones, but never disclosed whose fault it was.
We have lost 36 doctors and nearly 1,200 healthcare workers are infected. It is high time to appoint faculties and experts of Global Telemedicine and Teaching Network (GTTN) verification in quality assurance committees in both hospitals as well as supplier forums. The safety equipment is the arms of our frontline fighters and compromising with the quality is as big a crime as being a traitor.
Contact Tracing:
World Health Organization directed three basic steps of contact tracing. One, contact identification of infected; two, contact listing of the people who came in contact with the infected person; Three, contact follow-up where the infected and the listed are monitored.
Vietnam's success lies in detailed contact tracing. The health ministry recorded every detail of infected, suspected and exposed cases of Coronavirus. The rapid mobilization of health professionals, law enforcing agency personnel, the army, volunteers, civil servants and civil society made this extensive contact tracing possible.
Contact tracing is possible manually, but a thousand times more effective with technology. Vietnam's Ministry of Information and Communications (MIC) developed a mobile app called "Bluezone" - a Bluetooth-based app that helps determine if a person has come into contact with a Covid-19 patient. This has made the public update their health status daily, also had a sharing option of 'hotspots' of new cases.
Taiwan is recorded to be the first country to use a mobile phone for tracking purpose. Taiwan Government's related officials called every one, means every citizen twice a day. Officials also sent policemen to ensure people don't avoid tracking by leaving their phones at home.
South Korea expanded contact tracing by the access to CCTV footage of health authorities and tracing geolocation data from the new patients' phones. One specific example of South Korea's strict contract tracing is where a Covid-19 positive man infected more than 100 people as they all were present at Itaewon shopping and entertainment Seoul – a busy hub for shopping and movies.
According to the Korean Centres for Disease Control and Prevention - high-tech surveillance in accordance to the collective approach made the process easy. Their routes, Gender, age was inserted as data on the district website. They also noted, whether their houses have been disinfected, whether there were contacts, and whether they were wearing masks the entire time.
Thailand has introduced a dedicated mobile app for travellers especially. After arriving at an airport, they must download the app to help trace and monitor their whereabouts. The Covid-19 positive patients are also instructed to do the same.
Bangladesh is not in an advanced position in these criteria. We do have Corona tracer apps by DGHS, MOHFW Corona App. But there was no public announcement on the mandatory download of the app for the corona patients. Moreover, it's not clear whether it will be Bluetooth based and people are not provided sufficient information to make it popular.
The tracing app will find out the nearest devices along with the users whenever a user updates about coronavirus symptoms. Instead of asking the infected person of his whereabouts, they would access to the app database.
In our Digital Bangladesh. this is the easiest digital mechanism which can be easily executed efficiently. To make the best use of the apps, mass marketing to reach every people and vigorous communication channels need to be activated.
Bangladesh has the expertise and sufficient resources to utilize every example discussed from countries like Vietnam, Taiwan. Added energies, engaging little more will and context-based strategies can help us to bring down the infection and death rate.
Ishrat Binte Rouf is Communication Manager of Gen Lab, working in different socio-development projects with EU, UNDP and embassies. Email: ishrat.rouf@gmail.com.
