Lockdown, test, quarantine: Need of the hour
We must maintain screening and social isolation even if the number of new cases drops
Keep updated, follow The Business Standard's Google news channel
More tests, quarantine required
by Dr Mohammad Mushtuq Husain
We are witnessing the situation gradually deteriorating in the country. The novel coronavirus spread rate was low when the country detected its maiden cases on March 8. However, our situation in the last two weeks has worsened.
At present, it is difficult to predict in what direction we are going or what kind of situation awaits us in the upcoming days. It is also not clear how many people will be infected. However, the infection pattern is following the trend we saw in Europe and the United States of America. However, nothing can be said, now, exclusively about an infection rate surge or drop.
The measures taken so far, including isolating the country geographically and imposing social isolation, are certainly positive. However, we need to prioritise detecting new cases.
Once the infected are screened, quarantining them will be easy. We might slow down the upward infection rate if people are properly quarantined. If we can do so, even then we will have to be more cautious.
In many countries, the infection rate resurged when they suspended lockdown and returned to normal life. We must consider this.
We must maintain screening and social isolation even if the number of new cases drops. We will have to continue essential economic activities while maintaining social distancing. Our movement will have to be restricted even at that time.
All the infected must be isolated first by ramping up the number of tests.
The clusters, areas with concentrated coronavirus cases, must get special attention. Social distancing and isolation must be prioritised in those areas. The mentality to stay at home will have to be created through awareness-building campaigns.
Apart from this, we need to help infected patients recover fast. Medical facilities, including hospitals, should be ramped up. A positive change needs to be brought to our lifestyle so that the healthy people can strengthen their immunity.
Otherwise, a terrible situation awaits us.
Dr Mohammad Mushtuq Husain is the advisor of IEDCR
Over 20,000 tests required daily to withdraw lockdown
by Prof Ridwanur Rahman
We are close to the peak of the epidemic and we don't have the scope to turn back. Now all government organisations will have to work together taking all the people of the country along with them. We will control coronavirus together. Control means preventing its transmission. If transmission takes place, there will be patients and deaths.
If we want to withdraw our lockdown, we have to increase our testing capacity to more than 20,000 a day.
When more than 20,000 tests will be done daily, then if anyone anywhere in the country gets coronavirus symptoms, they will undergo the test, and if the result turns out positive, they will be isolated immediately. Then the disease will not spread anymore.
When we reach the position to identify everyone, and we will be able to prevent the spread of the disease through isolating patients this way, then the lockdown will be withdrawn.
Transmission can be curbed when we are in a position to identify most patients. Our target is to minimise the death toll. One cannot be done if the other is not accomplished. If the lockdown is withdrawn before doing this, the disease will spread.
The World Health Organisation will create pressure if the lockdown is not withdrawn even after two to three months. If coronavirus continues in our country, we will be isolated from others. If others can control the virus, then they will not allow us in their countries. Then our business will incur losses.
That is why we have to fully utilise the lockdown. We will get the solution if we can isolate everyone after increasing our testing capacity. Otherwise, 60-70 percent people will be infected. We cannot see transmission but we see the deaths.
The duty of clinicians is to prevent death of patients. But, now we see patients are dying due to the shortage of oxygen because the ICU and ventilator facilities in our country are very inadequate. We have only a few hundred ventilators for 17 crore people. They will be finished if 100 or 200 patients need ventilators. Because, when a patient is put on a ventilator, they will remain admitted for at least 10 days. Besides, we have non-coronavirus patients too.
We have to make sure that the treatment of non-Covid-19 patients is not stopped. That is why we have to bring changes to the health system during such a pandemic. But, we have not been able to do that yet.
Meanwhile, coordination has now improved from what it was before. Still, we are far away from the command and control, and the principal and control necessary to control an epidemic.
It is necessary to form a taskforce to observe the health of patients and to guide the government. Now we see doctors and nurses are getting infected every day.
We have one of the lowest doctor-patient ratios in the world. We had a shortage of health care providers even during regular times. That is why to cover such a notorious epidemic, we do not have the capacity to lose a single health care provider. We have to give importance right now so that our health care providers get enough personal protective equipment and other safety material.
Professor Ridwanur Rahman is the Head of Research Centre at Universal Medical College
Institutional quarantine must be prioritised
by Prof Muzaherul Huq
The number of novel coronavirus infections and deaths is increasing every day. A big job, now, is to identify those who came into contact with the infected people and to send them to institutional quarantine. Local administration should do the job. Those who have tested Covid-19 positive will have to be taken into isolation and provided with treatment. That is why we need Covid-19 hospitals.
We have to designate Covid-19 and non-Covid-19 hospitals in every district. Suspected cases will go directly to Covid-19 hospitals. Other patients will go to non-Covid hospitals. We have to ensure the supply of ICUs, ventilators and oxygen at the hospitals. At the same time, the doctors, nurses and other health care providers at Covid-19 hospitals must have proper training to provide treatment and services with ventilators and at intensive care units. If they are not trained, they have to be trained fast.
We see the older people are more prone to dying. We have to keep in mind that those who have been admitted to Covid-19 hospitals have comorbidities. So a multidisciplinary management approach is a must for them. They have to be provided with treatment for their other ailments along with Covid-19.
Additionally, eight of the nine people who were on ventilators have died. An enquiry should be conducted into the matter. We have to determine the facts behind this – whether this happened due to lackings in ventilator management or there were faults committed by the service providers. Action should be taken after identifying the reason. People are aware of enough but the government has not encouraged or engaged them.
The government has two jobs to do now. One is to save people from contracting the infection and the other is addressing the issues for which they go outside. People are going outside of their homes because they do not have work and food. The government has to deliver food to the people's doorsteps, and there is no alternative to it. The same thing is being done in other countries too.
People would pay for this service but volunteers of ward councillors – wearing different PPE than that of doctors – should deliver the food and medicines to them. People could pay using bKash or other means. Then people would be reassured. Additionally, local representatives will have to engage the people so that an incident like the one in Brahmanbaria does not reoccur.
Prof Muzaherul Huq is a former adviser of the World Health Organization's Southeast Asia region
It is time to adopt new strategies to fight coronavirus contagion
by Prof Saif Ullah Munshi
The country has stepped into the fourth stage of the coronavirus pandemic and this new status demands new strategies to fight the contagion.
The Directorate General of Health Services is yet to make any such revelation to the public but it declared last week that the entire Bangladesh was then facing the risk of the coronavirus pandemic.
Clear instructions must be issued by the authorities concerned with regard to what people with manifestations of the infection should do.
According to guidelines of the World Health Organisation (WHO), tracing contacts of a positive case and placing them under quarantine are no longer required at this stage.
Only patients with fever, cough, and throat pain will go for test, and if found positive, they will be prescribed treatment.
But not all patients have to get admitted to hospital.
Unless a patient has breathing difficulties, they should stay at home and take medicines. Only 20 percent patients might have to come to hospital. In that way pressure on the health system will be reduced.
However, a patient's condition might worsen while staying at home and in that case the government can put in place a mechanism to bring them to hospital from their home. Volunteers can be engaged to make that happen.
All the anti-viral drugs should be made available in the market at the earliest possible time because they have proven records of being useful. Some are on clinical trials.
Alternative tests must also be conducted alongside PCR test, which require less complicated and inexpensive procedures to follow and do not involve a setup as highly sophisticated as PCR lab. For example, the antibody test, that can be done 6-7 days after the appearance of signs and symptoms.
Because it is relatively cost-effective, the 30 percent coronavirus-positive patients who have not shown any symptoms can also be tested in this method to understand how widely the infection has spread.
The antibody test checks how the body's immune system has responded to an infection.
With the help of simple 10-minute training, health technologists even at the upazila health complexes can do these tests.
The only impediment in this regard is a lack of capacity on part of the authorities concerned to make decisions quickly. They are waiting for the WHO's approval of the tests.
Prof Saif Ullah Munshi is a virologist at BSMMU
We need humanised hospitals with sturdy management
by Professor Nazrul Islam
The number of deaths from the novel coronavirus infection is escalating in the country. To minimise the number of casualties we must place more emphasis on the hospital management system.
We would need to ensure sufficient oxygen supply and ventilator facilities. The patients cannot be saved unless the hospitals provide them with quality treatments. To save the doctors personal protective equipment (PPE) must be allocated.
Hospitals need to be more humanised. They are not veterinary but human hospitals. Thereby, it must be ensured that people are not scared to go to hospitals. The doctors must not shun their patients.
Till date, around 170 physicians have been infected with novel coronavirus in Bangladesh.
Why has this happened? Why the doctors were not equipped with proper protective measures?
Doctors are being infected for wearing counterfeit PPEs. It is being blamed on patients that they are hiding information, but with the help of original protective equipment doctors are supposed to be protected from virus contagion.
However, stringent lockdown measures should be imposed to prevent coronavirus transmission as the condition will not improve otherwise.
There have been no measures adopted for people who are being deprived of food and dying from sickness because they are not allowed to go outside amid the partial nationwide lockdown. Citizens need to be satisfied with their right to food and nutrition, and right to health services as well as other fundamental human rights.
Countrymen are not abiding by the rules of lockdown due to the fear of starvation. The reliefs are not being distributed properly.
Without ensuring the basics, the lockdown will never be successful. We need a genuine lockdown which can only be suspended once the virus infection and transmission abate.
Comparatively, a little number of people has been diagnosed with COVID-19 outside of Dhaka division but there is no reason to be delighted about it. The number of virus testing needs to be augmented to depict the real picture.
Moreover, 87 percent of the total coronavirus positive patients are hailed from Dhaka division. Hence, a strong taskforce needs to be formed for Dhaka city and special attention should be given to the virus focal-points of the division, like- Narayanganj, Gazipur and Savar.
Professor Nazrul Islam, is a noted virologist and former vice-chancellor of Banglabandhu Sheikh Mujib Medical University
Gaps in preventive measures made situation worse
by Be-Nazir Ahmed
The overall scenario of the country's healthcare system and the numbers of coronavirus cases and fatalities from it make it evident that we have not been successful in tacking the pandemic.
What we are seeing today is a reflection of gaps in all the measures undertaken to prevent the spread of the contagion – be it social distancing, identification of the positive cases, isolation of them, quarantine of those who have come into contact with them, and steps to ensure safety of healthcare providers.
When it comes to social distancing, the move would have brought better results had we managed it well and motivated people to comply with the prescribed guidelines for it.
Secondly, coronavirus positive cases should have been identified at a faster pace. To make it better understand, I would like to say that the risk of spreading the infection is less when one is identified on the first day of infection.
Isolation is less effective for delayed tests. And those who have not been identified keep on transmitting the virus to their friends and relatives. Strict quarantine could break the chain of transmission.
Thirdly, healthcare providers should have been provided with what they need for their safety.
Moreover, other precautionary measures such as hand washing and proper use of personal protective equipment (PPE) should be in rigorous practice. If someone follows the procedures completely, the risk of transmission from him can come down to zero.
Doctors, nurses, cleaners – everyone should be trained to ensure proper safety practices because they work as a team. The procedure has to be monitored by infection control supervisors who would fix the flaws, for example, helping a nurse wear a mask properly.
And the supervisors would also alert when masks are of substandard qualities. Had all these measures in place, so many doctors and other healthcare providers would not have contracted the virus.
To flatten the curve quickly, every positive case has to be investigated in order to find out the persons he has come into contact with, the places he travelled to, and the mode of transport he has used. The goal is to check if his contacts have become infected, and to disinfect the places he has visited to contain further transmission.
Teams should be set up from the upazila-level to cities to ensure strict quarantine. In hotspots, additional numbers of teams should remain vigilant to rein in the exponential growth of transmission. Then we can see the peak of the curve earlier and bring it to the bottom quickly.
Besides, highest efforts should be made to reduce the infection rate among doctors and other health workers. Another thing that needs to be made mandatory is wearing a facemask while stepping one step out of the home.
We have to decide immediately if we should strictly enforce social distancing and for how long. The last day of the ongoing shutdown, April 25, is approaching us. If we allow people to travel after the shutdown ends, the present localised transmission will reach every corner of the country.
Be-Nazir Ahmed is the country lead at ASCEND Bangladesh and head of Parasitology at the National Institute of Preventive and Social Medicine (NIPSOM)
