Disturbing curve ahead for Bangladesh?

Look at the graphs above.

Each represents the infection trend of a country since the first coronavirus patient was reported there. They all show a similar pattern – between the fourth and fifth weeks since the first reported infection, the lines curve up steeply, on days almost at a 90-degree angle. This means, the pandemic infection had started to spread uncontrollably.

For Bangladesh, the graph looks flat. This means the infection rate has not increased. But it can hardly give us any relief because of two factors.

One, we have just crossed the third week yesterday and have entered the crucial fourth week. If the world trend is any indication, then it is between now and the next 14 days that the curve is set to go up. The real challenge to cope up with the situation will arrive then.

Two, our number of tests conducted so far is too small and so we really do not know the actual situation.

IEDCR Director Meerjady Sabrina yesterday once again claimed Bangladesh has been following the WHO guideline and doing enough tests.

But numbers tell a different story. In the last two months, over eight lakh people had called the Covid-19 hotlines for tests. IEDCR hotlines alone received over 70 thousand calls. But only less than 1,100 have been tested and 48 positive cases have been found.

This means, Bangladesh is one of the lowest testing countries while the WHO has repeatedly been asking countries to test as many people as possible to get an exact bearing on the nature of infection and the geographic concentration.

Not only is low testing providing misleading data on infections, it has had another unintended impact. A look at the fatality rate shows Bangladesh now has a higher fatality rate than coronavirus-ravaged Italy. Our death rate is 10.4 percent against Italy's 10.2 percent.

It is the low number of tests that produces this chilling data for Bangladesh, no doubt.

Meantime, Meerjady has said it is still not time to calculate death rates.

Zero case similarity

After the first reported case of infection, Bangladesh did not report any new cases for the next five days. Then on March 14 two cases were reported. The next day no cases were reported.

New patients were detected between March 16 to March 24. But then on March 25 no case was found.

And yesterday, once again zero cases were reported.

The data shows, it detected a maximum of six cases only on each of two days - March 23 and March 24.

Such zero case reporting, however, can not give any sense of relief as other countries including the most affected Italy, US and Spain, France, South Korea and Germany also had zero cases on many days in the first three to four weeks.

Italy, which is now witnessing the highest number of infections and deaths in Europe, reported zero cases on six consecutive days after the first report.

It then reported one new case on the eighth day and again it found no new cases for the next two weeks. But then the numbers climbed at a dizzying rate.

Today Italy has over 86 thousand cases with over nine thousand deaths. Even yesterday over 900 people died.

Italy, like Bangladesh, was a low testing country and it could not geo-locate the risk areas.

"We cannot say none was infected in the last 24 hours. Rather, we should say we could not detect any new patient. It is because of fewer testing," said Professor Benzir Ahmed, former director of the health directorate (disease control).

In the light of the epidemiological projection, 10 to 20 cases of infection should have been detected everyday if a larger number of tests were conducted countrywide, he said.

"This means we are missing the scope to detect infected people while raising the risk of spreading the virus," he said.

Test, test, test

Other countries' examples show success and failure of containing the virus largely depend on testing capacity.

South Korea has become an example of containing the virus by conducting extensive tests immediately after the outbreak. It conducted more than three lakh tests. More than six persons every one thousand people were tested.

Italy, Spain and Iran are paying heavily for their failures to do enough testing. As the virus spread uncontrollably, European countries have now geared up testing and are now recording jumps in cases every day.     

In the meantime, the rate of tests conducted in Bangladesh is merely a little over six persons every 10 lakh people.

Virologist Prof Nazrul Islam, former vice-chancellor of Bangabandhu Sheikh Mujib Medical University, also expressed concern over the small number of tests and warned that the battle against Covid-19 could be lost if testing capacity were not increased.

"So far over 1,000 tests were run which was very low. It may turn disastrous if testing capacity is not increased on a large scale," he said.

For people who are comparing the data and attempting to divine how different countries' epidemics stack up against each other, experts have a warning: nations have different reporting standards, different approaches to testing, and different approaches to tracing cases, all of which make such comparisons dangerously misleading.

South Korea, the exception

Only South Korea stands apart. In the first week, it reported a single digit case every day. It reported double digit cases in the next three weeks. But the situation changed in the fifth week. The number of known cases jumped to thousand from hundred.

This jump in the number of detections was possible because of the large scale of testing. Nearly 20,000 people were tested every day for coronavirus, more people per capita than anywhere else in the world.

South Korea has created a network of 96 public and private laboratories to test for coronavirus. There was no shortage of testing kits. Four companies were permitted to make them. It means the country has the capacity to test 140,000 samples a week.

The ability to test so many people has made the country a role model as others look to battle their own coronavirus outbreaks.

In the middle of March, the fatality rate for coronavirus in South Korea is 0.7%. Globally the World Health Organization has reported the rate at 3.4% - but scientists estimate that the Korean death rate is lower because not all cases are reported.

However, South Korean health officials believe this wide approach to testing there may be saving lives.