“Has Covid-19 subverted global health?”, published in Lancet, criticised a universal lockdown as a one-size-fits-all policy, and argued that lockdown in resource-poor countries is actually counterproductive, causing reduced accessibility to essential health care, which leads to more death
With the two exceptions of Sweden and South Korea, the whole world took shutdown as a common strategy to contain Covid-19 outbreak. Every renowned Bangladeshi expert, living home or abroad, have vociferously supported this strategy.
Dr Omar Ishraq, the CEO of Medtronic, a global leader in medical technology which open-sourced one of its portable ventilator models so that others can come forward to increase production of the lifesaving equipment, opined that given Bangladesh's capability in health services, the best strategy for the country would be to ensure physical distancing through shutdown.
Dr Taufique Joarder, a public health expert who teaches at Johns Hopkins Bloomberg School of Public Health, in an interview with The Business Standard also warned that lifting the lockdown would simply pave the way for spreading the virus again.
Both the experts, however, acknowledged that feeding crores of people who lost work due to shutdown would be a hard job for Bangladesh, but they stressed that this was something that Bangladesh needed to do at any cost.
On the other hand, using the most widely-cited model of Covid-19 transmission and mortality in a study titled "Should Low-Income Countries Impose the Same Social Distancing Guidelines as Europe and North America to Halt the Spread of Covid-19?", Zachary Barnett-Howell and Ahmed Mushfiq Mobarak expected fewer deaths in poor countries, where the share of older population is smaller compared to rich countries. Published by Yale Research Initiative on Innovation and Scale (Y-RISE) in early April, the study also showed that social distancing policies in these countries would produce smaller benefits.
Recently, a more up-to-date article, apparently built upon the abovementioned findings, has been published in the medical journal The Lancet. Titled "Has Covid-19 subverted global health?", the article authors Richard Cash and Vikram Patel criticised a universal lockdown as a one-size-fits-all policy, and argued that lockdown in resource-poor countries is actually counterproductive, causing reduced accessibility to essential health care, which leads to more death.
The writers picked example from India where, due to ban on public transport, public health and clinical intervention have seen a significant fall. According to the article, "Data from India's National Health Mission indicate that there was a 69 percent reduction in measles, mumps, and rubella vaccination in children, a 21 percent reduction in institutional deliveries, a 50 percent reduction in clinic attendance for acute cardiac events and, surprisingly, a 32 percent fall in inpatient care for pulmonary conditions in March 2020 compared with March 2019."
In Bangladesh, both transport ban and denial of medical treatment have led to a rise in death and ailment. Since March 8, when the first case of infection was announced in the country, reports of patients with respiratory problems running from hospital to hospital and being denied admission made headlines. After a number of deaths due to denial of treatment, the prime minister lashed out at doctors refusing to treat patients, and said doctors who denied treating patients had no rights to continue jobs. Of course, a dearth of PPE and a mask supply scam involving distribution of low-quality products had actually rendered health service providers at a higher risk of infection.
Measles-Rubella vaccination campaign has also been postponed since late March, as the WHO released new guidelines recommending temporary suspension of preventative vaccine campaigns. This put millions of children at risk. In April, a measles outbreak in Sajek in Rangamati district claimed the lives of eight children and infected more than 300 people.
The authors of The Lancet article questioned the appropriateness of widespread lockdown and focus on sophisticated tertiary medical care as common strategies of tackling Covid-19 regardless of countries' resources.
In the wake of the outbreak, the Bangladesh government actually announced a countrywide general holiday instead of a serious lockdown. As a result, although public transports were banned, hundreds of thousands of people working in the capital left for their hometowns around the country. Photos of crowded ferries went viral and a further spread of infection was feared.
Even "serious" lockdowns aimed at maintaining physical distancing in the cities of developing countries like Bangladesh and India are predestined to fail. Low-income families live in crowed houses and slums who have to share kitchens and toilets with other families, thus increasing the risk of outbreak. The mass exodus of people of Dhaka is totally justified in that sense. Only, it could have taken place at least two weeks earlier.
In India, stranded workers left Delhi on foot for their homes in UP or Bihar a few days after a nationwide lockdown had been announced. Many day labourers had stayed back in the city as they expected to get food and accommodation from the government, but started leaving as they did not receive any support.
In the Indian state of Maharashtra, a group of migrant workers were returning home on foot. To avoid being stopped on the highways, they were walking along the rail tracks. Tired, they fell asleep on the tracks at night, thinking no trains would be moving because of lockdown. A freight train ran over them, killing 16 workers, and injuring two more.
In response to an uncoordinated announcement made by the apparel factory owners, workers in Bangladesh who had gone home earlier, set on foot to return to Dhaka last month from as far as Netrokona. And then the owners' association declared that the factories were not open yet!
Even now that the factories are in production, the ban on public transport is still on. To many, this feels like utter humiliation and negligence aimed at the working class.
Numerous reports have covered the desperation of the poor for work or relief. Nevertheless, the affluent people's advocacy for total shutdown has been heavily criticised by the authors of the aforementioned Lancet article, who said lockdowns are just inconveniences for the affluent, and that the rich countries "shape their view of how the society should respond to the pandemic."
The authors, both public health experts from the Harvard University, recommended that people be allowed to travel and carry on with their livelihood maintaining appropriate precautions, and active case finding with contact tracing mechanism be in place. In a nutshell, the governments of less-resourced countries are urged to devise policies considering their demographics and socio-economic conditions.