Lessons for the next pandemic

Covid-19, widely known as coronavirus disease, forced us to learn and adopt new healthy lifestyle practices, which are likely to continue in the post-recovery phase of the Covid-19 pandemic in Bangladesh.

Non-pharmaceutical public health practices, including washing our hands with soap and coughing etiquettes should be strictly maintained as a part of our regular lifestyle.

We need to analyse data on Covid-19 cases in Bangladesh to expand our understanding of the distribution as well as biological and social determinants of the disease, specifically key predictors of its severity and case fatality.

There should be a follow-up on the health and wellbeing of those who contracted the disease to check for any residual physical and psychological illness. Besides, there is an opportunity to identify individuals who are at higher risk of psychological distress due to Covid-19 related adverse factors such as social isolation, movement restriction, diagnosis and treatment-related issues, livelihood losses, deaths of family members, etc.

These are significant issues, as previous epidemics demonstrated the longer-term impact of such scenarios on the mental health of the masses. This ongoing pandemic has been uncovering unprecedented gaps in Bangladesh's health system.  

However, to be prepared for the future, we need to promote constructive discussion about both the positive and negative sides of proposed actions. We have seen some well-placed policies to deal with coronavirus pandemic, but as always, weaknesses are visible in implementing the actions.

Bangladesh developed safety guidelines to ensure protection in public places, including shopping malls, mosques, businesses and institutions to protect people against Covid-19 and, to be frank, standards of those guidelines are comparable to those of developed countries. Nevertheless, the implementation of those guidelines remain extremely poor.

As a result, new infections and deaths from Covid-19 continue to raise and remain a major public health threat in Bangladesh. Many institutions and citizens are not following guidelines as monitoring from authorities remains feeble.

We have observed miscommunication and unclear instructions from time to time, which are evidence of weakness in the enforcement and administrative processes.

Some measures were taken to implement guidelines, but not in a timely fashion. For example, like many other countries, Bangladesh also took several restrictive measures, such as border control, school closure, temporarily shutting down of businesses etc., but not early an d at the appropriate time.

For instance, if strict quarantine policies and border control measures were imposed earlier, the community spread of Covid-19 could have been controlled or be greatly reduced.

It is important to consult experts who have adequate knowledge and understanding of the social and cultural context of Bangladesh. Many decisions taken seemed to be impulsive, which did not reflect the expert opinions of social and behavioural health scientists.

To make it worse, no structured and systematic reopening strategy was developed before relaxing the restrictive measures. The current zone-based restrictions appears to be the outcome of the whimsical decisions taken before, and the effectiveness of these zone-based restrictions are also highly questionable.

Nevertheless, Covid-19 may not be the last pandemic that we are experiencing. We need to prepare for future events, and both prevention and the cure side of the health system should be given adequate attention by the government of Bangladesh.

Currently, our health system focuses mostly on treatment at the hospital level. As many infectious and chronic diseases are preventable, a health system that focuses both on the prevention and curative measures will increase the wellbeing of citizens and reduce healthcare costs.

We have learned during this pandemic that a health system cannot solely depend on the doctors and nurses. Public health experts, social and behavioural health scientists, data analysts, pharmacists, virologists and many other professionals, including the media and law enforcing agencies, need to work together to battle a fight of this size.

Regular collection of data on important health and socio-cultural issues and making them easily accessible to the researchers will help to facilitate a quick and informed decision-making process.

It is now evident that a skilled workforce needs to be ready to deal with a pandemic as devastating as the coronavirus. We should analyse the current situation and strengthen the capacity of existing health care facilities throughout the country.

This is a time to think whether we need to create a separate cadre service for public health professionals and let them lead the administrative and strategic processes to prepare for an epidemic situation that might hit Bangladesh in the years to come.

We have seen very poor communication from our health administrators, and we need to think whether we should only be blaming them for the mishaps or recruit and hire appropriate health professionals to act as the face of the government during health crises.

Last but not least, a corruption-free, transparent government system with qualified public health professionals consisting of varied technical skills can be our only hope for the future, even after this deadly coronavirus is wiped off from the face of our beautiful earth.

Shamim Ahmed is a doctoral researcher at the University of Toronto; Dr Ziauddin Hyder is a senior nutrition specialist at the World Bank; Dr Muhammad Aziz Rahman is an associate professor of Public Health at the Federation University Australia; Dr Shahriar Rozen is a public policy analyst in Canada, Dr Jahir Uddin Ahmed is an adjunct faculty of Public Health at the American International University, Bangladesh; Dr Shafi Bhuiyan is an assistant professor of Public Health at the University of Toronto. The authors can be reached at [email protected]