Covid-19 in Bangladesh: Where we are and where we are going?

Published : 01 Apr 2021 07:17 PM | Updated : 02 Apr 2021 01:49 AM

The last one year (2020) has been an unprecedented, historic and never experienced before year in human history. It has been a difficult year for all age-groups. Many had no means to earn an income during the lockdowns and are unable to feed themselves or their families in Bangladesh. Travel restrictions, school closures, series of lockdowns, illnesses and isolation, anxiety and depression among all age-groups have led to a rise in mental health disorders and created new barriers for people already suffering from mental illness and substance abuse disorders. 

For some this past year seemed to have lasted a century, for many this past year was their last. COVID-19 pandemic came out as the most devastating and challenging crisis for public health in the contemporary world. And while we adjust to the new normal, we experience pandemic fatigue. A phenomenon explained by WHO as a demotivation to follow recommended protective behavior’s, emerging gradually over time and affected by a number of emotions, experiences and perceptions.

The year of the Spanish flu, 1918, which lasted about one to two years and it is estimated that about 500 million people or one-third of the world’s population became infected with this virus. The number of deaths was estimated to be at least 50 million worldwide. Since then, covid-19 has been the most devastating experience, Although the death rate so far has been much lower, thanks to the modern anti-microbial that are used to combat the secondary bacterial infections caused by covid and the state of ICU care with modern mechanical ventilation. The overall standards of hygiene were lower 100 years ago. 

It was noticed that worldwide priority was given to distribution 

of the vaccine and the vaccine roll out that had begun in 

Bangladesh was a light at the end of this tunnel. 

But interestingly, the advice given during that time is nearly identical to what we advise for COVID-19: masking, keeping away from sick people, and washing your hands, also no vaccine no vaccine or antiviral agent was available.  And We did not have the scientific advancement for vaccine development, which would have prevented transmission and decreased disease severity and mortality.

In the early 1980s, during the pre-HIV times, focus was shifted away from the infectious disease and emphasis was placed on the burden of non-communicable diseases in developed and developing countries. HIV came along as a surprise and by the end of the 20th century and crushed the idea that infectious diseases can be controlled effectively, hence leading to the HIV epidemic and  42,575,135 number of infected people and 371, 590 deaths as of today. The learning we achieve from this is to expect the unexpected and always be prepared.

Non-Pharmaceutical Interventions (NPI) were effective in reducing COVID-19 transmission, from all of those measures, studies have revealed that social distancing has been the most effective in comparison to other NPIs in containing COVID-19. Aristotle the legendary Greek philosopher said, “Man is by nature a social animal; an individual who is unsocial naturally and not accidentally is either beneath our notice or more than human. Society is something that precedes the individual”. So, social distancing measures through the last year has been very difficult and daunting, yet it is the best control measure as concluded by numerous studies. However, Two or more synchronous NPIs are suggestive of being more effective than a single type of NPI.

Fast forward to the arrival of vaccine in Bangladesh, Runu Veronica Costa, senior staff nurse at Kurmitola General Hospital in Dhaka, took the first ever shot of Covid-19 vaccine in Bangladesh on January 27, 2020. Vaccine was made accessible for frontline health workers and those above the age of 40. The vaccine has been a positive breakthrough in Bangladesh, overcoming the challenges of vaccine hesitancy which were noticed initially. While Bangladesh did scramble after the outbreak of covid-19 to put into place effective testing facilities and subsequently increasing the testing capacity, the vaccine roll-out so far comparatively is going much smoothly. As of march 20th, 4.76 million doses of vaccines have been administered, as per the number of people who have received at least one dose of covid-19 vaccine. according to the ourworldindata.org. Which has made Bangladesh ahead of countries like Spain, Poland and Canada in the global vaccination race. Despite this smooth roll-out of vaccines since January, an increase in the number of cases has been seen after the 20th of February, from 350 to an approximate number of 4000 by the end of march. Can this sudden rise in the number of active cases of the deadly covid-19 be due to a high transmissible new variant?

The vaccine for covid-19 was developed in record speed never seen before.  The process of developing a viable COVID-19 vaccine candidate may appear like it occurred at lighting speed — because it did, according to Infectious Disease News Editorial Board Member Jeanne M. Marrazzo, MD, MPH, director of the division of infectious diseases at the University of Alabama at Birmingham School of Medicine. “Fortunately for humanity, COVID-19 vaccine development occurred in the spirit of a relay race,” said Gitanjali Pai MD, AAHIVS, FIDSA, Infectious Disease News Editorial Board Member and infectious disease physician at Memorial Hospital and Physicians’ Clinic in Stilwell, Oklahoma. “Every player virtually snatched the baton from the previous player and sprinted ahead, without wasting a single moment”. It was noticed that worldwide priority was given to distribution of the vaccine and the vaccine roll out that had begun in Bangladesh was a light at the end of this tunnel. The purpose of vaccination has been to decrease the mortality and the no. of hospital admissions first by giving the vulnerable group in the community the access to the jab and gradual progression towards the availability of the vaccine to the general population which would ultimately prevent transmission leading towards attaining herd immunity at some point. Although it’s looking like upward of 70 percent of the population will need to be immune to achieve herd immunity (though the exact figure needed is unknown). That’s already an extremely high and difficult bar to clear, given the slow early distribution of the vaccines all over the world. The COVID-19 vaccines have only been administered since December 2020 and hence, the long-term effects are yet to be known. Studies will continue to evaluate their safety and effectiveness long into the future and these studies will also reveal how long the immunity offered by the vaccine lasts. 

Out of this pandemic, we have learnt how to better control a pandemic of this magnitude and severity, the resilience of our health system was also evaluated, giving us a reality-check about the capacity of our health systems, access to healthcare facilities and efficiency of delivery of those services. Covid-19 is a health crisis with deep social ecological component, therefore It needs to be taken into account that social vulnerability and differential access to knowledge, power and resources that exist in our communities play an important role. Not only do the health systems need to be resilient, a transformative change, rather than an incremental change would have a strong potential to accelerate the change that is required. The concept of health system resilience should be extended to engage with the social and environment inequalities that health system both contribute to and shield against.

New Zealand may have left some lessons for us to learn from, science was prioritized and prompt adoption of Non-Pharmacological Interventions were taken. Effective Infection Control and Prevention (IPC) strategies put in place leading to only 26 deaths till date according to the Worldometer.

This pandemic also gives us an understanding of the importance of the public health model in terms of controlling the disease. The medical model, which suggests that a drug may be provided to a patient by a doctor to cure the disease, may not give us a way forward from this pandemic. We need to collaborate with communities for a solution. In this case, the solution may not be the best in a scientific perspective but has everybody’s buy-in. Community engagement and building their trust is an integral component of a public health infrastructure essential for a positive outcome and eventually to contain such pandemics in the future.

Looking forward from here, an early warning system on health which may help intervene at the right time before we experience an exponential growth of cases would be ideal. Public health awareness and access to credible source of information should be valued much more. We should be prepared for more variants of this virus to come and move forwards, together, in the fight against covid-19.

Dr. Sahar Raza is Senior Business Development Officer, Eminence Associates for Social Development, email: sahar.raza@eminence-bd.org