Let us not underestimate Covid-19

Published : 05 Sep 2020 08:41 PM | Updated : 12 Sep 2020 01:00 AM

Muhammad Rizwanur Rahman, Dr Shahed Imran, Dr Shahriar Rozen, Mohib Ul Haque Khan, Dr Jannatul Mawa

Bangladesh has now marched into its sixth month of the Covid-19pandemic. A retrospective of these unprecedented times suggests that even though a number of good measures have been taken, their delayed implementationsand limited coordination contributed to weaken thecontrol over the infection scenario.Not to mention, the unwillingness of many people to adhere to the health safety guidelines further exacerbated the exigency. Luckily, the country has not been devastated by the lethal coronavirus as contrast to the cases in many developed countries in the world, but none can rule out the possibility of such scenario in coming days.

The urgency of social isolation and distancing during the pandemic created a paradox between living and livelihood which challenged majority of the country’s population, and hence, of its administration. The harsh reality associated with a prolonged lockdownmade the government lift the restrictive measures early. Now most of the economic activities in Bangladesh are restored with few social distancing rules in effect. However, to what extent these rules are being maintained and what happens in the event of violation of such distancing rules remain unclear. As of August 12, a total of 266,498 positive cases were detected which constitute 20.5% of the total number of tests (positivity rate) with an infection fatality rate (IFR) of 1.32%. The high positivity rate indicates that many cases do remain undetected and untraced which continues spreading the disease in the community in an unleashed fashion. In contrast to the World Health Organization’s (WHO) strong recommendation of attaining the positivity rate below 5% for at least 14 consecutive days before reopening, our infection scenario and the testing measures are nowhere close to that.

The official records (IEDCR) show a steady decline of daily cases from the month of July - much of which can be credited to the decreasing number of daily tests. Notwithstanding this decline in daily case counts, a better infection indicator, the positivity rate has never gone below 20% since July 4th whichannounces that the country is missing a lot of infection cases. In the beginning of the pandemic, most Covid-19 patients were confined in Dhaka, but due to the lifting of cross-district mobilization restrictions, now the case counts from outside Dhaka are increasing at an acceleratedrate. As for an illustration, the number of patients outside Dhaka increased by a factor of twelve just in last two months, whereas the same increased three fold within the capital. On top of this, the number of deaths is doubling every nineteen days as of August 10. A recent study revealed that nine percent of Dhaka city dwellers have already been infected with coronavirus, clearly indicating that the case counts observed is an underestimation of the real situation and all thesestrongly suggest that the infection scenario in Bangladesh is far from a controlled situation.

If we gauze the different decision points in the pandemic period, undoubtedly, some good initiatives were taken in timely fashion; whereas some othersraised concerns. Though not much strict, some screening at international borders were in effect. Anopen ended countrywide restrictions were duly imposed on March 26th - the 49thindependence day of Bangladesh. This came with the wise decision of shutting down all the educational institutions for an extended period of time, imposing restrictive measures on social gatherings including religious and community events. But an undue haste was observed, perhaps due to the influence of numerous pressure groups, in lifting the restrictions. The RMG sector was reopened on the last week of April and the shopping malls were functional in early May. These reopening decisions came at the time when daily case counts were on the increase. 

On the bright side, government declared an allocation of Tk 72,750 crore as stimulus packagestocounter the adverse effects of coronavirus on the country’s economy. But it remained difficult for the administration to ensure that this goodwill of the government would reach their destination timely and appropriately as some misappropriations of these funds were identified.Another blow was the unveiling of a number of certified organizations that faked the corona test results intriguing mistrust among communities.Further, the decision of collecting fees for Covid testing sparked criticism as it would serve as a strong discouragement to testing.Whereas many jurisdictions around the globe are still wandering as to whether mask use should be declared mandatory in public places, Bangladesh clearly made it a rule violation of which would result in jail time and/or fine. 

Let us not downplay the crisis as it does not take a

 mastermind to realize that the cost of underestimating

 the infection can be very expensive in the long run. 

The low death rate and high asymptomatic cases 

that have been noticed in the country has granted

 us an opportunity to minimize the damage, but only so if properly dealt with

When there’s now a growing consensus among researchers that face mask is an essential element in our arsenal against Covid-19, time now demands a decision to make face masks very cheap, if not free, throughout the country.

Strong planning and evidence-based data driven decision are essential to address pandemics like Covid-19.  And this becomes more evident when we assess other countries – most of which were seen to develop their action plans based on their respective projection models and also have continued modifying, reshaping and fine tuning the strategies in line with the in-situ statistical data and expert opinions.In contrast, publicly open data is described at such a higher levelin Bangladesh making the authentic analysis of the situation difficult. Another telling difference is that while most developed countries followed the lead of their public health experts and scientists in developing the pandemic response plan, we rarely followed that approach.

It’s not atypical to have deficiencies in preparing for the fight against a pandemic – and this is true for most countries of the world, from Africa to America. But what’s striking is the absence of acknowledging the gravity of such situation. Perception of a false sense of security from this 

respiratory diseasewould only discourage people to follow the safety guidelines and may result in an upsurge of infection.

Let’s not downplay the crisis as it doesn’t take a mastermind to realize that the cost of underestimating the infection can be very expensive in the long run. The low death rate and high asymptomatic cases that have beennoticed in the country has granted usan opportunity to minimize the damage, but only so if properly dealt with. It is important to take precautionary approach and make evidence based informed decision to make sure that we don’t let the pandemic go unleashed. 

Muhammad Rizwanur Rahmanis a doctoral research fellow at University of Alberta, Canada; Dr Shahed Imran is a public health expert; Dr Shahriar Rozen is apublic health professional and a Senior Policy Lead at a Provincial Ministry of Health in Canada; Mohib Ul Haque Khan is a Senior Policy Analyst, Government of Alberta, Canada; Dr Jannatul Mawa is an MPH student at the University of Alberta.