How do you analyze the current state of the coronavirus pandemic in Bangladesh?
The present situation of Covid-19 is at the level of Community Transmission (Country Level 4) in Bangladesh.
The virus is highly contagious. So, by coming in contact with infected individuals, widespread person-to-person transmission of the virus is happening in several districts especially in and around Dhaka.
Due to people infected with the virus moving from one region to the other, such pockets of transmission are also being found in different districts.
Why is it spreading so quickly?
The virus is a new one, we do not have any immunity (resistance or protection) to it, our whole community, irrespective of age, is prone to be infected.
A virus-infected person can spread it to many others, may be 2-3 people, which is called R 0 (number of new infections estimated to stem from a single case) and in turn the newly infected people can spread it to other individuals; as a result multiplication is happening quickly.
R 0 depends on transmission probability for a “contact,” number of contacts per day, and duration of infectious period (when a person is infectious).
We have a high population density, sometimes having a large number of family members in individual households and our communities are only recently getting information about preventive measures of dangerous germs that are transmitted by coughing and sneezing.
Coughing etiquette was also not very common in our culture.
Is there any estimation regarding when we can reach the peak of the infection?
The curve by which one can determine the peak is called the epidemiologic curve of infection. The curve has an upstroke and a down stroke.
The nature of the curve is dependent on using various interventions to reduce R 0: using face mask, respiratory hygiene, hand washing, quarantine (avoiding contact of others), avoiding public transport and public events, quicker diagnosis, isolation (separation of virus infected person).
The measures are called “non- therapeutic interventions” which were used more than a century ago, during the Spanish flu.
We tried to use these interventions and our community tried to adhere to them as feasibly as possible in our perspective, so the upstroke was delayed to some extent.
It appears that we are going upward in certain districts but not all at a time. Historically 2-4 weeks are required to reach the peak, which will be determined by how many cases you are able to detect and manage by widespread testing.
Can you mention three challenges for the government amid the Covid-19 pandemic?
In the present phase of the increasing number of cases due to community transmission, providing clinical care and maintaining essential health services have put the healthcare system into huge stress.
The challenges include dealing with such a dangerous pathogen having no built-in system of infection prevention and control, providing logistics such as personal protective equipment (PPE) timely to the health workforce, quick deployment of a resource-intense complex new diagnostic method (RT-PCR) across the country, providing safe healthcare facility either by repurposing or reconfiguring the entire health sector, screening, triage, targeted referral of Covid-19, providing oxygenation and artificial respiration (ventilation).
Quick identification of contacts, contact tracing (for being quarantined for 14 days), isolation of suspected and confirmed cases and adherence to stage-specific (non-sporadic, clusters, community transmission) public health advice by the community are huge tasks to perform.
Another great challenge for the policy makers is to take evidence-based decisions considering both necessary public health measures and food and protection needed by the vulnerable.
What are the limitations we need to address immediately to fight Covid-19 more efficiently?
We need to ensure continued voluntary and enforced public health measures of physical distancing, quarantine and isolation, optimal utilization of existing health facilities and healthcare workforce, broader engagement of the community down to the lowest administrative units in both rural and urban areas.
The ways of bringing all on board to address Covid-19 by “Whole-of-society” and “Whole-of-the-government” approach should be sought after.
When can we overcome this crisis, any prediction?
In absence of effective specific treatment, antiviral drugs, antibody based therapeutics, effective usable vaccine and having no immediate hope of elimination of the virus we have to live with this virus for some time to come.
We have to adapt to the “new normal” by adhering to behavioural public health advice across society.
Any suggestions for the government and the people?
Health is closely related to personal awareness. As a community, we have to take responsibility for our own health.
Covid-19 is an opportunity in disguise to take measures for improving the public health system through developing a strengthened and resilient sustainable system of health for achieving universal health coverage (UHC).
According to him, this is the perfect time to focus on improving the healthcare sector of the country.