The idea of flattening the curve is to stagger the number of new cases over a longer period, so that people have better access to care
The World Health Organization has repeatedly underlined the importance of “flattening the curve” in order to tackle the Covid-19 outbreak, calling on countries around the world to impose sweeping public health measures.
While most countries have imposed strict measures such as social distancing, lockdowns, and increasing the number of people being tested, Bangladesh has been slow to react, prompting many to ask if the country can flatten the curve in time now.
Experts, epidemiologists and government officials told Dhaka Tribune there needs to be proper intervention now based on projected infection rates or a modeling of the infection rate, otherwise hospitals will be stretched beyond their capacity like Italy.
In epidemiology, the curve refers to the projected number of new cases over a period of time. In contrast to a steep rise of coronavirus infections, a more gradual uptick of cases will see the same number of people get infected, but without overburdening the healthcare system at any one time.
The idea of flattening the curve is to stagger the number of new cases over a longer period, so that people have better access to care.
Director General of Directorate General of Health Services (DGHS) Dr Abul Kalam Azad told the Dhaka Tribune that they are working on the assessment but several DGHS official seeking anonymity said it was a strategic mistake to have taken so long and it would be difficult to make that assessment since millions have left Dhaka when the general holiday was declared till April 4.
Dr Mohammad Mushtuq Husain, consultant for the National Action Plan for Health Security (NAPHS) and former PSO of Institute of Epidemiology Disease Control And Research (IEDCR), warned that the time for modeling is almost over as the virus has spread at the community level.
What is being done?
With low numbers of tests being done, a large population and a mixed approach to containment, flattening the curve is not going to be an easy feat. Additional Director General (Admin) of DGHS, Professor Dr Nasima Sultana, said they are looking at both a herd immunity and a flattening the curve approach in fighting Covid-19.
“We want to ensure people adhere to flattening the curve approaches with social distancing, working from home, but at the same time we want to build immunity to the virus so that if we cannot have people abiding by the rules then they might at least have some immunity,” she said.
On March 12, UK Prime Minister Boris Johnson announced that the UK would follow the herd immunity approach and they would no longer try to track and trace the contacts of every suspected case, and it would test only people who are admitted to hospitals as recommended by Health Secretary Matt Hancock.
Herd immunity occurs when resistance to the spread of a contagious disease within a population that happens if a sufficiently high proportion of individuals are immune to the disease, especially through vaccination.
On March 24, the UK government backtracked on the herd immunity approach with Boris Johnson in a televised address to the nation announcing a national lockdown. Both Hancock and Boris on Friday announced they were infected with Covid-19.
“As the country is entering the next phase of the Covid-19 pandemic, we have to ensure we test, trace, and the healthcare system is able to cope with the number of infections,” said Professor of Virology at Bangabandhu Sheikh Mujib Medical University (BSMMU), Saif Ullah Munshi. “We also have to make sure we have the right numbers to be able to fight this pandemic.”
Seeking anonymity, a public health expert said: “How are we going to tackle this without the numbers? The key to confronting this virus is to use a model of projected infections which can help public health professionals in flattening the curve.”
“There is also the matter of pooling resources, doctors, nurses, anesthesiologists,” he said. Other experts also warned that without proper projections hospitals cannot be prepared to deal with a high number of patients.
They said China is one of the best examples as they assessed the situation quickly and made decisions based on four aspects – patients, experts, resources and treatment. That ensures the best use of existing resources by the Chinese government.
China, Singapore, Hong Kong and Taiwan have managed to keep the number of cases down with some success, through vigilant monitoring and early intervention.
As interventions failed in Italy, the country is grappling with one of the highest numbers of infections and deaths in the world.
Experts warn that Bangladesh may suffer the same fate if the country fails to successfully implement full flattening the curve inventions.