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Tribune Talks: Good data, multisectoral coordination needed to fight pandemic effectively

  • Published at 11:13 pm June 29th, 2020

Dr Rumi Ahmed Khan, program director for Pulmonary Critical Care Fellowship Program and director for Cardiopulmonary Exercise and Lung Physiology Lab at Orlando Health; Dr Najmul Haider, post doctorate researcher at University of London’s Royal Veterinary College; and Dr Nusrat Homaira, senior lecturer at University of New South Wales, Australia, took part in the webinar

Health experts have said good and timely data, along with multi-sectoral coordination, remains essential in fighting any pandemic concerning a novel virus strain.

In a webinar with Dhaka Tribune Editor Zafar Sobhan on Monday, the experts also emphasized on the need for a stronger public health infrastructure along with proper guidelines as an effective deterrent to the spread of the ongoing coronavirus pandemic and transmission of novel virus strains among humans in future.

Dr Rumi Ahmed Khan, program director for Pulmonary Critical Care Fellowship Program and director for Cardiopulmonary Exercise and Lung Physiology Lab at Orlando Health, Dr Najmul Haider, post doctorate researcher at University of London’s Royal Veterinary College, and Dr Nusrat Homaira, senior lecturer at University of New South Wales, Australia, took part in the webinar.

What is spillover and what are the implications?

Defining the term, Dr Najmul Haider said a spillover is when any pathogen goes from one natural host to a non-natural host. 

“For example, if the Nipah virus goes from a bat to a pig, that too is a spillover. Generally, we describe spillover for any pathogens jumping from wildlife to humans. This is an evolutionary procedure and it takes a long time. It is also a chance event, not natural,” he added.

He also said spillover is different from zoonotic diseases, where a disease is naturally transmitted from animals to humans and vice versa, such as Rabies.

Mentioning that there were many evidences that the Covid-19 virus did not directly come to humans from bats, he also indicated that the loss of habitat of wildlife, whether man-made or climate change, has been closely related to such inter-species transmission of viruses.

While discussing the repeated outbreaks of the Nipah virus, another bat-borne virus in Bangladesh, Dr Rumi said although there are Nipah virus outbreaks almost every year, the outbreak remains short-lived as the transmission stops after one generation of the spread. However, the virus has a fatality rate of 50% to 90%, compared to the SARS-Coronavirus virus strain which is less than 1%.

“If the Nipah virus learns how to spread for more generations, then that will be a major problem. Almost half of the country’s population might be wiped out. This is the main fear in a spillover,” Dr Rumi added.

He also identified wet markets, where animals are slaughtered, as hotspots for spillovers.

Meanwhile, speaking on spillover research in Bangladesh, Dr Nusrat Homaira said a joint outbreak surveillance by the ICDDR,B, and IEDCR had been successful in detecting several viruses, such as Nipah, Bird Flu, and Swine Flu, in the early stages of an outbreak in Bangladesh.

Replying to a question on whether eating patterns can trigger a spillover of a novel virus strain, Dr Nusrat Homaira said in case of Nipah it was found that consumption of date juice contaminated by the saliva or urine of fruit bats, known as the natural reservoirs of the virus, had lead to infection.

However, in cases of previous outbreaks, such as the Bird Flu (H5N1) or Swine Flu (H1N1), most cases had contact history, but no food history. 

“Spillover events, coupled with contacts and eating patterns, will always be a threat for the emergence of epidemic or pandemics,” she added.

Contribution of international health research organizations during pandemic

The health experts have said even after six months into the pandemic, Bangladesh’s strategy in dealing with the outbreak remains highly centralised and lacks a multi-sectoral coordinated effort.

“There has been no multi-sectoral coordination from the very beginning of this pandemic....  There is a centralized approach in Bangladesh in dealing with this pandemic, where every directive has to come from the DGHS or IEDCR. But, this is not way to deal with a pandemic,” Dr Nusrat Homaira said.

Similarly, Dhaka Tribune Editor Zafar Sobhan also pointed out that when it comes to a national crisis where everyone should participate and want to, the existing political culture of the country makes cross-sectoral decentralized coordination and communication hard to implement.

Current state of vaccine development and its impact on Bangladesh

Replying to a question on when the world can find a vaccine for Covid-19, Dr Rumi Ahmed Khan said the global community can expect a vaccine for Covid-19 as early as next year, although it may not be perfect. It can be used to protect healthcare workers from getting infected.

Speaking on the call by influential leaders from across the globe, initiated by Yunus Centre, to declare Covid-19 vaccines a global common good and to distribute them for free, Dr Rumi also spoke on why nations such as the USA and UK would like to be the first to have the vaccines in hand and how several organisations, such as the Melinda Gates Foundation, raised millions of dollars to get the ground ready for third world countries to have access to these vaccines.

At the same time, the health experts also highlighted the lack of an adult vaccination program framework in the country, and resource constraints in reaching such a large population can always remain a challenge.

Serological testing

Speaking on the topic, the experts said fast test results are needed to serve the primary objective of the testing, which is to detect and contain the spread of the virus. 

“If a test takes 10 days to show results, then the probability of transmission of virus from the patient to others increases many times. However, if an antigen test which is being used in many places with a sensitivity of 80%-85% can give you results in around 30 minutes, then the spread can be cut off by huge numbers. These tests are being conducted to contain the spread first, and then treatment. Therefore, more tests are needed. In Bangladesh, the number of tests being conducted in comparison to the country’s population is not adequate.”

The health experts also emphasised that a lack of expertise, technical knowledge, and conditions needed to conduct an accurate Reverse Transcription Polymerase Chain Reaction (RT-PCR) test have called the the results into question.

They also said antigen tests could be used as a special screening tool in high-risk populations and Bangladesh should work towards building its capacity to conduct more tests during the pandemic.

Speakers at the webinar also highlighted the lack of availability of accurate and timely data in dealing with such pandemics.

Effectiveness of using face masks

Dr Rumi said artificial herd immunity can be achieved if everyone starts using face masks. This is because face masks help stop dispersing respiratory secretions of an infected person as droplets in air, especially in enclosed places using artificial ventilation system, such as air conditioning or heating. 

“Therefore, keep the masks up until there is a vaccine,” he added.

The experts also called for evidence based clinical care and guidelines for clinical care and infection control guidelines for hospitals.  

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