Without the right measures in place, we could see an explosion of cases, and a second lockdown
Globally, there have been over 2.6 million Covid-19 cases, and about 185,000 deaths; in Bangladesh, however, there have been only 4,186 confirmed cases and 127 deaths (as of April 23).
So far, we appear to have been very fortunate; we have 2% of the world’s population, but have had only 0.07% of the world’s Covid-19 deaths. Let’s try to understand why we have been so fortunate.
On March 25, the government shut down all workplaces in order to reduce the spread of the virus. Most workers in Dhaka responded by returning to their village homes; Dhaka’s slums, which would normally have been a perfect breeding ground for any epidemic, became much less crowded.
That is probably what prevented an explosion of cases in Dhaka. “Social distancing” is probably not possible in crowded Dhaka slums; if slum residents had remained in Dhaka, we probably would have seen a much larger number of cases by now.
The shutdown of workplaces has prevented infection, but it has also caused indescribable hardship. Many working class families have no savings, and can’t buy food as they now have no income; demand for food has collapsed.
Farmers have been unable to sell perishable products, which have gone to waste on a massive scale; in agriculture, production can’t be turned off with a switch. Clearly, workplaces must re-open; in richer countries, people can live off savings or government benefits for months while their workplaces are closed; that is not the case in Bangladesh.
When workplaces re-open, workers will return to Dhaka slums, which will again become overcrowded; we will probably then see an explosion of Covid-19 cases.
WHO has warned that the relaxation of a lockdown can trigger a “second wave” of coronavirus infections, and has advised governments to ensure that certain conditions are met (and that certain systems are in place) before relaxing a lockdown. We should think deeply about these recommendations.
(a) Disease transmission should be under control; there should be only a few new cases every day -- all of which should be known contacts of previous cases. On April 23, it was reported that 414 new cases were confirmed in Bangladesh in the last 24 hours; therefore, it can’t be said that transmission is under control.
The situation will probably get much worse once workplaces re-open and Dhaka slums are again overflowing with people. With hundreds of cases being detected every day, we must immediately set up quarantine facilities which can house all these cases; most of them will be mild cases which will not require hospitalization.
(b) Health systems should be able to detect, test, and isolate every case, and trace every contact. Unfortunately in Bangladesh, testing has been too narrow; initially, many patients were refused a test unless they or someone in their family had returned from abroad.
Government hospitals reported 11,930 cases of “acute respiratory illness” in March 2020; all of these patients should have been tested for coronavirus, but probably were not.
Moving forward, every single patient suffering from fever, dry cough, and fatigue (the most common Covid-19 symptoms) should be tested; if they test positive, all of the family members who live with them should also be tested.
In Dhaka’s overcrowded slums, every resident with symptoms will have to be tested, and all positive cases will need to be moved to a quarantine facility; quarantine is impossible in a crowded slum. Fortunately in Bangladesh, the government has the manpower required to trace contacts.
(c) Places at risk of becoming “hot spots” should be monitored, and effective infection prevention measures should be taken (such as the use of appropriate PPE).
Unfortunately, entire slums are likely to become hot spots; it will be necessary to have teams of community health workers and police in Dhaka slums to check people for symptoms, and to remove those who test positive to quarantine facilities.
It must be sufficiently explained to all slum residents that these unpleasant measures are necessary to protect the rest of the slum residents from infections. In other countries, people are most likely to be infected in public places like workplaces and schools; however, all Dhaka slum residents effectively live in crowded public spaces, and are likely to be infected where they live.
(d) Appropriate infection prevention measures should be taken at schools and workplaces, such as use of masks, hand-washing, and temperature monitoring. Anyone with symptoms should not be allowed to enter these places.
This will probably be easier than preventing the spread of the virus in Dhaka slums. A workplace where many people are infected can be shut down; is it realistic to think about shutting down a slum? Where would the residents go?
(e) Effective quarantine facilities must be set up for travellers from abroad to ensure that new cases are not imported; “quarantine at home” has proven to be ineffective in Bangladesh.
(f) Community participation should be ensured. The communities who live in Dhaka slums will have to cooperate with a regime of testing, contact tracing, and quarantine; the government must use mass communication to ensure that these communities understand and accept that these measures are necessary for their well-being.
If workplaces are re-opened without first taking these measures, it is very likely that we will see an explosion of cases (with a large number of deaths) which will result in a second lockdown.
Kazi Zahin Hasan is a businessman and an avid reader.