Should Bangladesh fight the Covid-19 pandemic in line with the UK system?
Since the start of the Covid-19 pandemic, there has been massive disruptions of economic, physical, psychological, and social wellbeing worldwide, consequent to the coronavirus’s disastrous effect on human health and fatality.
In order to slow down the spread of infection, widespread lockdowns were adopted, resulting in seriously depressed economic activity and sharp reduction in individual and family income, unprecedented unemployment, and, ultimately, to substantial decline in the GDP of nations.
A substitute for a lockdown
After complete lockdowns with untold devastation, governments and the scientific community have been zealously searching for an effective substitute for a complete lockdown.
Zone-based social distancing, dividing the population into areas, and when a cluster of individuals become infected, the area is locked down -- completely isolating the infected area from other areas may be effective in preventing or at least reducing the transmission. There has also been phase-wise lifting of lockdowns with gradual opening of activities.
With the start of lifting of the lockdown, there has been the re-emergence and growth of the Covid-19 pandemic observed in two cities in the UK recently; Leicester in England, where a large population of the people from the Indian sub-continent live, and in the southern Wales town of Myrther Tydfil.
In the city of Leicester, the rate of coronavirus cases jumped to 141 per 100,000 of the population and to 179 in Merthyr Tydfil compared to all other cities, towns, and localities in the British Isles, reporting a declining trend. Initial reports of the increase in the new cases, particularly in the city of Leicester, caused a bit of panic as initial precautionary measures taken by the authority failed to stop the tide for a few days, forcing them to lock down the city of Leicester from the rest of the country.
However, with the system in place, the root cause of the surge in both places was discovered quickly -- failure to abide by the guidelines issued for gradual lifting of lockdown by businesses in clothes and food industries.
Those businesses decided to ignore the instruction of maintaining safe distances between employees and, in some cases, forced the sick employees to come and work. Punitive measures are being handed out to the offending businesses.
Thanks to the NHS
In fact, it appears that the Covid situation in the UK is well under control, and the lockdown is being gradually lifted, thanks to the health care delivery system of the National Health Service (NHS), regarded by many as the most efficient health care system in the world.
It was announced on July 7 that no death from coronavirus infection has been reported in Scotland in the previous three days, and no death was reported from Wales on the same date of July 7.
The total number of diagnosed cases of coronavirus infection amounted to 290,000, with a daily number diagnosed on July 12 all across UK being 650 with a continuously declining trend. The total deaths declared from the coronavirus pandemic in the UK was nearly 45,000; around 40,000 in England, roughly 2,500 in Scotland, 1,500 in Wales, and 550 deaths in Northern Ireland. The figure declared for the total number of deaths in the UK on July 12 was 21.
At the peak of the coronavirus infection, death rate in the UK was the highest in Europe, greater than any of the 11 countries in the European continent. Its death rate was higher than Spain, Sweden, France, and Germany. Next to the UK, Spain had the highest death rate, and the UK being 109% higher compared to the country with the lowest death rate, more than double.
A question has been asked about the cause of such high death rates in the UK. The major cause of such rate was the late introduction of lockdown in the UK. The first case of diagnosed coronavirus infection was detected on January 31, the same date as the first case in Italy.
However, Italy introduced lockdown on March 9 in contrast to the UK, which introduced lockdown on March 23, almost two months after detection of their first coronavirus infection. The second-most important cause of the high death rate was due to authority’s failure to introduce test, trace, and isolate strategy early.
The full blame cannot be thrown on the shoulders of the government, as major reason behind their misfortune was the sub-standard quality of the rapid testing kit they imported from China, with substantial payment that turned out to be of low quality by the scientists at the University of Oxford, and had to be discarded.
Eradication without a vaccine
The question is also being asked if it is possible to eradicate coronavirus infection without the benefit of the development of the vaccine against this lethal virus. Scientists and academics from a number of universities in the UK agree that such an option of near eradication or substantial control of the virus is feasible, but would require a determined effort by the government and the people of a country, infrastructure support, and availability of resources both human and financial.
Public trust in their authorities leading the fight against the coronavirus is of paramount importance -- the people must be readily willing to collaborate with the authority in implementing the instructions and guidance handed out. The public trust in authority would require the honest and sincere delivery of the package of strategies leading to the success of the authority in combating the deadly disease.
Causes for worry
My major concern is the unplanned lifting of the lockdown, and the failure of the general population to adhere to social distancing, handwashing, wearing masks in public, and other public health measures advocated in combating the coronavirus pandemic with a structured gradual lifting of lockdown strategy.
Without the benefit of control on the transmission of the disease, and non-adherence to the recommended public health measures, it may lead to the more dangerous second wave of the pandemic with much greater catastrophic devastation as observed in the similar resurgence of the Spanish Flu in the second half of 1918, wiping out more than 50 million human lives in the short span of a few weeks.
Countries are failing to fulfil the pre-conditions recommended by WHO prior to lifting of lockdown; disease transmission to be under control; health systems are to be able to detect, test, isolate, and treat every case and trace every contact; hot spot risks are minimized in vulnerable places, such as nursing homes; schools, workplaces, and other essential places have established preventive measures. The risk of importing new cases can be managed and communities are fully educated, engaged, and empowered to live under a new normal.
Nowhere near fulfilment
These WHO pre-conditions are nowhere near fulfilment in our country, and I do understand the importance of lifting stepwise the lockdown to allow a minimum of economic activities with a gradual increase to full or near full activities over time.
We may explore how the authority in the UK have followed lockdowns and their gradual and stepwise lifting in response to transmission of this potentially fatal viral infection. Let us consider management of school activities from the start of the pandemic in the UK. Schools in the UK initially started to open only to a small number of children with the aim of reducing transmission of coronavirus infection to protect the National Health Service (NHS) and save lives.
With improved situation, the authorities started to consider bringing more and more of children and young people back into schools. From June 2020, education in schools began in small bubbles, students spending a short time in school in small groups, with public health risk reduction measures in place with flexibility to bring back more pupils where schools have space to do so.
As the prevalence of coronavirus decreased, and with the NHS Test and Trace system up and running, the government asked the schools to prepare for receiving pupils and opening fully from autumn.
The other important component in effectively combating coronavirus pandemic is the management structure strategy. In the UK, Gold-Silver-Bronze command structures and Programme Management Office (PMO) were introduced in combating the coronavirus pandemic.
The gold, silver, and bronze command structure is a command hierarchy used for major operations by the emergency services of the UK. It is not unusual to use the terms strategic, tactical, and operational command structure instead.
In some cases, the UK government acts as the Platinum level, and assumes ultimate control in the cabinet office briefing rooms. My advice for Bangladesh in the battle against coronavirus that the country should endeavour to establish command structure for the management of the coronavirus pandemic in line with the UK system, modified to its unique requirements and to its existing situation, imposing graded and area-based lockdowns in response to transmission scenarios of sporadic, clusters, and community transmission, make every effort and utilize every opportunity in controlling transmission of this potentially fatal disease, develop capacity to detect, test, isolate, and treat every case and trace every contact as soon as possible, establish preventive measures in workplaces, schools and other essential places, and educate, engage, and empower its population with the effective ways to live in the era of the potentially fatal Covid-19 disease.
Dr Raqibul Mohammad Anwar is Specialist Surgeon and Global Health Policy and Planning Expert, and Retired Colonel, Royal Army Medical Corps, UK Armed Forces.