The pandemic comes with lasting consequences
In December 2019, a new coronavirus, SARS-CoV-2, emerged in China. It transmits easily from person to person, persons are infectious before they show symptoms, and the mortality rate is moderate.
This disease, named Covid-19 by WHO, has spread around the world. At the time of writing, the number of cases is reported to be 15.5 million, and the number of deaths 634,000. The actual number of cases is probably 10-15 times the official estimates of reported cases, or around 150-225 million. The death rate is between 0.5% and 1% for a total of 0.75-2 million.
The full impact of the disease on the human body is not yet understood. Covid-19 is particularly hard on old persons, and those with medical problems such as obesity, diabetes, asthma, and hypertension. It will mutate but in what direction no one knows.
No reason to be optimistic
Make no mistake, this is a terrible disease and it will ravage the earth with death and destruction for the next few years. Until there is a vaccine, we have no hope of stopping its spread until herd immunity is reached, a condition that can mean as many as 100 million deaths. Covid-19 may destroy our current way of life.
The Spanish flu that struck the world between 1918 and 1920 is estimated to have killed 50 million people, or 2.8% of the world population of 1.8 billion. The current population of the earth is 7.8 billion; if the death rate from Covid-19 is similar, then 220 million persons would die.
Our medical care and public health facilities are better now; life expectancy has increased by about one-third. We can assume the death rate may decline significantly, but the number of cases will rise to 5 billion in the absence of a vaccine, resulting in 100 million deaths over the next three or four years.
Along with this comes the suffering of 400 million who recover but perhaps with lasting health consequences. This is a terrible disease and one should not underestimate the damage that it can do.
If the world separates into quarantined areas and there is strict control of movement from one area to another, then the number of deaths can be significantly reduced. This is likely to happen with Northeast Asia -- China, Korea, and Japan isolating themselves from all but Western Europe. Western Europe would do the same.
North America has shown limited ability to get the virus under control but may eventually do so. But for the next three to four years, the world will probably break down into isolated areas, and there will be very limited movement from one area to another.
There is no reason to be optimistic about the course of this pandemic. Currently, it is out of control in South Asia, Africa, Latin American, and North America. In these four geographic areas, there are essentially no effective public health measures in place.
Abdication of responsibility
In North America, in Mexico, there are limited public health measures; in the United States, some states are following sound policies and others virtually nothing. Large numbers of US citizens are demanding their rights to ignore public health measures, egged on by inadequate leadership. This abdication of responsibility leads to the virus spreading and killing.
Leadership everywhere is engaged in magical thinking that a vaccine will emerge to solve all problems. Let us hope that a vaccine can be developed, but it will take years to cover the earth’s population. But let us also recognize that a vaccine may not be forthcoming soon, and that if one becomes available it will be imperfect. The only sensible assumption is that the virus will continue to spread death and disruption.
In Bangladesh, the past 20 years have brought remarkable progress in the health of ordinary Bangladeshis. The main driving forces behind this are more food, clean water, and better infant nutrition. The emergence of a strong low cost pharmaceutical industry has contributed to a more healthy society.
Ordinary Bangladeshis are not obese. They exercise regularly by walking, and do not consume alcohol. There is still excessive smoking, but largely among males and perhaps incidence is declining. Mental health is good, indicated by the positive view of life and the widespread sense of things getting better.
Higher incomes and urban living are bringing many of the health threats that all societies have experienced: Drug abuse, chemical poisoning of the environment, stress and depression from an individual sense of uncertainty, and family stress arising from greater female participation in the workforce, more independent youth, and greater freedom for women.
Bangladesh had overcome the scourges of smallpox, polio, and cholera. Vaccination against childhood diseases has successfully reduced incidences of measles, typhus, and typhoid. Now the society is challenged with Covid-19.
The medical challenge
There are three areas of impact: Health and survival, economic impact, and what affects the way of life.
The medical challenge is the first. By July 2020, five months after the onslaught of the pandemic, it is clear that the virus is out of control. It is spreading rapidly, and normal prescriptions cannot be applied. Social distancing is impossible as homes are crowded. Most Bangladeshis have never slept alone.
Isolation and quarantine are theoretical concepts. There may not be enough water for frequent hand washing. Most people need to earn money on a daily or weekly basis to survive. The top 1% can lock down, communicate by internet, and send for food, but these are dreams for most Bangladeshis.
The first task is to tackle the implementation of enforceable rules. Factories can take precautions by increased spacing, use of hand-disinfectant, temperature screening, compulsory wearing of masks, and wiping down doorknobs, bathroom fixtures, tables, desks, etc. People will support these actions if carried out in schools, factories, and other workplaces like government offices.
If faithfully followed, it will slow transmission. Much of it is being done, but there is a need for monitoring, constant television announcements, and explanations of what must be done.
Unhappily, many shopping areas are crowded and many do not wear masks. Individual responsibility is obviously the key. Political, intellectual, and business leaders should be sending messages over television as to how important these actions are.
Inter-city travel should be discouraged. Bangladesh is a small country and the virus is everywhere, but there are ups and down in infection rates and limiting travel will slow transmission. Strict border controls with India are essential. There should be no movement across the borders.
The extent of the virus in India is probably worse than Bangladesh, so strict border control is necessary. Foreigners or Bangladeshi citizens who enter must go into quarantine for 14 days. Senior members of the government should do so to set an example. No exceptions should be allowed.
A second need is a much larger testing regime to help track the virus’s infection rates at different locations. This requires a sample of 5000 for each of the major cities, and for each division. This is a continuous program to be completed every month. Such a surveillance program calls for about 60,000 tests per month.
In addition, testing for people who may be sick, national leaders, school teachers, factory workers, and health workers will require another 500,000 per week. In total about twice the present rate of testing. This could easily be achieved although the sample testing would be expensive. It would be a very good idea to establish a special testing unit operating out of the PMO to execute such a program.
The third problem is medical care, and this is a very demanding problem. The front line physicians are the ones who should guide the government on this issue. These are the men and women who understand the real problems of treatment.
They should be encouraged to organize forums for discussion, presenting problems and information to each other and to the health authorities who should then work to try to achieve realistic actions and investments. Organizing health care is a task for those fighting the battles, not bureaucrats. Wars are won by combat officers, not the administrative staff.
The fourth problem is to prepare for access to the vaccine when it becomes available.
Obviously, discussion with countries that are trying to make a vaccine should be initiated, and agreements reached as to how Bangladesh can have access to such materials. The government should not worry about the cost.
One can assume that the necessary steps are underway. The second part of the vaccine use is distribution. A program should be worked out in advance as to how this is going to be accomplished. Who will administer the vaccine; how the cold chain will be maintained; who has priority in receiving the virus?
In summary, Covid-19 is a vicious disease. It will do great harm to Bangladesh. It is not going away anytime soon.
The magical thinking of miracle cures, of climate change, of mysterious genetic advantages is nonsense. Prime Minister Sheikh Hasina has been telling us what is needed: Courage, acceptance, and mental resilience. l
Forrest Cookson is an economist who has served as the first president of AmCham and has been a consultant for the Bangladesh Bureau of Statistics. A version of this article was previously published in AmCham Journal.