Jacinda Ardern, the honourable prime minister of New Zealand, at midnight on June 10, announced the good news of complete eradication of the coronavirus from her country and all of New Zealand moved to the lowest level of a four-tier alert system of the global pandemic, to level one.
There have been no new cases in the country in the last 17 consecutive days. The new regulations now lift all restrictions of social distancing associated with Covid-19 in earnest and allow unlimited numbers on public gathering. The border of the country, however, remains tightly shut to foreigners. Jacinda Ardern is happy but remains nervous about the future. Concerns rage through many other nations, including Bangladesh, as the number of cases and fatalities continues to rise. The novel coronavirus is continuing its spread across the world, with some seven million confirmed cases and more than 400,000 deaths.
Some of the countries are starting to observe a decline in these numbers as a result of their strict lockdown restrictions, while others, particularly India, Russia, Brazil, Mexico, Peru, Pakistan, and the Middle East still remain concerned as their figures continue to rise.
Latin America is bracing itself fearing new widespread outbreaks in Chile, Peru, and Ecuador. Brazil’s death is estimated by experts at the University of Washington to reach 125,000 by early August. In Europe, the UK, Italy, Spain and France, along with others, now appear to have passed the peak, with the number of new confirmed cases and deaths falling.
The countries in the sub-continent -- India, Pakistan and Bangladesh -- are failing to follow strict lockdown for a variety of reasons, economy being their greatest concern.
Under the existing situation, when lockdown restrictions are not being followed properly for whatever reason, measures of handwashing and others remain the mainstay of the prevention of coronavirus infections.
Soap used in handwashing dissolves the outer envelope of the virus and moderately frequent handwashing with soap and water, six to 10 times a day, may achieve significant reduction in the transmission and effectiveness of the novel coronavirus, almost by half.
This is evidenced from a research by Wellcome Open Research Group on the effect of handwashing in the prevention of other coronaviruses such as the seasonal flu infection. Using only water is less effective and alcohol hand rub can be used when facility for hand washing is not readily available.
The situation in Bangladesh
In the context of the epidemic in Bangladesh, it is much safer to use soap and water than to use contraband hand sanitizers.
The possibility of infection also rises with increasing engagement and encounters with physical surroundings such as door handles or knobs, desks, lift buttons, electric switches, computer keyboards, etc. Avoid directly touching those whenever possible or use alternatives like the elbow or disposable tissues with safe disposal after use, if feasible.
Social etiquette in coughing and sneezing should be strictly adhered to. Use disposable tissues or the inner side of the elbow when coughing or sneezing to stop the spread of droplets that carry the virus.
Spitting is a social curse and must be religiously avoided as it is in itself a pestilence and exponentially increases the possibility of spread, not only of the novel coronavirus but any other diseases that spread by droplets.
Do masks and gloves help?
Face masks are being used to assist in controlling and preventing the coronavirus infection and it is imperative to appreciate that it is only a part of a comprehensive prevention package and is not effective on its own in controlling and preventing the infection.
Many a people are using non-medical, fabric masks in public areas. Evidence of using such masks being effective is not readily forthcoming.
Non-medical or fabric masks could increase the potential for Covid-19 to infect a person if the mask is contaminated by dirty hands and touched often, or kept on other parts of the face or head and then placed back over the mouth and nose.
However, if it is difficult to implement control measures such as social distancing of at least one metre in areas of widespread transmission as in public transport, in shops, or in other confined or crowded environments. People should be encouraged to use non-medical fabric masks with insistence on covering both the nose and the mouth.
The British Medical Association has called for face coverings to be worn in all areas where social distancing isn’t possible. This follows the UK government’s announcement that face coverings will be mandatory on public transport in England from June 15, exemptions being people with breathing difficulties.
One of the main arguments against using non-medical fabric masks routinely is the false sense of security it may convey to the user, leading to the diminished practice of recognized beneficial preventive measures such as physical distancing and hand hygiene.
Medical masks have the ability to protect people from getting infected, as well as preventing symptomatic people from spreading them. WHO recommends that medical masks be used by health workers, people with symptoms including those with mild symptoms of Covid-19 infection, and people caring for confirmed infected patients outside hospitals.
Medical masks are also recommended for at-risk people such as people over the age of 60 and people of compromised health conditions for use in areas of widespread transmission and without the guarantee of a safe distance of at least one metre from others. The prolonged use of medical masks can be uncomfortable.
However, it does not lead to carbon dioxide intoxication or oxygen deficiency. Medical masks, also known as surgical masks, are flat or pleated; they are affixed to the head with straps or have ear loops. Ensuring that a medical mask fits properly is vital.
It should be tight enough to allow breathing normally. Disposable masks should never be re-used and should always be changed immediately once damp.
Masks should be used as a part of a comprehensive strategy of measures suppressing transmission of the virus and saving lives; the use of a mask alone is not sufficient to provide an adequate level of protection against Covid-19.
Hand gloves are not recommended to be used by the general public in day-to-day activities as there is danger of contaminations of the gloves followed by the self-transmission of the virus on to the face or mask of the user by touching with the contaminated gloved-hands.
However, gloves are mandatory to be used by health care professionals and health care workers involved in the care of coronavirus patients who are obviously aware of the protocols and guidelines of their use and safe disposal. For entry and exit from medical establishments, supermarkets, shops, office, banks, and financial organizations, facilities for hand sanitization has to be provided.
When the chances are high
The possibility of acquiring the infection is magnified in close proximity and during exposure for long periods to infected individuals, particularly in closed spaces. Researchers in China concluded that the possibility of acquiring the infection from an infected person at home was 10 times greater than from a hospital patient and 100 times greater in public transport compared to a hospital.
The multiplicity of a travelling person through communal areas enhances our susceptibility to acquiring the infection. Maintaining a safe distance of two metres (at least a metre) between individuals reduces the risk of being infected.
Small droplets carrying coronavirus may travel longer distances but usually carries smaller numbers of the virus load and are dispersed easily by wind, except those generated by forceful sneezing.
As such, the spread of the virus may be avoided by covering the mouth and nose by tissue and ensuring the used tissue’s safe disposal or simply using the inner side of the bent elbow when coughing or sneezing.
It is also important not to travel if it is not essential. If people have to travel, walking, if feasible, is the best option, or using a bicycle. Self-driving a private car or otherwise is also a safe mode of travel.
Car sharing may be used provided the car is not a taxi and is used by a limited number of people. Use of taxis or ride-sharing as modes of transport increases the risk of coronavirus infection.
Public transport carries the highest risk of infection by coronavirus as studies have shown that the use of public transport for travelling increases the risk by six times. If you have to use buses or trains, try to stay away from entry or exit doors.
Covid-19 is still very much shrouded in camouflage and much is unknown but enough information is in the public domain to appreciate the mode of transmission and viral durability and endurance in the environment outside the human host.
The majority of coronavirus-infected patients suffer from mild or moderate symptoms and recover well with only supportive care. However, patients who have a cough, fever, and difficulty breathing have to seek medical care early.
Dr Raqibul Mohammad Anwar is a Specialist Surgeon and Global Health Policy and Planning Expert, Retired Colonel, Royal Army Medical Corps, UK Armed Forces.
