How COVID-19 spreads on remote Hatia island

When the authorities confirmed the first novel coronavirus cases on a remote island under Hatia Upazila in Noakhali over three months ago, its residents bound themselves to their homes, closing shops and businesses.

The local authorities also began enforcing the lockdown strictly a month after the government announced the curbs across Bangladesh to stem the outbreak.

However, the enforcement of the curbs by the local authorities and self-restraint exercised by the residents barely lasted a month.

Locals soon began roaming around by giving the law enforcers the slip, and hanging out shoulder to shoulder at tea stalls.   

Many concealed COVID-19 symptoms and went on with daily lives as well. Now the residents appear to have become used to wearing masks in public after initially showing apathy towards the protective gear.

The first COVID-19 patients in Hatia Upazila were two health workers, who tested positive on Apr 26, over a month and a half after the government reported the country’s first infections in Narayanganj.

As many as 6,016 residents out of a 700,000-strong population of Hatia have undergone COVID-19 tests so far.

The number of confirmed cases there stands at 90, including a banker who eventually succumbed to the disease.

But doctors believe the number is much higher and a lack of tests has made it difficult to get the complete picture.

About 2,000 people use trawlers and motorised boats to travel daily between Hatia and mainland Noakhali, some 20 kilometres from the Upazila. Some 500 others take launches to and from Dhaka, an 18-hour journey.

The number of visitors, which even in normal days is less than the other parts of the country, dropped further due to the pandemic, Hatia police chief Abul Khayer said.

The authorities also monitored the entry-points and kept the in-coming passengers isolated.

But how did the virus spread throughout the Upazila, consisting of 19 islands with a total area of 1,500 square kilometres?

For that, doctors blame unnecessary roaming, carelessness, apathy towards health rules, wrong ideas, a lack of awareness of the disease and the tendency to hide its symptoms. 

SLOW TESTS

The government team for COVID-19 treatment in Hatia have earned plaudits for its laborious efforts round the clock. But the local health authorities are able to collect samples from suspected patients only two days a week as the monsoon hampers transportation by waterways.

And it is taking three to four days for the results to come back from the lab at Noakhali University of Science and Technology in Sadar Upazila after the samples are sent from Hatia Upazila Health Complex. 

In the present circumstances, if a resident develops symptoms on a Wednesday, he or she must wait until Saturday to give the sample and then wait for three to four more days for the result to come back.

If positive, the authorities restrict the patient’s movements. But there is no surveillance during the period between the development of symptoms and results.

Nizam Uddin Mizan, a doctor at the local health complex who is heading the COVID-19 team, recalled an incident by way of example.

The doctor advised a man to self-isolate at home after he developed symptoms of the novel coronavirus.

When the report came back positive, Nizam called the patient immediately over the phone to alert him so that he could take the necessary steps to avoid infecting others.

“The man told me that he wasn’t experiencing problems anymore and was preparing for the Juma prayers after taking a bath in a pond,” Mizan said. “Such incidents are happening very often on the island.” 

A patient who recently caught the virus said he had almost recovered when the report came back positive.

“If the report comes back so late, it will be difficult to stop the disease from spreading. Such a delay will also jeopardise efforts to treat a severely ill patient,” he pointed out.

HIDING SYMPTOMS

Many residents of the islands said those with symptoms were concealing the information in fear of social isolation, putting others at risk.

During a trip to Sagoria Bazar on Jul 15, bdnews24.com found that some of the shopkeepers were working despite being ill with high body temperature, headache, cough and other symptoms.

Many locals with a fever and cold were coming to the pharmacy at the market to buy medicine. The number of such patients has increased recently, according to Amirul Imam Sathi, the pharmacist.

He even sold drugs to a person who became sick after a relative tested positive. “The patient was not wearing a mask either.”

NUMBER OF TESTS DROP

People on the islands have recently shown a lack of interest in taking coronavirus tests.

The number of samples sent to the lab at a time has dropped to about 12 now from an average of 30 in early May.

bdnews24.com asked Dr Nizam whether the Tk 200 fees fixed by the government for the tests were the reason behind patients’ disinclination.

He believes the patients were going for tests whenever they had been feeling a bit unwell earlier out of panic. “Now they are thinking twice before taking the tests. I think only those with the actual symptoms are giving samples now.”

Abul Kalam, a fish farmer, however, suspects something else. He thinks the fake COVID-19 test scams created a lack of trust among the people in the testing system.

“I myself have been having dry cough and a fever for some days, but I won’t take the test now,” he said, adding that he was taking home remedies like taking lemon tea and talked to coronavirus patients to get an idea about what medicines he would need if his condition worsened.

“And there is another problem with the tests – the police lock the home down and neighbours spread rumours,” Kalam said.

HEALTH RULES DEFIED

The Upazila authorities shut the markets and shops down after the first cases were detected in late April. The people obeyed the stay-at-home orders for a few days but the situation returned to normal again as the shops reopened despite new infections.      

The authorities initially tried to enforce the rules by slapping fines on those who defied the curbs, but the number of customers passing time at shops, especially teashops, increased gradually.    

Dr Nizam said many patients were breaching quarantine rules as well.

Hatia police chief Khayer said it has been difficult to enforce the health rules among the islanders, who are mostly fishermen and farmers.

Mohammad Rezaul Karim, the Upazila executive officer, believes the situation came “under control” after the rising number of cases in early July.  

“Let’s see what happens after Eid,” he said, pointing to the exodus of holidaymakers from cities to their rural homes.

PREPARATIONS FOR TREATMENT

The Upazila Health Complex was caught off guard when the first cases were detected, lacking an adequate number of health workers and medical oxygen supply.

One of the first cases required oxygen but the doctors had to send the patient to Noakhali after they used up eight of the nine oxygen cylinders to treat him.

The situation has improved slightly after the recent launch of an isolation ward with 10 cylinders and two oxygen concentrators.

Doctors, however, are still sending severely ill patients to Noakhali without taking any risk, as it takes 15 to 20 days to refill the cylinders.

Nizam complained of a lack of health workers as well. “We have only five nurses. There’s no-one to look after the isolation ward at the end of their shifts at the general ward.”

Sourav Nath Suvo, the doctor in charge of the isolation ward, said they have admitted about 20 patients so far and most of them had moderate symptoms.

“The number of patients dropped a bit in the past two weeks. But people are returning home during Eid, creating a risk of infection,” he added, reports bdnews24.com.