The Financial Express

Is Bangladesh ready for Covid-19?

No option to aggressive testing to find affected cases

Mohammad Zaman | Published: March 29, 2020 22:40:59

No option to aggressive testing to find affected cases

As I write, Bangladesh reported 48 confirmed cases - including two physicians - and 5 (five) deaths from the novel coronavirus. The country is on a semi-lockdown for 10 days until 04 April 2020. All programmes for Independence Day were cancelled to avoid any potential mass transmission from crowded gatherings. Prime Minister Sheikh Hasina announced a stimulus package of Tk 50 billion (5,000 crore) to fight the adverse impacts of Covid-19 on the country's economy. The state of readiness and preparation to fight this strange terror appear inadequate as hospitals struggle with lack of testing kits, beds, ventilators, and personal protection equipments. The medial professionals fear that such shortages will severely strain the system to save patients and medical workers as well.

Covid-19 has so far infected 622,450+ people globally with over 28,794 recorded deaths in 190 countries. The United States is now the new epicentre of the global outbreak and leads the world in confirmed cases (112,000+) after surpassing China's reported total of 81,000.  New York city is now "ground zero" aside from three other hot spots - Seattle, Los Angeles and Baton Rouge in Louisiana.

An estimated 2.0 billion people - including 1.3 billion in India alone - are currently under lockdown around the world as governments take desperate action to curb the spread of Covid-19. Self-isolation, quarantine and social distancing are now strictly enforced in many countries in the Americas, Europe and Asia. This deliberate measure is designed to suppress the surge of Covid-19 patients to quickly flatten the curve enabling the public health care system to take care of the epidemic. China enforced the largest lockdown in Wuhan and rest of the country and saved millions; the world has learned lessons from the Chinese experience.

Many countries with strong healthcare systems such as those in Canada, Australia, Italy, Spain and the UK are struggling to detect and contain Covid-19. The US, with public-private partnership for medical supplies and services, is almost drowning and unable to meet the rising demands every day across the country. It appears from the ongoing experience that global infrastructure for fighting the outbreak is tenuous. In Bangladesh, the hospitals and the public health care system are hardly ready for the pandemic. The overall situation will likely get worse before it gets better.

For Bangladesh, there are no options but to lockdown - perhaps beyond 10 days - and aggressive testing to find the affected cases. According to a joint study conducted by epidemiologists and public health experts from BRAC University, North South University, and Johns Hopkins University, over half a million people in Bangladesh could die from Covid-19 virus infection by the end of May 2020 unless the government takes steps to mitigate and suppress the disease. The study, shared with government of Bangladesh policymakers and health officials, is based on Covid-19 modelling done at the Imperial College in London, which prompted the British and US governments in announcing robust measures aimed at tackling the spread of the disease by respective countries. 

The lockdown in Bangladesh came in the form of a 10-day general "holidays," including closure of public and private offices, without any enforcement plans. Instead of staying home and maintaining social isolation/distancing, hundreds of city-dwellers took buses, trains and whatever transport available for their village homes, taking potentially the virus with them unknowingly, and thus defeating the entire purpose of the lockdown. The impact of the 10-day holidays will soon become evident nationwide as "community spread," provided enough kits and testing are available with effective surveillance measures. 

The lack of planning was also evident early on with the return of expatriates, workers and students from China, the Middle East/Gulf states, and some European hotspots already dogged by the epidemic. There were uncoordinated efforts at quarantine and many returnees were allowed to go home on self-quarantine without effective follow-up actions. In the process, the government lost at least two months' time since Covid-19 hit China, South Korea, Italy, and Iran. The handling of the crisis by the government is much debated within the country. Many argue that the Institute of Epidemiology, Disease Control and Research (IEDCR), the lead agency responsible for control of this deadly virus, failed to act fast enough while others think that the measures adopted will be effective, if implemented seriously. In order to do that, IEDCR should open many more testing centres beyond Dhaka. The testing kits and personal protection gears received recently as gifts from the Chinese and Indian governments should boost the testing and speed up the detecting work on a larger scale.

The lockdown, however, has other major problems. First, is social distancing possible in a densely populated country of 170 million people? Even staying home, for instance in Dhaka - a city with no less than 23,000 people per square km - social isolation is barely possible. How can you lockdown Dhaka with 18 million people where nearly 40 per cent of the population live in slums/bastees as urban poor and earn their living from daily work and wages? This brings us to the second major issue, which is existential for a large number of these urban poor such as vendors, rickshaw pullers and so on. The Prime Minister's stimulus package does not cover these "hard to reach poor." The economic dimensions are too large to handle effectively without adequate resources and planning.

So, the question remains: what will it take for the lockdown to work? In addition to supporting industries and businesses afloat, the government - with support from external and non-government sources - should design appropriate livelihood support programmes for those who have been cut-off from their sources of income. There is no other way to minimise the impact of Covid-19 on vulnerable communities. Local community-based organisations (CBOs) and non-governmental organisations (NGOs) must be involved in designing and implementing such programmes. The government, working through CBOs and NGOs, can build trust, capacity and forceful and necessary communication campaigns by innovative partnerships. It is encouraging that celebrities and charity organisations have already come forward to help these hard to reach people. This is a trying time; therefore, all options must be explored and used to support those who are most vulnerable.

Right now, lockdown, self-isolation and social distancing are answers in the short-run to save millions in the country. The restrictions put in place will hopefully slow down the spread of the virus. Let us hope so. If needed, the lockdown should be extended further. The struggles with Covid-19 may provide an invaluable lessons for all of us.


Mohammad Zaman, PhD is an international development specialist and advisory professor, National Research Center for Resettlement, Hohai University, Nanjing, China.



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