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Covid-19 pandemic: A plan that works

  • Published at 12:58 pm April 26th, 2020
Bangladesh’s strategy might face its breaking point soon
File photo: Mahmud Hossain Opu/Dhaka Tribune

What is needed to end the coronavirus lockdown

In a natural health disaster like the Covid-19 pandemic, planning and its successful implementation for combating the disaster is dependent on the high quality of the public health care system, excellent standard of government leadership, and the affluence of the social capital. 

Achievement in many a sector has been spectacular in Bangladesh. Unfortunately, in the dazzlement of the celebration of our enviable feat, many a perverse act has slipped through the scrutiny. 

Our health care system has been one such debacle that had successfully sat in the midst of and in the shadow of “Bangladesh Miracle,” secondary to the Millennium Development Goals (MDG) in health. 

This undiscovered time bomb, many a time in the past, had attempted to raise its dirty head and now has the potential to destroy our society unless we are exceptionally lucky enough to slip through with a livable infliction by the benefit of another miracle.

We know that setting up and successful implementation of planning objectives is not easy, particularly in developing countries in the absence of a robust public health care system, debatable effectiveness of a government leadership capable of rational decision making at the highest level, and without the trust of the people on the leadership unless the country has a very small population with a centralized infrastructure and bureaucracy. 

Successful planning against a disease of such brilliance and devastation as Covid-19 and effective implementation of a detailed and comprehensive plan in a short span of time may prove to be extremely challenging as the success of such plan would depend on a need for a multi-sectorial, multi-professional approach, and spontaneous and active community involvement dependent on the richness of a country’s social capital. 

A comprehensive coordinated approach of responsible authorities and/or institutions at many levels of government involving various specialties of policy development, legislative review, public health, medical care, diagnostic test development, laboratory diagnosis, ancillary services, communication expertise, and disaster management are mandatory with community involvement making optimal use of local knowledge, expertise, resources, and networks is undoubtedly a powerful way to engage people and to build the commitment needed for policy decisions.

Why does the fatality rate between countries like South Korea, Singapore, Portugal, Germany vary so much compared to Italy, the UK the US, and many other European Countries? 

In most of Europe and the US, much after the substantial spread of the disease, the question of containment came, and instead of containing Covid-19 in its infancy, the policymakers were in the deep, struggling to keep up with the spreading pandemic. 

Analysis of the behaviour of SARS-CoV-2 virus causing Covid-19 illness is the mainstay for management planning by the government and knowledge of SARS-CoV-2 virus dynamics of transmission, virulence, observed ability to mutate and the host response particularly the hosts’ immune dynamics are essential for formulating strategies for antiviral treatment, vaccination, and epidemiological control of Covid-19. Facts we now know about SARS-CoV-2 that started as an epidemic in Wuhan China:

Covid-19 is not a rapid illness, the illness develops in different stages consisting of a pre-symptomatic phase after exposure and though not symptomatic, the sufferer may be infectious from very early on. 

Next, the patient may develop non-specific symptoms, often starting gently or insidiously continuing for a week or so. It’s only then become clear who is going to recover and who will be progressively worsened by the next phase, characterized by inflammation of the lung, the subsequent resulting in viral pneumonia. 

Peculiar to the Covid-19 illness, many of the seriously ill would demonstrate that their own immune mechanism instead of combating against the virus worsens the inflammation of their own respiratory mechanism and other vital organs, a high proportion requiring intensive care management and a substantial proportion progressing to fatality. 

Elderly patients, in particular, with underlying conditions of the heart and/or lung, are vulnerable to fatality due to the novel coronavirus. So far, the virus has shown no drifting to significant strain difference, demonstrated minimal changes in sequence and there has been no evidence to link sequence with transmissibility or virulence. 

Mathematical models

Mathematical modelling has been the principal basis of policy decision making in the UK and other western economies in order to manage the Covid-19 illness effectively. Mathematical modelling is represented by a curve in a graph indicating the spread of the virus at any point in time and has been used to help to make decisions controlling the spread of the illness. 

As the disease spreads, the line curves up until it peaks and then curves down as the virus is expected to decline eventually. The Imperial College London Research mathematical model has led to the social distancing policy to curve the spread of the illness quickly in order to prevent overwhelming of the capacity of the health care system in managing the outbreak, reducing the number of hospitalizations at any one point in time, and as such preventing and reducing mortality from the illness. 

The model uses two main parameters of R naught (R0) and Case Fatality Ratio (CFR), R0 being the Basic Reproduction number, estimating the number of people likely to be infected by a single infected person and CFR is the proportion of death among the formally diagnosed infected people. 

This model suggests that the illness is still in its initial rapidly growing part of the epidemic, contrasted by another model proposed by the Oxford Research Model that suggests that the epidemic started in the UK at least a month before the first reported death from the virus and the virus has already spread widely in the UK. Only time will tell.

Social model

As mentioned in the beginning successful combating of a disaster of such magnitude is dependent on the high quality of the public health care system, excellence of political leadership, and on the opulence of the social capital. 

Covid-19 since its inception has demonstrated and displayed alarming behaviour, challenging even the efforts of the most powerful governments to contain it, false footing the most sophisticated health care system. 

However, statistical data coming out globally, though not quality data as yet, indicates better response against SARS-CoV-2 from countries with better and more robust public health care systems. In addition, our human effort in combating the pandemic unexpectedly had, to some extent, been assisted by a breakthrough in Chinese transparency. 

Unlike in the SARS pandemic, when detailed information was slow to emerge, Chinese scientists submitted well written, detailed data-rich reports to the world’s leading medical journals, though there is a growing concern in the US and Europe that doubts the honesty and integrity of the information provided by the Chinese authority to the rest of the world.

Importance of early preparedness

The success of the authority in combating the Covid-19 epidemic in South Korea inspired German scientists and scientists from some of the other European countries like Switzerland and Austria, who became enlivened and were well disposed in their preparedness for the Covid-19 pandemic. 

In Germany, the scientists were furnished with ethical and legal clearance for the development of SARS-CoV-2 test implemented by mid-January, before most countries had even diagnosed their first case. 

These advances in their preparedness allowed Germany to conduct mass testing, identify cases early, and isolate them before they spread the infection to others, exemplifying the emphasis of the WHO and other authorities’ policies on early and effective disease diagnostic tests. 

Germany’s public health system is well-functioning and decently funded; cuts to the medical system, on the whole, were avoided, unlike in many other countries such as the UK, Italy, Spain, and others. 

On the contrary, under the effective leadership of Merkel, herself a scientist, Germany’s public health system had enjoyed the continued support of the government over the past many years and a robust public health system has proven to be important in the current crisis. 

The big lesson from this pandemic crisis seems to be that the state ought to shoulder a number of public responsibilities and be prepared to spend substantial financial resources on public health to avoid severe repercussions of the sudden surge of a biological disaster such as the Covid-19 pandemic as being observed now in many countries around the globe.

Germany was smacked hard too, but the percentage of fatal cases has been remarkably low compared to those in many neighbouring countries. Testing for SARS-CoV-2 has been free of cost removing the financial barriers from seeking access. 

The public health care system allowed testing far more people than most nations netting more people with few or no symptoms, increasing the number of known cases, but not the number of fatalities, automatically lowering the death rate, though, there are also significant medical care factors imparted automatically consequent on the availability of an excellent public health care system that has kept the number of deaths lower.

Medics outfitted in protective gear, driving around the empty streets of the cities to check on patients who are at home. Five or six days into the coronavirus illness, patients are given a blood test, looking for signs that a patient is about to go into a steep decline. 

They might suggest hospitalization, even to a patient who has only mild symptoms; the chances of surviving that decline are vastly improved by being in a hospital when it begins. 

Anyone with infection may arrive at a tipping point at the end of the first week when the lungs might start failing, heralding the deterioration in the Covid-19 illness pathway, necessitating hospitalization, and keeping the fatality rate low as has been achieved in South Korea, Switzerland, Austria, Singapore, and some others.

Excellence in political leadership

Different political leaderships have handled the Covid-19 outbreak differently -- in regulated societies like China and Singapore, instruction handed out by the government was easily adhered to by its populace and aggressive isolation of suspected cases, intensive tracing of their contacts, and early social distancing measures were successful in minimizing harm and death, a task not so easy where leadership is liberal western democracy. 

However, Germany, at the forefront of liberal democracy was able to successfully implement its Covid-19 strategy due, in addition to the high standard of the public health care system, to Chancellor Angela Merkel’s leadership. 

Her leadership was one of the main reasons, for the ability to anticipate, ensure pre-emptive early preparedness that culminated in low Covid-19 mortality. Angela Merkel recognized the seriousness of Covid-19 early on, much before her contemporary leadership in most other countries. She was transparent about the risks and open with communication. 

Merkel has communicated clearly, calmly, and regularly throughout the crisis, as she imposed ever-stricter social distancing measures on the country. The restrictions, which have been crucial to slowing the spread of the pandemic, met with little political opposition and are followed universally.

Importance of social capital

The pandemic of Covid-19 not only has immediate demographic losses but may render adverse long term economic, social, and cultural consequences. The experience of social disruption and generalized mistrust that characterized the past pandemics may determine the shaping of individual behaviour and human societies at large and may lead to a significant decline in social capital. 

Studies have shown a negative and statistically significant adverse effect on mortality is consequent on decrease in social trust. 

Experience of a viral pandemic and the associated condition of social disruption and generalized mistrust with permanent consequences on individual behaviour significantly lowering social trust also resulted in constrained economic growth for time unknown. 

Standard ethics -- an independent sustainability rating company -- only recently stated that in the emergency resulting from the spread of the Covid-19 virus, Italy has re-established remarkable solidarity and united purpose and the company improved its outlook for Covid-19 effected Italy from negative to stable. 

The company further stated that it was possible that by courageously overcoming this difficult time, a beautiful nation like Italy, will rediscover its vigour and optimism.

If we analyze the announcement by the BGMEA in Bangladesh for the opening of factories and misappropriation of food for relief of the poverty-stricken population in this pandemic, we may envision a complete disregard for the life and wellbeing of a devoted and hard-working significant section of the society signifies paucity of our social capital. 

Similar mistakes and failures in managing the Covid-19 would lead to social division instead of greater unity and solidarity and are bound to have long-lasting negative human and economic consequences.

How to reduce the risk of infection

  • Regularly clean surfaces, such as door handles and desks, with disinfectant, as well as your mobile phone. Also, thoroughly clean communal areas in your home, such as the bathroom and kitchen
  • Avoid touching your face with unwashed hands
  • Avoid contact with the sick, especially those with fever or respiratory symptoms
  • Wash your hands with soap, or use a hand sanitizer that contains 40-60% alcohol, for at least 20 seconds

How to boost your immune system

  • Eat a wide variety of fresh foods and lots of fruit and vegetables, probiotics such as yogurt and kefir, and foods high in dietary fibre, such as bran
  • Avoid highly processed foods, including sweeteners that can harm gut health.
  • Get enough good-quality sleep at night, between six and eight hours
  • Drink about two litres of water a day -- that is about eight glasses
  • If you are a smoker, now is a good time to stop. Drink alcohol in moderation

Mask and glove usage

  • Healthy individuals only need to wear a mask if taking care of a sick person
  • Wear a mask if you are coughing or sneezing
  • Masks are effective when used in combination with frequent hand cleaning
  • Do not touch the mask while wearing it. Clean hands if you touch the mask
  • Learn how to properly put on, remove, and dispose of masks. Clean hands after disposing of the mask
  • Do not reuse single-use masks
  • Regularly washing bare hands is more effective against catching Covid-19 than wearing rubber gloves
  • The Covid-19 virus can still be picked up on rubber gloves and transmitted by touching your face

Medical advice

  • Avoid close contact with others if you have any symptoms
  • Stay at home if you feel unwell, even with mild symptoms such as headache and runny nose, to avoid the potential spread of the disease to medical facilities and other people
  • If you develop serious symptoms (fever, cough, difficulty breathing) seek medical care early and contact local health authorities in advance
  • Note any recent contact with others and travel details to provide to authorities who can trace and prevent spread of the disease
  • Stay up to date on Covid-19 developments issued by health authorities and follow their guidance

Hygiene advice

  • Clean hands frequently with soap and water, or alcohol-based hand rub
  • Wash hands after coughing or sneezing; when caring for the sick; before, during, and after food preparation; before eating; after using the toilet; when hands are visibly dirty; and after handling animals or waste
  • Maintain at least 1meter (3 feet) distance from anyone who is coughing or sneezing.
  • Avoid touching your hands, nose, and mouth 
  • Do not spit in public
  • Cover your mouth and nose with a tissue or bent elbow when coughing or sneezing. Discard the tissue immediately and clean your hands 

Professor Doctor Raqibul Mohammad Anwar is Colonel, Royal Army Medical Corps, UK Armed Forces, and Specialist Surgeon and Global Health Policy and Planning Expert.

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