Mushtuq Hossain, consultant at the government’s Institute Epidemiology, Disease Control and Research (IEDCR), had earlier been the institute’s Chief Scientific Officer. In an exclusive interview with Prothom Alo, he talks about the current situation of the COVID-19 pandemic.
Ten months have passed since the first COVID-19 patient was identified in Bangladesh, but we still don’t have a clear and credible picture of the situation. What is the real state of the pandemic here?
It was possible to avert an excessive outbreak of coronavirus in Bangladesh by controlling people’s movement from the outset. Although there was no strict lockdown, it was possible to restrict the movement and relocation of people through an extended general holiday. As a result, the outbreak did not occur in Bangladesh as it did in China, Italy and other countries. The rate of transmission was slow from the start. The pandemic peaked in July-August last year, and then it started to decrease. This decrease was also slow and that trend continues. However, we have not been able to take any such protective measures for public health so that we can say with 100 per cent certainty that the infection will not increase again. We have seen the countries that handled the pandemic very well in the first phase had to face a higher infection rate later. Because of the large population in Bangladesh, we have not been able to effectively mobilise public awareness. There is also the reality of lives and livelihood. Considering all this, the possibility of a rise in the transmission rate in our country cannot be overruled.
The number of the positive cases has decreased significantly in proportion to the number of Covid tests. But can this be the real picture of the overall scenario of the pandemic situation across the country as the number of tests is low?
It is not difficult to get the overall picture, because the rate of transmission is almost the same all over Bangladesh. It’s not that the infection rate is high in some places and lower in some. Also, the infection rate of the people who are being tested before going abroad with non-COVID problems is also very low. Outside of that, the rate of infection is also lower among the samples of suspected cases. So even if the whole picture is not available, we can get a fair idea. However, it can be said in general that even when the infection rate is very low, at least ten times more infected people remain outside the reach of detection tests. And when the infection rate is higher, the number of infected people who are out of the reach of detection tests is higher too. Those who have severe symptoms are coming to hospital and the number of positive cases is assessed accordingly. But those with mild symptoms or no symptoms at all do not come under the test. So it is not difficult to understand whether the infection is fluctuating or not. Now samples are coming from every district of Bangladesh.
We can’t say that the second wave has come. If we look at the transmission rate graph, we do not see anything like such waves there. The first wave was going down, rising in the middle for a short time, but now it is going down again. But it cannot be said with certainty that the second wave will not come. In the countries like Japan, Thailand, Australia, New Zealand, who controlled the infection in the first phase, the thrust of the wave has returned again. We are more successful than the European and American countries in dealing with COVID, but we are not as successful as Thailand, Cambodia, Vietnam, Laos, Australia and Japan. We are in the middle stage. But there is the possibility of an emergence of the second wave of COVID-19 in our country.
We have been battling coronavirus for 10 months. Based on that experience, has there been any improvement in the medical care and medical management of our COVID patients?
The first task in the fight against coronavirus is to prevent the spread of the virus, that is, to stop transmission. If the number of patients is not kept under control, no matter how much the number of beds in the hospital is increased, the situation cannot be controlled. We have seen this in Brazil. COVID patients are dying due to the lack of oxygen there. So the first task in the fight against the virus is to stop the transmission. The second task is to bring changes in people’s daily lives so that the virus cannot spread from person to person. When the transmission continues despite all these safeguards, the third task is to save the lives of the Covid. Another thing to be kept in mind is that not everyone who tests positive has to come to the hospital. However, within 24 hours of the detection, the health department should contact the persons over on telephone to inquire about their physical condition before it worsens.
Is this really being done?
As the number of the newly infected patients is low, it has become possible to contact the patients within 24 hours of detection nowadays. But when the number of newly detected patients exceeds one thousand, it is not possible to contact the infected patients within a day. COVID patients come to the hospital after going through several steps, so if we can deal with those steps successfully, the number of patients can be controlled. Even if the patients have to go to the hospital, not everyone will go in a bad condition. We have gained a lot of experience during this time. Physicians and nurses are applying that experience now.
What about our overall management in the treatment of COVID patients?
Any kind of treatment is a holistic matter. The knowledge, experience and skills of physicians and nurses are not enough. As the number of our physicians and nurses for COVID treatment has increased, so has their experience. But medical equipment and related items were not provided within Dhaka or outside of the capital to the required extent. Inadequate logistics haven’t been resolved. This will create a challenging situation if the second wave of infection hits the country. Even last month, the ICU beds in Dhaka’s hospitals were almost full. If this is the case with a small number of patients, then it is possible to predict what will happen if the second wave occurs. Therefore, we should equip every district hospital in Dhaka and outside Dhaka with adequate medical equipment for treatment of COVID-19. If we add ICU to a new place, it would not come to any use if there is no skilled workforce to run it.
If the people, who are working in the ICU now, are taken to a new place, then both of the places will suffer. The number of the ICU beds in the medical college hospitals outside Dhaka where ICUs are running well can be increased if new doctors, nurses, technologists are appointed and they can work under the direct supervision of the experienced ones. I repeat that there is a real danger of a second wave of infection in our country.
What is the status of our vaccination programme? Vaccine collection, vaccination planning, management, manpower, training — altogether this is a huge task, are we prepared properly?
Vaccine management is a big challenge now. Of the four or five companies that have developed coronavirus vaccines so far, only one has received World Health Organization’s clearance. Other companies have not yet submitted the required documents. The World Health Organization has the financial capacity to provide 20 percent of the world’s vaccines; but if they don’t get adequate supplies from the vaccine companies, there will be problems. They are selling vaccines in the developed world. Of course, those countries need to be vaccinated first, because the number of infections and deaths is very high in those countries. But there are also many patients in Brazil, Argentina and Chile in South America. But no vaccine is being supplied there. And without the global initiative COVAX, it would be difficult for most countries to buy their own vaccines and apply them all. The same is true of our country.
Why does every person need to be vaccinated with two doses?
No vaccine is 100 per cent effective. Vaccines may not work for 10 per cent of the population. So it’s a huge challenge. I support the position of the World Health Organization in this regard. The World Health Organization is requesting the companies who have completed the second phase of the trial, to submit their scientific data. Many companies are in the third phase of the trial. We are hopeful that a single dose of vaccine will soon be enough.
A plan has been put in place for vaccination in Bangladesh. Training is ongoing in this regard and the plan is being checked and updated through this training. It is not possible to start with one hundred per cent preparation, especially against an unknown disease. Preparation is an ongoing process. As our vaccination programme starts, several plans will need to be updated then. Planning of the preliminary preparations has been drafted. It has been said that all the necessary changes should be made based on scientific data. We have started training. We are trying to make the tasks easier. Initiatives from civil society are very important here. There may be mistakes at work, there may be inconsistencies, and some things may be overlooked. Civil society will capture them and the media will highlight them. The pressure of vested interest groups can be countered by the pressure of public opinion. You, the journalists, have been playing a very important role since the beginning of the pandemic.
What are the priorities for the next few months?
The preparation includes the three steps which I have talked about earlier. These are – preventing transmission, following the health guidelines, and ensuring proper treatment. Now the fourth is added. That is to ensure the vaccination for all free of cost.
Mashiul Alam is assistant editor, Prothom Alo. This interview appeared in the print and online editions of Prothom Alo and has been rewritten for the English edition by Ashish Basu
