Go for mass tests in locked-down areas

TDS: How do you analyse the present coronavirus situation in Bangladesh?

Dr Rashid: From the situation of other countries, I can say that cases here will reach their peak in the next one to two weeks. But the question is if we are prepared to deal with it. Daily testing capacity has increased significantly, which is good.

But I would suggest the authorities conduct mass screening of people in areas now under lockdown. The government should go for antibody testing, which is based either on detection of proteins from the Covid-19 virus in respiratory samples (e.g. sputum, throat swab) or detection, in blood or serum, of human antibodies generated in response to the virus. Those found positive should be isolated and others should be under observation. The US and India have already approved antibody testing. Also, the government should have a prediction of the number of cases and prepare a fitting plan to address it. The problem we are facing now is that not all people are realising the need for isolation or home quarantine -- this needs to be enforced strictly.

TDS: The rising number of cases means more ventilators and intensive care units (ICUs) are required. How can we manage with a small number of ventilators and ICUs?

Dr Rashid: Five percent of the cases could require ICU. Government hospitals have some 500 ICU beds. It's difficult to install ICUs overnight, but whatever we have, these can serve well if there are proper technicians and trained doctors. But you cannot get trained technicians and doctors so quickly unless the government has a proper plan and experts are recruited to provide hands-on training. All the ICUs should be functional in order to save lives.

TDS: Under the present conditions, many hospitals or health professionals are refusing patients with Covid-19 symptoms. In some cases, patients have died though they did not have coronavirus. How do you explain this?

Dr Rashid: This problem has been there since the beginning of the Covid-19 pandemic. People with cold and respiratory troubles went from hospital to hospital but were not treated or admitted until they were declared free of coronavirus.

I would suggest to have designated hospitals for such patients in all the divisions -- district hospitals or medical college hospitals can be dedicated for them. They should be quickly diagnosed and isolated, if found infected.

However, doctors, nurses, and healthcare technologists, who will come in contact with them, will need to have special arrangements including PPE [personal protective equipment], as well as food and accommodation in a separate facility. They will need to work in turns -- for example, one group will work for seven days and then will stay in institutional quarantine for 14 days while the other group works. A lot of healthcare personnel will be required to execute this plan.

TDS: There is a sense of fear among health personnel, who are on the frontlines attending Covid-19 patients. How can this fear be addressed?

Dr Rashid: Boosting the morale of health professionals is very important. The government has declared special incentives for the healthcare professionals, which should have been done even earlier. Nevertheless, it is good; it was necessary.

 However, more important for the health professionals is their protection, and their sense of pride. Till now, some blame has been placed on health professionals, but this is not the time to discuss that. PPE has to be ensured.

TDS: What else should be urgently addressed?

Dr Rashid: There are efforts to increase hospital beds for Covid-19 patients but I think things are not moving fast enough. As the number of patients goes up, more beds will be required for their treatment. If necessary, members of the armed forces should be assigned to prepare hospitals for this purpose.

Apart from this, strong coordination of all those involved in fighting coronavirus is a must. Also, the government has to maintain transparency in what it does and about the evolving situation. There is no alternative to free flow of information.