'Put all suspected cases in institutional quarantine'

The government needs to gather evidence-based data on the current Covid-19 situation immediately to understand the trend of the outbreak in the country, experts told a roundtable yesterday.

This would help the future course of action, they added.

They urged the government to identify and bring all the suspected cases under institutional quarantine, saying the home-quarantine strategy is futile in the Bangladeshi context, and suggested mobilising all government wings and resources in this regard.

The experts also suggested increasing the number of tests for coronavirus detection and decentralising the testing facilities. Currently, such tests are carried out only at the IEDCR in the capital's Mohakhali.

Besides, they pointed out that providing doctors, pathologists and other healthcare professionals at the frontline with adequate protective gears should be a top priority now.

The Daily Star organised the discussion, titled "Corona Pandemic: Tasks Ahead", in collaboration with Unilever Bangladesh Limited at The Daily Star Centre in the capital.

"The government needs an immediate estimate on how many people may get infected, how many will need hospital care, including ICU and other special interventions, and supply of protective gears for healthcare professionals," Prof MA Faiz, former director general of the Directorate General of Health Services (DGHS), told the roundtable.

He said the government should prepare assuming that the Covid-19 situation in the country may turn as such as in China or Italy.

Terming the decision to place suspected cases in home-quarantine a "big mistake," Prof Muzaherul Huq, a former regional advisor of WHO South East Asia region, said, "Apart from tracking and tracing people who might have contracted the virus, the government can implement institutional quarantine [for all suspected cases]. It is now very easy for the government and they should be strict; they have to mobilise law-enforcement agencies for this."

Renowned medicine specialist Prof AMB Abdullah, personal physician of the prime minister, stressed the need for ensuring personal protective equipment for all healthcare professionals, who might come in contact with suspected coronavirus cases.

"Unless the doctors and nurses are provided with protective gears, how will they treat the patients? They must be supplied with the required protective gears," he said.

Dr Mustafa Jalal Mohiuddin, president of Bangladesh Medical Association (BMA), said, "There are 70 thousand doctors in the country. Their safety is a major concern."

Brac Bangladesh Executive Director Asif Saleh emphasised on decentralisation of testing arrangements. "The government should prioritise the decentralisation of testing facilities. If people are diagnosed with the virus, they should be quarantined effectively."

Mentioning that home-quarantine is not possible in slums, he said, "Poor people, who cannot be home-quarantined, should be taken to the government's quarantine facilities and provided with livelihood support so that after two weeks of isolation, they can return to regular economic activities."

"Next two-three weeks are crucial for us [Bangladesh]. After that we could be able to understand the level of transmission. So we have to prepare accordingly."

Dr Bardan Jung Rana, WHO country representative in Bangladesh, spoke of how misinformation and rumour affects all efforts badly and suggested key measures for Bangladesh.

"Misinformation and the rumours -- these are the things which are scarier than the virus. These things are hampering efforts by countries in mitigating and containing this spread [globally]," he said.

Citing experiences from different countries that successfully controlled the outbreak, Dr Rana said, "Physical distancing measures are very useful; it has been proved that it can slow the transmission … To control the epidemic, we should intensify measures to trace, isolate, test and provide treatment."

Unilever Bangladesh CEO Kedar Lele said, "Acknowledging the problem can lead us to the solution. The government should form a centralised command centre so that all initiatives can be implemented in a coordinated way."

He stressed on ensuring that people's livelihood is protected in case of any emergency.

"It is extremely important to maintain uninterrupted flow of essential commodities in the neighbourhood. It's because consumers will start panic-buying if they find that commodities like rice, pulse, and oil are not available in the nearest stores. In our opinion, unlike the last global crisis, the epicentre of this crisis will not be financial institutions, it will be livelihood.

"So, what the government needs to do is to ensure livelihood for people, whether they are daily wage earners, whether they are working with companies or they are government employees. When you force people to practice social distance and not go to work, how would they earn?

"If consumers, people and citizens do not get their financial support, you might see a pandemic resulting into violence. These are things we should focus on."

Prof Nazrul Islam, former vice chancellor of BSMMU, talked about ensuring critical care facilities at all district and local hospitals.  "There should be separate counters for receiving patients with respiratory illness. Protection of health professionals is also very crucial."

He opposed the idea of lockdowns during emergency situations. "Lockdown or emergency -- these are the favourite words of the politicians. Why would we do these? We have to face the situation, have to sort out the infected people. Maybe they are spreading infection in a village or in a certain area. Why would we lock down the whole country for this?"

Dr Fazle Rabby Mohammad, representative from Square Hospitals, said they were dealing with an "unusual" increase in the number of patients with respiratory illness.

"Patients often hide their travel history and it poses threat to all of us. As we have no testing facilities, we are unable to know the reality. The government should permit us to test Covid-19 infection," he said.

Mahfuz Anam, editor and publisher of The Daily Star, moderated the discussion.