Coronavirus: Know true extent, know it now
As Bangladesh enters fourth week since it reported the first Covid-19 case, public health experts now call for expanding and speeding up the testing process immediately to understand the scale of the outbreak.
Though the country didn't report any new cases for two consecutive days, the low count is the result of limited testing, and the situation could change quickly like it did in several countries, including Italy, Spain, France, Germany and the US, they say.
These badly affected countries had also reported a low number of cases in the initial weeks but saw a spike in the number of infections from fourth week, the experts mentioned.
Without widespread testing, it's not possible to gauge the spread of coronavirus in the country with a population of 16.5 crore. Widespread testing can give the authorities a clearer picture of the scale of virus transmission, they point out.
The country recorded its first coronavirus case on March 8. Three weeks later, the number stood at 48. So far, five people have died from the virus.
The Institute of Epidemiology, Disease Control and Research (IEDCR) claimed to have carried out enough tests. It said there has been community transmission on a limited scale.
The World Health Organization has urged countries to test as many people as possible to curb the pandemic, but Bangladesh has one of the lowest testing rates compared to many other Asian countries that have been successful so far in containing the spread of the virus.
From January 21 till yesterday, Bangladesh tested 1,185 people for the virus, which is far below South Korea's daily testing capacity of around 20,000.
The IEDCR has been testing only those who have returned from the affected countries or come in contact with an infected person or shown symptoms after two weeks of quarantine. It, however, is now expanding the scope of testing.
Over the last two months, more than eight lakh people called the IEDCR hotlines for virus-related issues.
According to official records, 802,580 corona-related calls were made to the hotlines from January 21 till yesterday. Yesterday, 73,134 such calls were made on three hotlines, but the IEDCR tested only 109 individuals for coronavirus infection.
Abul Kalam Azad, director general of the Directorate General of Health Services (DGHS), said the large number of phone calls does not mean that all wanted to undergo coronavirus tests.
"People called to know about coronavirus, health problems and many other things. Yesterday, we analysed the sources of the calls and found that the calls were made from all the 64 districts. So, it is a positive side that people are aware of the issue."
He, however, could not say how many calls were made to request for corona tests.
A large number of people with virus-like symptoms are struggling to get tested. Besides, there have been reports of deaths of several people who had virus-like symptoms. In the last one week, this newspaper found at least seven such cases in Bogura, Sylhet, Mymensingh and Rajshahi.
At a press briefing through video conference yesterday, Health Minister Zahid Maleque dismissed the necessity of carrying out widespread testing and a survey to know the scale of virus transmission.
Experts, however, disagreed, and said community transmission is going on.
"If the situation was like what the IEDCR is saying, it would be very good news for us. However, the [IEDCR's] claim is based on a very small number of tests and it [the claim] is unscientific," said Prof Nazrul Islam, a virologist and former Vice Chancellor of Bangabandhu Sheikh Mujib Medical University.
"The system has not really been revved up to what we need right now."
To break the chain of virus transmission, the government should increase its capacity to test and detect cases without delay, he noted.
"It [limited testing] gives a false sense of security. It seems the whole mechanism is working on a very limited scale."
If the data provided by the IEDCR turns out to be incorrect, the transmission in communities will go on, the virologist said, adding, "We will see a sudden rise in cases and we will be at a loss about what to do."
He said the government is not providing correct information about the number of test kits it has at present.
"If we had run tests on most of the returnees and found only a few positive cases, then it could be a reason for optimism. But that didn't happen; there are not enough kits for that, I think."
Seeking anonymity, an expert said, "As an epidemiologist, I would say virus transmission is there, and it is going on."
"We need to analyse the deaths in hospitals and communities, run tests at the community level and expand the scope of testing to understand the real situation."
"We are not searching for the cases the way we should have been. That's why we are not getting the real picture."
Though the authorities have taken some measures to expand testing facilities, it is already late, the expert mentioned.
In the US, the number of confirmed cases was 53 around 40 days after the first case was reported on Jan 21. After that, it saw big jumps in the number every day.
As of March 27, the US recorded 103,321 cases.
Spain also is facing a similar crisis for "delayed" response from the authorities.
The country reported its first case on February 1, and the number of cases went up to 45 within 31 days. And then it saw 1,000 cases in just 10 days. As of March 28, the total number of confirmed cases crossed 64,000.
On the other hand, South Korea is a glaring example of how a country can contain the spread of the virus through widespread testing. Nearly 20,000 people were tested for coronavirus a day, more people per capita than anywhere else in the world.