A blueprint for Covid-19 preparedness in Bangladesh
It all began when Patient Zero was identified with Covid-19 on December 31, 2019, in Wuhan City, China. Since then, life around the world has changed. All the little things that used to be taken for granted—from stepping outside for a cup of tea to touching one's face—are now a threat to oneself. Compared to the overwhelming numbers of many countries, there are 3,772 confirmed coronavirus cases in Bangladesh as of April 22. But the potential for a surge in cases remains unless we adopt necessary measures and prepare for a possible catastrophic future.
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Covid-19 is not only a public health or medical issue; it requires a multidisciplinary planning and approach. The outbreak of the virus challenges not only the virological and epidemiological fields but also requires the critical intervention of spatial planning. Urban systems and deadly diseases have historically maintained a correlation that functions in parallel during and after the outbreak. The 19th-century cholera pandemics in Europe resulted in the development of water and sewage systems. In 1854, British physician John Snow used geographic mapping to locate a cholera outbreak in London that led to the saving of many lives. Even though scientists at that time did not fully understand what caused the Yellow Fever outbreak in 1793, Philadelphia began building one of America's first water treatment plants after the fever subsided.
Many of the successful measures taken by some countries to reduce the spread of Covid-19, as well as bring down the number of deaths, are based on a collaborative and multi-agency action.
Covid-19 may gradually create a substantial change in the urban system once it de-escalates. But while it is still in progress, it is also extremely crucial to have a better assessment of successful strategies in various countries so that we can identify and analyse possible measures that may work in our own context.
Most virus-affected Western countries have imposed a temporary lockdown, or a slowdown, on their people to ensure fewer gatherings so that the spread of the virus is slowed, and the surge on hospitals is levelled. Until recently, Europe was the epicentre of the Covid-19 pandemic. Currently, on a global scale, the United States has the highest infection rate and the highest number of deaths. While these countries have imposed lockdowns and closed borders, they still have a difficult time keeping the numbers down.
On the other hand, New Zealand seems to have managed to contain the outbreak before it ever had a chance to begin. Some East Asian countries are also managing it in an effective way. Vietnam, for instance, has had fewer cases with no death count so far. With the motto of "proactiveness and consistency throughout the response," Vietnam is one of the first countries to have sealed down neighbourhoods when workers started coming back from China after the Chinese New Year. They also put great emphasis on building awareness in their own cultural way of dancing, singing, and making short animations.
Of all countries, South Korea, Singapore, China, and Taiwan have taken effective strategic measures at the right time, and have been largely successful in slowing down the spread of the virus compared to many developed countries. It is known that the novel coronavirus (SARS-CoV-2) has a genetic relation with SARS-CoV that caused an outbreak during 2002-2004, mostly in Eastern Asia. South Korea, Singapore, China, and Taiwan took lessons from that epidemic, and started taking precautions for future epidemics long before they tracked down the first coronavirus patient in the region.
Since the antidotes or vaccines for the coronavirus are still in the pipeline, the East Asian countries cited here used both pragmatic and high-tech systems. Taiwan used prevention policies to reduce the infection rate. China teaches us the importance of preparedness to prevent and control infectious disease outbreak with technology and pragmatic systems. On the other hand, the South Korean experience emphasises the need for isolating the patients and building awareness among the people using the social media platform. The main focus of Singapore was to track the virus-affected people, and isolate the virus-free people from the affected ones by keeping the latter in hospital until they recover.
Researchers at Bengal Institute looked at Taiwan, Zhejiang Province and Hangzhou in China, South Korea and Singapore to understand the strategies that each country developed and implemented to fight Covid-19. We in Bangladesh can learn from these strategies in order to devise our own successful measures.
Taiwan: Taiwan implemented a 124-point action plan to keep the death rate to less than 2 percent of the confirmed cases. The country was also very strict about border control and screening. Government policies to isolate people and mandate on the mask export, as well as fixing selling price and local production proved effective for public health.
Hangzhou, China: Hangzhou is the capital city of Zhejiang Province in China, about 1,000 miles away from Wuhan—the ground zero for the coronavirus pandemic. Authorities in Hangzhou were cautious the very moment the virus spread in Wuhan, going into a lockdown to prevent the infection. China's use of technology helped management facilities to isolate, monitor and treat positive cases with accuracy. With constant tracking, there was breach of privacy but identification of infected cases was prompt and efficient. This also reduced the contamination in clusters.
South Korea: Having conducted over 15,000 tests daily, South Korea also maintains an expansive and well-organised texting system. This allows the country to completely isolate the patients from the virus-free people. Through the use of apps, the authorities keep track on a patient's whereabouts, and also lets people know who may have come in contact with the patient in recent times based on their recent locations. The idea is to identify and isolate every single person who may come closer to the affected person.
Singapore: The early preparation taken by the authorities has been in favour of Singapore. It relied on tracking the affected people using the vast network of social media, apps, and text messages. Over 9,000 temporary health clinics have been established to keep the patients isolated. The goal is to keep the affected people completely separated in temporary clinics, away from the virus-free community, and to make sure no transmission takes place by them.
What we can do in Bangladesh
As there is no universal antidote yet, Covid-19 is here to stay for the long haul. Even when the virus subsides, there is a danger of a second wave and greater economic and social pandemonium.
From Madrid to Mumbai, from Detroit to Dhaka, no place on earth is currently immune from the reach of the coronavirus. But the outbreak, spread and eventual subsidence of the coronavirus will vary from region to region. In the first part of this article, we have looked at the strategies of four countries with a high success rate in managing the virus. Let us now identify and analyse possible schemes that can be implemented in Bangladesh, and can be both effective and fitting in our social and economic contexts.
The most crucial thing to consider is how to gradually regularise everyday public activities with proper safety measures, utilising the resources we have. Provided that all variables remain constant, it is possible to keep the infection rate low with timely policies and pragmatic steps. For example, a community of 50,000 Chinese in Prato, Italy, who went under lockdown even three weeks before the confirmation of Italy's first Covid-19 case, kept their infection rate at less than 50 percent than that of the whole of Italy.
As the virus slowly spreads its insidious tentacles in Bangladesh, the country stands on a vulnerable precipice. With a high transmission rate, especially in densely populated places, it becomes a challenge to tame the numbers of people getting infected.
There are many measures already underway in Bangladesh. The country has been under lockdown since March 26, suspending all modes of inter-city transport and shutting down institutions, offices, and businesses. Testing for Covid-19 infection is now being conducted in 14 labs: 9 in Dhaka and 5 in different districts (as of April 18). Private groups have started to set up temporary hospitals around Dhaka to accommodate the growing number of infected people. Several awareness campaigns are already in circulation on social media, television, and newspapers. While these developments are crucial to tackle the crisis, for a coordinated response we need to formulate a "Covid-19 Management Action Plan" from the national to the neighbourhood levels.
Besides scarcity of funds and resources, and well-trained personnel who can deal with the virus, Bangladesh faces other challenges too, such as shortage of approved testing centres and treatment facilities, lack of prevention and hygiene awareness, and social inequity. This could become more of a trial if we are to face a surge in cases of both virus transmission and hospitalisations. Bengal Institute researchers believe that we can still keep the death rate low with a choreographed community and government support.
The show should certainly go on. Even during a pandemic, the need for basic amenities and services does not vanish. Essential services such as wet markets and groceries, banks, ATM booths, and regular hospitals need to be accessed by the people. Additional health screening and/or sanitising should be a priority for such points of congregation.
At a national level, controlling modes of transportation and mobility holds the key to preventing future infections. At present, there are 18 national highway gateways to Dhaka city. Besides, there are airports, private helipads, train stations, and bus stations connecting the capital to the rest of the country and the world. Strict border control and inspection at gateways can cut down a lot of foreign-borne contamination.
Preventive measures can certainly begin from the national level, but they can be applied to three key scalar conditions: city or town, neighbourhood, and healthcare facilities. For each city or town administration, measures may be taken to locate the critical nodes of the city. At those nodes—such as gateways and entry points—strict screening may be applied. Travel restrictions and control may be applied at city and even neighbourhood levels, which can be eased only with the lowering of transmission and hospitalisation rates. A strategic plan should be in place for establishing temporary hospitals with a focus on the site, emergency transportation facilities, water-electricity access, and key staff. Infected neighbourhoods and areas should be under the surveillance of city and town administrations along with community participation. To make a multi-scalar plan work, it is critical to maintain a close overall supervision by a central task force.
At the metropolitan level, such as in Dhaka, decisive public health and hygiene actions come with a demand for logistics. A surge may not only require setting up of more health centres but also burial grounds. In Dhaka city, there are at least 247 mosques and 22 parks under renovation. With supply of water, some of these places can be potential "hubs for hygiene."
At the neighbourhood level, public spaces can be mapped both for the facilitation of regulated food and wet markets and setting up field hospitals, if needed. Such mapping is important as provision of amenities and facilitates is not equal for every neighbourhood. Points of crowding can also be mapped and measures can be taken for regulating gatherings, as well as setting up sanitisation booths, especially for pedestrians, rickshaw pullers and certain vendors. Such booths may also be set up at the entry and exit points of the main mohallas and urban blocks. Houses and other buildings may be sanitised regularly. The awareness momentum should be kept through posters, banners and leaflets.
The business-as-usual approach embedded in existing healthcare facilities will not work in case of a highly infectious disease like Covid-19. Segregation of virus-affected patients from the non-infected patients is critical as far as hospitalisation is concerned. Even such services as testing and check-up for coronavirus should be conducted in clearly designated areas.
While surveillance is always a tricky practice, it is essential to continue to track and trace infected people and isolate them. Apps may be used to trace the infected and their movement patterns. At the end of the day, personal awareness remains the starting point of prevention against Covid-19. The more awareness we can create, the more we can prevent infections.
Sabiha Haque and Samira Marzia are respectively Senior Research and Design Associate and Research and Design Associate at the Bengal Institute for Architecture, Landscapes and Settlements. Nusrat Sumaiya Tani facilitated the research.
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