Covid-19 and the missing data conundrum
The recent outbreak of Covid-19 is unprecedented. Given the novelty and the rapidly evolving contexts, data gathered from the field is the only path to attaining the true picture of the disease's progress. Unfortunately, we do not have a handle on this yet. To design an evidence-based, feasible and effective response, the true extent of the spread and impact needs to be known, which can only be done through accumulation of accurate and up-to-date statistics. Such data is needed not only on the health sector but also on economics, businesses, education, remittance, social safety nets, etc. A constant flow of new and updated data on the response from different actors including in government, NGOs, healthcare, industry and agriculture are needed to monitor and effectively combat the disease.
Much like the lack in coordination of responses, the same holds true for data generation. Here perhaps, concerns extend well beyond coordination. It is the sheer absence of some relevant state machineries in the game. Let's take the case of two prime public sector agencies vested with the responsibility of generating data, particularly during the emergency situation in which we find ourselves—the Institute of Epidemiology and Disease Control Research (IEDCR) and the Bangladesh Bureau of Statistics (BBS).
The IEDCR was established in 1976 as the country's "disease detectives". Surveillance is an epidemiological practice through which the spread of a disease is predicted, observed and monitored to minimise harm to the populace. Over the years, it has made several important contributions. During 2007–2011, they investigated 76 disease outbreaks including the Nipah virus outbreak (although there is no recent information available on their website). In 2009, when the H1N1 threatened Bangladesh, they instituted screening of incoming passengers through 16 points including three airports, and recommended textbook containment measures such as social distancing, wearing masks, washing hands and isolating patients. An important function the IEDCR has been performing since 1978 is collecting and reporting on nationally notifiable diseases through weekly morbidity reports from upazila levels, and monthly disease profiles from medical college hospitals.
Once Covid-19 hit our shores in early March, IEDCR was designated as the sole source of information for the disease's spread in Bangladesh. The wait for the afternoon update became almost ritualistic. The situation has come a long way since the initial days when the sole testing site for Covid-19 was the IEDCR itself. Testing capacities have been somewhat decentralised now and extended to over 30 locations in Dhaka and the main divisional cities. The fact that this is not enough—which is agreed upon by epidemiologists—is clear given that we have one of the lowest test rates in the region. Our testing rates (per million population) are almost half of those in India or Pakistan. There are limitations to expanding the facilities fast if the quality is to be ensured and IEDCR is being relieved of its responsibilities of carrying out the tests. In the absence of widespread testing and reporting of related deaths, the media regularly reports on the number of deaths from "corona-like symptoms", which gives an alternative but less robust understanding of the spread of the disease. Couldn't this be done by IEDCR itself by using its upazila-based weekly morbidity data? Why have they not used the medical colleges-based disease profile data to give additional estimates? If reported correctly, such data would have been more reliable than any other sources, and, in the interim, could make national preparedness more evidence based.
On the other side of the crisis, the premier agency for demographic and socio-economic data is the Bangladesh Bureau of Statistics (BBS). Conspicuously, they have been eerily quiet in this current crisis. The BBS is unilaterally responsible for running projects of national importance such as the Census, Household Income and Expenditure Survey and the Labour Force Survey. They have also been running a Sample Vital Registration System (SVRS) through which data on vital events are collected and analysed on a periodic basis since 2011. Implemented in 1000 primary sampling units, it gives district-level estimates of births, deaths, marriages, and migration. Data is collected using a dual record system with the help of field registrars and staff of the upazila statistical office. Although there are genuine concerns about its quality, the SVRS has the potential to be a critical source of information in understanding the progress of Covid-19 at the community level, particularly in terms of the number of deaths. BBS could help the national response by recommending how the testing facilities correspond to the needs, not only in medical terms but also other relevant factors such as socioeconomic status of the region and capacity of local health facilities and staff, among others. Given BBS's extensive knowledge of the population and population characteristics, they are well placed to suggest where healthcare is most needed.
The silence on their part likely stems from several reasons. Hamstrung by unyielding bureaucracy, hierarchical modus operandi, and a strong resistance to change stifles the enthusiasm of eager staff from the get-go. Finally, activities of the BBS are typically placed in the non-essential category, to the extent that the recent government closures stopped all BBS activities, including the preparation for Census 2021. Once we put it all together, it paints a vivid picture of why we see no movement on their part.
Given our weak infrastructure, the government needs to ramp up efforts to fill the gap—while far from perfect and much left to be desired, they're beginning to get a better handle on the technical side of the issue, that is, increased testing and supplying protective gear. On the socioeconomic front, we don't know much beyond what has been reported by various universities and think tanks in the country. While there are many ambitious plans to reach aid to those who need it, we have not heard much on how the support will target and reach the intended beneficiaries. Traditional approaches and thinking will unlikely be effective here as we have seen so far. We understand BBS's trepidation and reluctance to engage. But in a world that considers data to be the new oil, we as citizens should demand more from them—especially in the face of resistance when it comes to receiving bad news. The reputation of these organisations is not up for debate in this article, but rather to encourage them to remain relevant in a fast-changing world. The post-coronavirus Bangladesh will demand their data even more.
Mushtaque Chowdhury and Farzana Misha are respectively Adviser and Research Coordinator of BRAC James P Grant School of Public Health, BRAC University.