We must remain vigilant and stick to the guidelines provided by experts

There are 218,815 coronavirus cases confirmed worldwide, with a death toll of 8,810 as of March 19, 2020. The numbers will keep soaring before it starts declining. On the other hand, the number of recovering patients is also rising — currently 84,114.

As the virus moves from country to country, sparing no continent except for Antarctica, the nations are enforced to take unprecedented measures to contain the spread. Bangladesh has also been anticipating and preparing for the hit. As developed countries battle with this pandemic, we now have considerable information from their experiences on how to contain the spread.

However, there’s no denying the fact that Bangladesh is not equipped with resources to confront a disaster comparable to China, Italy, Iran, Germany, and many others who are reeling from exponential numbers of new cases daily and weekly.

As responsible citizens it is our duty to remain vigilant and maintain the guidelines provided by the experts in the face of this pandemic.

Mode of transmission

According to the US Centre for Disease Control (CDC) the virus spreads mainly from person to person. The person infected may or may not be showing symptoms but is still a source of infection. The respiratory droplets from coughing and sneezing carry the virus and any person within six feet can potentially get infected.

It is also possible to get the infection by touching surfaces containing the virus and then touching the face (mouth, nose, eyes) with the contaminated hand. CDC and the National Institute of Allergy and Infectious Diseases are studying how long the virus can survive on surfaces (2-4 hours on coppers, 24 hours on cardboards, and up to three days on plastics and steel).

According to a report by WHO, the virus can remain suspended in air longer depending on humidity and heat.

It is fairly evident that corona can spread easily and sustainably. The sources remain: Imported cases in travellers, close contact with known cases, and community-acquired cases where the source of the infection is unknown.

The symptoms of the disease appear 2-14 days after being exposed. They include fever, cough, and shortness of breath. Emergency warning signs when one must seek medical attention include: Difficulty breathing or shortness of breath, persistent pain or pressure in the chest, or bluish lips or face.

Is there a chance of re-infection?

The virus is new, so a lot of research is required before this query can be answered. So far, there have been several reports from Wuhan, Japan, and South Korea that a second test for the virus came positive after recovering from the first episode.

This could be due to: Testing errors, patients released prematurely from the hospital while still carrying dormant fragments of the disease, the infection simply lasting a long time for that particular patient, or the individual’s immune system’s response.

Usually, when a person is infected with a certain virus or is vaccinated, the body’s immune system is revved up to produce antibodies against that virus. This gives the person roughly two to three years’ immunity against that particular strain. After that, the antibody level against that virus may go down.

Although this depends on an individual’s immune system response, one person can be more susceptible to a strain than others. And then there is herd immunity, which is the percentage of the overall population that is immune to a given pathogen. When 70% of the population is immune to a virus, transmission of the virus becomes a struggle and herd immunity is established.

However, Covid-19 is a new strain and there is no evidence yet that it cannot re-infect. It will take a while to study the antibody titre against this virus.

Trends from different country analyses show that the cases start trickling in initially and within weeks there are steady currents of cases with sudden spikes. Interestingly, more contagious doesn’t mean more deadly. Ebola’s reproductive number was less than two but it was more deadly and killed half the people who became infected.

Experts believe that the alarming exponential spread of the disease can be mitigated by “social distancing.” A Washington Post article showed a simulation model of the pandemic where the best outcome could be reached with extensive social distancing.

When no measure is taken, 90% of healthy people will be affected. When there is forced quarantine like in Hubei, there will still be at least 60% people getting the disease and a high number of cases for some time. When there is social distancing but still a quarter of the population moves, the chances of large numbers of people getting the virus goes down over time (it comes down to 35%). When even fewer people go out, maybe one in eight — which is extensive social distancing — chances of the virus spreading go down to 17%.

Most countries are implementing a combination of travel restrictions (to stop the import of new cases into a community), quarantine (to prevent transmission between infected cases and others in the community); and social distancing, self-isolation, and heightened hygiene (to reduce transmission by reducing contact between individuals irrespective of exposure).

Singapore     

  • Travel banned from Wuhan after the first imported case
  • Screening travellers for temperature and respiratory symptoms; further assessment with isolation
  • Travellers from affected regions sent for 14-day quarantines at government designated places
  • Government compensation for individuals and employers for lost workdays
  • Intensive efforts by authorities to trace the contacts of people known to be infected
  • Health professionals interviewing patients about their recent whereabouts
  • The Ministry of Health collected data from transport companies and hotels, including by consulting CCTV footage
  • Large gatherings suspended
  • Schools and workplaces remained open — students and staff were subjected to daily health checks, including temperature screenings
  • Public-health campaigns reinforcing stringent standards of cleanliness and public hygiene — use tissue while sneezing, designated utensils of eating, toilet cleaning, regular handwashing
  • Masks only for people who were already unwell
  • Tracking people on smartphones and enforcing them to click on their location.
  • Breaching quarantine is followed by a fine of $10,000 or six months in prison
  • Testing made free

Taiwan

  • Initial screening and inspection of incoming travellers inside planes
  • Banned flights from Wuhan after the first imported case and all flights after three weeks
  • Predominantly imposed home quarantine despite having state run facilities available
  • Fines up to $33,200 upon breaking isolation
  • Encouraged to cancel events
  • Religious institutions suspended services
  • Schools and high schools remained closed for two weeks after the end of the Lunar New Year holidays
  • Scaled up mask production, stopped exporting to retain supply, controlled distribution and fixed prices of surgical masks from existing stockpiles through community stores
  • By March 11, 15,000 people were tested
  • CDC websites stated: “Wear a surgical mask when coughing or sneezing,” “Wash hands thoroughly with soap,” and “Avoid crowded places, including hospitals”
  • 58% of their cases were from local transmission

Hong Kong

300,000 people usually cross the border with China every day. Hong Kong’s focus was on preventing transmission within their community. Five days after the first imported case, they closed the border. Only 750 people crossed the border with the mainland daily.

  • Temperature-screening stations at ports of entry were expanded
  • Travellers from affected regions have to undergo a 14-day mandatory self-quarantine
  • Extensive efforts were made to track down and quarantine the close contacts of confirmed cases
  • Hong Kong has 1,000 negative pressure hospital beds among its 40,000 hospital beds. Confirmed cases were properly isolated
  • Designated newly constructed public facilities and holiday camps were prepared for quarantine facilities. 24,700 people were still in quarantine till March 12
  • Extensive social distancing. Working from home, large scale events cancelled, schools closed till April 20

The government has mounted a public-education campaign to promote hand hygiene and environmental hygiene. Nearly everyone in Hong Kong wears a face mask in public.

Online government resources detail Hong Kong’s cases, including the ages of infected patients and what parts of Hong Kong they live in. Maps also show the general location of the thousands of people under quarantine or self-isolation.

South Korea

  • 20,000 people are being tested every day for coronavirus in South Korea. There is no shortage of testing kits. Four companies have been given approval to make them. It means the country has the capacity to test 140,000 samples a week
  • Wherever the virus hits in large numbers, makeshift test centers follow
  • The disease spread was traced from the Shincheonji Church of Jesus group’s secret religious event
  • New infections slowed after health authorities completed Covid-19 tests on 210,000 Shincheonji followers
  • No lockdowns, no roadblocks, and no restriction on movement. But social distancing was encouraged
  • Trace, test and treat is the mantra. 200,000 screenings done already. It has also set up about 50 drive-through testing centres
  • Smartphone alerts were set to track movements of people who have tested positive
  • Schools are closed, offices are encouraging people to work from home, large gatherings have stopped
  • Thermal imaging cameras in the entrances to major buildings. Most people wear masks, bottles of hand sanitizers placed everywhere

Hubei, China    

  • Lockdown of the city
  • Increase testing capacities of designated labs
  • Relieved pressure on hospitals. Patients with milder symptoms are to be placed in temporary isolation facilities set up in gymnasiums and event halls
  • Designated vacant buildings for prophylactic quarantine for the people coming in contact with the infected people
  • Built two new temporary hospitals
  • Schools, factories, and workplaces shut down
  • Tracking of people’s movements from mobile location data and facial recognition technology

The outcome has been that the number of new cases is now much lower than that in the last few weeks.

It is well documented that from the time of the first case till now, these Asian countries have taken all the necessary measures to contain the outbreak.

It should be noted that Singapore, Taiwan, Hong Kong, and China have had a previous experience with the SARS outbreak of 2002-2003.

They had developed their testing, treating, isolating, and mitigating capacities to manage patients with novel pathogens.

The European countries and the US have not been able to move as fast as these Asian nations.

Recommendations from US emergency physicians

  • Use surgical masks to preserve the longevity of N95 masks. Dispose the mask after it gets soiled
  • Reuse N95 masks
  • Self-isolation of the asymptomatic
  • Minimize the use of nebulizers, switch to metered-dose inhalers (MDIs) with spacers for asthmatics and COPD patients. This will reduce risk of airborne contamination
  • Intubate for hypoxia and avoid BIPAP or CPAP
  • Mask patients and limit the number of health care workers that treat the patients.
  • Solicit help from surgical and anaesthesia mid-level providers
  • Medical students can be brought into the workforce to screen people, track down contacts of people exposed, interview the patients, and make calls. Free up critical care physicians to do their job
  • Do not use Ibuprofen

How does Bangladesh stop the outbreak? 

This is a time of emergency and we are well aware that the country is not well-resourced to manage an outbreak like the ones in China, Italy, Iran, Germany, UK, or the US. We must do our part to stop the spread. As the first death has already happened in Bangladesh, we have no time to waste.

The cycle of breaking the spike is: Detect, test, treat, isolate, and trace contacts. When the disease is imported to a new community, the same cycle needs to be followed.

Individual and community level activities:

1. Report cases to the authorities. IEDCR has set up a cell where they are collecting information on cases: Call at 16263 or 333.

2. Know the signs and symptoms — depending on the severity of the symptoms, either take medical intervention or stay home with limited movement and no visitors. Understand that you are the source who might affect your near and dear ones.

3. Social distancing — avoiding going out, keeping 3 feet of distance from others in public spaces, and avoid going to events. If one is exposed, then self-isolation should be a mandate to avoid spreading the disease further.

4. Maintain hygiene — wash hands for twenty seconds every time when in contact with surfaces and after going out, use hand sanitizers, cover your mouth when coughing or sneezing. Follow the protocols set by the health system authorities.

5. Self-tracking individuals’ movements so that if one does get infected, they can warn the people they came in contact with in the last seven days. Also, look for the source of who was the original spreader.

6. Maintain a healthy diet, stock up on vitamin C and D, and zinc (upon the advice of a health care provider); drink warm fluids to boost the immune system.

7. Take care of your elderly relatives, relatives suffering from immuno-compromising diseases like cancer, kidney failure, and respiratory illnesses.

Co-ordinated activities of government agencies and health agencies:

1. Early testing is the key to breaking any outbreak. It is imperative to make testing toolkits available.

2. Ensure that cases are being reported.

3. Detection and treatment of cases with total isolation.

4. Providing enough Personal Protective Equipment (PPE) for healthcare providers working on the frontlines.

5. Making more information available on how to self-quarantine.

6. Tracking the movement of infected cases. Some countries are using anti-terrorism tracking technology — real-time tracking of infected persons’ mobile phones to spot quarantine breaches and back-tracking through metadata to figure out where they have been and who they have contacted.

7. Extensive interviewing of patients to report their movement history.

8. List from hotels about people entering Bangladesh from the affected countries.

9. Tracking the flight details of imported cases from immigration for possible cases exposed. Data should be available at immigration centres.

10. Make thermal detection and reporting mandatory from high traffic public structures.

11. Reinforce personal hygiene and focus on personal responsibilities of individuals to remain vigilant through media, social media, and other formats.

12. Public-private hospital co-ordination for case-reporting transparency.

13. Postpone non-essential, elective medical procedures till further notice.

This list can go on, and ultimately, we still don’t have real answers regarding what can stop the spread, and finally this pandemic. The government has shut down all educational institutions and stopped gatherings of people.

However, people need continuous reinforcement lest they forget that these interventions were measures to break disease transmission and reduce exposure. Even though some studies claim that the weather change may not affect the strength of this virus, we can hope and pray for a divine intervention at this point.

Dr Maliha Mannan Ahmed is an entrepreneur and healthcare specialist.

Source of Dhaka Tribune