Dhaka Courier

No room for complacency

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Just as the world was set to welcome some good news out of China regarding the fight against Covid-19, the seventh coronavirus disease known to man that emanated from Wuhan, the bustling capital of the Chinese province of Hubei, some rather disconcerting news from other parts of the world have served to heighten concerns globally, even as the number of cases appeared to be stabilizing in Hubei, according to government figures.

In particular, the way the virus has been seen to take hold in three far-flung countries over the past week - Italy in the south of Europe, Iran in the Middle East, and South Korea in the Far East, close to the epicenter of the outbreak - has rattled some nerves and shown there is no room for any complacency yet among those entrusted with ensuring public health.

The number of people in Italy infected with the new virus from China increased by 45% on February 25, and the number of deaths grew to 10, civil protection officials said.

Officials reported 322 confirmed cases of the virus, 100 more than a day earlier. They said that some of the new cases showed up in parts of Italy well outside the country’s two hard-hit northern regions, including three in Sicily, two in Tuscany and one in Liguria.

As cases continued growing at a worrisome rate, evidence emerged that the virus was spreading from its epicenter in Europe to other countries with vacationing Italians and Europeans who visited the afflicted northern regions. Austria, Croatia and Spain’s Canary Islands reported their first confirmed cases on the same day.

“Obviously, I can’t say I’m not worried because I don’t want anyone to think we’re underestimating this emergency,” Italian Prime Minister Antonio Conte said before a meeting with visiting World Health Organization representatives. “But we trust that with the measures we’ve implemented, there will be a containing effect in the coming days.”

Italy has closed schools, museums and theaters in the two regions where clusters have formed and troops are enforcing quarantines around 10 towns in Lombardy and the epicenter of the Veneto cluster, Vo’Euganeo.

But Italy hasn’t yet identified the source of the outbreak - essential to a national health system’s tracking of the virus, and one of the biggest concerns one would imagine, were an outbreak to occur in Bangladesh. From China putting an entire province on lockdown to the meticulous recording and tracking of the movements and interactions of people taking place in say Singapore, the question may well arise if Bangladesh would be able to react with the same rigour and focus and meticulous attention to detail.

Man with a plan?

Which might be slightly unfair on the authorities here. Besides, the World Health Organization and even the Centres for Disease Control, a US federal agency under their Department of Health and Human services, would be pitching in with their expertise to help tackle any outbreak here.  Asked if the government is ready to tackle any possible advent of the Coronavirus, or Covid-19, in Bangladesh, Health Minister Zahid Malek this week told Dhaka Courier that the Bangladesh government is “fully prepared” for any such outbreak.

“We have medical teams at every airport and port of Shahjalal. All those who come from different countries are being subjected to monitoring and testing. We have all sorts of preparations for combating the coronavirus. We are in touch.

The minister also said, “God forbid, if the Coronavirus comes, we will take care of it in the same way that they do in other countries. But we’re currently giving priority on preventing its entry into the country.”

Asked what steps will be taken in the hypothetical situation that the first case of the Coronavirus in Bangladesh is discovered, the minister said the authorities have made necessary arrangements at the Kuwait-Bangladesh Friendship Government Hospital in Uttara, which was inaugurated in 2001 but over the course of the next nearly two decades, has turned into something of a white elephant, to act as a specialised centre for treating patients suffering from Covid-19 in Bangladesh. Besides, quarantine facilities have been installed in most hospitals.

On being pushed on whether the government has a plan in place to deal with localised transmission in the country, i.e. if the disease starts spreading rapidly from one patient to another in Bangladesh territory, he said “We’ve kept a hospital on standby to treat coronavirus patients to avoid further contamination. The hospital (Kuwait-Bangladesh Friendship Government Hospital) will treat no one except people infected with Covid-19.”

More than three lakh people have so far been screened while entering the country through different ports and none of them was diagnosed with the virus, he mentioned.

Regarding the availability of Covid-19 testing kits in the country, he said Bangladesh has a total of 2,500 testing kits, including the 500 most advanced testing kits presented by China. Besides, there are eight machines in the country to identify the virus.

“Hopefully the country won’t suffer shortage in testing kits as there are more kits in the pipeline,” he added.

Bangladesh has already formulated a treatment protocol to combat the novel coronavirus. Apart from this, China shared their protocol so that we can learn from their experience. A number of doctors were trained in Corona patient treatment. Besides, all deputy commissioners (DCs), superintendents of police (SPs) and civil surgeons were asked to remain alert about infection of the virus.

Around 80,000 people have so far been diagnosed with Corona throughout the world while the death toll is 2618 in different countries. Recently, Kuwait, Iran and Iraq have confirmed Corona cases. Bangladesh is still safe, the minister said.

Asked whether there is any plan to suspend air-communication with the Middle Eastern countries, including Iran where the virus has definitively sp[read this week, Minister Maleque ruled out any such plan.

“Currently, we don’t have a plan to cancel flights from and to Middle Eastern countries, including Iran. The number of flights however dropped across the world as people reduced moving. In such a situation, the tourism industry is suffering the most,” he said.

Health Services Secretary Asadul Islam echoed the minister’s remarks, saying the country is all set to fight Covid-19.

“We would work in coordinated manner with other countries including China to handle any worse situation. We’ve asked all to remain alert as the virus spreads rapidly from person-to-person,” he told UNB recently. The Health Services Division is maintaining regular communication with civil surgeons of all districts, he added.

When it comes to the important work of tracking the virus if it were to arrive in Bangladesh though, the responsible organisation in that case would be the Institute of Epidemiology Disease Control and Research (IEDCR), located in Mohakhali close to ICDDR,B, with a bit of help from WHO and other foreign institutes.

Meerjady Sabrina Flora, director of Institute of Epidemiology Disease Control and Research (IEDCR), said they have installed a data centre for monitoring the situation, collecting information about the virus and analyzing them.

“At the data centre, specialist physicians from World Health Organization (WHO) and US Centers for Disease Control and Prevention (USCDC), in addition to local doctors, are closely monitoring the situation and analyzing the latest data,” she added.

Responding to another query, she said “We’re not concerned at all over Coronavirus. We’re ready to combat it. It’s true that there is fear as the virus is spreading rapidly to different countries, but there is no reason for us to be concerned.”

All precautionary measures were taken as per direction of the Ministry of Health and Family Welfare and the Directorate General of Health Services (DGHS). A 24-hour hotline too has been launched so that immediate treatment is ensured if anyone gets infected by the virus. As she urges in all the daily press briefing she has been conducting over the past few weeks, Dr Flora urged all to contact IEDCR directly by dialing their hotline numbers, if there is any query about Coronavirus. She is wary of what other sources may tell people. With an eye on that, she asked everyone to refrain from spreading rumors.

In one of those briefings this week, Dr Flora actually advised people to avoid foreign tours unless they were mandatory, to stay safe from the novel coronavirus infection. She obviously considered the advice to be prudent after the World Health Organization (WHO) chief expressed concern over the increase in coronavirus cases in many countries with no clear epidemiological link.

The number of COVID-19 affected countries has risen well past 30 now and the WHO has kept the global alert level at “high” and “very high” for China.

“It [avoiding non-mandatory travel abroad)] is not any directive; an advice only. We are advising this considering the latest spread pattern across many parts of the world where the source of infection is unknown,” Dr Flora said.

Director General of WHO Tedros Adhanom Ghebreyesus this week said of particular concern are “the number of cases with no clear epidemiological link, such as travel history to China or contact with a confirmed case.”

The WHO termed the rapid spread of the virus from indirect contact and unknown source “a complex situation.” Tedros also said the WHO is “worried about the situation in the Islamic Republic of Iran and in Italy.”

Still, the outbreak has not yet reached the level of pandemic, according to Tedros. A pandemic is an epidemic that has spread over several countries or continents, according to the U.S. Centers for Disease Control and Prevention (CDC). “There’s a lot of speculation about whether these increases mean that this epidemic has now become a pandemic,” Tedros said. “Does this virus have pandemic potential? Absolutely, it has. Are we there yet? From our assessment, not yet.”

The new global spread of the coronavirus may be attributable to the difficulty of detecting infected travellers. The virus’ long incubation period—the 3 to 14 days it usually takes before symptoms begin to show—and its often mild symptoms make it difficult to find with measures like thermal screening, which has been rolled out at airports across the world. A study by researchers at the London School of Hygiene and Tropical Medicine estimates that 46 out of 100 infected travellers will be able to pass undetected through both exit screening at their departure destination and entry screening at their arrival location.

Complicating matters is that experts do not yet know all the ways the virus can be spread.

The CDC told reporters on February 25 that community spread in the US is likely — a question of when, not if. Health officials urged American businesses, hospitals, schools and communities to think and plan for spread in their area while there is time to prepare.

“We recognize that implementing [measures] at this level will be disruptive to people’s day-to-day lives” if they become necessary, said Dr. Nancy Messonnier, Director of the CDC’s National Center for Immunization and Respiratory Diseases, noting possibilities such as lost income and the need for alternate childcare arrangements. “We want to prepare people for that possibility.”

A wing and a prayer

Ultimately, even the best-laid plans may sometimes be breached, when the adversary is such an unknown quantity. Experts are puzzled for example, over how Italy, a country that took especially tough early prevention measures, has been hit by an outbreak. Italy was the first European Union country to ban flights to and from China. The WHO has spoken out against flight bans, although numerous countries went on to join Italy in banning travel to and from China. “The WHO doesn’t recommend and actually opposes any restrictions for travel and trade or other measures against China,” the WHO Director-General had said in January.

Conte, the Italian PM, shocked Lombardy officials by taking to task the hospital in Codogno, southeast of Milan, where Italy’s first positive patient went on Feb. 18 with flu-like symptoms. The man was sent home, only to return a short time later with worsening conditions, at which point he was tested for the virus.

Many of Lombardy’s 200-plus positive tests have a traceable connection to the Codogno hospital, including several doctors and nurses, patients and relatives who visited them. Conte told reporters that the Lombardy cluster grew “because of the hospital management that wasn’t completely proper according to the protocols that are recommended for these cases.”

“This surely contributed to the spread,” he said.

Lombardy’s chief health official, Giulio Gallera, said that the man presented none of the main risk factors for the virus — travel to China or contact with an infected person — when he first went to the emergency room.

The man was eventually tested after doctors ascertained from his wife that he had met with someone who had recently returned from China. But officials have excluded that contact as the source of the outbreak since that person tested negative. It has all contributed to the sense of alarm among health officials worldwide.

In Iran, the head of a government task force on the coronavirus who had urged the public not to overreact about its spread tested positive for the illness himself. Only a day earlier, a coughing and heavily sweating Iraj Harirchi said at a televised news conference in Tehran that “the situation is almost stable in the country.”

The acknowledgement of Harirchi’s illness underscores a growing crisis of confidence felt by many in Iran after nationwide economic protests, a U.S. drone striking killing a top Iranian general and Iran accidentally shooting down a commercial jetliner and insisting for days that it hadn’t.

Turkey and Pakistan both closed their borders with Iran, with Turkey also halting incoming flights, in an effort to stop the potential spread of the virus. Qatar Airways, one of the Mideast’s biggest carriers, also said it was essentially halting operations to Iran and South Korea until further notice.

Health Ministry spokesman Kianoush Jahanpour confirmed Harirchi had the virus. Harirchi himself posted an online video saying he had it and that he had quarantined himself at home. He promised that authorities would bring the virus under control.

“I wanted to tell you that, rest assured that with efforts of your servants at the Health Ministry ... and backed by you people, the government and all elements of the establishment, we will be victorious in our combat against this virus within the next few weeks,” Harirchi said.

Jahanpour said 15 people had died in Iran so far amid 95 confirmed cases. However, experts remain concerned Iran may be underreporting cases and deaths. The Health Ministry spokesman suggested it may take at least until Nowruz, the Persian New Year on March 20, for Iran to reach a point where the virus was contained. He added that a more “pessimistic” assessment suggested Iran would contain it by late April.

South Korea has seen by far the highest numbers of  coronavirus cases outside of China - within a week confirmed cases jumped from a few dozen to more than 900. The country had seemed well prepared and so the skyrocketing numbers have many asking how this happened - and whether a similar sudden outbreak could happen elsewhere.

The Daegu region accounts for over 80% of South Korea’s nearly 1,000 virus cases and 10 of its 11 deaths. More than half of the cases in the Daegu area are linked to a controversial church that is viewed as a cult by mainstream Christian organizations.

The region’s first patient is a member of the Shincheonji Church of Jesus who had attended services before being diagnosed with Covid-19. But authorities say it’s unlikely that the woman, who has no record of recent overseas travel, set off the chain of infections. As South Korea’s central government vows all-out efforts to contain the region’s outbreak, public anxiety is destabilizing everyday lives and threatening to seriously impact the local economy.

While declaring the novel coronavirus outbreak a global emergency at the end of January, the WHO chief had specified that “the main reason for this declaration is not what is happening in China but what is happening in other countries.” The concern, he was careful to say, was that it could spread to countries with weaker health systems. That concern would now seem to have been well-founded. And even as we laud the work of institutions such as IEDCR and place our confidence in them, rest assured Bangladesh too would have been one of the countries Tedros Adhanom Ghebreyesus had in mind.

  • No room for complacency
  • Covid-19
  • The deadliest crown of them all
  • Coronavirus
  • Vol 36
  • Issue 34
  • DhakaCourier

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