The coronavirus surge continues to ravage Bangladesh and, given what transpired in India and Nepal in recent months, the path looks painfully familiar. Many areas are short on oxygen, and hospitals are under great strain. The hardest-hit places now tend to be the districts bordering India, from where the intrusion of the highly infectious Delta variant of the virus is thought to be the principal driver of the surge in cases this time.

Dhaka, the capital, is also reeling, and authorities worry hospitals will run out of beds in a few weeks if they continue to increase. This week, the government announced an ongoing nationwide lockdown will be extended until July 14. But factories, including those in the garment sector, remain open as long as they follow health protocols.

The daily caseload hit a new high again on Thursday (July 8), prompting the government to order local administrations across the country to ramp up oxygen supply and increase hospital capacity.

The health authorities reported 11,651 new infections in the 24 hours to Thursday morning surpassing the previous peak of 11,525 on Tuesday. The total caseload now stands at 966,406. Dhaka logged 4,949 cases, the highest among eight the divisions followed by Chittagong with 1,936, Khulna with 1,732 cases, and Rajshahi with 1,048.

On Wednesday (July 7), the country reported its highest daily death toll since the start of the pandemic, with 208 deaths. On Thursday it dropped just slightly to 199. It is safe to say that Bangladesh is going through its worst phase of the entire outbreak at present. The first week of July was the deadliest of the pandemic so far, with 1,090 fatalities.

The positivity rate (the percentage of all coronavirus tests performed that are actually positive) has been hovering close to or above a very high 30% over the past week. On Thursday, as many as 36,850 samples were tested across the country for a positivity rate of 31.62%. This almost certainly means there are many more infections that are not showing up on the record.

According to Johns Hopkins University, the positivity rate helps public health officials answer questions such as:

What is the current level of SARS-CoV-2 (coronavirus) transmission in the community?

Are we doing enough testing for the amount of people who are getting infected?

A higher percent positive suggests higher transmission and that there are likely more people with coronavirus in the community who haven't been tested yet. The percent positive is a critical measure because it gives us an indication how widespread infection is in the area where the testing is occurring-and whether levels of testing are keeping up with levels of disease transmission.

The higher the percent positive is, the more concerning it is. As a rule of thumb, however, one threshold for the percent positive being "too high" is 5%. For example, the World Health Organization recommended in May that the percent positive remain below 5% for at least two weeks before governments consider reopening.

We are currently a long, long way from that - although on two occasions after cases spiked, Bangladesh did manage to rein in the positivity rate: the first time over the winter after the first wave, before cases spiked again in March. Thereafter too the infections were again reined in, before the latest spike that began around late May. Now the authorities have to do it all over again, in what could be described as a third wave for the country.

A new epicenter

Amid an alarming surge in Covid-19 cases and deaths over the past few weeks, Khulna division has been clamouring for oxygen -- a component key in saving the lives of critical patients. While a few hospitals in Khulna division have already run out of the life-saving gas, many other medical facilities are operating on the edge due to an acute shortage of oxygen.

On June 30, seven Covid-19 patients were said to have died in the space of roughly an hour as the central oxygen supply failed at the Satkhira Medical College Hospital, the largest hospital in the frontier district of Satkhira. A probe has been ordered into the deaths.

In Khulna district, the largest specialised government hospital is overwhelmed by a sudden surge in Covid cases -- it was forced to stop corona testing earlier this week, and is also scrambling for beds and oxygen. Our sister newsagency UNB learned that testing at the Khulna Medical College and Hospital had to be suspended due to technical problems.

Moreover, nearly 190 patients have been admitted to the hospital as against 130 beds in the last few days. The hospital has only 77 centralised oxygen beds, making other critical patients dependent on cylinders sourced from outside. Though the hospital authorities claim they have 500 cylinders in stock, relatives of critical Covid patients are struggling to get hold of portable cylinders.

"Within minutes, the cylinder I kept beside my relative's bed became someone else's," said the kin of a Covid patient.

"We have been running from pillar to post for an oxygen cylinder. My sister will die if we don't get it soon," said an anxious brother of another patient.

Vice president of KMCH, Dr Mehedi Newaj, pleaded helplessness. "Whenever the number of patients crosses 170, the crisis becomes hard to handle. If patients keep rising, the situation will get out of control."

According to oxygen suppliers, only in Khulna city, the daily demand is currently 700 cylinders while they are only able to supply 410.

"The demand for small cylinders has skyrocketed in Khulna, as we get calls even in the small hours of the day," said a supplier, who did not wish to be named.

In fact, the gap between the demand and supply of oxygen is narrowing by the day in Khulna, in a clear indication of an impending catastrophe. Khulna has been leading the country in the number of fatalities frequently during the latest wave. On Thursday it reported 51 deaths, over one-fourth of all deaths in the country.

Alarm bells ring

The Prime Minister's Office (PMO) on Thursday instructed authorities concerned to ramp up medical oxygen supply and increase hospital capacity as record Covid-19 surge crashes into the country. It also directed the officials to strictly follow the health safety protocols and keep those who have tested Covid positive in isolation, if required.

The PMO also called upon the countrymen to abide by the health rules and lockdown guidelines properly to curb further spread of the deadly virus. The directives came from an urgent meeting held virtually with the divisional commissioners and deputy commissioners to find out the way out to ensure health protection for the people and coordinate the ongoing government activities to offset the Covid onslaught.

From the PMO's end, Prime Minister's Principal Secretary Dr Ahmad Kaikaus presided over the meeting, where it was also decided that if needed, all public and private medical college hospitals at the district level will be used for providing treatment to Covid patients. A plan to import more oxygen from India was also discussed, although given India's own troubles, that may not see the light of day.

According to DGHS, as of July 4, there are 14 358 general beds dedicated to COVID-19 treatment countrywide, 53.6% (7693) of which are occupied. Close to 40% of the dedicated general beds are in Dhaka City. There are 1 191 dedicated ICU beds in the country, of which 65.6% (781) are occupied; almost 70% of the dedicated ICU beds are in Dhaka City.

In the week extending up to July 4, the general and ICU beds' occupancy increased in all divisions compared to the week before. As per the total capacity, the Rajshahi division experienced the highest general bed occupancy (88%), followed by Barishal (65%), and the highest ICU occupancy observed in the Rangpur division (92%), followed by Sylhet (90%).

Also this week, the government expanded the nationwide Covid-19 vaccination campaign by reducing the minimum age for registration to 35, following the arrival of shipments of the Moderna and Sinopharm vaccines. The decision was taken during a meeting at the Prime Minister's Office on Sunday. The government began the vaccination campaign on February 7 with a minimum age for registration of 55. Subsequently, the minimum age had been reduced to 40.

Now, citizens aged 35 and above will be able to sign up for vaccines using the government website, surokkha.gov.bd. The DGHS halted Covid-19 vaccine registration in the last week of April due to a shortage of doses. Since then, only medical and dental students, university students, law enforcement officials, and migrant workers have been able to register for vaccination.

Meanwhile, the Ministry of Expatriate Welfare and Overseas Employment inaugurated special vaccine registration for expatriate workers. To avail the vaccine, expatriate workers must first register through the "Ami Probashi" app for identity verification. They can then register with the Surokkha website under the "registration (passport)" category. Only expatriate workers travelling to Saudi Arabia and Kuwait are eligible for the Pfizer vaccine, due to guidelines issued by the two countries.

Meanwhile news of our local efforts at coming up with a vaccine for COVID-19 ended up providing this week's comic relief.

Monkey business

Collecting animals for vaccine trials turned into a 'monkey business' for Globe Biotech Ltd as five of their employees were assaulted by locals following their unannounced arrival in the Barmi Bazar locality of Gazipur, known for its thriving population of rhesus macaque monkeys, on Sunday (July 4).

"Although Globe was permitted to collect monkeys from Gazipur forests, we did not know they were coming on Sunday," said an official of the local wildlife department Tabibur Rahman. The incident took place in Barmi Bazar area under Sreepur upazila of the district.

According to local sources, hundreds of people in the area got agitated and surrounded the Globe employees upon receiving information that an unidentified group was putting monkeys inside cages after pushing them with anaesthetic injections. Later police rushed to the spot and rescued the Globe employees.

Globe Pharmaceuticals Ltd Media Consultant Anisur Rahman, one of the employees, portrayed the situation as more or less like "an extortion."

"Some of the locals demanded money from us and physically assaulted us when we refused," he claimed. However, locals claimed that they mistook the Globe employees as poachers and were enraged observing their attitude towards the monkeys.

Abul Hashem, president of the Barmi Bazar Merchants' Association, denied the allegations and said that the incident could have easily been avoided if local administrations were informed earlier.

Confirming the incident, OC of the Sreepur police station said: "We rescued five of them and later let them go after verifying their identities."

Globe Biotech received a licence to produce their potential vaccine for trial on December 28 last year and subsequently applied for ethical clearance to begin clinical trials (on human subjects) on January 17.

That however was held up for a long time. It was only in June that the Bangladesh Medical Research Council, which oversees all such trials, got back to them with certain conditions that had to be met before the clinical trials could go ahead.

The key condition was that Globe would have to run trials on monkeys or chimpanzees first. Although grudgingly at first, Globe was left with no choice but to meet the condition. One of the bottlenecks the company identified at the time was that the country did not have a third-party clinical research organization (CRO) that could conduct such tests on animals. They would however look to engage one from abroad, they said.

Sunday's incident raises a few questions- one being why no legal actions have been taken if the Globe employees were assaulted, and secondly how exactly Globe is planning to conduct their trials. The use of their employees - with positions in the media and administration departments - to catch the monkeys for trial suggests they are not engaging a CRO for the job, even though that is the usual practice.

Globe at one stage had established an agreement with a firm called Clinical Research Organization Bangladesh to conduct the human trials component of developing Bangavax, but eventually that got scrapped.

The Animal Welfare Act of 2019 makes certain exceptions to allow for the use of animals for research purposes and is silent on how they are to be sourced. Even the Bangladesh Medical Research Council (BMRC) has no specific guidelines on animal testing.

Globally, most animals used in research are specifically bred for use in medical research, and there are specific ethical considerations for conducting such trials. But the way they are going about the job of collecting their subjects suggests Globe is paying them scant attention.

Most importantly, the Ministry of Environment, Forests and Climate Change did permit them to source 56 monkeys for clinical trials of their vaccine Bangavax, in the way that they did. They had the necessary No-Objection Certificates to prove it. They have already collected 30 monkeys from the Bhawal National Park and the Bangabandhu Sheikh Mujib Safari Park.