With the second wave (or third, depending on who you ask) of the Coronavirus in Bangladesh now undeniably staring the country in the face, the government has been forced to field questions over how it is planning to tackle the spread of the virus. Most people would find a return to the lockdown mode witnessed last year difficult to accept. Yet the truth is last year, in fact almost exactly a year ago now when the country entered the severest phase of a nationwide lockdown that would last for the first 66 days, everything from the number of people getting infected daily, to the infection rate, to the number of people dying each day, were all at significantly lower levels than they are present, if you look at it from March 1st.

Stating the obvious, the government has not yet taken any decision to enforce lockdown again in the country for curbing the transmission of coronavirus, Health Minister Zahid Maleque said Thursday.

'Currently, we have no plan to impose lockdown. No decision has been taken yet in this regard but mobile courts will be operated. If everyone follows the health protocols, the transmission won't go beyond control,' he said, instead naming a number of micro-steps that the authorities will try and ensure, largely centring people's behaviours.

Mobile courts will be operated across the country to ensure social distancing and mask use, Maleque said, adding, 'People are moving carelessly despite knowing that they could prevent transmission by following health guidelines. We know how to prevent the coronavirus transmission but still we don't follow the health regulations.'

The minister called upon all not to hold social programmes, including wedding ceremonies, to reduce the number of infections. If the COVID-19 situation goes beyond control, it will affect the national economy and create problems for all, he said.

Bangladesh registered 16 more deaths and 2,187 new cases of COVID-19 in 24 hours till Thursday morning. With the latest figures, the COVID-19 fatalities climbed to 8,624 while the total infections to 564,939, according to a hand-out released by the Directorate General of Health Services.

The daily infection rate jumped to 10.45 per cent from Wednesday's 7.68 per cent and the daily number of infected people - 2,187 - the highest this year on both counts. The daily fatalities too hit the highest number of the year -26- on two consecutive days this past week (March 15-16)

The fact that this has happened after Bangladesh launched its nationwide COVID-19 vaccination drive on February 7 has almost inevitably drawn attention to the efficacy of the Oxford-AstraZeneca vaccine, of which more than 4.5 million Bangladeshis have already received the first dose. The second dose has to be taken between 8 and 12 weeks of the first one.

Not having really developed the technical tools to manage the spread of the virus (such as effective contact tracing, or robust testing) the trump card the government was looking to was the vaccine, where it got off the blocks at an admirable tilt. It is providing the vaccine for free. It has an agreement for the purchase of 30 million doses with the Serum Institute of India, which has been licensed by AstraZeneca to manufacture the shots. More will be coming under the WHO's Covax facility. SII would provide five million doses every month between January and June, with the first two shipments having already arrived. The Indian connection has been kept close to hand from the very beginning by the blindly or unhelpfully anti-Indian elements in society as a sort of last resort to create uncertainty and fuel some sort of social discord over the vaccine by fuelling 'vaccine hesitancy'.

Suggestive comments were made to lend the impression that 'Covishield'- which is merely how the Oxford-AstraZeneca vaccine is being branded by SII- was somehow pharmacologically different from the original (it is not). Or that inferior inputs may be used in the process by an 'Indian manufacturer'. SII's track record however is very good and provides no fuel for such claims.

Maleque had said that the age limit for getting the vaccine will be revised when more doses will be available in the country.

Bangladesh does not plan to suspend its rollout of the AstraZeneca vaccine although a cascading number of countries doing so over reports of some recipients developing dangerous blood clots.

Noting the suspension in some European countries this week, Md Abdul Mannan, secretary of Health Care Division, said that no unusual side effects had been reported after taking the vaccine in Bangladesh.

'Those who've taken the first dose of the vaccine so far are all in good health. So, Bangladesh has no plan to halt its vaccine drive,' he said, before adding, 'I don't see why some countries have chosen to suspend its use.'

Bangladeshis would do well to recognise there may be other politics at play behind the decisions by some European countries this week. Besides, they have had to go back on those decisions within days. As things stand, getting the vaccine is still the best way forward for us to beat the pandemic. And it is hugely irresponsible to try and drive a different narrative.

Much ado over clotting

First, France abruptly halted AstraZeneca vaccinations. Now, the French prime minister wants to get one as soon as he can.

With the virus rebounding from Paris to Budapest and beyond, European governments that rushed to suspend use of AstraZeneca vaccines after reports of blood clots are realizing the far-reaching impact of the move. And they suddenly seem eager for any signal - or fig leaf - that allows them to resume the shots.

That came as soon as Thursday, when the European Medicines Agency released initial results of its investigations into whether there is a connection between the vaccine and the blood clots. So far, the EMA and World Health Organization have both said there's no evidence the vaccine is to blame.

Italy, France, Germany and several other countries will resume administering AstraZeneca jabs from Friday after Europe's medicines regulator said the vaccine was "safe and effective" and its benefits outweighed its risks.

Portugal will resume on Monday, Spain and the Netherlands next week, while Sweden's public health agency said it would take "a few days" to decide.

The European Medicines Agency (EMA) had launched a review after about 30 cases of unusual blood clotting and low platelet counts in recipients of the vaccine prompted more than a dozen EU countries to suspend its use.

The EMA's director, Emer Cooke, said the agency's safety committee had reached "a clear scientific conclusion" and had not found that the vaccine was associated with an increase in the overall risk of blood clots.

However, it did uncover "a small number of cases of rare and unusual but very serious clotting disorders", and Cooke said the EMA could "not rule out definitively a link between these cases and the vaccine", which was being investigated.

A warning in the vaccine information would draw attention to "possible rare conditions" to help recipients and healthcare professionals "prevent and mitigate any possible side-effects", she said.

Fight the hesitancy

DGHS in a statement on Monday was forced to clarify there is no risk of testing Covid-19 positive as a result of taking the Covid-19 vaccine shot.

It comes after some public figures revealed they tested positive despite taking their first dose of the vaccine.

Disaster Management and Relief secretary Md Mohsin tested positive for Covid-19 twelve days after receiving his first dose of the Oxford-AstraZeneca vaccine that is being rolled out in Bangladesh.

Bangladesh national hockey team coach Mahbub Harun tested positive with 65 per cent infection in lungs within a week of taking his first dose of the vaccine.

Renowned film director Kazi Hayat and his wife also tested positive within just six days of receiving their first dose of the vaccine.

These prominent cases combined with the current upswing in infections as well as deaths to fuel questions over the efficacy of the vaccine - to the point that some began to link testing positive to having taken the vaccine.

Why you may still test positive?

While some vaccines stop people from getting infected, providing what is called sterilising immunity, others are aimed at preventing symptomatic disease - you may still get infected, but the immune response triggered by the vaccine will fight off severe disease. The Covid-19 vaccines fall in the latter category.

The DGHS statement rested on the fact that no-one in Bangladesh has yet received the recommended two doses of the vaccine in the first place.

"One has to wait a minimum of two weeks after taking the second shot to get the maximum immunity from the Covishield vaccine used in the Covid-19 vaccination drive," it said.

The Oxford-AstraZeneca vaccine is being branded as Covishield by its licensed Indian manufacturer the Serum Institute of India (SII).

"The risk of being infected with Covid-19 stays the same if the health guidelines are not maintained properly during this waiting period (between the first and second doses)."

"It is true that the immune response starts after taking the jab but protection comes only once a person completes the recommended dosage," Be-Nazir Ahmed, former director (disease control) of the DGHS, told on Monday evening.

He also said, "Vaccination means one has to complete taking all the doses of a vaccine to get the complete protection."

"As the AstraZenecca Covid-19 vaccine is a two-shot vaccine, one cannot claim to be infected by Covid-19 despite vaccination before taking both the shots," he added.

To measure the efficacy of a vaccine, completing all the doses is a precondition, Be-Nazir said.

"The virus can enter one's body before taking the shots and be in incubation period, without showing the symptoms. During this period if one takes the vaccine and then tests positive, that would actually be due to a prior exposure. As the virus was already in the body and the immune response triggered by the shot hadn't started yet, the person would end up with Covid-19," said the former director of DGHS.

It may be mentioned that Covid-19 is the name given to the disease caused by infection with the novel coronavirus.

Be-Nazir pointed out that it is being advised across the world to keep maintaining the non-pharmaceutical health guidelines alongside vaccination drives now underway in a number of countries.

"The AstraZeneca Covid-19 vaccine was claimed to have an efficacy of 60%-70%, meaning caution has to be maintained even after taking the two shots," he reminded.

"However, vaccination is important and logical as it lowers the risk of severe disease or death from COVID-19. To protect your life you must take the vaccine," he concluded.

Return to lockdown?

Experts advising DGHS on Tuesday suggested that the government should impose a complete lockdown throughout the country to rein in the coronavirus situation as both COVID-19 infections and deaths are spiking again. If a countrywide complete lockdown is not possible, the DGHS meeting advised the government to restrict public movement maintaining the 'economic balance' of the country.

DGHS director general ABM Khurshid Alam presided over the meeting. The suggestions from the meeting were sent to the Health Ministry, officials confirmed.

Talking to reporters after the meeting, Khurshid said that the decision about a total lockdown had not been taken yet but people should follow the health practices. The meeting was held on the back of the sudden deterioration in the COVID-19 situation. The meeting also advised the government against opening educational institutions - at present set for March 30, unless the authorities do step in.

It suggested restrictions on religious gatherings during the upcoming Ramadan and a shorter Eid vacation.

The worsening COVID-19 situation has stirred the authorities, with the health minister ordering legal actions against those not following the mandatory mask-use rule.

'We've ordered the authorities concerned to take legal measures, including mobile court operation and fining those who violate the mask-use rule,' Health Minister Zahid Maleque told reporters at his office on Monday. 'The district committees have been asked in writing to ensure that the people follow the health guidelines or they take legal actions against the violators if needed.'

People ignoring health practices like wearing masks and maintaining social distancing have become commonplace in recent days after the country witnessed a comparatively better COVID-19 situation in January and February. Some public health experts concede that people's reluctance to follow the health practices most likely was fuelled by the unpragmatic and unscientific statements made by people in positions of authority, of having defeated COVID-19, or making not altogether relevant comparisons with rich, industrialised nations that have been ravaged by the virus (Italy, UK, USA, and others) to hog the credit for something they may actually have no power over.