‘Our capability to fight infectious disease is low’

MA Faiz is a professor of medicine (retd) and former principal of Dhaka Medical College. He also worked as director general of the health directorate of the Bangladesh government. Prothom Alo’s Mizanur Rahman Khan talked to him about preparations to face the probable risk of novel coronavirus infection and Bangladesh’s capabilities and weaknesses in this regard.

Prothom Alo: We have been hearing about the government’s preparations to prevent novel coronavirus. But let’s assume the virus entered Bangladesh. How far is the country ready to fight it?

MA Faiz: Our health service institutions have to follow the guidance on infection prevention and control (IPC) strategies issued by the World Health Organisation (WHO) to treat the ‘suspicious cases of novel coronavirus infection’ to prevent infection and control its outbreak. Since the SARS and MERS outbreak, five strategies have been taken up to prevent or limit transmission of such virus. Those are: early recognition and source control (isolating patients with suspected COVID-19 infection), applying standard precautions for all patients, implementing empiric additional precautions (droplet and contact and, whenever applicable, airborne precautions) for suspected cases, implementing administrative controls and using environmental and engineering control.

Prothom Alo: That's the government's task. What will the citizens do?

MA Faiz: That guidance also specifies the responsibilities of citizens. Encouraging hygiene related to breathing is important for prevention. Using tissues or handkerchiefs while sneezing, trying to control sneezing and coughing and washing hands properly are very important.

Prothom Alo: Virus attacks have become incessant. How strong is the infrastructure of our health sector to detect and treat those viruses?

MA Faiz: Health departments with well-trained and sincere health workers are essential for treating and control infectious and viral diseases. There are scopes to make the existing institutions stronger as well. There’re over 110 government and private medical colleges in the country. Those colleges teach about infectious diseases on a limited scale but the hospitals attached to them have very limited facilities of treating infectious diseases. In fact, the colleges, including the Bangabandhu Sheikh Mujib Medical University (BSMMU), do not have specialised departments for detection and treatment of infectious diseases.

Prothom Alo: Has not anything cropped up in the last decade?

MA Faiz: It is a harsh truth that there’s weakness in establishing our institutions for infectious diseases.

Prothom Alo: Wasn’t there any step taken after the independence? What was the situation before independence?

MA Faiz: Considering the importance of the discipline, the government established the Bangladesh Institute of Tropical and Infectious Diseases (BITID) in Faujdarhat, Chattogram in 2013. During the Pakistan period, five government medical colleges opened ‘isolation wards’ following the outbreak of cholera, chicken pox, smallpox and other infectious diseases. You can consider those as the precursor of current treatment system of infectious diseases in the country. But there was the Institute of Tropical Medicine in Mohakhali in Dhaka then. That was the only institution of its kind but it was closed in 1972. There is the Institute of Public Health on that premises.

Prothom Alo: Maybe we will forget everything when the coronavirus crisis is over. Tell us something more about it.

MA Faiz: Deceased national professor Nurul Islam has written the ‘History of IPGMR’ (current BSMMU). He said there was a reason to shut down the Institute of Tropical Medicine at Mohakhali. The plan was to shift all kinds of specialised treatments, including the works of abolished institute about infectious diseases, to IPGMR. But that did not happen for various reasons. That created a vacuum in detection and treatment of infectious diseases in the country. The effect is still going on. But to some extent prime minister Sheikh Hasina has filled the deficiency by inaugurating the BITID in Chattogram in 2013. There’s a specialised facility to conduct research on infectious diseases.

Prothom Alo: We talked to the BITID director professor MA Hasan Chowdhury on 5 February. He said the institute’s hospital facility was actually opened after another four years. Out of its Tk 3 million budget, only Tk 250,000 is for research. The number of staff is only 11. Even the small research facility was established with aid from France.

MA Faiz: That’s why I am saying there’s a huge scope of developing the country’s only specialised infectious disease research institute. If you look at other sectors of medical treatment, you would see tremendous development. There are 16 departments or facilities (for example heart, kidney, liver, lungs etc.) in medicine. But though the infectious disease is a very important problem of the country and new infectious diseases are infecting people more often than not, our preparation is not enough.

Coronavirus is the name of a group. SARS and MERS also were coronavirus. The latest one is 2019 novel coronavirus. Maybe we will get escape from this one but there will always be new infectious diseases.

Prothom Alo: The BITID treated over 100 patients of measles in 2017, 76 patients of Hepatitis-B in 2018, around 275 dengue patients recently, 28 policemen suffering from food poisoning. But the proposal to turn its 3-storey building into 10-storey one is yet to see light.

MA Faiz: I think development in the health sector needs to be balanced. The focus can be shifted to areas that did not get much attention earlier. It is necessary to open separate departments to study infectious diseases along with lab facilities at medical colleges and universities. For example, the microbiology department at medical colleges is for study only, not for research.

Prothom Alo: How much importance is given to the curriculum of medical colleges?

MA Faiz: I think the current curriculum is not enough. Changes should be brought in syllabus and practical training.

Prothom Alo: BITID director professor Hasan informed us that seven new infectious have come to Bangladesh in the last decade. How are the physicians are treating these?

MA Faiz: Based on their assumption, because we don’t have the facility to get microbiology lab test results all the time. As a medicine physician I can say, study of infectious disease must be seen as an specialised discipline. Otherwise, we will not get out of the current practice of treating infectious diseases like dengue, or coronavirus infected patients based on assumption.

Prothom Alo: What was the government’s reaction to the demands for reform in health sector?

MA Faiz: I don’t think there were any well-planned and specific demands raised in this regard. This is one of most significant weaknesses to measure the development of our health sector. The government has special attention to the situation following the coronavirus outbreak. Steps have to be taken to create trained manpower and permanent infrastructure to detect and treat infectious diseases scientifically. What we have to realise most is we must increase our capability to fight against germs including virus. We need to remember it was the poor who were the victims of diseases like smallpox or diarrhoea. But this is not true now. Another thing is the threat of infectious diseases will never end. No one can say there won’t be a new virus. You would get names of over 50 types of germs which are tough to control. So, Bangladesh must come up with a cutting edge disease detection system. Identifying the germ is a must to detect the infectious disease. This is why the working sphere of microbiologists has to be increased. We have made advancement in prevention but we are lagging behind in detection and treatment of infectious diseases in comparison to other countries. We are not talking about providing universal medical treatment. Instead, we are talking about providing quality treatment as was said in Sustainable Development Goals (SDGs). This is why medical colleges should have facilities to study infectious diseases, their detection method and treatment.

Prothom Alo: Why do you think novel coronavirus broke out in Wuhan? Why three viruses bear the same name-corona?

MA Faiz: In Wuhan, there are live animal markets. It is assumed that the virus, like Mers and Sars, was transmitted to human from animal. Genome analysts found out that 80 per cent case of coronavirus resembles with bat-borne coronavirus. So, scientists suspect that the virus might have originated from bats. Also, other animals might have a role. Apart from those three, four other coronaviruses exist which cause flu. Fatality rate of Sars and Mers were 10 and 35 per cent respectively. The rate is 2 per cent in novel coronavirus.

Prothom Alo: Dhaka Medical College Hospital’s medicine professor Robed Amin said infectious disease specialists play significant role in fighting infectious diseases around the world. But there are only 5-6 specialists in our country who are playing active role this time like previous occasions. He thinks, there are no infectious disease specialists in Bangladesh with an authority on the issue. Do you agree?

MA Faiz: I kind of agree. As far as I know, six people got MD (Doctor of Medicine) degree from Chattogram Medical College Hospital on tropical medicine and only one attained FCPS degree from Bangladesh College of Physicians and Surgeons (BCPS) on infectious disease since Bangladesh’s indepedence. There are no posts of teacher or consultant for infectious diseases in any medical college hospital or university in the country.

Prothom Alo: Bangladesh Society of Medicine provided a guideline for the government during the outbreak of Swine Flu and Bird Flu. Professor Robed said he prepared the draft with your help. He prepared a draft guidance within 24-hour of coronavirus outbreak. What do think of that?

MA Faiz: I have seen it and think it dependable. But things like infection, prevention and control have to be included in it.

Prothom Alo: Thank you.

MA Faiz: Thank you too.

*This interview, published in the print edition of Prothom Alo, has been rewritten in English by Shameem Reza and Galib Ashraf