Rumi Ahmed Khan currently is the director of training programme at Orlando Regional Medical Centre in Florida. Also an associate professor of medicine (Respiratory and ICU), he migrated to USA in 1995 after doing his MBBS from Chattrogram Medical College in 1993. He spoke to Prothom Alo on COVID-19 over phone on Monday.
USA and Europe are at high risk due to the weather. Are we less likely to be attacked by coronavirus as claimed by the director general of the Directorate General of Health Services (DGHS)?
Rumi Ahmed Khan: There is a relation of this disease with cold. It spreads in bitter cold and it cannot survive for long in hot weather. But it is highly contagious. If it survives for a little time, it infects and transmits into human body. After transmitting into human body, it grows in same temperature as the temperature of human body is same under all weather. So it cannot be claimed that it will not spread due to hot weather. Miami is hotter than Bangladesh. Louisiana is similarly hot. Both of these places are badly affected by coronavirus. Singapore is not a cold country either. One thousand tested positive in Miami on Monday alone.
Director general of DGHS said he will closely observe next seven to ten days.
Rumi Ahmed Khan: He should have started this one month earlier.
How is the experience of your hospital? How are the tests being conducted? Is it true that a single test cannot detect the virus accurately?
Rumi Ahmed Khan: It is a very important issue. We have to keep in mind that the tests conducted by PCR have only 60-70 per cent accuracy.
So the guidelines of Center for Disease Control and Prevention (CDC) in Atlanta suggest conducting tests in two ways. We conduct reverse transcription polymerase chain reaction (RTPCR) twice on a patient with COVID-19 like symptoms if he or she comes from a hotspot. If they test negative, we call these patients free from COVID-19.
On the contrary if a person does not come from a high risk area and his symptoms have different explanation and other reports are good, without depending on test, it can be said the person is free from coronavirus.
In many cases, China, South Korea and Singapore conducted test twice. First time test results were negative. With a pause of 24 hours, they have conducted test again on a patient with symptoms.
How many patients died in your unit? Whom they contacted with?
Rumi Ahmed Khan: As there is a regulation, we cannot disclose the total number. Three people died in the last one week. They all lived in nursing homes. It is noticeable that those who died in Florida did not have any contact with any foreign source. First infected person visited Egypt. Most of them were living in nursing home. 29 patients with coronavirus positive admitted in the hospital today (Monday). 136 suspects are waiting for test.
As the test is very important at this moment and it would be better to explain the matter in detail.
Rumi Ahmed Khan: BBC health and science correspondent James Gallagher wrote a report on 20 February. According to the report, a person is free from coronavirus after he tests negative for six times.
Quoting journal radiology, the report said out of 167 patients whose lungs are sick and test negative first, five patients test positive for coronavirus later. How is the study credible?
Rumi Ahmed Khan: It is definitely credible. Chinese journalists found patients, who test negative for coronavirus for six times, test positive for coronavirus for the seventh time. On 29 March, Saurabh Jha in the Health Care Blog wrote that as per a Chinese study tests conducted by PCR are 70 per cent correct. Of 1000 infected, 300 patients test negative for coronavirus but they were infected. US experts agree to this study.
In Bangladesh, IEDCR spokesperson in regular briefing assures that the number of infected patients is low. They conducted tests on 162 persons with coronavirus like symptoms on Sunday and Monday. None tested positive for coronavirus.
Rumi Ahmed Khan: Tests are being conducted very little in Bangladesh. The government will not be able to do it alone. Bangladesh has made a mistake while enforcing lockdown. The city was hotspot for coronavirus in Bangladesh.
Coronavirus was not detected in rural areas. While enforcing lockdown, people were allowed to travel to different parts of the country. This has heightened the risk.
What can Bangladesh do at this moment?
Rumi Ahmed Khan: On an average, 100,000 people have to be tested every day.
Is it possible? Bangladesh has tested 1,185 people so far.
Rumi Ahmed Khan: Many countries including South Korea have done this. The government has to hold meeting with the authorities of private labs. They have to be provided with all sorts of support. They will be able to do. Ten labs can carry out 1000 tests every day. I believe our private labs have such capacities. All including US and China have increased capacity with the help of private organizations.
BUET engineer Hasmatuzzaman is a hospital affairs utility professional. In an interview with Prothom Alo, he said hospitals or bed rooms of infected have to be brought under negative pressure flow. This means air of the room should not be allowed to go out, only filtered air will be allowed to go out.
Rumi Ahmed Khan: I fully agree with him. As soon as possible, negative pressure flow system has to be built at hospitals and healthcare facilities If this can be done, physicians and nurses will be safe there. This is necessary.
The health minister on Sunday said there are 500 ventilators in the country. Besides, there are 400 ICUs at public hospitals and 700 at private ones.
Rumi Ahmed Khan: ICUs at the public hospitals are filled with patients throughout the year. We have to determine who will be given priority. I think young people should be given priority to save them.
Skilled manpower is necessary for ICU. Only ICU beds will not yield good results. Developed countries including US are struggling to increase ICU beds.
The government says there are sufficient PPE and masks. But the reality does not say so. What should the physicians in Bangladesh do?
Rumi Ahmed Khan: There are various types of PPE. We use one time PPE. When I go to a patient, I use P-100 mask. But all US physicians and health workers do not use P-100 mask. Many of them use N-95. We collected P-100 mask during the outbreak of Swine flu in 2009.
This mask is used in gas fields. I must say training is necessary in using PPE and mask.
Can you suggest some steps for policymakers of Bangladesh?
Rumi Ahmed Khan: Bangladesh needs an Anthony Fauci who will brief the nation every day. He will be the person who has guardianship among the physician community. IEDCR is a specialized laboratory. They are not related to the treatment. They can only provide information. It requires updated information with analytical reports every day.
On 30 March, CNN said Fauci on the basis of a model on Sunday said one million or above people may die in the US. Do the people believe this?
Rumi Ahmed Khan: Physician Fauci is a respected person in the US society. General people and experts believe him.
What is this model? Is this the model of London Imperial College on which Boris Johnson’s adviser professor Neil Ferguson has come to discussion. Experts including WHO fear that 500,000 people may die if proper steps are not taken on the basis of that model.
Rumi Ahmed Khan: It is an intellectual exercise. Epidemiologists of entire world have accepted the model of Imperial Model and Johns Hopkins Model. There is no controversy over it.
Suggest steps for the government to tackle coronavirus.
Rumi Ahmed Khan: A national taskforce will have to be formed. A person like Fauci will lead it. The briefing now is being presented, the situation and intensity of coronavirus are not reflected. The head of the taskforce will advise like a guardian and others will follow.
The government has to consult with the medicine companies whether are adequate seductive if 5,000 people need ventilators. With help of BGMEA, proper PPE have to be made. Health workers have to be trained up how to use it. Infected patients will need sufficient oxygen. The government has to settle with Bangladesh Oxygen how they will provide oxygen.
In 1918, deadly flu lasted long. How do you view the lasting of coronavirus?
Rumi Ahmed Khan: The soldiers were in the bankers and they helped spread. That will not happen this time. I hope the intensity of coronavirus will subside by June next.
Rumi Ahmed Khan: Thank you.
* This interview, originally published in Prothom Alo's print edition, has been rewritten in English by Rabiul Islam.