Mushtaq Hussain, adviser to the Institute of Epidemiology, Disease Control and Research (IEDCR) and former chief scientific officer of the institute, speaks in an interview with Prothom Alo about various aspects of the coronavirus outbreak in the country.
In the recent Economist report, ‘Deadly Tide’, it was said that by the end of July, the number of coronavirus cases in India, Bangladesh and Pakistan may reach 5 million and the death toll 150,000.
Commenting on these estimates, the IEDCR adviser said the report was based on epidemiological modeling. Such reports would not be openly published before due to the sensitive nature of the issue.
If we provide the marginalised people with food and raise their health awareness, we can prevent the infection from spiking.
He pointed to Peru as an example, though it has a higher per capital income than Bangladesh. Over there, people emerged from their homes within one month of the lockdown. The social distancing conditions were violated by the working people and the transmission of the virus shot up, with around 200,000 infected and over 5000 deaths. And in its neighbouring country Brazil, known for its complacence, the death toll reached 35,000.
It is the marginalised people who are having to come out of their homes, said Mushtaq Hussain, pointing out that like Peru and Brazil, the densely populated areas of the working class would be at risk.
He recommended that the government, volunteers and NGOs be on alert to ensure this situation does not arise in the country. He said a Philippine health worker, in a Zoom conference, had said that they were being very cautious so that the transmission of the virus did not spike as it did in the deprived areas of Italy and the US. Mushtaq Hussain said, If we provide the marginalised people with food and raise their health awareness, we can prevent the infection from spiking.
Recently Mushtaq Hussain had told the media that the number of COVID-19 cases in the country was around 30 to 40 percent more than the government’s figures. Did that apply to the number of deaths too?
It is an epidemiologic calculation, he responded. During swine flu it was said that there were at least 10 percent more cases than those testing positive in the labs. That rate was 1.5 percent. This is called the reproductive factor. In Wuhan, the rate of COVID cases was 2.5 percent. In Bangladesh it is 1.25 percent, but this is on a rise. So in Bangladesh the patients with mild symptoms are 10 percent more than detected in the labs.
This, he said, did not apply to the death rate. In Bangladesh it is difficult to hide the number of deaths. The number of people dying with COVID symptoms, just based on Prothom Alo reports, is less than 500. So you can just add 500 to 888. Then again, not all those dying of these symptoms are COVID positive. Of course, many want to hide their symptoms, but when respiratory problems develop, the patient has to go to the hospital. But the hospitals are not really overflowing with patients.
He went on to say that a couple of weeks ago, IEDCR collected information from the local government and hospitals regarding the number of people who had died of such symptoms. This is referred to as ‘verbal autopsy’.
It has been three months that the World Bank appointed Mushtaq Hussain as a consultant. He said that they were providing them all sorts of assistance to increase the government’s capacity to tackle COVID-19 in order to avoid an explosion of the contagion. They share the same view as the World Health Organisation (WHO) concerning Bangladesh. The government and the World Bank have taken up a three-year project to tackle COVID-19.
That does not mean that COVID-19 will linger on for three years, he hastily added. The project will be speedily implemented, but there are some other additional issues that are of a three-year term. The immediate implementation includes increasing tests, supply of emergency medical equipment, masks and PPE as well as training.
If the marginalised population is not provided with adequate assistance and if the people all over the country are included in this process, then the rate of transmission and damage will go out of control. We may fall into a total crisis then.
The IEDCR principal scientific officer recently told Prothom Alo in an interview that if the virus spreads extensively, then tests won’t be needed. Treatment will be simply given according to the symptoms. Will the government take up this strategy?
Mushtaq Hussain replied that the IEDCR principal scientific officer may have been referring to the institute’s surveillance test, that is, to assess how many cases have increased in each area. There may be a misunderstanding here. IEDCR wanted tests for research purposes, he said, but when we began testing, the number of confirmed cases was below 20 percent. But from 24 May, one out of every 5 persons tested were COVID-19 positive. That was a small leap.
Prothom Alo pointed out it took three months to reach 15,000 tests a day. This needs to be upped to at least 30,000 tests daily. Accurate sample collection is required too. Also, medical technologists were not being appointed and they had been demonstrating at the IEDCR campus in Mohakhali on Sunday.
In response, Mushtaq Hussain that it would not take long to reach 30,000 tests a day as the process had already gained momentum. However, the delay in appointing medical technologists was unfortunate. He said if the crisis in this workforce could be resolved and if the labs in various universities could be involved in the process, then within a month it would be possible to test 30,000 samples per day.
About the feasibility of area-wise lockdowns, given that so many members of the police force had been infected, Mushtaq Hussain said that Tolarbag in Dhaka and Madaripur were examples of effective lockdowns. This was possible because it was the local people, not the police, who had be included in the process. This must be done in the coming days too and that is why the local government and volunteers were being included. In densely populated areas where people can’t be isolated at home, they can stay in community isolation. But it is also true that the number of cases in every urban area of the country is on an alarming rise.
About the hopes and the concerns ahead, Mushtaq Hussain said that till now the rate of transmission was slow. That was the first sign of hope. The second sign of hope was the government’s zone-based lockdown strategy. If this is successful, we will be able to keep the transmission in control.
As for the concerns, he said that if the marginalised population is not provided with adequate assistance and if the people all over the country are included in this process, then the rate of transmission and damage will go out of control. We may fall into a total crisis then.
* This interview has been rewritten in English by Ayesha Kabir