MA Faiz, professor of Medicine and former Dean of Medicine, Principal, Dhaka Medical College and Director General of Health Services, is an internist and a recognised global expert on tropical and infectious diseases for conducting research on malaria, snakebites, etc. He was associated with a number of collaborative researches leading to publications in peer reviewed journals like Lancet, AJTMH, Brain. One of his articles on malaria in the Lancet was awarded BMJ research paper of the year 2010. He recently spoke to Prothom Alo about COVID-19 and related issues.

How do you see the risk of COVID-19 attack among the Rohingya in Bangladesh?

COVID-19 has been recognised as a serious international health problem. There are a few specific population groups who are especially endangered and vulnerable like the displaced population and refugees.

There are more than one million Forcefully Displaced Myanmar Nationals (FDMNs) in Bangladesh who live in extremely confined spaces in large refugee camps located at Ukhiya and Teknaf in Cox’s Bazar district, Bangladesh. A lot of foreign organisations and researchers are working there. In recent times, the COVID-19 has turned into a pandemic and the IOM and UNHCR should take urgent and realistic steps regarding the refugees.

We have seen that people coming in from abroad have been told to self-quarantine in their own homes or in hospitals if they are infected. Yesterday the Journal of American Medical Association (JAMA) released an important publication where they talked about ways of preparing and tackling COVID-19 in poorer countries where resources are limited. They have clearly mentioned refugees in the publication. Since the FDMNs have larger families than Bangladeshis and live in single-room or double-room houses, it might not be possible to quarantine them in the same house as the rest of the family. Quarantine areas have to be arranged outside of the camps for the refugees if the virus emerges there.

How do you evaluate the UN move to protect FDMNs from the menace of COVID-19?

I don’t know if the international organisations or researchers have carried out any tests or raised awareness there yet, but it falls under their responsibility to raise awareness, identify symptoms and keep everything under surveillance. There are many organisations there to carry out surveillance. They have to look into this area to address COVID-19 among the refugee population (FDMNs) housed in Bangladesh.

This should be addressed very quickly because if there is an outbreak, it will spread very rapidly and there might be havoc, not only among the refugees, but also among the hosting population of Bangladesh in Ukhiya and Teknaf.

In order to prevent that, they have to have adequate preparation, having small facilities with particular attention to quarantine with health structure facilities to deal with patients with adequate infection prevention and control with a dedicated infection related hospital having attached intensive care units with resources. I think this would be a priority area for the organisations including UNHCR, IOM, WHO and so and so who are dealing with these problems in that area.

There are lots of repatriates working there. We have to have a very close watch on them because there might be some repatriates from affected countries there. There is a lot of humanitarian assistance, health assistance, there are many workers working there so we have to keep watch on those workers as well. If someone has returned within last few days then they have to be quarantined. That quarantine facility may be at Cox’s Bazar in some hotel or somewhere else. This should be the top most priority in order to prevent the emergence of COVID-19 in the refugee camps among the Rohingyas in Cox’s Bazar.

Has there been any statement from WHO or other international organisations regarding steps to prevent coronavirus among the Rohingyas?

So far, no, I have not seen anything significant. It didn’t come to my notice but there is coordinating mechanism at Cox’s Bazar under the leadership of the coordinator, under the guidance of the health ministry. I am not quite sure if they are taking it as an important agenda to prevent the COVID-19 among the Rohingyas, but this should be a priority for them as well.

What should be the major concern or the immediate measures and should the Bangladesh government take measures?

I think it is the responsibility of the international organisations not only the government of Bangladesh. I think there should be an effort particularly to have surveillance on COVID-19 not only in the host community but also among the refugees, in the FDMNs as well as the migrant workers who are working the repatriated workers.

There are the FDMNs having limited space, compromised nutritional status. They are more vulnerable, there are women, elderly and they are poor in nutrition. There should be a surveillance for them. There should be a surveillance for the workers working there and there should be a mechanism to detect them early. In order to detect this disease, there should be some diagnostic facilities in that area. At the same time they have to have adequate preparation like Bangladesh has drafted an action plan, there should be some action plan for FDMNs also related to COVID-19. There should be a hospital dedicated to treating patients with special reference to critical care or ICU care because small proportions will require respiratory support on the eve of outbreak.

There should be a separate space for quarantine because they are the population who cannot be quarantined at home. We can request for quarantine or dealing with the early stage of diseases at home in our community but for them, their houses are very dilapidated, they are very small and compact so there should be a separate system for them may be close to the community. They should not be transferred to Cox’s Bazar district hospital because there would be an additional problem in the health system. In order to prevent pressure on the existing Bangladesh health system, there should be proper system of infrastructure and quarantine, for management of patients, with special reference for infection and control with dedicated, trained human resources for dealing with this particular issue of COVID-19.

Don’t you think that taking quarantine measures at Cox’s Bazar would be difficult?

This is a very new emerging problem in Bangladesh. Bangladesh has taken enough steps earlier for prevention, treatment and diagnosis of so many conditions like ARI, diarrhoea, measles, TB, malaria, HIV, Hepatitis-C, so on and so forth. So this is a new emerging problem so definitely there might be steps because already there is a drafted action plan from Bangladesh government, definitely they will look into it because Bangladesh providing humanitarian service with our limited resources but we have to keep it in mind that we have limited resources. Our system will be distressed if there are a large number of cases. By this time we have 18 cases, half of them are from within the community giving some hint that there is already human to human transmission happening so I think we have to that keep in mind.

Transmission can happen through asymptomatic cases. There are so many workers there, so many migrants, so many people from different countries, even from Europe, America so many workers. We don’t know what is happening. We have to have a very quick surveillance system in place in the FDMN camps.

Do you suggest that WHO should immediately send a specialised team to visit Cox’s Bazar and take necessary action?

I’m sure the coordinating system in place at Cox’s Bazar is also on the watch but I request them to have an immediate surveillance system, facilities for diagnosis of COVID-19 in that area. In Bangladesh we have got only one diagnostic centre in IEDCR in Dhaka. They have limited capacity for bringing samples from remote areas. By this time there should be some samples collected from surveillance sites based in the camp area.

Prime minister Shiekh Hasina had inaugurated the Bangladesh Institute of Tropical and Infectious Diseases (BITID) in Chattogram but it is still in limbo. The French-donated Rodolphe Merieux Laboratory at the BIDIT is suffering from lack of equipments. Keeping in mind the future need for testing and treating the FDMNs, should it not be allowed to function fully?

Thank you. You know the Bangladesh Institute of Tropical and Infectious Diseases (BITID) is the national institute for dealing with infectious diseases based in Faujdarhat, Chattogram. It has started functioning with limited resources, with limited space. This is an opportunity where we have to have much attention to develop it further.

We have a full-fledged institute with enough human resources, enough space, enough logistics for diagnosis and detection of dangerous organisms like the COVID-19. They have limited capacity. This needs much strengthening, because this is the only national referral hospital dedicated to infectious diseases. On the other hand, it will not be wise to send patients from the FDMN camp in Ukhyia to Chattogram because during transfer, there might be a problem if there is a suspected case then there may be spread through droplets, through other mechanisms. It is better to have a dedicated facility close to the camp area instead of transferring into Chattogram.