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.