MA Faiz, professor of medicine and former principal of Dhaka Medical College, had also been the director general of the health directorate. In an interview with Prothom Alo, he talks about the fear of another wave of coronavirus, what is to be done and the existing competence and limitations of the country’s health system.
There is a prediction of a second wave of coronavirus this winter. Commenting on the apprehensions in this regard, professor MA Faiz said that during the winter months of November-January in Bangladesh, temperatures fall below 10˚Celsius for a few weeks. All sorts of respiratory diseases crop up in winter. We still don’t have much flu vaccine coverage for older people here. Most homes don’t have temperature regulating systems. People live in cramped accommodations with less ventilation. These are high risk conditions for the transmission of coronavirus.
Also in winter, due to the cold, less attention is paid to cleanliness. People wash their hands less. And if physical distancing is not maintained, respiratory diseases may increase, the professor pointed out. He said that the COVID-19 cases can’t be separated out unless there is testing, but the testing facilities in the country are not adequate.
When asked about apprehensions of a ‘second wave’ of coronavirus, MA Faiz said that the World Health Organisation (WHO) had repeatedly been urging all to follow certain essential basic measures to control COVID-19, such as rapid detection of Covid cases, isolation, quarantine, timely hospitalisation to reduce deaths and so on. Many countries have seen successful by following these steps, with a significantly reduced rate of coronavirus cases and the transmission of the disease in control.
However, he added, as there was still no effective vaccine, there remained the fear of the virus continuing to spread. Given the present state of community transmission, there were apprehensions of an increase in coronavirus cases.
When asked if he agreed there was no longer any need to carry out 25,000 to 30,000 tests a day, MA Faiz said that there was definitely need to carry out tests alongside observing the symptoms. He said that though the coronavirus was a new disease, there were new methods evolving to detect the virus and so on. Bangladesh’s competence in testing has increased too, with 103 PCR labs. New, rapid and easy testing methods and antigen tests were being approved. The government was encouraging suspected patients to undergo tests. The more the tests were increased, the more the cases could be detected. That would facilitate further treatment.
Vaccines were not the only means to control the disease. It was vital for the people to be empowered and knowledgeable about public health
Commenting on opinions that high flow oxygen was adequate to treat patients and that ICU and ventilators were not needed that much, the professor of medicine said there were rules for the medical treatment of patients according to the state of their health. After observation and lab tests, medication, oxygen supply and artificial respiratory support were to be provided according to the requirements. A patient could have mild symptoms or acute symptoms.
There were technical matters involved in the treatment of acute cases, he said. There was no easy way as yet to tell when a patient may turn critical. If patients with mild or medium COVID-19 symptoms could be observed and treated appropriately, the number of critical patients would lessen. Critical patients required intensive case and this was costly too. He said that the government has taken this into consideration and was taking initiative to set up ICUs at a district level.
How will people react if there is another lockdown? MA Faiz said that the entire world was going through the first phase of the global pandemic and Bangladesh was no exception.
He said, “Did we ever imagine that we would have to follow such an extensive worldwide public health regimen? It will be possible to ensure wide public participation by mobilising public awareness. Actually there is no alternative to public health empowerment of the people. That hasn’t been adequate until now. But there is scope to effectively follow the standing orders of disaster.
Will risks grow as air travel gradually resumes? MA Faiz said that in this day and age of globalisation, it is essential to remain connected globally. COVID-19 has actually created scope to apply the basic public health rules in travel.
The former principal of Dhaka Medical College, when asked whether, in the last six months, there has been an improvement in the professionalism of the health directorate, the physicians, the nurses and in the overall management, remarked that health management was a collective complex matter. Trained health professionals were an essential part of the process. Creating health professionals of a high standard involved time. From the outbreak of COVID-19, there has been various programmes, guidelines, papers, fund management, the involvement of development partners and professional groups. The work strategy to deal with the pandemic has been updated by WHO on 7 August 2020.
Has the coronavirus transmission spiked and started to go down in Bangladesh?
MA Faiz said that why coronavirus hadn’t spiked so extensively in Bangladesh was a matter of observation and research. Further research will make things clearer. Things were at a community transmission level now. It could not actually be said that the transmission had decreased.
In reply to the questions about genetic factors being behind the relatively less COVID deaths Bangladesh and also the impact of herd immunity, MA Faiz said it was observed that that within the limited health system of the country, there were around 5000 or so deaths among the over 300,000 cases. There needed to be scientific study of the matter.
Speaking about the vaccine, MA Faiz said that vaccines were not the only means to control the disease. It was vital for the people to be empowered and knowledgeable about public health.