Interview: Poonam K Singh, Regional Director, WHO South-East Asia Region
‘The virus is spreading at community level in Bangladesh’
Dr Poonam Khetrapal Singh, Regional Director, WHO South-East Asia Region, in an exclusive interview with Prothom Alo’s Delhi correspondent Saumya Bandyopadhyay, talks about the coronavirus outbreak in the region, trends in the transmission of the virus, health systems in the countries of the region, challenges and the way ahead.
South Asian countries got a few weeks extra to tackle the COVID-19 pandemic as it started in China last year and then travelled to South Asia during the early quarter of this year. Have South Asian countries have been able to successfully utilise this advantage?
WHO South-East Asia Region was the first outside China to report a confirmed case of COVID-19 in Thailand on 13 January. Ever since the outbreak was confirmed by China, countries in the region initiated surveillance at all ports of entries to check travellers for symptoms of the new coronavirus. Isolations centres were set up. Countries started preparing hospitals, laboratories, training health workers, and began engaging with communities on the new disease with whatever was known about the virus, even before they received their first cases of COVID-19 importations.
The lockdowns initiated in several countries of the region was an opportunity used to scale up capacities. And this has been ongoing. The speed and scale of response that we have seen and continue to witness, has been possible with top leaderships of our countries driving the response to ensure all sectors are engaged.
Pakistan, India, and Bangladesh are contiguous nations. It is apparent that the pandemic is well controlled in Pakistan and to some extent in Bangladesh. But in India it is spreading daily menacingly. What could be the reasons for this?
India and Bangladesh are part of WHO South-East Asia Region. However, no two countries are the same and can’t be compared. Even within a country the challenges, capacities, and even transmission of virus differs.
The pandemic is on the rise globally. Across the world we have seen COVID-19 case numbers go down and then rise again. Therefore, we cannot assume that the situation is under control anywhere.
The rise cases in India can be attributed to a number of factors, the most important one being aggressive testing and contact tracing in recent weeks. India has ramped up its testing to over a million tests per day, the highest by any country globally. While the health authorities are focusing on strengthening implementation of core public health measures – test, trace, isolate and treat - this needs to be complemented with more stringent implementation of COVID-19 appropriate behaviours such as physical distancing, wearing of masks, hand hygiene etc. It’s only together, and with efforts of each and every person, that the COVID-19 transmission chains can be broken.
Which South Asian nation, according to you, has done a great job to combat the pandemic?
All countries are making concerted efforts. As I said, we cannot compare one with another. Countries with long term investments into health systems like Thailand and Sri Lanka have been able to manage the outbreaks earlier than others. For some other countries in the region like Bangladesh, India, Indonesia, Bangladesh, we must factor in their unique challenges. Their size, population size, density of population, diverse geographical and socio-economic conditions add to their challenges for stopping transmission of any communicable disease, including COVID-19, despite their unprecedented efforts.
What is the nature of, and at which stage is, COVID-19 in Bangladesh?
Bangladesh is in the community transmission phase which means the virus is spreading at community level without always knowing the precise source of transmission. However, the efforts of the Government of Bangladesh in coordination, early detection, and promotion of medical and non-medical interventions, have succeeded to limit the spread of the virus in the country and to keep the number of newly infected persons in need of medical assistance to levels that allow the health system to cope.
The death toll in Bangladesh is less compared to the number of infections. What could be the possible reason for this? Is it perhaps herd immunity?
WHO is working closely with the Ministry of Health & Family Welfare on the COVID-19 response, including for recording deaths due to the virus. There is no technical evidence supported with relevant data to speculate about herd immunity.
In addition, efforts have been made to strengthen capacity of the health facilities by providing human resources, equipment, and training of health staff on infection prevention and control, contact tracing and case management.
Is Bangladesh conducting fewer tests for the virus? What suggestions has WHO given to the government?
WHO has been working with the health ministry to scale up COVID-19 testing capacity in the country. From one laboratory at the start of the outbreak, the country now has 92 laboratories across the country that are testing for COVID-19. Bangladesh is following WHO’s surveillance guidelines. There are plans to further expand laboratory capacity especially in low reporting districts and areas to ensure that every suspected case is tested, confirmed cases isolated, and their contacts traced and tested.
Do you consider the steps taken by the Bangladesh government to be correct? Are there any shortcomings?
Bangladesh has been making concerted efforts, mobilising health care systems, public employees, security forces, and engaging communities. Like other countries, Bangladesh’s response has been impacted by global shortage in COVID-19 related supplies and disruption in international supply chains. Furthermore, the high population density from Bangladesh is an additional challenge in fighting any communicable diseases, including COVID-19.
Therefore, while the country continues to respond to COVID-19, it is very important to make sure that provision of essential health services is resumed, after being disrupted by COVID-19. We are already seeing vaccination services getting back on track and encouraging improvements in restoration of services for noncommunicable diseases, maternal and new born health, etc.
What steps should be taken by the Bangladesh government to arrest COVID-19 at this stage?
At this moment Bangladesh should continue the blended approach of strengthening prevention measures at community level while ensuring adequate capacities to offer medical treatment to those affected by COVID-19.
While restrictions have been lifted, it is essential for people to understand that the virus is still in the communities and therefore adequate protection measures must be observed, such as wearing of masks, maintaining physical distance and observing proper hand hygiene.
The key priorities for countries across the world should be to protect the vulnerable, empower and educate people and communities to protect themselves and others, and focus on the public health basics: find, isolate, test and care for cases, and trace and quarantine their cases.
Is there any approximate time by when it can come under control in the subcontinent?
It’s hard to predict. Globally the pandemic is still on the rise.
What are the future dos and don’ts for Bangladesh?
No country can afford to lower their guard. We need to continue our efforts to suppress the virus.