‘We are in critical times’

Should the number of coronavirus cases and deaths cause us to panic?

Zahidur Rahman: Viral infections have our stages. The first stage is when the virus spreads in foreign countries but has not entered our country. In the second stage, the virus has been detected in someone who returns from abroad. In the third stage, the people are infected after coming into contact with the returnees. We also call this stage local transmission.

The fourth stage is community transmission. The virus has been detected in somebody who has neither a history of foreign travel or contact with any such person. We call this stage community transmission. If we cannot control this stage, this is an epidemic. We are at the community transmission stage on a limited scale.

If we take the experience of the most affected countries into consideration, we see the number of infected patients was very thin at the beginning but increased all of a sudden.

How do you view the number of infected persons in our country?

Zahidur Rahman: Infection and detection are not the same thing. The most dangerous thing about COVID-19 is the symptoms do not appear in the patient in many cases. Many do realise that they are carrying the virus. As a result an infected person infects others easily. So testing is very important.

As we cannot test all suspected persons as per WHO guidelines, it is difficult to estimate the number of infected persons on the basis of detected patients.

Maybe there are many infected persons around us. As they are not being tested, they are not being detected.

What stage is the risk at now?

Zahidur Rahman: We are now at a critical stage. We are at the beginning of the outbreak. There is serious risk. As I said earlier, if we take the experience of other countries into consideration it is found that the number of infected was not big for two to three weeks after the detection of first person. But after one and half months, the number of detected patients increased in large numbers. In that consideration, we are at high risk.

Different countries enforced lockdown and carried out tests to prevent spread of coronavirus. But we did none of these properly.

We have failed to realise the matter properly. We had a lot of time. Even developed countries also made mistakes to contain coronavirus. They showed negligence at the beginning. We should have learnt from their mistakes. We did not enforce lockdown in that sense, we declared a holiday. Moreover, public transport was open. As a result, people left for home.

Lockdown may be enforced in a city, in an area or whole country. This means people cannot leave or enter. If we shut down public transport first and then enforced lockdown, people would stay at their respective places. The disease would not spread countrywide.

What strategy have we adopted?

Zahidur Rahman: There is a WHO guideline to tackle such a situation. We should keep in mind that the current situation has been declared a pandemic. It is not possible for a government to tackle such a situation alone. And this is not a matter of the health ministry. All the ministries have to work jointly. It requires coordination. Perhaps we could not realise the gravity of the situation.

The scope for tests has been widened and many labs have been set up.

Zahidur Rahman: I am a virologist. PCR is a modern system and gold standard. But this has to be done professionally, otherwise reports will be wrong. So special training is necessary. Steps could have been taken much earlier.

At the beginning we were told that only IEDCR has the facility with the lab and the environment necessary for this test. So far as I know there are at least such 15 labs in the public sector and 20 in the private sector. At the beginning the virologists made a proposal to include all institutions and to widen the scope for test facilities.

IEDCR could have remained in control, but involve others. There are at least 60 to 70 virologists in the country. They were not engaged in policy making. A few of them were engaged but their opinions were not taken into consideration. They could have been engaged in training. Testing under the PCR system, sample collection is very important. Special training is needed for those who will collect samples. But that has been done unprofessionally and on a limited scale.

It is positive that labs have been increased for testing. I must stress on the quality of the test. Otherwise the purpose will fail.

What is your advice as a physician to the general people?

Zahidur Rahman: The death rate of infected persons is low. This disease is highly contagious and this can infect others without any symptoms. The first task is to stay home. Hands have to be washed regularly. The eyes, face and nose should not be touched with hands.

Unless absolutely necessary, no one should go to hospital. Talk to physicians over the phone if necessary. Use surgical masks if anyone catches fever, cold and cough. Eighty per cent of infected persons recover naturally. You have to remain cautious so that you are not infected. Old people at home and those suffering from other diseases have to be kept in isolation. Children should not mix with them.

What is your advice to the government?

Zahidur Rahman: Community transmission has to be controlled to a tolerable level and the outbreak has to be tackled. A few of the infected patients have to be admitted to hospitals and those who will be admitted will need ICU support. The population of Bangladesh is 170 million. Many patients will need to go to hospitals. Ventilators have to be procured on an urgent basis. The government must pay attention so that oxygen supply is not hampered. Private sector ICU’s along with ventilators have to be kept ready. Experts’ advice has to be taken into consideration.

Thank you.

Zahidur Rahman: Thanks