An alternate strategy to control COVID-19 by A M Zakir Hussain

DISEASE-related estimations give information on the number of the diseased, number of severe cases, outcome of the disease such as whether cured, suffered from permanent damage to the body or death from the disease, etc. The estimations usually are based on a numerator and a denominator. The denominator should include (i) all those infected but might not show any clinical feature — one estimate from China puts this figure in 20–80 per cent, on an average about 30 per cent; (ii) all those who show mild clinical features, up to 80 per cent, as we know, and (iii) all those who show severe and critical manifestations, which may be 20 per cent, and 5 per cent of this 20 per cent respectively.

For estimating the case fatality rate of COVID-19, the numerator would be the number of people who died of COVID-19 and denominator all those who were infected. The possibility of including all the infected people, silent or overt, in the denominator will be lower, as fewer of those who were to be in the denominator will, in fact, be identified, counted and included in the denominator while the possibility of including all those who died of COVID-19, the numerator, will be higher, because missing of death, that is easily identifiable, will be fewer. In this situation, the estimated case fatality rate will be high wrongly (this is what is happening now). The case fatality rate may also fluctuate based on its definition, for example in Italy, when testing was started only for severe cases, the case fatality rate jumped from 3.1 per cent to 7.2 per cent. The magnitude of a disease is measured by the incidence rate, in an acute and short-lived disease like COVID-19. It will remain unknown, when the denominator, ie all those who were supposed to be tested for finding disease in them, was not selected or not selected randomly.

COVID-19-related estimates

THE case fatality rate was noted to be age-specific. In Spain, Italy, South Korea, and China by March 21, there was no case fatality in children less than 10 years of age. Among the children aged 10–19 years in Spain, the fatality rate was 0.4 per cent (4 in 1,000 children). Italy and South Korea have reported no fatalities for this group (10–19 years); China reported a case fatality rate of 0.2 per cent in this age group.  In the United States, there had been no death among people less than 20 years of age. Among the people aged 20–29 years, fatality from COVID-19 was 0.3 per cent in Spain. Italy and South Korea have reported no fatalities for this age group; China reported 0.2 per cent fatality. In the United States, among 20–44 years old, fatality was 0.1 per cent. Among the adults of 30 years to 49 years of age, the fatality rate were 0.2 per cent, 0.3 per cent, and 0.2 per cent in Spain, Italy and China respectively. The case fatality was 1.4 per cent in Spain among people aged 50–69 years. In this age group, fatality ranged from 0.4 per cent to 3.6 per cent in Italy, China and South Korea. In the United States, fatality was 0.5 per cent in patients aged 45–54 years, 1.4 per cent in patients aged 55–64 years and 2.7 per cent in patients aged 65–74 years. Among the patients aged more than 70 years, the case fatality was 11.4 per cent in Spain; in Italy, China and South Korea, it ranged between 6.2 per cent and 20.2 per cent. In the United States, the case fatality rate was 4.3 per cent among people aged 75–84 years. Among people above 85 years of age, fatality was 10.4 per cent in the United States. In Iceland, which has the highest rate of population-based infection (26,762 per million population), the case fatality rate was 0.21 per cent.

The epidemic curve in China peaked in January 23–26 and then began to decline up to February 11. Most cases belonged to 30–79 years of age (87 per cent), 1 per cent aged ≤ 9 years, 1 per cent aged 10–19 years, and 3 per cent 80 years or older. Also, the case fatality rate in China was higher in early stages of the outbreak (17 per cent for cases from January 1 to 10), which reduced to 0.7 per cent after February 1.

Patients with no co-morbidity, in China, had a case fatality rate of 0.9 per cent, while critical cases (respiratory failure, septic shock, and/or multiple organ dysfunction/failure) had a rate of 49 per cent. In Italy, there are two reasons of a high COVID-19 mortality — higher rate of smoking than in many European countries and 88 per cent due to co-morbidity (76 per cent had hypertension, 36 per cent diabetes and 33 per cent ischemic heart disease, the heart not getting enough blood/ oxygen). On the Diamond Princess, the cruise ship, initial estimates reported six deaths out of 705 who tested positive, a case fatality rate of 0.85 per cent. All six deaths occurred in patients >70 years of age.

Table I shows deaths among COVID-19 patients with some critical co-morbidities and death among patients with the critical morbidities without COVID-19. Table I shows that most of those who died of COVID-19 in comorbid conditions had a likelihood of dying from the critical morbidities anyway (71 per cent to 80 per cent probability). Table II shows the risk of death from COVID-19 by age, with comorbidity (underlying cause).

Deaths from competing causes

THE number of COVID-19 fatalities is small, would remain to be small probably, compared with the 12 million total number of people who have already died this year from all causes globally. Without COVID-19, 60 million people will die expectedly in 2020, with 18 million people dying of heart diseases, 10 million of cancer, 6.5 million of respiratory diseases, 1.6 million of diarrhoea, 1.5 million in road incidents and one million of HIV/AIDS. Suicides could number 800,000.

In China, COVID-19 mortality occupies the 49th position among all the killer diseases; in Italy, it is the eighth important cause of mortality because of its high number of elderly population. Notice may also be taken of the fact that because of attention on COVID-19, some emergency patients might have died unduly. Lockdown, isolation and quarantine also robbed people of developing natural (herd) immunity, which could give longer-term protection to people. The next advent of SARS-CoV-2, therefore, may be equally devastating, s it will get a sizeable population to infect.

Proposed alternate strategy

WHAT the above discussion brings us to? Is the strategy of asking everyone to hide behind the four walls of their homes both epidemiologically correct and economically efficient? How many more people would die of COVID-19 if they were exposed to SARS-CoV-2? Contrarily, how many more people might die next time when exposed to a more fatal form of the virus if they are not exposed to the virus now? Right now against a crude death rate of 5 per 1,000 people in Bangladesh without COVID-19 (which is 900,000 deaths a year or 2,466 a day), 27.1 per cent of it occurs among infants. Death falls after that age up to 45 years, to about 2 per cent. At 45 years of age proportionate mortality is 4.5 per cent, increasing to 14.1 per cent among people above 60 years of age, going to 27.5 per cent among people aged 70–74 years and 81.9 per cent in people above 75 years of age. The same trend of death is seen among people of these different ages from COVID-19.

What is happening to the economy? How many people would die from poverty and under-nutrition consequently in the long run due to the lockdown? Let economists churn the figure out. But we are staring in the face of a discomforting economic slump.

Based on the analyses, we, therefore, suggest an alternate strategy. We propose to lift the lockout and let people, with minimum risk of dying (20–49 years), get exposed to the virus and develop herd immunity. We cannot prevent the various competing deaths in people even if we save them from COVID-19. Those competing deaths are in fact much higher in number. If we are not preventing those deaths, why are we exhausting all our resources to save people from only one disease? As part of the proposed strategy, we suggest keeping those who are vulnerable, ie those with critical co-morbidity, those who are aged, children less than one year of age and people with other immune-compromised conditions, etc. under dedicated attention to protect them from exposure. For example, families with elderly/debilitated members, members with co-morbidity and infants with their family caregivers should be isolated from those members of the family who have to go out for occupational and educational reasons. We encourage this strategy also in light of the finding that SARS-CoV-2 gets less fatal gradually.

Since managing too many severe cases of COVID-19, all happening within a short period of time, will be beyond the capacity of the health systems, we propose to lift the lockdown following a gradient of the economic vibrancy. But the health systems should be strengthened in these GDP producing areas so that, when necessary, those who need critical care can get it. What would be the size of this need may be worked out. It is also suggested that authorities and management arrange lung capacity enhancing exercises for their staff several times per day to cope efficiently when any comes down with COVID-19 and also encourage them to adopt other measures touted by some cured people, eg drinking and gurgling with hot water, taking lots of citrus fruit, etc. Alternatively, antibody tests may be instituted for the staff. Those who are found to exhibit the presence of antibody in their blood may be allowed to resume their offices. Antibody tests may be sponsored by the employers for their staff. It should be conducted by a dependable laboratory. Antibody may not impart complete immunity but will reduce the impact of a re-infection. This is a managed or controlled exposure strategy towards herd immunity.

          

AM Zakir Hussain is Working Group member of Bangladesh Health Watch (BHW), former director, Primary Health Care and Disease Control;  former director, IEDCR, DGHS; former regional adviser of SEARO, WHO and former staff consultant, Asian Development Bank, Bangladesh.

কোভিড-১৯ বিষয়ক গবেষণার ফলাফল

বাংলাদেশ হেলথ ওয়াচ এবং ব্র‍্যাক জেমস পি গ্রান্ট স্কুল অফ পাবলিক হেলথ, ব্র‍্যাক বিশ্ববিদ্যালয় বাাংলাদেশে বৈশ্বিক মহামারী করোনা ভাইরাসের বর্তমান পরিস্থিতি এবং জনজীবনের বিভিন্ন ক্ষেত্রে এর প্রভাব নিয়ে যৌথভাবে ছয়টি পৃথক গবেষণার ফল প্রকাশ করেছে। যে গবেষণাগুলোতে করোনাভাইরাস ছড়িয়ে পড়ায় বাংলাদেশের বৃহৎ জনগোষ্ঠী, গার্মেন্টস কর্মী, ফ্রন্টলাইন স্বাস্থ্যকর্মী ও হিজড়াসহ প্রান্তিক জনগোষ্ঠীর শারীরিক ও মানসিক স্বাস্থ্যগত প্রভাব ‍দেখা হয়েছে। ১৮ এপ্রিল ২০২০ তারিখে আয়োজিত এক ভার্চুয়াল সংবাদ সম্মেলনের মাধ্যমে এই ফলাফল তুলে ধরা হয়।

বর্তমান পরিস্থিতির ওপর ভিত্তি করে পরিচালিত গবেষণায় হঠাৎ করে ছড়িয়ে পড়া করোনা ভাইরাসের প্রভাব মোকাবেলায় বিভিন্ন স্তরের মানুষের সংগ্রামের একটি উদ্বেগজনক চিত্র ফুটে উঠেছে। এদের মধ্যে রয়েছে করোনা রোগী ব্যাবস্থাপনার সাথে যারা সরাসরি জড়িত অর্থাৎ ফ্রন্টলাইন স্বাস্থ্যকর্মী তথা চিকিৎসক ও সেবিকা, গার্মেন্টস কর্মী এবং শহরের বস্তিগুলোতে বসবাসরত দরিদ্র জনগোষ্ঠী।

স্বল্প সময়ে পরিচালিত কেস স্টাডিতে দেখা গেছে, ঢাকা শহরের দরিদ্র ও হিজড়া জনগোষ্ঠীদের মধ্যে করোনা ভাইরাস নিয়ে ব্যক্তিগত পর্যায়ে উচ্চ মাত্রার ভয় ও আতংক বিরাজ করছে। অধিকাংশ ক্ষেত্রেই করোনার লক্ষণগুলো প্রায় অস্পষ্ট হওয়ায় এই জনগোষ্ঠীর প্রতি সামাজিক বৈষম্য, হেয় প্রতিপন্ন, নজরদারি ও হয়রানি অনেকাংশে বৃদ্ধি পেয়েছে।

মোবাইল ফোনের মাধ্যমে আরেকটি গবেষণায় কোভিড-১৯ ব্যবস্থাপনার সাথে যারা যুক্ত রয়েছেন, এমন ৬০ জন ফ্রন্টলাইন স্বাস্থ্যকর্মীর সাক্ষাৎকার গ্রহণ করা হয়। এতে  ফ্রন্টলাইন স্বাস্থ্যকর্মীরা জরুরীভিত্তিতে মানসম্পন্ন পিপিই’র প্রয়োজনীয়তার কথা উল্লেখ করেন। এক্ষত্রে তারা সম্প্রতি মাননীয় প্রধানমন্ত্রী কর্তৃক ঘোষিত আর্থিক প্রণোদনার চাইতেও মানসম্পন্ন পিপিইর প্রতি অধিক গুরুত্ব আরোপ করেন। সমীক্ষায় আরো উঠে এসেছে, তারা শুধু শারীরিকভাবেই পরিশ্রান্ত নন বরং তাদের মাধ্যমে পরিবারের অন্যান্য সদস্যদের আক্রান্ত হওয়ার যে ঝুঁকি রয়েছে সেই ভয়েও তারা তীব্র মানসিক চাপের মধ্যে রয়েছেন।

জেপিজিএসপিএস বিভিন্ন পর্যায়ে মানুষের উপার্জন, পুষ্টি, লিঙ্গ, মানসিক স্বাস্থ্য ইত্যাদির উপর  কোভিড-১৯ এর প্রভাব জানার জন্য একটি বহুস্তরীয় টেলিফোনিক জরিপ পরিচালনা করছে । প্রথম ধাপে, এপ্রিল ৬-১৩ তারিখ পর্যন্ত সময়ে, ১৩০৯ জন মানুষের সাক্ষাৎকার গ্রহণ করা হয়েছে। মানসিক অবস্থা বিচারে দেখা গেছে যে, আংশিক উপার্জন (২৯ শতাংশ) কিংবা যাদের (১৩ শতাংশ) ‍উপার্জনে করোনার কোন প্রভাব নেই তাদের তুলনায় একেবারেই যাদের উপার্জন নেই (৫৮ শতাংশ) এমন পরিবারের মধ্যে অধিক মানসিক চাপ লক্ষ্য্ করা যায়।

একইভাবে ৩৭ ভাগ গৃহস্থালি হতে পাওয়া তথ্যানুযায়ী জানা যায়, চলমান এই সময় তারা প্রধানত ভাত, ডাল, এবং আলু খেয়ে জীবনধারণ করছে। পুষ্টিগত দিক বিচারে বাধ্য হয়ে যারা এইরকম বৈচিত্র্যহীন খাবার খেয়ে বেঁচে আছে তাদের মাঝে অধিক মানসিক চাপ লক্ষ করা গেছে। 

অন্য একটি সমীক্ষায় গ্রাম ও শহরের মানুষের কোভিড-১৯ সম্পর্কিত জনসচেতনতা এবং জ্ঞানের ভিন্ন চিত্র উঠে এসেছে। শহর এবং গ্রামের তুলনামূলক বিশ্লেষণে দেখা গেছে , শহরের তুলনায় গ্রামের মানুষ করোনা সম্পর্কে কম জানে। একইভাবে, পুরুষ অপেক্ষা নারীদের মধ্যে করোনা সম্পর্কিত জ্ঞান কম। তবে, সার্বিকভাবে কেবলমাত্র ৩৮ ভাগ তথ্যদাতা একজন আরেকজন থেকে ৩ ফুট দূরত্ব মেনে চলার কথা উল্লেখ করেছেন। ভাইরাসের কারণে সামাজিকভাবে যে হেয় প্রতিপন্ন হওয়া এবং মৃত্যুভয় রয়েছে তার একটি সুদূরপ্রসারী ব্যাপকতাও এখানে লক্ষ্য করা যায়।  

এই ছয়টি গবেষণা  মূলত কিছু গুরুত্বপূর্ণ সুপারিশমালা সামনে নিয়ে আসে যেগুলো বাস্তবায়িত হলে ফ্রন্টলাইন স্বাস্থ্যসেবাপ্রদানকারী, নগরের দরিদ্র জনগোষ্ঠী এবং অন্যান্য প্রান্তিক মানুষজনের উপর এই মহামারীর  প্রভাব কমাতে সাহায্য করবে। এগুলো হচ্ছে, ফ্রন্টলাইন স্বাস্থ্যসেবা প্রদানকারীদের জন্য পর্যাপ্ত পরিমাণে সঠিক এবং  মানসম্মত পিপিই সরবরাহ করা; ফ্রন্টলাইন স্বাস্থ্যসেবা প্রদানকারীদের দুশ্চিন্তা কমানোর জন্য তাদের কর্মক্ষেত্রের কাছাকাছি বাসস্থানের ব্যবস্থা করে দেওয়া; এবং চায়নার উহানে অনুসরণকৃত ৭/১৪ মডেল (৭ দিন দায়িত্ব পালনের পর ১৪ দিন কোয়ারেন্টাইন পালন) অনুসারে ফ্রন্টলাইন স্বাস্থ্যসেবা প্রদানকারীদের পর্যায়ক্রমিক দায়িত্ব বন্টণ ও তাদের বাধ্যতামুলক ১৪ দিনের কোয়ারেন্টাইন নিশ্চিতকরণ।

নিম্ন আয়ের লোকদের খাদ্য ও আর্থিক সহায়তা বৃদ্ধি করা দরকার এবং ভুল তথ্য, গুজব ও সামাজিক নিগ্রহের বিষয় প্রতিরোধের জন্য প্রচারণার বাড়াতে হবে। এই জাতীয় প্রচারণাগুলো আরো কার্যকরী করার জন্য নির্দিষ্ট গোষ্ঠীভিত্তিক সহজবোধ্য প্রচারণামূলক কার্যক্রম চালাতে হবে।  

BRAC JPGSPH and BHW research findings on COVID-19

BRAC James P Grant School of Public Health (JPGSPH), BRAC University and Bangladesh Health Watch (BHW) unveiled the research findings of six different studies that looked at the impact of the coronavirus outbreak on the general and mental health of the population at large, RMG workers, front line health workers, and marginalized groups – including the transgender community – in Bangladesh.

BRAC JPGHPH was established in 2004 as an international educational and research institution focusing on integral areas of teaching, research and services. BHW was established in 2006 as a multi stakeholders civil society body dedicated to improve the health system in Bangladesh through evidence based critical review of policies and programs, and recommend appropriate actions for change.

The findings of the studies were shared with journalists during an online press launch on April 18, 2020. The findings paint an alarming picture: frontline health workers such as doctors and nurses, garment workers, and the urban poor living in informal settlements are struggling to cope with the sudden effects that the coronavirus outbreak has had on their lives.

Rapid case studies of the urban poor in Dhaka city and transgender community found high levels of fear and panic among individuals about coronavirus. For most, the symptoms of corona remain unclear. Stigma, surveillance, discrimination and harassment have also increased within these communities.

Another study carried out 60 telephone interviews of frontline health workers (FLWs) involved in COVID-19 management. According to the study, the FLWs mentioned the urgent need for PPEs of appropriate quality. They showed greater preference for PPEs compared to monetary incentives such as those announced by the PM recently. Not only are FLWs physically exhausted, they are also experiencing immense mental stress due to the fear of infecting their family members.

JPGSPH is also running a multi-phase phone survey to gain a better understanding of the effects of COVID-19 on aspects such as income, nutrition, gender, and mental health. Phase 1, spanning April 6-13, reached 1,309 individuals. In terms of psychological well being, households with complete loss of income (58%) are significantly more stressed than households with partial (29%) or no loss of income (13%). Similarly, 37% of the households reported that they are surviving on staple foods such as rice, lentils and potatoes. These households – that have been forced to adopt a diet lacking in diversity – showed significantly higher levels of stress.

Furthermore, the overall “quality” of the awareness and knowledge about COVID-19 paints a grim scenario. Rural and female respondents know much less about the mode of transmission than their counterparts (urban and male respectively), and only 38% of all respondents mentioned maintaining the 3-feet rule. Stigma and fears of death because of the virus, remain widespread.

The six studies came up with a range of recommendations which, if implemented, can greatly help alleviate the effects of the pandemic on FLWs, the urban poor and other marginalized groups. They include: ensuring adequate number of PPEs of appropriate quality for all FLWs who are directly or indirectly involved in the management of the COVID-19 patients, arrangement of accommodation for the FLWs near their workplace to allay anxieties, and implementation of roster and rotation of FLWs as per the 7/14 model (7 days of duty followed by 14 days of quarantine) as was followed in Wuhan.

Cash and food support for low-income groups have to be boosted and there also remains scope for more proactive awareness and knowledge campaigns, including addressing misinformation and the issue of stigma. To be effective such campaigns need to be targeted and customized to ensure optimal effect.

The news on this event has been published/telecasted on more than 26 media.

Some of the links of mainstream media house:

https://www.bbc.com/bengali/news-52340065

https://www.prothomalo.com/bangladesh/article/1651634/

https://www.thedailystar.net/coronavirus-deadly-new-threat/news/covid-19-taking-toll-peoples-general-mental-health-six-studies-show-1894243

https://www.dhakatribune.com/business/2020/04/18/survey-47-rmg-workers-lose-jobs-amid-covid-19

https://bangla.bdnews24.com/health/article1748488.bdnews

https://www.youtube.com/watch?v=diJnnzZQxXs&feature=youtu.be

https://www.youtube.com/watch?v=1zyzDEysUuo

Winning the corona war and more

The Health Watch Group

The Coronavirus (Covid-19) crisis has been labelled as one of the most daunting crises that humanity has ever faced. There is hardly any country which has not been affected by it. About a half of the world's population is under 'lockdown' condition. Fortunately, there is some light being seen at the end of the tunnel. After Wuhan, the curve is expected to 'flatten' shortly in Italy and Spain, the countries most devastated by the onslaught. However, our knowledge of the virus' epidemiology is far from complete, and the responses to it are not devoid of controversies (To publically use the mask or not, for example). 

Bangladesh is at the crossroads now. After weeks of low reported figures (both of cases of infection and deaths), the curve has started to rise steeply in the past three-four days. This is perhaps due to both selective decentralisation of testing and the beginning of community transmission. Of late, the government has moved to implement a number of measures. On the mitigation side, decentralisation of the testing has been initiated, allowing a few others to do the same along with IEDCR, and supplying the protective equipment to frontline healthcare workers.  On the containment side, the measures include a nationwide chhuti (short of a lockdown), closure of transportation, shopping areas, congregation at mosques and other places of worship, the fielding of army and police to enforce these measures, large incentives to revamp the economy, and promotion of hand washing and social distancing. Unfortunately, these initiatives have been very disjointed. The Health Minister himself expressed his anguish at the lack of coordination among the various actors.

The Bangladesh response has largely been a reactive one. There has been indecisiveness and confusion along the way. The most recent fiasco relating to the RMG sector is a case in point. If the government and the sector leaders had been transparent and clear, such a situation would not have happened. Fortunately the government has now come clearer in closing the factories but the BGMEA has not apologised for its mishandling of the situation which put the lives of thousands of workers and ordinary citizens in great jeopardy. Another example is the mosque. The government and the Islamic Foundation have been utterly indecisive in this. The instruction to hold the congregations but with 'a small number of devotees' did not make any sense and added to the confusion, as a result of which the congregations went on unabated. The recent clarification by the Islamic Foundation (on April 6) created further confusion. It said that mosques can hold normal prayers with no more than five persons and Jummah prayers with no more than ten persons. However, in the evening, the Minister of Religious Affairs came out with the instruction that no 'outsider' would be allowed in the mosques to offer prayers. While even Makkah and Madinah are under curfew, we hesitate to enforce such strict disciplines!

The economic incentives which are equivalent to 2.5 percent of the GDP (compare this to 15 percent in UK) have been largely hailed, although there are questions of how this will be implemented and who will benefit. The issue of the morale of the frontline health workforce (FLW) has also been flagged, with many of them complaining about poor support from the authorities in terms of their safety and the future of their families in case some lose their lives while providing care. The government should include incentives for them in the economic packages should any FLW dies in action. Many countries have introduced such incentives in order to keep the healthcare systems functional. Fortunately, the Honourable Prime Minister has announced on April 7 the introduction of life and other insurance coverage for the FLWs—a correct and timely step.

Although the virus attacks anybody and everybody, irrespective of his/her socio-economic standing, there is a huge equity issue in the response measures. One example is the support we provide to the lower class employees such as the cleaners and domestic workers. They are equally exposed to the virus but their safety and wellness are hardly included in any discourse. They, along with other staff such as ambulance drivers carrying corona patients, should be covered by the newly introduced health insurance.

Both the for-profit and not-for-profit sectors have so far involved themselves only to a limited extent in the war against Corona. However, in a crisis of such magnitude, it is imperative that all actors come together for a proactive, agile, collective response that can commission and utilise multiple strategies in parallel to minimising the spread and impact of the disease. The health sector is trying to implement several instructions without putting them into a comprehensive plan, thus leading to a lack of coordination of activities. Whether such lack of enthusiasm is because of the sectors' reticence to embrace the risks involved, or the failure of the government to mobilise and make them partners in this war, is being debated. However, the private sector has resources which can substantially complement government action and contribute to winning this war—from disseminating information to expanding treatment facilities to making scarce hardware and software supplies available. The absence of a strong role by most NGOs (with the exception of BRAC and a handful of others), which have been at the forefront in almost all such crises in the past, is especially felt now. The war against Corona cannot be won single-handedly, and a united front with the involvement of every sector is a call of the day.

The role of the health workforce in this war has become controversial. Many healthcare professionals not directly dealing with the disease have receded from providing services, with many reportedly not turning up for their assigned duties.  The interns at Mymensingh Medical College not joining the internship programme is a case in point, as well as numerous anecdotal reports of doctors not opening their private chambers, and hospitals curtailing their outdoor practices and patient admission. This is all due to the 'fear factor' prevailing among healthcare providers. Such actions stem from a feeling of insecurity among them due to a lack of protective gear and devices. But there are also positive examples whereabout many doctors, paramedics and lab technicians have kept many of the Surjer Hashi Clinics functional. 

It is only natural to expect that healthcare professionals will live up to the commitments they had subscribed to when they signed up to be a health professional. However, appreciation and recognition of their work could do much to boost the morale of this group. 

The government, meanwhile, is under pressure from the Middle Eastern countries to bring the remaining workers back, numbering about 100,000. Fortunately, they are living in countries which are not yet hotspots for the virus. Once they return, we must ensure a better management of the quarantine and isolation. 

The plight of the wage labourers and other vulnerables at the time of lockdowns is well known also. We are heartened to see many private citizens and civil society groups providing succour to them. However, many of these are done without proper management, creating new grounds for virus transmission. The government's plan to deliver food to individual homes is a welcome move but it has to ensure that the real needy get the support. In this, the government may wish to solicit participation of the NGOs who are known to have grassroots contacts without political affiliation or favour. It is important for the NGOs to bring their workers back to the field to participate in the fight, particularly in promoting social distancing—they have the potential to contribute immensely if they work in coordination. 

Finally, the government needs to be resolute and decisive in its policy actions. Whatever draconian route the measures may take, there is hardly any alternative to it if we wish to avert a big calamity. Ambiguity in policy implementation will only hasten the crisis.  Every crisis is also an opportunity and we should not let the current one to go to waste. This pandemic is a reminder to reconsider the functioning of our health systems and how we can make it more robust to in order to face major crises such as Covid-19 and the unfinished agenda of high mortality, morbidity, malnutrition and fertility. Can this crisis create enough enthusiasm for the government to work zealously towards universal health coverage?

The Bangladesh Health Watch is a civil society initiative, set up in 2006, to monitor progress in good health for all. The Secretariat of the Watch is hosted by BRAC James P Grant School of Public Health, BRAC University. Email: mushtaque.chowdhury@brac.ne

Source: https://www.thedailystar.net/opinion/news/winning-the-corona-war-and-more-1891489

Bangladesh Health Watch (BHW)

Bangladesh Health Watch (BHW), a multi-stakeholder civil society advocacy and monitoring network dedicated to improve the health system in Bangladesh through critical review of policies and programmes and recommendation of appropriate actions for change. It was initiated in 2006 aiming to improve health of the people by way of monitoring progress in the health of the population and health systems, and playing a catalytic role in making lasting changes in the health sector. The main activity of Bangladesh Health Watch is to publish an annual report on the state of health in Bangladesh every year by commissioning researches. A Working Group consisting of researchers and activists from different organizations carry out the different activities for the Watch. The Bangladesh Health Watch Reports identified the most critical challenges to the health sector at particular points of time and published insightful situation analyses leading to practical recommendations, based on evidence from existing and primary research. The overall achievement of Bangladesh Health Watch over the period of 2006-2020 is significant in terms of Publishing Research based reports and News Letters. There are six research reports published in every alternative years and six newsletters have published from December 2013 in every six months interval up to December 2016. The contemporary and emerging issues were highlighted in all publications to persuade government on the emerging issues.

Bangladesh Health Watch has started its three years journey from December 2019 to December 2022 title “Making Bangladesh’s Healthcare Systems More Responsive and Participatory” to execute a comprehensive plan for meeting its agenda of working as a citizens’ watchdog bringing lasting positive changes to the health scenario in Bangladesh by critically analyzing policies and programs and influencing policy changes. The overall objectives of the project is to utilize the opportunity to transform an active, evidence based, impactful watch-dog for the health sector, bringing citizen’s participation and voice to the health policy arena, and enhancing transparency and accountability. The theory of change is set for the project is to “A more responsive healthcare system that delivers better quality, more transparent and equitable healthcare for all being informed by people’s participation and voice”.

Bangladesh’s health sector has impecunious presence of citizens’ participation and voice in the policy arena, the need for a strong platform to raise issues and concerns, suggest solutions and support and lobby the government in achieving its programmatic goals and international and national commitments including the PHC, UHC, and SDGs, promote transparency and accountability and take stronger measures to drive equity is being strongly felt by various sectors of the society including academics, program experts, development partners.