Friday, August 7, 2020

The COVID-19 myths

 by AM Zakir Hussain | Published: 00:00, Aug 08,2020

WE LOVE catch words and punch lines. They excite our imagination and stir thoughts. Some such phrases are the ‘new normal’ that is in store for us and ‘a complete overhaul of the health care system.’

Myth of ‘new normal’

Will we keep wearing masks for the rest of our life or for years even after the COVID-19 disappears or when the graph based on daily or weekly or monthly cases of COVID-19 infection falls to a negligible level? Or will we have to practise for the rest of our life a less heroic measure like sneezing into the sleeves. Does the new normal mean that we continue washing our hands every 30 minutes for 20 seconds for the rest of our life? Or we will continue distancing socially, by six feet or more, even in religious congregations or in social events? Will we continue meeting and running the court of law virtually or attend office twice or three times a week? Will we continue with trading online? The advice should hinge on epidemiological facts.

What is the lesson we learnt from the pandemic flue that devastated the world in 1918–1920? Fifty million people reportedly died of the disease. Some sources claim that the figure was double and some claim that it was a third. This figure has to be seen against the total world population of 1.8 billion that time — at 50 million, about 3 per cent of the world population was wiped out. What happened after 1920? Did people change their way of life? The virus H1N1 that caused the 1918-1920 pandemic still exists. Have we adhered to the same way of life since 1920?

 Epidemiological lesson that might shape life

EVERY disease-causing agent or pathogen tries to develop a co-existing or commensal relationship with its host. It learns that destroying or killing the host means ending its own life as well. So with time, pathogens become less harmful and hosts become more tolerant to the pathogens. The H1N1 influenza virus is such an example. The same virus which killed 50 million people now is a disease that kills only immunity-compromised people, usually above 65 years of age, while for others it is only a mild flu. Incidentally, H1N1 possesses a remarkable finesse to mutate itself within the same year, but still it is much less deleterious. Will it be incorrect if the same is assumed for SARS-CoV-2? After all, several of the coronaviruses have already disappeared, eg B814 and even SARS-CoV-1 since 2004, just after two years. So, it is too early to predict a ‘new normal’ life. In fact, we believe that people forget their days of trial and tribulation and begin with their known and familiar ways of life when things become close to normalisation. Changing ways of life that is unfamiliar and discomforting frighten people. Nature teaches living things to go back to square one, not only in case of humans but even in animals and plants. We do not see animals with new a way or life or any new life pattern in birds or plants. One thing does not change into another unless there is a serious question of survival or pressure of natural selection. Humans have come a long way to be under any pressure which it cannot surmount or be compelled to adjust itself naturally to satisfy the needs of natural selection.

 Complete overhauling of health services

IN THE light of the crimes committed by outsiders with blessing from some ever-unidentified dark forces and by some inside managers, some of whom are ignorant of their own laws, business people stroked the iron as it was hot. Some pundits who never worked in the public health sector suggest an overhaul of the whole sector without any idea how things work at the top and what is at the bottom. We have not really heard as to what should be the extent, type, area and nature of such overhaul. What we can make out from what they say is that we need to change the vehicle since it met repeated accidents. Would not it sound more pragmatic if we rather change drivers only? After all, there has already been a system in place which has worked albeit with some complaints about its quality, for which, weaknesses in some system components, never addressed, is actually responsible — the absence of adequate human resources and adequate healthcare financing. The same people boast of an exemplary system of health care in Bangladesh. So what happened all of a sudden that we want to throw it away, tear it apart and install something that we do not even imagine. While the fault is with the people who work in the system, experts want to throw the bath-tub with the baby in it.

We need to realise that systems develop based on years of experience and experiments. Some systems elements develop and take their place automatically as a natural corollary. Changes in them should also, therefore, occur based on experience and experiments, some of which will, of course, auto-adjust. What we may think about is bringing in some modifications or making upgrade in some terms of reference of the system drivers or change them who are at the helm of management to suit the existing or modified terms of references. This is some small change in different elements of the system which may include financing and financial management, personnel management and logistics management. Questions have, however, been raised time and again about the performance of the people who handled the system elements. Either they would need further capacity-building or they need to be changed if a failure in transparency is the issue.

One overhaul that has been long overdue though is the separation of clinical and diagnostic care from public health. A public health expert will not be able to conduct a surgery; similarly, a clinician will not be able to manage public health. The faster we realise this, the better. Clinicians will be able to manage hospital and diagnostic care and relevant procurement; but they will not be able to contain epidemics, under-nutrition, health communications, personnel management, public health planning and budgeting and alternative financing modalities etc.

 Weighing of advices

Ideas, suggestions and dreams of people who call themselves expert that do the rounds are highly likely to be dangerously misleading. Clinical expertise and public health are different. Some people even do not understand that their realms. People talk about epidemiology without knowing epidemiological principles. Epidemiology is a pure science of probability that determines the association of factors as cause and effect. The discipline of public health also, similarly, needs theoretical and practical knowledge and experiences in public health. People may be masters in their discipline but everybody cannot be a master of epidemiology or public health. Advice given by people, of other disciplines, on public health or epidemiology should, therefore, be taken with a grain of salt.

 Myth of increased daily test

There is a general perception that the more the tests, the more the number of cases identified. Proportionately speaking, this is not entirely true. Observers have noticed that when the criteria for COVID-19 testing were restricted to cases suffering from four noticeable clinical features, the number of tests decline while the test result rate became higher and the identified cases were fewer. If the number of tests is increased, test positivity will be lower as more non-COVID-19 cases will be included for testing. So an increase in the cases will be marginal and not proportionate to the number of tests. This will reduce test efficiency and as money will be spent unnecessarily on non-COVID-19 cases. The tests conducted now do not tell us about the number or percentage of infection any way, but they show only a falling or rising trend, for which death counts, tested or clinically suggestive, should be a better approach. We need to do random sampling and run antibody tests which will tell us the percentage of infection at the time of test and the percentage of people who recovered.  We do not have any information on this in Bangladesh as yet.


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

Saturday, July 25, 2020

Media Synthesis Report on Fake COVID-19 certificates and fraudulence in COVID Treatment

Media Synthesis Report


Fake COVID-19 certificates and fraudulence in COVID Treatment 





                            Bangladesh Health Watch





a) A gang 


Fake COVID-19 certificates sold at Tk 4-7 thousand

A ring was operating within and outside of the capital’s Mugda General Hospital to collect COVID-19 certificates and later forged those for selling to people. The Rapid Action Battalion has recently busted a ring, recovered nearly one hundred fake certificates and held four members of the ring in this connection. Police has been investigating the case and found that the ring was using long queues of COVID-19 test seekers as an opportunity to lure some of them to buy counterfeit COVID-19 certificates. RAB personnel detained the four people on June 15 from a photocopying shop in Mugda on charge of printing fake COVID-19 negative and positive certificates.


Fake Covid Reports: Cops track down dozen syndicates

Some hospital staffers involved in it; each report sold for Tk 5,000-9,000

While the coronavirus itself is a cause for grave concern in the country, some people are out there making business by putting others at further risk of infection by selling fake Covid-19 certificates. Law enforcers claimed to have detected around a dozen syndicates, who are selling fake certificates during the pandemic. They provide a printed "Covid-19 negative/positive" certificate or an E-mail as per desire, for Tk 5,000 to Tk 9,000. In cooperation with some hospital staffers, these syndicates mainly target those in need of a Covid-19 negative certificate to go abroad, said officials of police and Rab. They have medical staffers, graphic designers and IT experts involved in their gangs. For the certificates, they mainly use DGHS or IEDCR pads.

b) Regent Hospital

Fake Covid-19 certificates: DGHS directs Regent Group to shut down its hospital branches in Mirpur, Uttara

The Directorate General of Health Services (DGHS) has directed the authority of Regent Hospital to close the Uttara and Mirpur branches of its hospital immediately."We have asked them to close the hospitals immediately," Aminul Hasan, director (hospital) of DGHS said, adding that, "Patients of those hospital would be shifted to the hospital in Bashudhara. If necessary, patients will be shifted to Kuwait Bangladesh Friendship Hospital."  The move comes after the head office of Regent Group and its hospital in Dhaka's Uttara were sealed off on charges of issuing fake Covid-19 test certificates and collecting money from Covid-19 patients.


Seven Regent Hospital employees remanded in a case filed over fake COVID-19 certificates

A Dhaka court on Wednesday placed seven Regent Hospital employees on a five-day remand in a case filed over their alleged involvement in issuing fake COVID-19 test certificates.


DGHS claims health ministry high-ups directed it to sign Regent Hospital MoU

Directorate General of Health Services (DGHS) has claimed that it took initiative to sign a memorandum of understanding (MoU) with Regent Hospital as per directives from the top authorities of the health ministry. DGHS came up with the claim on Saturday in a press statement. The statement was made to clarify DGHS’ stand about the fraudulence of Regent Hospital owner Md Shahed and JKG Group.


সাহেদের ভঙ্গুর রিজেন্ট হাসপাতাল ছিল অধিদপ্তরের ভরসা

As per announcement on Md. Shahed's Facebook, a female join at Mirpur branch  but  she escaped after a month and a half. She had to work the rest of the day except sleeping. She was the only physician in this hospital. Necessary medical supplies were also not there. But the Department of Health found confidence in this fragile hospital. According to agreement between Regent and Health Department termed this as a state-of-the-art hospital.


What were in the Agreement

The agreement further states that the Regent has all  types of services in its two hospitals in Mirpur and Uttara. There is a laboratory for testing and a radiology department. They have a hotel called 'Milina'. There are 36 rooms for health workers to stay in quarantine. They have three ambulances, which are engaged in  patient transportation at all times. The regent was supposed to provide free medical treatment to any patient sent by the health department. All expenses will meet by the health department.

রিজেন্ট হাসপাতাল কোভিড ডেডিকেটেড হয় কার ইশারায়?

The RAB led by Executive Magistrate Sarwar Alam raided the hospital. The hospital would have given COVID-19 'positive' and 'negative' certificates without testing, said Sarwar Alam. Sarwar Alam told reporters that they have received evidence of three types of allegations and crimes. They used to give fake reports without testing the samples, they were supposed to provide free medical services as prescribed by the government, but they have taken lakhs of taka per patient and have submitted a bill of more than Tk 1.96 crore to the government. The RAB executive magistrate said, "Regent Hospital has so far treated 200 COVID patients." The third offense of the hospital authorities was that there was an agreement with the government they would test the COVID for free for admitted patients. But they have tested free samples 4,200 patients from IEDCR, ITH and NIPSOM.


সরকারকে নিম্নমানের মাস্ক ও পিপিই সরবরাহ করেছিল সাহেদ

Regent Group Chairman Mohammad Shahed provided low quality masks and PPE to the government. These protective materials were supplied by an organization called Albert Global Garments Factory Limited. He does not have a garment factory by this name. He started this scam by opening a Facebook page.


c) JKG Health Care

Fake Covid-19 certificates: JKG chairman Dr Sabrina on 3-day remand

JKG Health Care Chairman Dr Sabrina Arif Chowdhury, also a government official, was placed on a three-day remand by a Dhaka court today in connection with a case filed over issuing fake Covid-19 test reports.


44 booths set up for collecting COVID-19 samples

A private voluntary organisation, getting the green light from the government, has installed a total of 44 booths to collect samples from suspected coronavirus patients in Dhaka and Narayanganj. The organisation -- JKG Healthcare -- collects around 300 to 350 samples daily from six places of Dhaka and Narayanganj and later sends them to government laboratories for testing.



d) Shahabuddin Medical College Hospital

Unauthorised Covid-19 tests: Assistant director of SMCH, two others detained

Three people, including an assistant director of Shahabuddin Medical College Hospital (SMCH), were detained on charges of conducting unauthorised antibody tests on patients to detect Covid-19 and test report forgery. A mobile court, led by Executive Magistrate Sarwoer Alam, conducted a drive and found the anomalies. The hospital authorities have been deceiving patients in the name of detecting Covid-19 through rapid test kits which are not approved by the government yet.


RAB arrests Shahabuddin Medical College Hospital MD

The Rapid Action Battalion on Monday night arrested Shahabuddin Medical College Hospital managing director Foysal Al Islam hours it filed a case against hospital authorities. RAB officials said they would seal off the hospital and file a case against its authority as they unearthed yet another COVID-19 testing forgery scam there while they also found other irregularities.


e) Pabna’s Rooppur Medicare Clinic

Fake Covid-19 certificates: Pabna’s Rooppur Medicare Clinic sealed off

The local health department authority 16 July 2020 sealed off Rooppur Medicare Clinic, in Ishwardi upazila of Pabna, for issuing fake Covid-19 certificates and charging patients for treatment.





DGHS chief Azad quits amid scams

Amid severe criticism and scams related to Covid-19 tests, Prof Abul Kalam Azad has stepped down as the director general of the Directorate General of Health Services (DGHS). He tendered his resignation letter to the public administration ministry yesterday, Abdul Mannan, secretary of Health Services Division,


DGHS DG Azad’s appointment cancelled

The government on  23 July 2020 cancelled the appointment of Directorate General of Health Services director general Abul Kalam Azad. Public administration ministry in a notification made the announcement. It said that the appointment of Azad as the DG of DGHS has been cancelled with effect from July 21, 2020 upon his application. Azad submitted his resignation to the public administration ministry on 21 July 2020 amid widespread criticism over corruption in the health sector.


DGHS director (hospital) being transferred

After Prof Abul Kalam Azad stepped down as director general of the Directorate General of Health Services (DGHS) yesterday, its Director (Hospital) Aminul Hasan is now being removed from the post amid severe criticism over Covid-19 tests.

Khursid Alam made new DG of DGHS

The government on 23 July 2020 made Dhaka Medical College surgery professor Abul Bashar Mohammad Khursid Alam as the new director general of Directorate General of Health Services. Khurshid Alam’s appointment comes hours after the public administration ministry cancelled the appointment of outgoing DGHS director general Abul Kalam Azad.


Minister for stern action against messed up DGHS wings 

Health minister Zahid Maleque on Wednesday said that the Directorate General of Health Services wings, which faced criticism during the ongoing COVID-19 crisis, would be inspected and stern action would be taken against the officials. The minister made the comment replying to a query if the director for hospital wing Aminul Hassan would be removed from his post amid criticism over his role during the crisis.





g) Destination Italy

151 Bangladeshis refused entry to Italy

Italy did not allow 151 Bangladeshi passengers to enter into the country today who were on board a Qatar Airways flight from Dhaka. Qatar Airways will fly the Bangladeshi passengers back to Dhaka on 9 July 2020. "We did not know of the Italian government's decision that no passengers from Bangladesh wound be allowed to enter into Italy," the official said.,Italy%2C%22%20the%20official%20said.


Italy bars entry to passengers from Bangladesh till October 5

In a major setback for many Bangladeshi expatriates waiting to return to their workplaces in Italy, the European country today put restriction on entry of passengers from Bangladesh into its territory till October 5. Earlier on July 7, the Italian government imposed the restriction for a week after a significant number of passengers of a special flight of Biman Bangladesh Airlines tested positive for Covid-19 once they landed at the airport in Rome on July 6. The passengers had documents certifying that they had tested negative for Covid-19 and were safe to travel.Later, Italy on July 8 denied entry to around 151 Bangladeshi passengers -- on board a transit flight of Qatar Airways -- into the country and sent them back to Dhaka.


h) Health Scams and aftermath

Fake Covid Certificates: Public health, country’s image abroad at stake

The fake Covid-19 tests have not only posed a risk to public health but also put the Bangladeshi expatriates in trouble. Many expatriates might face problems returning abroad if other countries have a poor impression of Bangladesh's testing and overall handling of the pandemic.Japan, Italy and South Korea have already restricted the entry of Bangladeshis after some of them, with documents certifying that they didn't have the coronavirus, tested positive after they arrived in those countries.

Regent and JKG scams: Is this the face of a new normal in healthcare?

Nowadays, we often hear the term "new normal", which refers to the coping strategy in the post-Covid-19 era. Will this be the new normal healthcare in the post-Covid-19 era in Bangladesh? Hopefully not. But these two scandals are not isolated incidents; scams like these have long been feeding on the healthcare system. The DGHS seems to have finally woken up a bit as it cancelled Covid-19 testing approvals awarded to five different hospitals on various grounds. But neither the health ministry nor the DGHS can avoid their share of responsibilities in the blunder, and engaging in a blame game is futile. Those who are responsible for this must be brought to justice.


i) Covid-19 certificate for traveler

Covid-19 certificate must for travel abroad from July 23

The government on 18 July 2020 decided to implement its earlier decision that all passengers need to show Covid-19 negative certificates -- from government-authorised testing centres -- at the airports before leaving the country, from July 23. "As per directives of the Directorate General of Health Services (DGHS), all departing passengers from Bangladesh must show Covid-19 negative certificates from government-listed 16 testing facilities -- done no more than 72 hours before their international flights," said Civil Aviation Authority, Bangladesh (CAAB) in a circular.