The government’s efforts to ensure self-isolation and quarantine has slowed own and public health experts fear this decline could make the surging coronavirus infection rate even more dangerous.
They say infections will continue to rise until the transmission is stopped. The only way to improve the situation is to break the cycle of infection, by taking measures to stop the transmission of the pathogen from the infected to the uninfected.
For this to happen, everyone has to be vaccinated. But until most of the people are immunised, the experts do not see an alternative to isolation and quarantine of the COVID-19 patients and people who came into close contact with them.
They emphasise increasing awareness and support by involving people in the communities besides government efforts for successful isolation and quarantine, reports bdnews24.com.
However, the Directorate General of Health Services says that is no longer possible as the infections have spread far and wide already.
The health system is buckling under the weight of a devastating wave of coronavirus infections and deaths surging across Bangladesh since the outbreak began here last year despite the government imposing a two-week lockdown with strict measures to curb the spread.
Over the past five days, more than 11,000 cases were identified and over 200 fatalities registered, according to government data.
Dhaka was the epicentre of the infections at the early stages of the outbreak, but since April this year, cases have also been found in areas near the borders of the country.
The Delta variant of the virus, which originated in India and is now the dominant strain globally, is raging like wildfire across Bangladesh.
A former additional director general at the DGHS, Dr Sanya Tahmina Jhora thinks a lack of proper isolation and quarantine of individuals with symptoms will scupper efforts to tame the spread of the disease.
“The rate of infection will increase if we don’t start scientifically isolating or quarantining the infected,” she said.
“Mutations can change the characteristics of a virus, causing the original virus to either weaken or become more aggressive. But in the current circumstances, we don't see the coronavirus letting up any time soon.
“We’ve seen the results of the failure to maintain isolation and quarantine before and after Eid-ul-Fitr. Vaccination and wearing masks have to be made obligatory to halt the spread of the disease," she added.
“And the lockdown was so loosely enforced that we saw no signs of the infections easing in 14 days. Now they’ve reopened everything. It’s also not possible for the people to follow these restrictions for a long period of time.”
The DGHS confirmed Bangladesh had 152,114 active coronavirus cases with 74,627 of them in isolation while 109,604 others were in quarantine.
Bangladesh logged 12,148 new COVID-19 cases in the daily count published on Friday, taking the tally of confirmed infections to 1,08,39,22. The death toll surged to 17,465 after 187 fatalities were registered in the 24 hours to 8am.
DGHS spokesperson Dr Md Robed Amin claims that isolations and quarantines lose their effectiveness all over the world once the infection rate hovers from 30 to 70 per cent.
“Isolation and quarantine are effective when the rate of infection is between 5 and 10 per cent. But these measures are less effective when the rate surges higher.”
“When the rate spirals to 30-40 per cent, who do we send to isolation or put into quarantine? All the districts of Bangladesh are now registering high rates of infection, so who will you quarantine or put in isolation? Every one of them is suspect.
“If 500,000 people are suspected cases, do we have the capacity to isolate or quarantine all of them? No country in the world can do it,” he added.
Prof Sanya Tahmina also thinks isolations and quarantines are not being executed effectively due to a lack of capacity on the part of the government.
“Isolations and quarantines [have become] a personal choice of a citizen. The government has to secure their food and medicare. But we don’t have the manpower or the mindset to work on ensuring isolations together with authorities from each sector at a time.”
Public health expert Dr Mushtuq Husain, however, believes that it is possible to arrange for proper isolation and quarantine even amidst the ongoing crisis.
The advisor to the government’s disease control agency IEDCR also warned that the risks of infection and subsequent deaths may rise to a point where it can no longer be controlled if the right deterrents were not deployed.
“Isolation centres have to be set up in every ward. Most of the people can stay at home. Those who live in huts in villages, they can be served food in their yards. These measures have to be put in place in densely populated villages,” he said.
Dr Mushtuq also believes both the government and the people need to step forward to carry out the efforts effectively.
“Those who are traveling abroad for work, we have to ensure food for them. Many are often unable to isolate themselves at home since there are a lot of people in a room. Then again, many people don’t even have homes.”
“For them we have to set up community isolation centres, which we are calling field hospitals or makeshift residences. This is how we need to separate the infected.”
Dr Mushtuq urged the local government bodies to take steps and assign local government leaders, teachers, students, religious individuals as volunteers.
“We need more physicians and volunteers. Volunteers play a huge role in preventing infections. Weve to encourage more people to come forward in taking care of COVID patients.”
Taking into account the shortage of vacancy in hospitals against the number of patients, he stressed stronger and prompt moves to prevent infections.
MORE SAMPLE TESTING NEEDED
With cases of infection increasing by the day, more than 40,000 samples are being tested daily. But experts urge authorities to acquire more samples to test for a proper assessment.
A member of the National Technical Committee on COVID-19, virologist Dr Nazrul Islam recommended setting up sample collection centres in all villages.
“We can test samples at one village at a time, then follow it up by carrying out tests in the one nearby. Things can work out that way. But none of these is happening. We’re only rebuking people who are not wearing masks,” he told bdnews24.com.
“We’ve to put everyone through tests at the slightest suspicion to prevent infections from spreading. If they test positive, they have to either be isolated or quarantined. And we’ve to make everyone wear mask. The government has to take the initiative.”
A former vice-chancellor of Bangabandhu Sheikh Mujib Medical University, Dr Islam was unhappy with the authorities not yet being able to reach out to marginalised people with health services more than a year into the pandemic.
DGHS spokesperson Amin said COVID-19 antigen tests are being carried out in villages to increase the number of sample testing amidst the soaring rate of infections.
“We don’t have this facility in cities. It’s in the villages so that people are encouraged to undertake tests. This has given a boost to sample testing.
Although Bangladesh’s capacity to do tests has increased much, many are still not getting the tests out of fear of social ignominy, especially in the rural areas.
“Many people don’t want to get tested for fear of being stigmatised. People think, if they test positive, they’ll be locked up. That fear will dissipate once they receive social assistance.”
“Once tested positive for COVID-19, if they notice that society is providing food or making arrangements for any other necessities so that they don’t have to go out, they won’t have to worry about income, then they’ll be interested in getting the test.
“And that’ll help us to identify more cases, and also isolate people effectively. They’ll also receive advices, which will reduce the odds of getting infected and the number of deaths.”
