According to the Financial Express of June 1, Bangladesh had 47,153 cases of Covid-19 infection and 650 people died from the infection by the end of May. The paper quoting officials and experts pointed out that Bangladesh was set to emerge as a new global hotspot for Covid-19 because of fast-spreading contagion and fatalities. The rate of infection has been on the rise reaching 57,563 with 781 deaths by June, 4 (FE, June 5). The growing Covid-19 crisis now threatens the country not only as a health crisis but also as a far reaching economic crisis. The health and economic crisis triggered by the pandemic has been further aggravated by super cyclone Amphan hitting coastal areas of Bangladesh a couple of weeks ago killing 16 people.
The healthcare system is already seriously overstretched to a point of collapse due to inadequate hospital beds (8 beds for per 10,000 people) with the situation already dire even long before the outbreak of the pandemic.
The Covid-19 pandemic, in fact, has exposed the serious deficiencies that existed for a long time in the healthcare system in Bangladesh. It is now being overwhelmed by the pandemic. Now a blaze killed 5 patients in a Covid-19 dedicated section of a privately run hospital in Dhaka which also further exposed the serious deficiencies in the private sector healthcare system which primarily cater for the wealthier section of the population.
The situation has further been aggravated by many doctors and other healthcare and support staff who are in fear of getting infected due the lack of PPEs and very low rate of testing. So far, in a country of 170 million people, only 358,187 people have been tested (FE, June, 5). As a consequence many of them are refusing to attend to treat any patient, let alone any suspected Covid-19 patients. Those who do attend face serious risk of infection and many of them already died. Another Bangladesh English daily in its editorial on June 2 expressed great concern about hundreds of frontline workers including healthcare workers who got infected with the virus and dozens already died of the infection.
This pandemic is a health crisis but it is challenging the government to implement monetary and fiscal policies that support sustained economic activity. There is now a growing fear that the country may risk a massive reversal of economic gains made over the last three decades; more alarmingly an entire generation may be lost, if not in lives, but in opportunities and dignity. This is not a picture unique to Bangladesh alone, but a generalised picture for the entire least developed world as well as for many developing economies including the countries in the neighbourhood of Bangladesh.
Bangladesh is now battling with the Covid-19 pandemic with limited financial resources and a long history poor healthcare infrastructure, especially for the poor. The healthcare problem is further seriously compounded by the presence of thousands of Rohingya refugees housed in crammed refugee camps in Cox's Bazar.
Many observers opined that a highly densely populated country like Bangladesh is a sitting target for Covid-19, potentially causing large number of deaths and impoverishment of the country. Now the fear is while Bangladesh is not unfamiliar with very high levels of poverty in a historical context, may be heading towards a level of poverty that was unimaginable just a few months ago.
While the World Health Organisation (WHO) first declared Covid-19 a world health emergency in January as well as the Chinese government first shared the news of the deadly virus, Bangladesh like many other countries was slow in responding to the crisis. But the government eventually recognised the gravity of the crisis and introduced the WHO guidelines such as social distancing, personal hygiene, imposing lockdown etc.
The WHO prescription appears to be one size fits all. Given Bangladesh's situation even in big cities like Dhaka and Chittagong with teeming slums without proper running water supply or electricity, poverty, and poor healthcare and sanitation facilities, most of those recommendation are difficult, and in many instances impossible to implement such as working from home or staying at home when one does not have a home, and washing hands when one does not have water and soap.
More importantly, lockdown is also infeasible in the absence of any viable and ongoing state assisted provision of basic needs of life. Furthermore, lockdown makes it impossible for businesses to maintain even skeletal operations. It has ruptured the supply chains of essential item such as food, medicine, personal hygiene products.
On March 25, Prime Minister Sheikh Hasina announced a stimulus package of Tk 50.0 billion for export oriented industries to mitigate the impact of Covid-19 on the economy. On April, 1, the government further unveiled four new packages of Tk 677.50 billion to be implemented in phases - immediate, short and long term. The IMF also extended US$732 million to Bangladesh to mitigate the impact of the pandemic.
Now some experts hope that younger population of Bangladesh ( median age 27.1) will limit the number of fatalities in the country. There is also a speculation that the virus might spread much slowly or even die out in hot and humid tropical climate of Bangladesh. But the Singapore experience does not give much hope on the view that tropical hot and humid climate help fight Covid-19.
It is now fairly clear that the Covid-19 crisis will take a long time to play out. It is a health crisis that has already started to lead to a serious economic crisis. Unless the health crisis is resolved or brought under control, issues relating to the economic crisis can not be satisfactorily addressed. So the government needs to figure out how to keep the pandemic at bay while keeping the economy afloat.
Bangladesh's response so far involved implementing the WHO guidelines with the objective to flatten the curve. But the measures like lockdown is not sustainable for the amount of time that will take to develop a vaccine-- the most fitting way to mitigate the crisis. As such, the government needs to put in place enabling mechanisms to deal with the pandemic while keeping the economy functioning. That will require minimising the number of people getting infected and to minimise the infected people becoming seriously sick.
In this regard Bangladesh can look to its neighbouring country India's state of Kerala as a comparator. Kerala has designed a very successful model which followed a very aggressive 'testing, isolating, tracing and treating' to contain the outbreak of the pandemic. Kerala, indeed, has become the global benchmark for how effectively to deal with the current health crisis caused by the Covid-19. Kerala has very successfully quarantined the infected people, especially migrants returning from the Middle-East and other countries with very active community participation. At the district level, the Covid-19 First-Line Treatment Centres have been established to treat mild and moderate cases so as to avoid crowding at Covid-19 designated hospitals.
In addition, Kerala's disaster response has included extensive social welfare measures to provide food and social security during the lockdown period including doorstep delivery of food and essentials where such services were required. Kerala with a population of 35 million, only recorded 1088 cases with only 9 deaths by the end of May and no community transmission.
The 'Kerala Model' may be difficult to replicate as the state has developed a publicly funded extensive health care system along with social development over many decades giving rise to the term 'Kerala Model of Development' in the 1970s.
Kerala offers some important insights. Bangladesh can learn lessons from Kerala's robust health care system which has been in existence for decades. In fact, a well performing health care system has helped Kerala to meet an emergency like the current pandemic. The WHO representative in India also attributed Kerala's prompt and effective response to its past experience and investment in emergency preparedness.
Overall, under the situation prevailing now, Bangladesh has three strategic policy options that it can follow; (1) suppression of the virus strategy which involves continuation of lockdown until the infection rate falls to zero, (2) controlled adaptation strategy implying gradual widespread easing of restrictions while eliminating the transmission of the virus, (3) Swedish model of herd immunity which scientists believe is achieved when more than 60 per cent of the population has had the virus and enables the government to keep schools, restaurant and most businesses open. Each strategy has its own costs, risks and benefits. The choice of the strategic policy option by Bangladesh will depend on weighing those factors keeping in view resources deployed to contain the spread of the virus within the preferred strategic policy framework while working to get the economy back on track.
Much about the disease still remains poorly understood, that opens up the further possibility of more severe outbreaks down the road. As such until a vaccine is found, countries around the world including Bangladesh will have to continue to manage the pandemic while striving to contain it. The economic future remains challenging for Bangladesh as the country is grappling to contain the virus. As the Bangladesh economy now reopens amid demands for 'hard' lockdown from some sections of the population (see FE, June 5), the long term public health response will become clearer as time passes. But for the moment, any rapid rebound of the economy from the current economic downturn is unlikely. Bangladesh may have to face the economic pains of the pandemic crisis for years to come.
Muhammad Mahmood is an independent economic and political analyst.
