The pandemic situation in the country is breaking its record every day. The newly found South African variant, though not necessarily virulent as evident in other countries, is more infectious. However, the evidence on Bangladesh is not available regarding its fatality rate. Country evidence suggests that it has a similar death rate to other strains. The rapidly spreading variant can spark faster in a country like Bangladesh with huge population density and massive social contact. The number of daily deaths has exceeded 90. The number of daily cases of infection spiraled from four thousand to seven thousand within a span of 15-20 days. Those who are dying now mostly got infected 10-15 days ago while country's total cases were less than 5000 daily, and hence, it is extremely likely that within a few days the death tally will cross the gruesome 100 mark. Proper preventative measures, management of disease, and carrying out context-specific risk communication measures are crucial at this stage. The role shifting-experts decide, administration executes-is the key to making effective and full-proof policy decisions.
PERCEPTION OF RISK: There is a tendency of underestimating the actual risk of Covid-19 among the common people. In one of our recent studies, it is revealed that people perceive that anyone might get infected but a large number of them think that it could be himself/herself. There is a myth that young or hardworking and poor people are not infected. Appropriate campaigns are required to demystify these myths. The news or print media should highlight the number of young people dying every day along with the older population. In addition, how irresponsible behaviour of the youths is putting the family members in danger has to be communicated well.
COLLECTIVE DECISION MAKING: In a widely populated country like ours, we cannot control the situation just by imposing laws on people or with a set of directives. The decisions should be taken collectively and all stakeholders should be engaged. The first lockdown of the country would have been more effective had the government taken the decision in consultation with organisations like the Shop Owners Association, Paribahan Malik Samity etc., to strongly enforce it. It should be evident that the preventative measures are not just government directives, rather it is for the betterment of all, including those who might oppose them. Keeping a few sectors open, while other sectors closed may, in fact, reduce confidence in the government decisions and people of some sectors may feel they were treated unfairly.
PREPARING QUALITY COMMUNICATION MATERIALS: Preparing communication materials should be one of the topmost priorities. Experts should be consulted for this purpose. For example: wearing masks could be established as a heroic activity. Regrettably, the opposite has occurred. If these could be highlighted, then a positive change might occur. Besides, the young population can be involved more. Each area can have a representative from public or private universities who will work for creating awareness among the people. More content on wearing masks, sanitising hands etc should be prepared and widely circulated.
REDUCING THE HASSLE OF PATIENTS: A dashboard can be created on any website or social media on the real-time update of the number of ICU beds available in various hospitals. This is very important at this moment. It might be difficult for the government. A consortium comprising of non-government organisations (such as BRAC), universities, IT firms can be formed. A volunteer in every hospital can be appointed to provide information. It is cost-efficient and less time-consuming. This will save time and reduce the hassle of the critical patients and their relatives.
Besides, telemedicine service should be provided. As a result, it will be easy for the less critical patients to get treatment staying at home. Campaigns should be organised to make people aware of the severity of the cases and when to or not to rush to the hospital. With this, we can reduce unnecessary or panic visiting.
DECENTRALISING THE HEALTH FACILITIES: The ICU facilities are Dhaka-centric. Even if there are some ICU facilities outside Dhaka, people may have a lack of confidence in those. A connection can be created among top surgeons and the local doctors in the district. This might increase the confidence of common people in their local hospitals.
Besides, many hospitals currently have more patients than the capacity while the hospitals may have oxygen supply for those with beds Therefore, alternative arrangments have to be made. The smooth supply of oxygen should be ensured in every hospital.
INCENTIVISING THE FRONT LINERS: It is very unfortunate that the incentive packages for the front-liners were announced by the honourable Prime Minister but were not properly implemented. This should be implemented immediately. Moreover, some non-financial incentives-- such as recognising the good work could inspire health workforce dedicated to Covid-19 management.
CLEARING THE MISCONCEPTION REGARDING VACCINE: The number of people taking vaccines is dropping day by day. Many people perceive that the Oxford vaccine is not effective especially against the newly found South African variant. The Oxford vaccine meets the WHO standard. Although the Oxford vaccine is not much effective for mild symptoms or asymptotic cases against South African variant, it reduces disease severity. At this moment, the main purpose should be to focus on reducing the risk of infections. To achieve this goal, demonstrating the vaccine's effectiveness to the general populace can be a useful method.
SIMPLIFYING THE VACCINATION PROCESS: The vaccine registration process should be made simple. The online process is very difficult for the commoners. The rickshaw pullers or CNG drivers are not taking vaccines due to complicated registration processes. Besides, it is difficult for poor families to spend money for the registration and printing of the card. As they won't be able to complete registration by themselves, they might need to seek help from computer shops for registration and printing of card which means they have to spend on it. Moreover, the vaccine booths should be decentralised and registration corners will need to be set up in convenient locations. Most of the vaccine booths are in big hospitals. That being the case, the day labourers or low-income groups hesitate to opt for taking the vaccine because this involves opportunity costs--giving up the work for that day and transport costs.
GIVING AUTHORITY TO HEALTH SECTOR: In a crisis like this, decision-making should be on the health ministry and health experts. Currently, a serious lack of coordination is observed. To fix this, the health ministry should lead the Covid-19 management with the help of experts. The decisions and directives should come from the experts and scientists, and the role of administration or other sections of the government should be execution. Correct and timely decisions should dominate, not the bureaucracy.
Pandemic control will be a severely difficult job if we cannot make the decisions by consulting the experts. Hence, it is extremely important to bring health sector experts to the leadership. Otherwise, it will be an uphill battle.
Dr. Shafiun N. Shimul is an Associate Professor of the Institute of Health Economics, University of Dhaka.
