Coronavirus continues to wreak havoc on many countries. Nationwide lockdowns have already been imposed in Italy, Spain, France and India, among others. Some experts state national lockdown as a "panacea" for preventing coronavirus (Covid-19). However, when China shut down Wuhan-the epicentre of the coronavirus outbreak as a draconian measure to prevent further spread of the disease, the world was stunned, and many were left sceptical. Quarantine had never been tried on such an enormous scale in the modern world. Chinese President Xi Jinping has described the sweeping quarantine measures over vast areas of the country as "people's war."
Many commentators opine Chinese lockdown as "brutal," considering the social (and economic) costs. But nearly two months on, China's approach appears vindicated since the number of domestic transmissions of Covid-19 has drastically fallen. Right now, in Wuhan city, people are getting back to work as restrictions eased in most of the virus-hit Hubei province. In contrast, in Europe, the coronavirus death toll is sharply increasing.
The lockdown approach is not producing the desired outcome in many European and Asian countries, like China. As a result, the Covid-19 outbreak spreads exponentially outside China. Scientists report that if the number of cases were to continue to double every three days, there would be about a hundred million cases in the USA by May. In this context, a pertinent question: is national lockdown adequate for preventing Covid-19?
Of late, Dr. Michael Ryan, Executive Director, WHO Health Emergencies Programme, says, "lockdown is not enough to defeat coronavirus." Countries can't simply lock down their societies to defeat coronavirus, but rigorous public health measures are crucial to avoid a resurgence of this virus. "What we really needed to focus on is finding those who are sick, those who have the virus, and isolate them, find their contacts, and isolate them," Dr. Ryan adds.
The Covid-19 outbreak is accelerating in Bangladesh. Experts have said an outbreak would pose a severe challenge in Dhaka (and in this country) due to the dense population. A large portion of the Dhaka population suffers from chronic health conditions, putting them at high risk from Covid-19. The government is passing a critical time to adopt the "as aggressive as possible" approach. People from all walks of life are apprehensive that the situation in this country may deteriorate further and said stringent social distancing is mandatory right now to flatten the corona outbreak curve. Three-pronged distancing is most effective in controlling Covid-19, a recent study conducted by researchers from the National University of Singapore (NUS) and published in the "Lancet Infectious Diseases" journal shows. This study shows quarantining infected people and their family members, closing schools, and imposing workplace distancing and homeworking can all limit the spread, but a combination of all three is most effective in reducing Covid-19 cases.
Decision-makers say "Chinese lockdown strategy" will not be fully applicable to Bangladesh due to people's poor socio-economic conditions and other factors (such as government's capacity, (IT) infrastructural support, technologies, and country's medical facilities). Our lockdown strategy has to be imposed in a way that the measures required to stop transmission completely may not be too socially or economically extreme. No doubt, shutting down cities/communities pose complex challenges. The government has to implement proactive measures for low-income people with more regularised jobs and businesses. The government must address a whole lot of questions, like how daily wage earners (rickshaw-pullers and day laborers) can earn enough to live on, how to ensure available daily commodities supply with reasonable prices, and how to manage regular medical services and others issues connected to livelihood security, i.e., adequate and sustainable access to income and resources to meet basic needs.The lockdown strategy must be complemented with a plethora of prevention and control measures to set an ambitious and agile disease containment effort.
First, controlling the source of infection, blocking transmission, and preventing further spread is vital. The response mechanisms have to be a "collaborative" effort where multi-sectoral involvement performs joint prevention and control measures such as shutting down wet markets and identifying the zoonotic source of Covid-19 outbreak like transmitting the virus from vertebrate animals to humans. Updating protocols for Covid-19 diagnosis and treatment, surveillance, epidemiological investigation, management of close contacts are essential. Moreover, diagnostic testing kits have to be available at all districts (and Upazila) and bringing wildlife and live poultry markets under strict supervision.
Second, deploying strategies to reduce the intensity of the epidemic and slowing down the increase in cases. In Wuhan, the Chinese government placed the highest priority on treating patients and reducing deaths. Other focused areas were restricting imports, curbing the spread of the disease, and implementing joint prevention and control measures. AS for ouselves, we need a meticulous policy for contact identification of Covid-19. For example, in Wuhan, more than 1800 teams of epidemiologists, with a minimum of 5 people/team, are tracing tens of thousands of contacts a day. Contact follow up is painstaking, with a high percentage of identified close contacts completing medical observation. Strict measures are needed for managing traffic, strengthening public risk communications and health education, coordinating the allocation of medical supplies, building new hospitals, and maintaining a smooth supply of commodities and price stability to ensure the normal operation of the society.
Third, mapping knowledge gaps and the timely filing of these knowledge gaps is imperative to enhance control strategies. Since the start of the Covid-19 outbreak in China, there have been significant attempts to thoroughly know about the virus and disseminate information to the people. It is remarkable how much knowledge about a new virus has been gained in such a short time. We can learn much from the WHO, Centres for Disease Control and Prevention (CDC), and China. Still, vast knowledge gaps remain in understanding transmission dynamics, surveillance and monitoring, and clinical management of severe and critically ill patients.
Fourth, deploying aggressive disease containment effort requires the supervision of the apex body. For instance, Chinese President Xi Jinping personally commands and deploys the prevention and containment efforts. Following the Chnese example, a "National Approach" can be introduced that promotes temperature monitoring, masking, and hand washing.
The WHO-China Joint Mission says that truly "all-of-government and all-of-society approach" that has been implemented in China has averted or at least delayed hundreds of thousands of Covid-19 cases. The WHO Director-General Tedros Adhanom Ghebreyesus said: "In many ways, China is setting a new standard for outbreak response." Chinese experience tells we can effectively contain the epidemic and finally overcome it if adequate measures are in place. To this end, we have to learn much from the Chinese experience to manage the outbreak in areas with no cases vs. sporadic cases vs. clusters of cases vs. community-level transmission. Such a strategy is essential for ensuring a sustainable approach while minimising the socio-economic impact.
Anecdotal evidence from China indicates that without adopting aggressive disease containment measures, we cannot defeat Covid-19. Fundamental to these measures is extremely "proactive surveillance" as regards immediate detection of cases, rapid diagnosis and immediate case isolation, rigorous tracking and quarantining, and understanding and acceptance of these measures by the people. The efficacy and effectiveness of these measures are contingent on near-term readiness planning, which has also to embrace large-scale implementation of high-quality and non-pharmaceutical public health measures.
Covid-19 is spreading at astonishing speed. Experts say the world is on fire, the flame of the pandemic is erupting and raging across the globe. National, regional, and city lockdowns are crucial as a firebreak. Coronavirus vaccine is still a long way away to be made available. Human trials will begin imminently - but even if everything goes well and a cure is found, there are many steps before global immunisation is feasible.
In sum, the country's lockdown strategy should be a balance between protecting people's lives and their livelihoods, i.e., a means of securing the necessities of life.
Ranjan Roy Ph.D. is an Associate Professor in the Department of Agricultural Extension and Information System, Sher-e-Bangla Agricultural University, Dhaka.