We are now in the middle of a perfect storm. The third wave of Covid-19 is at its zenith but the shore seems to be afar. More than 200 people are dying each day and the infection rate is above 30. We are in search of a miracle but nothing seems to be shining on the horizon. A countrywide strict lockdown has been imposed in the hope of curbing the spread of the virus but the favourable result is yet to come. We know that the lockdown is not a permanent solution. There is a technical term called "Flattening the curve". This means that more patients should not come together so that the existing health system does not collapse. Lockdown is a tool to slow down the transmission. We've seen it worked in China and even in our country. But this time it is seen that the lockdown is not working as expected. Every day new records are being set in terms of the rate of infections and the number of deaths. People are now suffering en masse. Due to the heavy burden of the COVID patients, the health system is on the verge of collapse. The air is getting heavy with the tears of the relatives of the deceased. The situation is deteriorating day by day. We will try to find out why this is happening.
The Delta variant is really dangerous. This variant is mainly responsible for the recent outbreak in Bangladesh. This variant, initially called the “Indian variant”, caused a devastating onslaught not only in India but also in its neighbouring countries like Nepal. This specific strain of coronavirus has a greater ability to infect and kill. Geographically, we are surrounded by India in such a manner that the virus penetrated our peripheral part initially and then within a span of time it has spread all over Bangladesh. During Eid-ul-Adha, millions of people left Dhaka to visit kith and kin in every corner of the country. They are coming back after acting as a “super spreader” of the virus.
Over time, people have become impatient. Their life is in danger due to the lockdown in corona pandemic both financially and physically. Many have lost their jobs and are sitting on the road with their children. We, as a nation, have tested such extreme patience in 1971 of the great liberation war but the duration was merely nine months. But this time we are facing an invisible foe for an indefinite period of time. We don’t know how much to wait to see the end of this havoc. The people of our village had the idea that corona was a disease of the rich. As a result, there is no awareness in rural areas. There is growing reluctance to wear a mask; social distancing is also being neglected. The irony is that more patients are coming from rural areas this time to seek healthcare. Half of the patients admitted to different hospitals in Dhaka are from rural areas. Common people don’t understand the scientific jargon uttered by health care professionals. Lack of emotion in the logic behind lockdown, wearing mask, washing hands and social distancing is another factor behind non-compliance of the toiling mass. We should explain the fact regarding general measures to prevent and treat in a simple, easy-to-understand language. Coronavirus will not spare anyone irrespective of his or her urban or rural origin, rich or poor background.
The patients do not want to seek medical attention at the outset. They initially stay at home, get over the counter treatment from local quacks or take traditional medicine. After the condition gets deteriorated, they eventually go for appropriate medical management. But then the doctor cannot do much to salvage the patient. Again the patients think there is no seat in the hospital, no oxygen, no ICU beds available and so there is no point seeking help. Ultimately they think it is better to get treated at home by relying upon the Almighty. For these exact reasons, the patients need to be aware from the very beginning, especially the elderly and those who have comorbidities. Pulse oximeter is a crucial device that needs special mention. It helps to measure the oxygen saturation which is user friendly, easy to operate and also relatively cheap. If the patient has low oxygen saturation or shortness of breath at home, he or she should go to the medical centre immediately to ensure proper treatment. It is possible to reduce the death rate if proper treatment is continued from the beginning.
The Ministry of Health has much more to do. I will not say that they have failed utterly but they have missed many opportunities to curb the infection. Handling pandemic is not the job of a single ministry but it demands a multi-disciplinary approach. From the recent decision of the opening of the RMG and industrial sectors, it has been obvious that there lacks a coordination in formulating proper planning and strategy. More RT-PCR tests, oxygen supply, high flow nasal cannula supply, provision of more ICU beds, training of medical professionals and boosting the morale of the concerned are the top priority. So far, the medical personnel of our country have not received proper incentive. They are exhausted and their physical and mental well-being is also overlooked. Whispers can be heard on the wall with thin ears. The ministry has to stand on its own two feet. Various scandals and failures are not the last words. We have to turn around with eternal morale and patriotism. We need desperate measures from the ministry in these desperate times.
Vaccines save lives. Vaccines are the greatest remedy of this period. We need to be more careful about procuring vaccines. Not all eggs can be kept in one basket. We need to collect vaccines from different sources. We have to find a way to produce vaccines in our country. The situation in Dhaka is not yet the same as in the border districts due to one of the reasons being that vaccination in Dhaka is comparatively higher than other regions. However, there is a lot of propaganda against the vaccine. We have to be patient and make our answer. Vaccines should be taken on the doorsteps of ordinary people. Vaccination programme should include cluster oriented plans so that a particular group of people should be vaccinated and monitored over and over again. If 70 per cent of people can get vaccinated, only then herd immunity can be achieved. There was a standstill in the vaccination programme. If we had had a continuous supply of vaccines and proper implementation of the programmes, then we could now be in a better place than this current fragile situation.
The porous lockdown has not worked as we expected. Where there is a democratic, social organisation in which individualism is strong, there is no magic of lockdown indeed. Lockdown works better in a regimented society. Our recent experience has seen the act of the lockdown paling gradually like “hartals” in previous years. No bureaucratic lockdown will not work if the lockdown does not come from the people out of their collective consciousness. People may be scared for one or two days and then the pumpkin is the pumpkin. Moreover, it is important for low-income people to have free access to rice, pulses, salt and oil during the lockdown. It is important to determine now whether the lockdown is becoming a weapon of choice. You don't have to just sit with lockdown; at the same time, you have to go for mass diagnosis, contact tracing and vaccination. We need a smart, mini, precise, calculated lockdown than calling for a nationwide “shutdown.” Hopefully, our health policymakers will come out from relicense and formulate appropriate strategy within due time.
Voluntary activities are very important during this time. But sadly, none has been seen as much as in the past. One of the reasons may be that the disease is highly contagious. Everybody has the fear of their life. But like in the past, we have to carry out voluntary activities. NGOs have a specific role to play. College and university students who are at home should come forward as they are their own community leaders. They need to be used, especially to promote awareness among common people for the importance of wearing masks, washing hands, social distancing and mass vaccination. The religious scholars from their own institutions, school teachers from the locality should go ahead to take the responsibility. The local administration will co-ordinate and form an area-based team. At any cost, the students have to make use of this critical time of the nation. Managing pandemic is not the job of the government only. Everyone must provide their utmost effort and co-operation to tackle this epidemic together.
In the end, the political parties have not stepped in yet to their full potential. Our politicians have a glorious past, especially the monumental events of 1952 language movement and 1971 liberation war. We have to remember that bureaucrats know the process, procedure but it is the politicians who know the people. Everyone has to come forward irrespective of caste, creed, religion and party affiliation. It is not an affair of any particular party; rather it is the affair of the whole nation. It is a matter of life and survival of 170 million people. Everyone must come forward to save the country and the people, leaving behind all petty interests.
The country is at a crossroads. Our future is uncertain. If we cannot handle this pandemic, our lives, society and economy will be threatened. This is a crisis that we cannot afford to lose. We are the torchbearers of that nation which rose from the ashes like a phoenix in 1971. It is possible to get a line of light only if everyone agrees in a respectful manner. Victory can be achievable but proper timing is the ultimate key.
Shamim Ahmed is an Associate Professor at the Department of Respiratory Medicine, Bangabandhu Sheikh Mujib Medical University.
shamim.chestphysician@gmail.com