Lessons of Covid-19: Are we ready to work on them? 

Oxygen that is all around us was what Taposhi Ghosh needed to survive but she could not suck it into her lungs all by herself.  

A patient of long-term breathing problem, her condition got worse in December 2018 than in previous occasions when she had been admitted to hospital for oxygen support. 

As she was gasping for air on a bed at a Khulna hospital, her family was carrying oxygen cylinders up the stairs to the fourth floor to keep those standby before the one in service became empty. That was not enough. Her organs were failing one after another, and in a matter of two days, the body gave up on her, trying to function with limited oxygen supply. 

More than a year later as a new coronavirus wreaked havoc on public health across the country, the first thing that became conspicuous was breathlessness of the infected. They quickly grew in numbers, putting pressure on the health system to do something about it. 

That led to the installation of central oxygen supply lines, not only in healthcare facilities in Dhaka but also at many district-level hospitals, and equipment like high-flow nasal canola and oxygen concentrators to save lives without high-tech, high-cost intensive care treatment.  

Taposhi's life might not have been cut short at the age of 52 had there been these resources in place. Patients of chronic obstructive pulmonary disease like her who account for 12.5% of Bangladeshi adults, according to a 2019 article published by the Cereus Journal of Medical Science, will have a better chance at survival now. 

The pandemic has forced many such fast-tracked developments, pointing to the weaknesses of the national healthcare system. It has also awakened the authorities to the fact that public health has great influence on the economy. Now, whether changes will continue to shape the system for the better would depend on policymakers' willingness to tread on the path lit up by the global crisis. 

As the coronavirus infection is waning, experts and healthcare providers fear that the lessons learnt will lose the attention, if it is not forgotten altogether, and the nation will again be caught off guard when faced with another pandemic. 

One of the once-forgotten issues that came into discussion amid the contagion is the World Health Organization's guidelines for infection prevention and control. The fear for catching the virus that earned the tag of a super-spreader has compelled a strict enforcement of measures to break the chain of infection. 

Until then, the lives, which were lost for passing of the communicable diseases, such as pneumonia, at hospitals when people went there with other illnesses, failed to raise the alarm.  

The practices of sanitization and segregation of patients suffering infectious diseases should continue even after the pandemic is over, said epidemiologist Kinkar Ghosh, Department of Epidemiology and Research of Dhaka Shishu Hospital. 

"That will bring down the disease burden and the burden of treatment expenditure." 

The government also recruited doctors, nurses and technologists to fight against Covid-19 and the additional manpower will surely help improve quality of services at public hospitals.

But as the entire system shifted its focus to dealing with Covid-19, patients of chronic diseases like diabetes, hyper tension and cancer slipped into oblivion and neglect, and that has both health and economic toll. 

Delayed actions make some curable diseases incurable too. For example, 70% of the child cancers are curable if they are diagnosed and treated in time. Researches may be able to shed light on how deep is the wound caused by Covid-19. 

However, Bangladesh should be better prepared for the next pandemic if it has to avoid such ramifications. 

And should it be forgotten that more than a hundred doctors died of Covid-19 while serving as front-line health workers, an irrevocable loss when the number of doctors, nurses and midwives per 10,000 population is 6 in the country against a minimum threshold of 23 set by the WHO!  

The loss might have been less if the healthcare system could provide its workforce with required logistics at the onset of the pandemic last year. 

The highly-centralised health system was another reason as to why patients of Covid-19 and other diseases -- from outside Dhaka rushed to the capital, straining the capacity of the public hospitals here over the last one year.

The importance of an effective hierarchical system with functional primary, secondary and tertiary facilities, has never been more obvious. 

The pressure at the centre can be reduced if patients get treatment at the primary and secondary facilities before being referred to the tertiary facilities for issues that demand specialised care, said Nezamuddin Ahmad, former head of the palliative department at Bangabandhu Sheikh Mujib Medical University. 

Such an effective referral infrastructure will also improve the quality of healthcare and bring down the number of preventable deaths and treatment cost.

Speaking of cost, Sushil Ranjan Howlader, a retired professor of the Institute of Health Economics, Dhaka University, said the government should work to reduce out-of-pocket health expenditure from 74%, which was very high. 

Not only the poor, people of lower-middle, middle- and upper-middle classes as well fail to absorb the shock of catastrophic health problems, such as cancer and heart complications. 

"There must be a health insurance policy at least for sharing the risk of major diseases," Sushil said. 

In the middle of a pandemic when people face a compounding impact of a contagious disease like Covid-19, one or more other ailments and income loss, health financing emerges to be a major concern to be addressed. 
The mass vaccination began on 7 February and till 6 March, nearly 37 lakh people got their first dose of the Oxford vaccine, made available by the government from India's Serum Institute through Beximco Pharma. 

The ongoing vaccination drive seeking to cover 80% of the population against Covid-19 rekindles hope that the country can overcome all these challenges if it resolves to do so.