Utilisation of past experiences, lockdown and quarantine policy
As disaster and turmoil are old stories in Bangladesh, we can easily use our past experiences to control the present for a better future. This is the first part of a series looking into the best practices in Covid-19 management that can be emulated by Bangladesh
It has been seven months since the detection of patient zero and four month since the World Health Organization declared the novel coronavirus as a pandemic. It is time for nations who are still struggling to flatten the infection curve learn from countries who have succeeded in containing the virus.
In the second part of the article published in July 17 2020, we looked at global steps versus our own travel restrictions and early actions. Today, we look at how other countries utilised past experiences and implemented lockdown strategies, which others can replicate according to their context.
Utilisation of past experiences
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One thing that is common in all the countries who succeeded in the Covid-19 fight is – proper utilisation of past experiences of epidemics.
According to CNN – in 2003, Taiwan experienced the Severe Acute Respiratory Syndrome (SARS) outbreak which killed 73 people. But the crisis also prepared Taiwan to handle any future pandemics.
The previous experience showed them two ways, first – swift border control and second - mask custom. Taiwan assembled the "SARS Unit" which had 124 actions to implement in Covid-19 management. The domestic production of masks instead of relying on imports from China and vigorous island-wise testing – allowed Taiwan to move fast against the coronavirus.
The Vietnamese government and its people are habituated to dealing with infectious diseases. They learned from SARS in 2003, Avian influenza in 2010 and hence are ready to cope with any outbreak including Covid-19.
South Korea also learned a lesson from the 2003 SARS outbreak, H1N1 influenza in 2009 and MERS in 2015 - which killed several hundred people. The contact tracing method was learned after the Middle East Respiratory Syndrome (MERS).
Following these outbreaks, the South Korean health officials recognised the value of early testing, the importance of isolating new patients.
Bangladesh has seen a series of outbreaks like Diarrhea, Cholera, Influenza, Smallpox, Measles, Tuberculosis, Malaria, Dengue and now – the novel coronavirus. According to WHO, 30 cluster cases of Nipah virus-infected and 18 deaths were reported in 2004.
In 2008, the health ministry documented the first case of H5N1 avian influenza. Moreover, flood-prone Bangladesh has best experience of disaster management along with relief management.
After the coronavirus outbreak in the country in March, the Directorate General of Health Services (DGHS) published a National Preparedness and Response Plan for Covid-19.
The document contains the country's management plan broken down to six levels:
Level 1 - where there is no case in the country. We can say we were in level 1 before March 8.
Level 2 - is when a country has imported cases of virus - which is after arrival of infected Italy and China returnee Bangladeshis.
Level 3 - denotes where there is limited local transmission. This started when Italy and china returnee Bangladeshis disobeyed mandatory quarantine.
Level 4 - indicates widespread local transmission. This started when the garments workers were misguided and forced to return to work infecting people in the city, as well as villages.
Level 5 - there is a decrease in transmission and the sixth stage is the recovery phases.
From this, we can say that we are in the fourth stage, which likely started in late April.
As disasters and turmoil an old story in Bangladesh, we can also use our past experiences to control the present for a better future.
In addition to the DGHS, setting up a separate "National Epidemic Centre" or "Covid Response Unit" is necessary. According to media reports, the DGHS was unable to provide the exact numbers of daily tests and have been marred by many other accusations of mismanagement.
So this new unit can be set up to play the monitoring role. It can be assigned to create a pool of public and private practising doctors who are specialised in respiratory and viral diseases. The nurses will be trained for handling the pandemic, including wearing a PPE, to assisting doctors while giving Covid-19 treatment to the patient. The deployment of forces and volunteers will be determined after a report submitted by the unit.
Lockdowns/quarantine policy:
Vietnam utilised reactive propaganda like "It's a War" - to run a dynamic awareness campaign and unite the public to fight against a common enemy. Vietnam was the first country after China to close down large residential areas.
For example - a case was traced where an infected migrant worker returned to the Phuc province from Wuhan in China. Vietnam imposed a 21-day quarantine in the entire province. In late January, the government started quarantine facilities for patients as well as suspected citizens exposed to Covid-19. The facilities are staffed by a combination of government employees and volunteers, often university students.
Although India is no winner in managing Covid-19, they still used some good strategies and some of them are easily implementable in Bangladesh too. The lockdown policy in India was appreciated by the international media during the early days of the outbreak.
On March 22, the Indian government declared a Janata Curfew / Public Curfew followed by a total lockdown. The Janata Curfew was billed as a pro-people decision - by the people - for the people - from the people.
A 24/7 drone aerial surveillance was a significant and important step by the Delhi police. The patrolling police rushed to wherever the drone spotted a crowd or public transportation in the lockdown. Chandigarh police created the e-beat book app to keep a database of quarantined citizens, border checking, facial recognition-based monitoring and locating nearby pharmacies.
The Chandigarh stadium was converted into mass jail for lockdown breakers with makeshift tents with 5 feet distance in between. The local fields were utilised to restrain captured vehicle for breaking lockdown laws and the owners had to pay 5,000 to 20,000 rupees to get back the vehicles.
Also, Thailand had compulsory isolation at a government quarantine facility for travellers entering Thailand. The government turned the Royal Thai Air Force Flight Training School into isolation centres.
This is the point where Bangladesh appeared to be the weakest. Instead of a nationwide lockdown, a country-wide "general holiday" was declared for two weeks from 26 March 2020, which was later extended until May 30 2020.
The holidays initially gave people the scope to visit tourist spots and native villages. Later, the government banned public vehicle movement all over Bangladesh, which was a great decision. But during the lockdown, ready-made garment industry owners announced the reopening of factories which drove thousands of workers to rush back to the capital.
The workers then had to return under vicious circumstances - hiding inside shipping containers and water drums. The same incident was repeated on 26 April 2020, several days before the scheduled end of the restrictions.
In June, Dhaka was divided into red, green and yellow zones – which was faulty as the people in high-risk red zones had to attend offices in other areas and vice versa. Eid Holidays and withdrawn impositions on public transport gave rise to public gatherings and the Covid-19 curve moved abruptly upwards.
From the above discussion, we can easily point out the strategies to replicate in Bangladesh. We do not have any more lockdown announcements now, roads are clogged with traffic and shopping malls are crowded. We are adopting to the new normal.
One good example which other countries like Brazil, USA can emulate from Bangladesh is, engaging the local volunteers to provide 24/7 service for people who were stuck in the lockdown area. A very good initiative by the government was taken recently when the authorities said that using a mask at a public place is mandatory for all and shall be an offence if the directive is not followed.
Increasing quarantine/isolation centres with better facilities is necessary so that people do not get scared and find excuses not to report. We can also utilise local fields and schools as quarantine facilities. We can also utilise Vietnam's propaganda and publish the exact scenario of deaths due to Covid-19. This will have an operative reaction on the public.
With proper tactics and wiser decisions, it will be easier to control the madness of this virus. As said earlier, we can be victors too! Where there is dark cloud, there is an obvious silver lining of hope.
Ishrat Binte Rouf is Communication Manager of Gen Lab, working in different socio-development projects with EU, UNDP and embassies.
