Covid-19 Pandemic: Bangladesh Perspective
Current global pandemic scenario
The world is currently experiencing a devastating pandemic of an infectious disease called novel coronavirus disease 2019, or Covid-19. Covid-19 is caused by the severe acute respiratory syndrome coronavirus (SARS) and is part of a large family of coronaviruses, which has infected most of the powerful nations of the world. Coronavirus is spreading across the world, with more than 23 million confirmed cases in 188 countries. Cases of the disease are continuing to surge in many countries, while others, which had apparent success in suppressing initial outbreaks, are now seeing infections rise again. In terms of individual countries, Brazil has the second highest number of cases in the world, after the United States of America (USA). It has recorded more than 114,000 deaths. Mexico has the second-highest death toll in Latin America with more than 60,000 deaths, and cases have also risen rapidly in Colombia, Peru, Argentina and Venezuela, says a BBC survey. The other countries who are also affected are Russia Spain, Germany, the United Kingdom (UK), and Italy now have the most cases worldwide. India and African countries also affected with this deadly virus. Many countries around the globe are now enforcing lockdowns to try to slow down the spread of the killer disease. Such restrictions and measures differ from country to country however usually involve- cancelling public events, closing borders, closing schools and encouraging people to work from home.
Bangladesh reports the first Covid-19 death detected on March 18, 2020, and numbers of active cases are now in sharp upward trend, according to press briefing at Institute of Epidemiology, Disease Control and Research, IEDCR. The Covid-19 affected patient, who is more than 70 years old, had multiple pre-existing complications, such as high blood pressure, chronic obstructive pulmonary disease (COPD), heart problems and diabetes, and adding that he had heart stenting installed previously. Around 9% or almost 20 lakh of Dhaka city residents could be Covid-19 positive with approximately 78 % of them showing no symptoms, said a study jointly conducted by the IEDCR and the International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b). The percentage is much higher than the figure provided
History of Coronavirus
AccordingÂ toÂ theÂ CanadianÂ studyÂ in 2001,Â aboutÂ 500Â patientsÂ wereÂ recognizedÂ asÂ Flu-likeÂ system.Â 17-18Â casesÂ ofÂ themÂ wereÂ confirmedÂ asÂ infectedÂ with coronavirusÂ strainÂ by polymerase chain reaction. Until 2002,corona treated as simple non-fatal virus. In 2003, numerous reports published with the evidences of spreading the coronavirus to many countries, such as Hong Kong, Singapore, Thailand, Vietnam Taiwan, and in the United States of America. In 2003, numerousÂ caseÂ was reported ofÂ severeÂ acuteÂ respiratoryÂ syndromeÂ instigatedÂ byÂ coronaÂ andÂ theirÂ mortally more than 1000 patient. This known as the black year for microbiologist. When microbiologists started focusing to comprehend these problems and afterÂ aÂ deepÂ exerciseÂ microbiologists,Â concludeÂ andÂ comprehendÂ theÂ pathogenesisÂ ofÂ diseaseÂ andÂ discoveredÂ asÂ coronavirus.Â NonethelessÂ tillÂ totalÂ 8096Â patientÂ wasÂ confirmedÂ asÂ infectedÂ withÂ coronavirus.Â Therefore, in 2004, World Health Organization (WHO) and centres for disease control and prevention declared as â€œstate emergencyâ€. Another study by Hong Kong confirmed 50 patient of severe acute respiratory syndrome, while 30 of them confirmed as coronavirus infected.Saudi Arabian reports also stated several infected patient and deaths in 2012 with coronavirus, which published in Centers for Disease Control and Prevention (CDC) and World Health Organization (WHO) in 2003.Â Covid-19 was first identified and isolated from pneumonia patent belongs to Wuhan, China in late December 2019.
Discovery of Viruses
Back in 1964, a B814 virus with a lipid coating first identified by Scottish virologist Dr June Almeida, (1930-2007) at her laboratory in St. Thomas Hospital in London. A Doctor of Science, Almeida succeeded in that were previously unknown, including in 1966 a group of viruses that were later named coronavirus, due to their crown-like appearance. At the Ontario Cancer Institute Dr Almeida developed her outstanding skills with an electron microscope. She pioneered a method, which better visualised viruses by using antibodies to aggregate them. In 1971, using her immune electron microscopy technique, Almeida made the landmark discovery that the hepatitis B virus had "two immunologically distinct components"â€” an "outer coat and a small inner component".According to Miller published in a journal in1986, the most obvious method of virus detection and identification is a direct visualization of the agent. The morphology of most viruses is sufficiently characteristic to identify the image as a virus and to assign an unknown virus to the adequate family. Furthermore, certain non-cultivable viruses can be detected with electron microscopy.
Mode of Transmission and Characteristics
Coronaviruses transmitted from animals to people, with this specific strain of coronavirus thought to have originated in the city of Wuhan in China from a seafood market in late December of 2019. Symptoms of coronavirusbe similar to that of the common cold, especially who are infected often experiencing fever, coughing, and shortness of breath. Nevertheless, infection can lead to pneumonia, severe acute respiratory syndrome, multi-organ failure, and even death in more severe cases. The elderly (mostly 80+) and those with pre-existing chronic health conditions have accounted for the mainstream of deaths from coronavirus. Most critical ill patients were older at age and had more underlying circumstances than patients not admitted to the Intensive Care Unit (ICU). Most patients required oxygen therapy and a minority of the patients needed invasive ventilation or even extracorporeal membrane oxygenation.
A recent study showed that Covid-19 detected in stool samples of patients with abdominal symptoms. Nevertheless, it is hard to differentiate and screen patients with atypical symptoms. Yet, the rapid human-to-human transmission among close contacts is a vitalcharacteristic in Covid-19 pneumonia. The patients admitted to the ICU were older and had a greater number of comorbid conditions than those not admitted to the ICU. This suggests that age and comorbidity may be risk factors for poor outcome. However, there was no difference in the proportion of men and women between ICU patients and non-ICU patients. These studies differ from the current information that showed Covid-19 infection is more likely to affect men. The possible explanation is that the Covid-19 infection in patients in the previous report related to exposure associated with the Huanan Seafood Wholesale Market, and most of the affected patients were male workers. Compared with symptoms in non-ICU patients, symptoms were more common in critically ill patients, including abdominal pain, dyspnea, and anorexia. The commencement of symptoms might help physiciansidentify the patients with poor diagnosis. In this cohort, the overall rates of severe invasive ventilation and hypoxia were higher than the previous study, likely because the cases in the previous study were from the early epidemic stage of the Novel Coronavirus Infected Pneumonia (NCIP) in 2019, and the current cases are from the stage of outbreak.
Spreading history of 2019-nCoV
On January 3, 2020, the 2019 Covid-19 identified in samples of bronchoalveolar lavage fluid from a patient in Wuhan, China and confirmed as the cause of the NCIP. Full-genome sequencing and phylogenic analysis showed that Covid-19 is a distinct clad from the beta corona viruses associated with human Middle East Respiratory Syndrome (MERS) and severe acute respiratory syndrome (SARS). The Covid-19 has close similarity to bat coronaviruses, and it has suggested that bats are the primary cause. While the origin of the Covid-19 is still being investigated, current evidence suggests spread to humans occurred through transmission from wild animals, illegally sold in the Huanan Seafood Wholesale Market. According to Huang et al first reported 41 cases of NCIP in which most patients had a history of exposure to Huanan Seafood Wholesale Market.Consequently, Chen et al reported findings from 99 cases of NCIP from the same hospital and the results suggested that the Covid-19 infection clustered within groups of humans in close contact, was more expected to affect older men with comorbidities, and could result in AcuteRespiratory Distress Syndrome (ARDS). Nevertheless, the difference in clinical characteristics between severe and non-severe cases was not stated. Reports confirmed human-to-human transmission of NCIP.
Covid-19 may not originated from China
According to Science Focus, in 6 July 2020, Prof. Dr. Tom Jefferson from the Centre for Evidence-Based Medicine at Oxford University expert believes that the novel coronavirus may not have originated from China, rather it stayed dormant across the world and turned up when the environment conditions were friendly for it to flourish. He further maintains that there is growing evidence that coronavirus was already located on earth. A Spanish scientist proclaimed they had found evidence of coronavirus in the samples of wastewater collected in March 2019, 9 months before the coronavirus disease traced in China.Italian scientists had also found traces of this virus coronavirus in sewage samples in Milan and Turin, in mid-December, whereas experts found evidence of this disease in Brazil in November 2019.
The Oxford scientist believes that many viruses stay dormant all over the world and emerge when the circumstances are favourable.In 1918, around 30% of the population of Western Samoa died of Spanish Flu, and they had not had any communication with the outside world."The explanation for this could only be that these agents don't come or go anywhere. They are always here and something ignites them, maybe human density or environmental conditions, and this is what we should be looking for," he added.
Bangladeshi scientist prediction on microbes in 1999
An internationally renowned medical microbiologist and recipient of first-ever Independence Day Award of Bangladesh (Medical Science, 1977), the late General M R Choudhury was an eminent medical scientist and physician of Bangladesh. The late Professor Emeritus Dr. Mahmudur Rahman Choudhury (1928 - 99) was a pioneer of immuno-electron microscopy in Bangladesh in 1978. He obtained D. Bact. from the University of London, and awarded fellowships of the Royal College of Pathologists (FRCPath),London, the Royal College of Physicians, Edinburgh (FRCP), the American College of Physicians (FACP), the International Biographical Association (FIBA), the American Biographical Institute (FABI), the Bangladesh College of Physicians Surgeons (FCPS), and the Bangladesh Academy of Sciences (FAS). He was a member, Board of Trustees, icddr,b, and member of the WHO Expert Advisory Panel on Health Laboratory Services. He was also Founder Commandant of Armed Forces of Institute of Pathology (AFIP), Bangladesh, and Founder President of Bangladesh Society of Microbiologists and Bangladesh Society of Immunologists.
In relation to Covid-19, we can relate to the late Dr. M R Choudhuryâ€™s famous book, Modern Medical Microbiology (1999), where he mentioned in the section Emerging and Re-emerging Infectious Diseases â€œThe myth that infectious diseases are being controlled & are fading away has evidently been found to be not correct. There exist definite indications that alterations, which we make in our lifestyles & environment, could have profound impacts on the dynamic biological changes in the microbial world. The results can be disastrous. It is quite obvious that microbes can strike us back whenever the delicate ecological balance is disturbedâ€. Professor Emeritus Dr. Choudhuryâ€™s prediction in June 1999 and Oxford Professorâ€™s observation in July 2020 are similar. Twenty years ago, Dr. Choudhuryâ€™s prediction was completely accurate and he forecasted that this might happen, if we do not keep the ecological balance intact. In other words,â€˜the ecological balance must not be disturbedâ€™.
Management and Vaccination
Untilnow, no explicit treatment recommended for Covid-19 infection except for detailed supportive care. Presently, the approach to Covid-19 is to control the source of infection; use of personal protection precaution to decrease the risk of transmission; and early diagnosis, isolation, and supportive treatments for affected patients. Antibacterial agents are ineffective. Furthermore, no antiviral agents have found to provide benefit for treating MERS and SARS. All of the patients in the study received antibacterial agents, 45% received methylprednisolone and 90% received antiviral therapy. The dose of methylprednisolone and oseltamivir varied depending on disease severity. Yet, no effective results observed.
Multiple organizations around the globe are currently working on a vaccine for Covid-19, but it is difficult to voice just how long it will take, until one is available to the community. In other words, at present, there are no effective therapies or vaccines for NCIP. Up till now, the WHO has urged those living in regions with infections to take basic protective measures, such as regularly washing hands, covering the mouth and nose with a bent elbow, when coughing and sneezing, and avoiding contact with people,wearing mask while meeting people and maintaining distance at least three feet, who may be infected.
Covid-19 pandemic is an unprecedented global public health risk affecting acute infectious respiratory disease. For Bangladesh, Covid-19 is a humanitarian crisis with a public health dimension. We need to find other options to mitigate the economic tremor, which will bring the majority of the country into food insecurity in coming days. In cities, especially who are living their lives as daily wages, may have to skip meals. We need to find solution to keep Bangladeshi people safe in the same time we need to protect their livelihoods. One solution would be absolutely must stay home, for that case, government and NGOs and donor communities can play a key role by providing food or emergency cash transfers. The mobile money providers need to keep their agents active during this pandemic time. With digital cash financial system, money can be transferred into the villages and could deliver money to almost every household.
Bangladesh can learn important lessons from China, South Korea, Italy and other countries, who are deeper into their Covid-19 response than Bangladesh is. Bangladesh should also monitor and evaluate their policies, so that Bangladesh can grasp the relevant part, which can be replicated in Bangladesh policies.
The migrantsâ€™ workers, who recently lost their jobs, started their journey back home to their villages. However, most workers have planned not to return to Dhaka city for a while. Now the major challenge is the students who are at home and depended on the financial condition of their parents whether they can pursue on line education.
In urban areas, domestic issues in households, especially in the absence of house cleaners has become a worry. Man, girls and boys overburdened with house work.Â Mental health problems could be a serious issue by taking stress and pressure, such as education, work and daily life.Pandemic has also uncovered the unpreparedness of the health systems globally, not just Bangladesh. Bangladesh needs to increase the investment in health infrastructure as well as in hospitals.
The people, who are staying at home can uses their smart phone to get connect to the world and canÂ buy groceries, sending money to loved ones and video chatting with friends and family to stay mentally active and positive. Based on Covid-19 surveillance data (like China) online people can know where they should go and where not to go by putting a red, green or yellow message on their phone. The system should use easy way to understand messages (by pictures or by other means) as in Bangladesh many people struggle to understand text messages.
To practice the social distancing norms that most developed countries have relied on to reduce transmission is proving to be culturally completely impossible here. However, in Bangladesh stocking up on 30-day supplies is not possible for most of the people in Bangladesh, where their income is limited and they can only buy foods for a few days. Â
Covid-19 is new globally and different in many ways. This country has a home to premiere public health experts and institutions. Bangladesh has one of the worldâ€™s best networks of community health workers, a rich history of public-private partnerships in emergencies, and communities with incredible levels of resilience. The people of Bangladesh have experienced cyclones disaster, floods, and so much more. Above all, people are resilient with all kind of situation.
World Health Organization (WHO) chief Dr. Ghebreyesus uttered that the only way out of this paradox of pandemic is investing a system that will pledge all countries have fair and timely access to a Covid-19 vaccine. He has written to 194 Member States, urging them to join the COVAX Global Vaccines Facility, a mechanism aimed at guaranteeing fair access for all countries, rich or poor, to effective immunization. Warning against â€œvaccine nationalismâ€ in the Covid-19 pandemic, the WHO chief has underlined the importance of global solidarity in addressing the crisis. â€œAs new diagnostics, medicines and vaccines come through the pipeline, it is critical that countries don't repeat the same mistakesâ€, he said, adding, â€œWe need to prevent vaccine nationalism.â€
The Covid-19 pandemic is changing the balance of power at the global level. Therefore, world is going into a major shift of power relations. However, spread and exchange of scientific information may be possible and it can lead to faster solving problem. A good surveillance system and a good public health system in Bangladesh are going to be absolutely a key and act very fast for prevention of Covid-19. In addition to this, the ecological balance in global atmosphere should not be disturbed. It is clear that to eradicate the paradox of pandemic, the ecological balance need to be restored in the global atmosphere, otherwise humans will suffer more in future from microbes. Humansâ€™ behaviour need to be changed, when it comes to environmental issues. It is an injustice to nature, in other words, not doing a natural justice to the nature. The relationship between humans and nature should be harmless. Do No Harm- not only to humans but also to nature. It appeared that â€˜behavioural changeâ€™ is the â€˜keyâ€™ to prevent all domain of infections, viruses and microbes.
Shakeel Mahmood is Ph.D. Fellow of Faculty of Education and Arts in The University of Newcastle, NSW, Australia. He holds an MPA from University of Maine, MBA from University of Delaware, MCom from Dhaka University and MPH from North South University. He is a Fellow of the Royal Society of Public Health, London, Fellow of the Institute of Business Administration, London, and a Fellow of the Royal Society of Arts, London, UK. Member, Australian Public Health Association and Expert, Australian Academy of Science.