Emerging into the new normal

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Bangladesh is now hosting over 1.1 million Rohingyas. In this file photo, Rohingya children, who crossed over from Myanmar into Bangladesh, wait to receive aid during a distribution near Balukhali refugee camp, Bangladesh. AP/UNB file photo

As Bangladesh, and a number of other countries around the world, began the process of gradually opening up their economies this week, the World Health Organization (WHO) said any country needs to make sure that good and appropriate health measures are already in place demonstrating its ability to tackle the situation confidently before it slowly starts withdrawing its lockdown.

"When we start slowly opening the lockdown, we need to make sure that this doesn't resurge again. We have to ensure that," WHO Representative to Bangladesh Dr Bardan Jung Rana said in an interview with our sister newsagency UNB and Dhaka Courier.

He referred to countries’ ability to detect, isolate, test and treat people which should be in place so that anything that suddenly emerges can fully be responded to.

"When we're in a more comfortable area (of health system) and feel more secure by what our abilities are then a country can slowly start thinking (withdrawal of lockdown)," Dr Bardan said, adding that there are many other factors that countries are suffering from at this time of crisis.

The WHO Representative said it has been very helpful for the countries that have been practising social distancing.

He said Bangladesh is a densely populated country that gives a wonderful environment for the coronavirus to transmit easily.

"This is the reason we're very pleased that the government has brought in this social distancing directive," Dr Bardan said, mentioning that this helps the government reduce the pressure in the health system giving time to strengthen it to be able to respond to this outbreak.

Though it helps absolutely, the WHO Representative said, social distancing or physical distancing is not the only way to deal with the situation.

He said there are other areas -- early detection, isolation, testing and treatment -- that need to be strengthened and have the focus on.

"These are the areas we really need to strengthen to be able to fight this virus and be able to win this war," said the WHO Representative.

He said this is a global pandemic and there are other challenges as well. "There's a massive shortage of equipment and supplies globally. For that reason, we need to get ourselves prepared for all these things."

All the UN agencies and development partners -- right from the very beginning -- have been supporting the government of Bangladesh to ensure that supplies and requirements are coming in, said the WHO official.

"We'll continue to do so until we win this war," Dr Bardan said.

Social Distancing in Rohingya Camps

The WHO Representative said this social distancing directive has gone throughout nationally, including in Cox's Bazar, and it has been practising in the Rohingya camps as well.

He said social distancing has been a good measure that has helped keep the Rohingya camps free from coronavirus infected people so far.

Highlighting other measures taken by the government with the support of other agencies to reduce the footprint of the virus in the camps, the WHO Representative said there has been restrictions, too in the camps.

He said only the essential activities are going on in the Rohingya camps by shutting down or slowing down all non-essential activities to halt the transmission of the virus there.

"There's already quarantine space made and people, including health workers, are being trained," Dr Bardan said adding that Rohingya people are being kept informed to help them know how to protect themselves following preventive measures.

UNHCR, the UN Refugee Agency, has said there has been "incredible progress" in setting up Ukhiya Isolation and Treatment Centre.

This centre is one of several isolation and treatment centres being prepared by the humanitarian community and the government of Bangladesh, which will be used for both Rohingya people and local Bangladeshi communities.

All efforts are underway to ensure a response capacity in the case of an outbreak of the coronavirus in Cox's Bazar, the UNHCR said.

Bangladesh has so far recorded the death of 168 people due to COVID-19 (until April 30) while the number of infected cases in the country stood at 7667 during the same period, according to Directorate General of Health Services (DGHS). Over 300 Bangladesh nationals died in a number of countries, including in the United States and the United Kingdom.

There are lots of research and analysis about the coronavirus to understand how the world will look like after the coronavirus disappears with no crystal ball in hand at this moment. The global coronavirus crisis will not end any time soon, with many countries still in the early stages of the fight, health experts have warned.

World Health Organization (WHO) chief Tedros Adhanom Ghebreyesus has cautioned that the struggle is far from over. “Make no mistake: we’ve a long way to go. This virus will be with us for a long time," he said.

Governments looking for long-term solutions for managing COVID-19 could start with their relationship with the general public, Michael J. Ryan, Chief Executive Director of the World Health Organization Health (WHO) Emergencies Programme said at a briefing on April 29. Sweden has gained attention worldwide for its unique approach to managing the virus. The country has not implemented many of the lockdown measures taken around the globe. For instance, while gatherings of more than 50 people are banned, restaurants and bars have remained open.

Ryan said the country has, however, adopted a range of measures to help tackle the virus. Sweden has ramped up its intensive care capacity, has a strong public health policy around physical distancing and key protections in place for those in long-term care facilities, all of which have helped its health system cope with COVID-19 cases.

The major difference in Sweden’s approach is trust in the population. Ryan said: “What it has done differently is it is very much relying on its relationship with its citizenry. It really has trusted its own communities to implement that physical distance.”

That trust, combined with strategic controls and clear communication, could provide a template for other countries that are loosening lockdown restrictions to safely adapt to a new normal. Ryan said: "If we are to reach a new normal, in many ways Sweden represents a future model."

Still, Ryan cautioned on Sweden's strategy: “It remains to be seen whether [its approach] will be fully successful or not.”

Continued vigilance will be key regardless of the exact model countries follow. Ryan said: “If we wish to get back to a society in which we don't have lockdowns, then society may need to adapt to a medium[-term], or potentially a longer period of time in which our physical and social relationships with each other will have to be moderated by the presence of the virus.

“We will have to be aware the virus is present and we will have to, as individuals, families and communities, do everything possible on a day-to-day basis to reduce the transmission of the virus.”

On the trenches

Bangladesh Doctors Foundation, a forum of physicians, on Thursday, April 30 said that a total of 475 doctors had so far been infected with the novel coronavirus while treating COVID-19 patients at both government and private hospitals.

‘Among the total, 35 were infected in the last 24 hours till Thursday,’ said Nirupam Das, the chief administrator of the foundation.

Of the total infected doctors, 316 are from government hospitals while 122 are attached with private hospitals and 37 doctors are shown in another category.

The BDF data reveal that 343 doctors got infected with the virus in Dhaka division alone as of Thursday, including 203 from government hospitals and 119 from private hospitals. Fifty-four doctors were diagnosed with COVID-19 positive in Mymensingh division while 14 in Chattogram, 25 in Khulna, 10 in Barishal, six in Sylhet and seven in Rangpur division.

Asked about the safety of doctors while treating Covid-19 patients, Dr Nirupam said there is no alternative to personal protective equipment (PPE), quality gowns, masks, gloves and goggles for doctors’ safety. Dr Nirupom also said doctors should be careful while opening the personal safety gears after closing the duty at coronavirus hospitals. The safety gear must be disposed of accordingly after using it, he added.

Meanwhile, according to the Bangladesh Basic Graduate Nurses Society, at least 320 nurses have already been infected while some 250 others are in quarantine as they came into contact earlier with infected patients.

According to the Bangladesh Medical Technologists Association, some 25 medical technologists have contracted Covid-19 so far, whereas the figure for diploma pharmacists stands at seven — all in government hospitals, claims the Bangladesh Diploma Pharmacists Association.

On the other hand, the Bangladesh Medical Association (BMA) says 881 healthcare professionals (392 doctors, 191 nurses, and 298 other health workers) had been infected by coronavirus as of Thursday. Whichever way you  look at it, the numbers make for harrowing reading.

As people are increasingly using protective gears, including gloves, masks and gowns, to protect themselves from the coronavirus, health experts have cautioned that these safety equipment can become the means of transmission of the deadly virus for lack of their proper management, use and disposal.

They said many doctors and nurses are getting infected with coronavirus for not properly using and discarding the safety gears. Although the general people do not need to wear the PPEs, they are still buying substandard and used protective equipment from roadside vendors, exposing themselves to infection.

On April 25, a mobile court conducted a drive in the city’s Bhatara area and seized huge used white gowns and masks that were collected from different hospitals and prepared for sale by washing and ironing those.

Who needs PPE?

Health experts said general people only need to wear masks and should refrain from buying protective gears from street vendors. They said washing hands with soap frequently or using hand sanitiser and staying indoors as much as possible are the best measures to remain safe from the virus instead of going out of homes using protective gears.

A group of researchers at the University of North Carolina Chapel Hill said the virus may survive on objects of PPE for hours, posing a continued risk of transfer to the user during handling over multiple uses.

The potential long-term survival of viruses on contaminated PPE is an important factor when formulating recommendations for removal and handling of used PPEs and reuse of PPEs in the pandemic setting. It also highlights the continued importance of reinforcing good hand hygiene after PPE removal for preventing the spread of infection, they said.

Dr Samia Tahmina, additional director general of the Directorate General of Health Services, said, “Many people are using masks and gloves and thinking that they are safe. If these protective gears are not properly used and safely disposed of those can cause the virus contraction.

She said anyone wearing gloves can touch surfaces or objects that might have become contaminated by the corona droplets and thus the virus can travel to his/her home. “If this contaminated glove is not removed and disposed of properly it can cause the transmission of the virus.”

Talking to UNB, Professor Dr Mohammed Atiqur Rahman, treasurer of Bangabandhu Sheikh Mujib Medical University (BSMMU), said there are some guidelines provide bye WHO about the use and disposal of the protective gears, including gloves, medical masks, goggles or a face shield, and gowns.

According to WHO, masks are effective only when used in combination with frequent hand-cleaning with sanitiser or soap and water. “Before putting on a mask, people should clean hands with soap and water. Musk must be replaced with a new one as soon as it is damp while the single-use masks should not be reused.”

Dr Atiqur said if its possible people should use single-use masks and gloves and discard it in a closed bin and then wash hands with soap.

Similarly, the doctors and nurses who attend corona patients, should use PPEs/gown and perform hand hygiene before putting on and after taking off it.

The discarded PPEs should be thrown in an appropriate waste container after use.

“These are the main guidelines of WHO about using and disposing of the safety gears. If these guidelines are not followed, people may invite danger,” he added.

Prof Dr. Harun-or-Rashid, head of medicine department at Dhaka Community Medical College & Hospital (DCMCH), said PPEs, masks and hand gloves can be means of travelling and spreading coronavirus if those are not properly managed, used and disposed of.

In many countries, one-time masks and PPEs are used for safety reason. “As now there’s a crisis, we can reuse the safety gears after making those safe. After attending a corona patient, doctors or nurses should dispose of their masks and PPEs and gloves in a safe way. If anyone wants to reuse the PPEs, he or she should wash it properly with soap and dry it up in sunlight properly.”

Dr Harun said many doctors and nurses are not aware of proper use of coronavirus safety gears. “As a doctor phoned me from Sunamganj, I asked him how he was handling the patients under the current situation. He said a medicine company gave him a PPE he reuses it after keeping it in sunlight for some time. It’s not the safe way of reusing the PPE.”

He said the government should make the health professionals aware of the safe use of safety gears as they are the frontline corona warriors.

Dr Harun thinks common people need not to use surgical or N95 masks and PPE.

He said general people should use masks made of clothes and they should wash it with soap and hot water before reusing.

General people should also not use gloves but they should use hand sanitiser and wash hands after touching any surface or substance.

“We also must be aware of disposing the masks and PPEs and gloves. The used masks, gloves and PPEs should not be kept here and there where children and other people may go and touch. Before disposing of the safety gears, we should wrap those in a polythene bag and discard into a trash bin having a cover,” the health expert added.

Additional reporting by A.K. Moinuddin & A.R. Jahangir

  • DhakaCourier
  • Issue 43
  • Courier Briefing
  • Vol 36
  • Emerging into the new normal

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