The way out of the woods

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The relentless logic of vaccination to beat a virus has had quite the effect across countries of the West mainly, i.e. North America and W Europe, and some Pacific powers. Probably leading the charge to get Western nations to cast off the chains brought on by Covid for the best part of two full years now not a day later than they absolutely must, would have to be the UK prime minister, Boris Johnson. The eyes of the world today are on a date circled in Johnson’s calendar – the 21st of June, a Monday. And the day that the prime minister has set as the target for his government to lift the UK’s lockdown.

The UK’s leadership role during the pandemic has been quite impossible to ignore of course. Not just for the way that reveling in this nationalist fervour that almost inevitably sweeps through nations in times such as this. They always have punched above their own weight, even when they managed –whether by hook or crook - to establish the British Empire’s dominion over far-flung corners of the world British people could hardly relate to.

In the pandemic though, they have shown their capability to rally their embarrassment of riches in technical knowledge and highly-skilled human resources to remain at the forefront of vaccine development, as well as delivery. Now they are looking to lead the world out of Covid-19, and into the period of recovery.

Yet we now know that the fearsome new variant out of India (B.1.617) has been gaining traction in the UK, bucking the trend of its own variant (B.1.1.7) rise steadily throughout May, even as it ran up against impressively high vaccination rates. It has fueled fears of a possible third wave, which would have been unthinkable even a few weeks ago at the peak of the vaccination drive. Now even June 21 is in serious jeopardy, as the decision point gets closer. B.1.617 is known to have spread to at least 62 countries, where the genome has been sequenced, and submitted to a public global database. Most countries are not doing anywhere near enough sequencing to allow scientists to keep track of the evolution of the virus, and the emergence or even the spread of these new variants.

Looking at the latest sustained bump (upwards) in the numbers, could Bangladesh too be on the cusp of a third wave to the pandemic, in the course of the evolutionary process by which the highly infectious Delta variant gradually takes over as the dominant strain of SARS CoV-2?

The UK, where they're doing more genome sequencing of the virus than anywhere else in the world, disclosed their scientists’ estimates this week, with health secretary Matt Hancock coming out and putting a more definitive number to what had been hitherto more ballpark estimates, falling anywhere in a range between 30%-100% more transmissible than the variant first found in Kent, that subsequently gained notoriety as the UK virus, but from now on shall be known as the far less inspiring (even that can be a good thing, in such polarised times) Alpha.

We will come to the WHO’s new naming scheme for the variants, presumably forced upon it by apprehensions over the increasingly political terrain its doctors and public health specialists routinely find themselves dragged into. But first it should be mentioned that the cases have again taken a slightly worrying course in Bangladesh over the last 7-10 days. The trend is consistent with the first reports of the Delta variant entered into the GIS global database for sequenced genomes of SARS CoV-2 from Bangladesh. The actual entry is likely to have preceded reporting by several days.

In any case, Delta is now expected to become the dominant strain, so of course it was hardly any surprise to learn the variant has made its way into Dhaka and other parts of the country from the frontier districts. Some of the experts fear an impending health catastrophe in the coming weeks since there is no strict measure in place to stop the worst effects.

They said half-hearted preventive measures, lack of seriousness in the local administrations, reopening of intra-district transport services and people’s apathy to maintaining the health safety guidelines are the major reasons behind the country’s inability to get past the worst of the Covid situation in the country.

The virus curve has been on a particularly worrying upward trend in Rajshahi, Chapainawabganj, Dinajpur, Joypurhat, Naogaon, Kushtia, Jashore, Satkhira, Khulna, Bagerhat, Natore, Noakhali and Cox's Bazar districts for several days.

The experts who spoke with our sister newsagency over the course of the past week all said the government should immediately increase the number of beds, doctors and nurses and treatment facilities, in these hospitals to cope with the pressure of Covid patients. Many hospitals in these districts still lack central oxygen supply, necessary ICU beds, high-flow nasal cannula and other Covid treatment facilities, contributing to increasing the fatality rate.

Some of the people you would presume to be most knowledgeable on the state of the country’s readiness to beat down any spike that may occur, sound the most alarmist. Dr Mohammod Robed Amin, spokesperson of the Directorate General of Health Services (DGHS), is more-or-less anticipating ‘a terrible time’, noting how the chains of transmission, that would seem to have been broken at least twice in Bangladesh, have again gone up, increasing alarmingly in the latest phase.

“Our infection rate had come down to below 7 percent early last month, but it’s now growing gradually. Our virus transmission has become unstable. Over 12,000 cases were reported in the first 8 days of this month (June),” he said.

Robed said the highly infectious Delta variant has already hit many frontier districts and it is now spreading to other areas of the country. “We’re unable to contain the virus transmission locally. Some people with the variant have already been identified in Dhaka. It’s very alarming.”

He said it is still a good sign that the virus cases have not been growing significantly in the central part of the country, including Dhaka. "But the way people are being diagnosed with Indian strain in different areas, we fear a serious outbreak of the virus in the days to come.”

Sources of infection

IEDCR consultant Prof Mushtuq Hussain said the virus cases doubled in many districts over the last few days. “The hospitals in the frontier districts are now overwhelmed. These are the signs of a serious outbreak of the virus.”

Under the situation, he said, preventive measures should be strengthened all over the country. “Those who are being infected must be brought under treatment and isolation. As over 90 percent of infected people stay at home, necessary support should be given to them so that they need not go outside. If we can do this, we’ll be able to control the direct source of infection.”

To control the indirect source, the expert said, health safety guidelines must be followed and cent percent mask use will have to be ensured. “Besides, people’s movement should be strictly controlled by enforcing stringent lockdowns in the areas where the transmission rate is high.”

He said those who are found infected with Indian variant in Dhaka and other parts of the country will have to be kept in isolation and people coming in contact with them should be identified and kept in quarantine.

Besides, Prof Mushtuq said logistic support and manpower for providing healthcare in the badly-affected areas should be enhanced. “Adequate oxygen supply should be ensured in the hospitals where the number of patients is growing.  If the patient with low saturation level can be given oxygen support initially, they’ll recover fast.”

Public health expert MH Chowdhury (Lenin), chairman of the medicine department at the Health and Hope Hospital, said the coronavirus situation has become complicated in the country. “Earlier, the virus used to hit major cities, including Dhaka and Chattogram, and then it spread to other areas. But now there has been an outbreak of the virus in bordering areas, and it is now spreading to central areas and different cities. The type of outbreak of the virus is now very aggressive as we know Delta strain is much more contagious than any other ones.”

Lenin said many of those who are getting infected with the Indian strain, need oxygen support at the initial stage. “It’s a bad sign which can lead to a rising fatality rate. The Delta variant can mount huge pressure on the immune system of the infected people. That’s why we've seen many Covid patients in India have been infected with black fungus as a post-Covid complication.”

Dr Lenin said a central medical pool should be made immediately to provide support to the virus-hit areas. “We see when the virus cases go up in any particular area, patients suffer from bed, oxygen doctors, and nurse crisis there. So, we can make a central medical pool to overcome such a problem.”

“For example, the Covid patients are surging in Joypurhat and Natore, but the hospitals there are not ready to tackle the situation. So, we can send the necessary doctors, nurses, beds and oxygen and other equipment there from the central pool if we can form it,” he said.

Lenin also said the capacity of carrying out tests will have to be increased substantially to identify the infected people quickly and to send them into isolation. “Or else, undetected people will turn into superspreaders of the virus.”

The Scramble for Vaccine

On May 27, the Cabinet Committee on Public Purchase approved a proposal for buying 1.5 crore doses of Sinopharm's Covid-19 vaccine. Right after the meeting, a Cabinet Division official told reporters at a briefing that they would purchase the vaccine at $10 per dose. It is not clear yet whether the government would be able to buy the Sinopharm vaccine doses at this price in the future.

A consignment of 20 million doses of China’s Sinopharm vaccine is expected to arrive in Sri Lanka this month and is reported that Sri Lanka has purchased one dose of the vaccines at $15, according to the Daily Mirror. Before the price disclosure, Bangladesh was assured by the Chinese government that they would keep 15 million vaccine doses for Bangladesh.

On the other hand, India is currently focusing on their own vaccination programme. Although things have looked up slightly again, with both cases and death off the stratosphere at least, there is a feeling that what the country has gone through together is not something to just get over with and past quickly. They cannot possibly be in any position to push for export, or honouring export contracts signed in a previous period.

“I think you'd appreciate that against this background it wouldn’t be right to talk about the supply of vaccines abroad just now. As we’ve repeatedly conveyed, we’re currently proposing domestic vaccine production for our own vaccination programme,” said Arindam Bagchi, Official Spokesperson at the Indian Ministry of External Affairs.

He said the government of India has been making all efforts to augment the availability of vaccines in India, whether through enhanced production in the country, or through supply from abroad.

Finance Minister AHM Mustafa Kamal said 6.80 crore doses of coronavirus vaccine will be available from the Covax facility under the World Health Organisation for 20 percent of our population, that is, for 3.40 crore people. Out of this 1.06 lakh doses have already been received.

Apart from India and China, there are plans to buy vaccines from the governments of China and Russia, Pfizer Co. from the USA and Sanofi/GSK from France/Belgium. Negotiations are underway on procuring Sputnik-V vaccine from Russia, and, if necessary, manufacturing the same in Bangladesh.

The World Bank provided US$ 500 million for procuring COVID vaccines and US$ 14.87 million for logistics support. Loan Agreement for US$ 940 million with the ADB to procure COVID vaccine is at the final stage. Alongside, there is a good possibility to receive support for vaccine procurement from the European Investment Bank and AIIB.

Plans have been worked out to vaccinate 80 percent of the people in phases, and people with risks will be vaccinated in the first phase. The first dose of vaccination began on February 7 while that of the second dose began on 8 April. That of course is the government’s simple, straightforward narrative.

The registration for vaccination and distribution of vaccine certificates and vaccine cards are being done digitally through the surokkha.gov.bd web portal using National ID cards.

Meanwhile, Japanese Prime Minister Suga Yoshihide has expressed his country’s intention to provide around 30 million doses of vaccines manufactured in Japan to other countries and regions, including through the COVAX Facility. He said Japan will provide the vaccine doses when circumstances allow and at an appropriate time.

As one of the largest contributors to the COVAX Facility, Japan welcomed the arrival of 106,000 doses of the Pfizer/BioNTech’s COVID-19 vaccine to Bangladesh on May 31, which was made possible through the COVAX AMC. Japan said it will continue to cooperate with Bangladesh to suppress the spread of the Covid-19 and overcome this unprecedented crisis, said the Japanese Embassy in Dhaka.

United Nations Secretary General Antonio Guterres has renewed his call for countries to share vaccines, particularly with those that are struggling to cope with new surges and variants. He also renewed his call to the international community to come together to address the unprecedented challenge of the Covid-19 pandemic.

"There’s an urgent need for increased global solidarity to ensure that vaccines are available to everyone, everywhere," said his Spokesperson Stephane Dujarric. Equitable access to vaccines is a prerequisite to ending the pandemic and kick-starting a strong recovery, he said.

The UN welcomed the announcement made by the Biden administration that it will be sharing millions of vaccine doses with both the COVAX facility as well as bilaterally with countries in particular need. The Administration announced its framework for sharing at least 80 million US vaccine doses globally by the end of June and the plan for the first 25 million doses.

Approximately 7 million doses will be shared in Asia covering countries and entities, including Bangladesh, India, Nepal, Pakistan, Sri Lanka, Afghanistan, the Maldives, Malaysia, the Philippines, Vietnam, Indonesia, Thailand, Laos, Papua New Guinea, Taiwan, and the Pacific Islands, according to the White House.

‘A hard rain’s a-gonna fall’

Amid the growing Covid-19 cases, health experts fear that Bangladesh’s frontier districts await a serious healthcare crisis as most hospitals and health complexes there are ill-equipped to cope with any worsening situation. They also voiced frustration as local administrations in different frontier districts are “buying time” in enforcing strict lockdowns and halting the inter-district transport services to control the virus locally.

They said the government should focus on preventing the spread of the virus transmission to other areas from the frontier ones and enhancing the number of hospital beds, treatment facilities, equipment, and ensuring an adequate supply of oxygen, high-flow nasal cannula and necessary medicines at hospitals and upazila health complexes in the bordering areas witnessing a surge in the virus infection rate.

Covid cases are growing alarmingly in Chapainawabganj, Rajshahi, Satkhira, Khulna, Kushtia, Jashore, Naogaon and Natore since the last week of May apparently for the prevalence of the highly transmissible Indian variant. People quote research apparently conducted in India, to show one person carrying B.1.617 (Delta or ex-Indian), can infect about 406 people in just one month.

Though the government has already empowered local administrations to enforce lockdowns in the virus-affected districts, only Chapainawabganj has been put under lockdown so far. What follows is a regional accounting of where things stand with regards to Covid-preparedness.

Hospitals as theatres of war

Nazmul Islam, the spokesperson of the Directorate General of Health Services (DGHS), said Covid infection rates in the bordering districts are growing and they have taken necessary measures to ensure treatment at both the district-level and medical college hospitals in the bordering areas.

He suggested people to go to district hospitals in those districts as most upazila complexes lack necessary facilities to deal with Covid patients.

Talking to UNB, Prof Muzaherul Huq, former adviser to WHO South-East Asia region, said the government should take immediate steps to equip the frontier district hospitals and upazila health complexes with necessary facilities and oxygen support as the Covid situation is turning worse there with the rise in positivity rate.

“All the upazila hospitals in the frontier districts must have necessary oxygen support, high-flow nasal cannula, oxygen masks, necessary medicines and other equipment. The number of ICU beds and ventilators will have to be increased in the district hospitals. Or else, a serious healthcare crisis will be created there and the fatality rate will go up and we’ll lose control on the Covid situation,” he warned.

Noted virologist Prof Nazrul Islam, also a member of the National Technical Advisory Committee, said they have advised the government to enforce lockdowns in the eight bordering districts to control the virus transmission, but it is still unimplemented in seven of the districts.

“The number of infections is now growing in the frontier districts as we’re failing to tackle the transmission. Most of our hospitals in the frontier districts lack adequate facilities to deal with the deteriorating Covid situation. So, we’ll have to intensify the preventive measures as well as preparing the hospitals to tackle the growing number of patients,” he said.

Additional reporting by A.R. Jahangir, UNB

  • Coronavirus
  • Covid-19
  • Vaccine
  • Covid-19 vaccine mixing
  • The way out of the woods

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