Strengthening our collective preparedness to fight Covid-19

I work as a consultant anaesthetist and intensivist in a small district general hospital in north-west England. I work in the intensive care unit (ICU). I would like to share my experience with this virus and warn my country about the dangers of this pandemic and tell them about how to face it. I have been looking after coronavirus-infected patients for the last four weeks now. We have, unfortunately, lost two patients in our ICU despite multi-organ supports (lungs, heart and kidneys). Both had pre-existing multiple co-morbidities. Five of our ventilated patients came from the same area of Cumbria and both went to the same music festival. They had social contacts with each other before they had been admitted to the hospital. One of our anaesthetist colleagues and three nurses have contacted the infection while looking after ventilated patients in the ICU. We have sent them home for self-isolation. I continue to look after very sick patients in the ICU who are fighting for their lives.

The disease is called Covid-19 (Corona Virus Disease 2019). The viral infection had started in the Wuhan city, capital of Hubei province in China, in December 2019. This is a deadly virus. The virus is encapsulated, highly contagious and dangerous. There is no specific drug that can kill this virus. No vaccine is available against it either. The virus enters into the human body through the respiratory route, mainly nose and mouth. It ultimately settles in the lungs and very quickly damages the lungs by causing acute pneumonia. The chest x-rays of all patients look very similar and horrific. The patient finally dies from multi-organ failure. The initial symptoms of the infection are dry cough, high temperature, running nose, sore throat and shortness of breath. The infection spreads directly from person to person. The majority of patients have mild symptoms and eventually recover from the illness. Only a small percentage of the affected population dies. The elderly population with co-morbidities are mostly at risk and very vulnerable.

The epicentre of this pandemic is moving fast from country to country like a typical tornado. First it was in China, then Iran, then Italy and the rest of the Europe, including the UK, and now the epicentre has moved to the USA. So far, the highest number of people died in Italy. In the UK, the number of reported cases is doubling every five days. The number of fatalities is also rising every day. In the UK, more than 10,000 persons are being tested every day. So far, more than 203 countries and territories worldwide have been affected by this virus. No continent except Antarctica has been spared. The situation in the whole world is unpredictable, dangerous, crazy and very scary.

Message to the public:

Awareness about the pandemic is vital. Please note that the enemy is very strong and powerful and we need to be prepared fully to defeat this virus. We need to be united as one nation to win this war. Simple measures like good hand hygiene, e.g. hand washing with soap, and maintenance of public health hygiene is important to stop the spread of infection. Self-isolation is very important. Don't go out of your house unless it is absolutely necessary and urgent. Don't invite your relatives or friends in your house. If anyone develops symptoms at home, isolate him/her in a well-ventilated room. If the health of the affected person deteriorates, please seek medical help or take him/her to the nearest hospital for further treatment. Strictly maintain social distancing. Avoid meetings, public gathering, crowds and mixing with others. Avoid public functions, shopping malls, bus and railway stations, sea beaches, holiday places, clubs, restaurants and gymnasium. Don't come in close contact with others. We may have to consider isolating the elderly, especially those with significant health conditions, e.g. chest disease, diabetes, hypertension, and heart disease, for at least 2-3 months. Listen to the public health warnings and follow their recommendations. Support the elderly, vulnerable people in your area with food, medicine and necessary domestic supplies. Also support the doctors, nurses and healthcare workers in your locality.

Message to the doctors, nurses and healthcare workers:

You have an ethical and moral responsibility to look after the sick patients with Covid-19. Protect yourself from contacting the disease. Hand washing with water and soap is a simple measure and very effective to stop spreading the virus. Avoid close contact with an infected or suspected patient, if you can. Take all the precautions before you approach an infected patient or even a suspected patient. Avoid a patient's droplets, sneezing, coughing, and aerosols falling directly on you. Put on FFP3 mask, hat, gown, goggles/visor, gloves and shoe cover. Take special precaution during intubation and extubation of a patient in the ICU and in theatre. Dispose all the equipment and accessories you have used (mask, gown, gloves, etc.) to treat the patient. After use, send all of them for incineration. Clean the infected area with antiseptic/alcohol wash. Adopt the policy of barrier nursing. Train the healthcare workers about hand hygiene, donning (how to put on PPEs) and doffing (how to dispose the PPEs). Don't allow any visitors or relatives to come near the infected patient. Follow the public health recommendations and WHO guidelines.

Message to the government:

This is a global public health disaster. More than 53,000 people worldwide have died already. Unfortunately, Bangladesh can't escape from this onslaught. People's lives are at stake here. Please take it seriously. I would like to urge you to take the following urgent measures: 1) Import and produce testing kits to diagnose Covid-19; 2) Prepare and support our doctors, nurses and healthcare workers to face this challenge; 3) Equip them with PPEs and necessary equipment to protect them from the disease; 4) Train the healthcare workers to combat the disease; 5) Make emergency provisions for extra treatment facilities in hospitals throughout the country; 6) Also make extra provisions for ventilatory support of seriously ill patients in both government and private hospitals; 7) Ban public meetings, public functions and social gathering to stop the spread of the disease; 8) Encourage the public to stay at home and maintain social distancing; 9) Recruit and involve the recently retired doctors, nurses and other healthcare workers to join the government health service; and 10) Involve the army medical core doctors and nurses to care for the coronavirus victims.

I express my sincere thanks to the government for the limited measures Bangladesh has taken so far. I also express my deepest sympathy for those who have already perished and also for their families. Let's pray for the safety of the health of Bangladesh.

Dr Md Salimuzzaman Bhuiyan is the General Secretary of Bangladesh Medical Society in the UK.

Email: mszaman57@yahoo.co.uk