Fear of the unknown: Stories of Covid-19 in Bangladesh

A patient on ventilatory support was removed from the ICU of a private hospital in Dhaka when it was found that he was Covid-19 positive. The patient passed away after a short time. After a brain stroke, a 22-year-old non-Covid-19 female patient was taken to the hospital where she worked as a nurse. She was denied admission to the ICU as her family could not produce a Covid-19 clearance certificate. She expired a little later.

These and many more cases, too numerous to list here, demonstrate that the possibility of finding a hospital and a team of physicians ready, able and willing to treat patients, whether Covid-19 positive or negative, is difficult in Bangladesh unless one is well-heeled, or well-known, or well-connected. Clearly, these incidents are in blatant violation of the government's order forbidding hospitals from refusing to treat possible Covid-19 patients. 

Meanwhile, as scientists from across the world are striving hard to slow the spread of the virus and to find effective treatments, a team of doctors from the Bangladesh Medical College Hospital claim to have achieved "astounding" success in treating patients suffering from Covid-19 with two commonly used drugs: Doxycycline, an antibiotic, and Ivermectin, an antiparasitic drug. Soon after the news media ran the story, both these drugs disappeared lickety-split from the shelves of pharmacies all over Dhaka.

The concept of treating a virus with antibiotic or anti-parasitic drug has no scientific basis. The doctors did not pursue the normal protocol that is assiduously followed in the research and development of any new drug. Instead, their claim has allowed the sale of unproven medicines among a hysterical population. There was tremendous price-gouging in the process, each drug selling at 1,000 percent more than the regular price. After all, when we feel existentially threatened by a deadly virus, and doctors claim we can take control of our health with a product available at local pharmacies, the price becomes immaterial.

Surprisingly, deaths due to Covid-19 in Bangladesh remain relatively low—1.3 percent of those infected as opposed to 5.1 percent worldwide. Is there a scientific reason for the unusually low death rate? We do not know, but we can conjecture.

In terms of the number of tests, Bangladesh remains at the bottom among the South Asian countries. Manifestly, fewer tests mean fewer infections. Apart from that, due to the sheer size of the population and because tests are done mostly in big cities, only a small part of the picture is visible. Also, the lockdown in the populous cities was fairly strict with police involvement at every step of its enforcement.

Furthermore, an average Bangladeshi with a median age of 25.7 years is bombarded year-round with bacteria, viruses and parasites. Additionally, endemic diseases such as Dengue, Chikungunya, Hepatitis (A, B and C), together with amoebic and bacillary dysenteries, have never left the country. By living amidst these diseases, the youthful population as an organic body has gained some degree of immunity, which their counterparts in affluent nations do not have, as they are hardly exposed to these diseases.

Having said that, health care system in Bangladesh is least equipped to handle a pandemic such as Covid-19. Private hospitals—an integral part of health care in major cities—have failed miserably to respond to the crisis. No significant effort has been made by them to triage clinically symptomatic patients who could be considered Covid-19 positive. This has more to do with bottom line considerations. They probably feel that their facilities might get inundated with suspected patients having the least financial wherewithal to take care of their regular medical bills, let alone pay for their care in the ICU, should that ever be necessary.

Moreover, while current focus is on treating Covid-19 patients in a hospital environment, those suffering from other life-threatening ailments are ignored or set aside. This will create far more morbidity and mortality after Covid-19 eventually tapers off.

Besides, confusing medical information fed regularly to the public and the plethora of statistics continually being bandied about the affected demographics need to be sorted out carefully. In particular, it is important to make a clear distinction between a patient "dying of Covid-19" and "dying with Covid-19." For example, in all likelihood, an 80-year-old person with multiple comorbid conditions and who is Covid-19 positive may have died with Covid-19, rather than died of Covid-19.

As the number of Covid-19 cases exceeds 10 million globally, with half a million deaths, many countries are still suffering from sustained community transmission. As such, the pandemic for these countries, including Bangladesh, has not peaked yet. In fact, public health experts fear that there will be a massive resurgence of the virus this fall as it sickens people simultaneously with the seasonal flu.

This brings us to the question: When will this invisible killer disappear? Just like influenza, it will never, ever disappear completely, despite an effective Covid-19 vaccine, and antiviral drugs are forecast to be approximately 12 months away. That is because since that fateful day in December 2019, when somebody in Wuhan decided to snack on a bat, or a rat, or a snake or whatever it was, the course of history changed forever. The coronavirus found a good host in us. And when a virus finds a good host, it becomes part of the host species' existence forever.

The virus is impalpable. It is blind to age, sex, race, wealth and social status of its victims. Neither does it respect international boundaries. It also lies totally outside the elaborate social nuances we have carved out through patterns of communication, representation and discourse. These traits have made Covid-19 a lethal adversary, so much so that in an "era when it is easier to smash an atom," we are unable to kill this virus which is 1,000 times larger. Rather, the virus has turned our world upside-down, leaving us scared, lost, devastated and defeated.

Hopefully, exposure to Covid-19 over time, just like the influenza virus we are seasonally exposed to each year, will create a critical mass—60-70 percent of the population—that will develop "herd immunity." In the meantime, the virus is winning. Consequently, more people, particularly the vulnerable ones like the elderly and those suffering from multiple chronic illnesses, will test positive in the ensuing months and succumb to the disease.

The pandemic has spurred calls for national unity. But as in so many aspects of our life, politics and corruption in Bangladesh are dividing the population at a time when they are facing financial, social, moral, religious, psychological and emotional problems. Nevertheless, until the pandemic subsides, our solemn duty toward social distancing, unflinchingly wearing face masks in public places, and practicing strict hygiene should be paramount. That is the daunting reality confronting us. The sooner we vow to embrace this reality, the better we will be equipped in matters of reduction of our stress and anxiety levels, and thence, march as one global community on the path of general wellbeing, human welfare and world peace.

Ajmal Sobhan is a retired vascular surgeon living in Virginia, USA. Quamrul Haider is a professor of physics at Fordham University, New York.