Winning the corona war and more

The Coronavirus (Covid-19) crisis has been labelled as one of the most daunting crises that humanity has ever faced. There is hardly any country which has not been affected by it. About a half of the world's population is under 'lockdown' condition. Fortunately, there is some light being seen at the end of the tunnel. After Wuhan, the curve is expected to 'flatten' shortly in Italy and Spain, the countries most devastated by the onslaught. However, our knowledge of the virus' epidemiology is far from complete, and the responses to it are not devoid of controversies (To publically use the mask or not, for example). 

Bangladesh is at the crossroads now. After weeks of low reported figures (both of cases of infection and deaths), the curve has started to rise steeply in the past three-four days. This is perhaps due to both selective decentralisation of testing and the beginning of community transmission. Of late, the government has moved to implement a number of measures. On the mitigation side, decentralisation of the testing has been initiated, allowing a few others to do the same along with IEDCR, and supplying the protective equipment to frontline healthcare workers.  On the containment side, the measures include a nationwide chhuti (short of a lockdown), closure of transportation, shopping areas, congregation at mosques and other places of worship, the fielding of army and police to enforce these measures, large incentives to revamp the economy, and promotion of hand washing and social distancing. Unfortunately, these initiatives have been very disjointed. The Health Minister himself expressed his anguish at the lack of coordination among the various actors.

The Bangladesh response has largely been a reactive one. There has been indecisiveness and confusion along the way. The most recent fiasco relating to the RMG sector is a case in point. If the government and the sector leaders had been transparent and clear, such a situation would not have happened. Fortunately the government has now come clearer in closing the factories but the BGMEA has not apologised for its mishandling of the situation which put the lives of thousands of workers and ordinary citizens in great jeopardy. Another example is the mosque. The government and the Islamic Foundation have been utterly indecisive in this. The instruction to hold the congregations but with 'a small number of devotees' did not make any sense and added to the confusion, as a result of which the congregations went on unabated. The recent clarification by the Islamic Foundation (on April 6) created further confusion. It said that mosques can hold normal prayers with no more than five persons and Jummah prayers with no more than ten persons. However, in the evening, the Minister of Religious Affairs came out with the instruction that no 'outsider' would be allowed in the mosques to offer prayers. While even Makkah and Madinah are under curfew, we hesitate to enforce such strict disciplines!

The economic incentives which are equivalent to 2.5 percent of the GDP (compare this to 15 percent in UK) have been largely hailed, although there are questions of how this will be implemented and who will benefit. The issue of the morale of the frontline health workforce (FLW) has also been flagged, with many of them complaining about poor support from the authorities in terms of their safety and the future of their families in case some lose their lives while providing care. The government should include incentives for them in the economic packages should any FLW dies in action. Many countries have introduced such incentives in order to keep the healthcare systems functional. Fortunately, the Honourable Prime Minister has announced on April 7 the introduction of life and other insurance coverage for the FLWs—a correct and timely step.

Although the virus attacks anybody and everybody, irrespective of his/her socio-economic standing, there is a huge equity issue in the response measures. One example is the support we provide to the lower class employees such as the cleaners and domestic workers. They are equally exposed to the virus but their safety and wellness are hardly included in any discourse. They, along with other staff such as ambulance drivers carrying corona patients, should be covered by the newly introduced health insurance.

Both the for-profit and not-for-profit sectors have so far involved themselves only to a limited extent in the war against Corona. However, in a crisis of such magnitude, it is imperative that all actors come together for a proactive, agile, collective response that can commission and utilise multiple strategies in parallel to minimising the spread and impact of the disease. The health sector is trying to implement several instructions without putting them into a comprehensive plan, thus leading to a lack of coordination of activities. Whether such lack of enthusiasm is because of the sectors' reticence to embrace the risks involved, or the failure of the government to mobilise and make them partners in this war, is being debated. However, the private sector has resources which can substantially complement government action and contribute to winning this war—from disseminating information to expanding treatment facilities to making scarce hardware and software supplies available. The absence of a strong role by most NGOs (with the exception of BRAC and a handful of others), which have been at the forefront in almost all such crises in the past, is especially felt now. The war against Corona cannot be won single-handedly, and a united front with the involvement of every sector is a call of the day.

The role of the health workforce in this war has become controversial. Many healthcare professionals not directly dealing with the disease have receded from providing services, with many reportedly not turning up for their assigned duties.  The interns at Mymensingh Medical College not joining the internship programme is a case in point, as well as numerous anecdotal reports of doctors not opening their private chambers, and hospitals curtailing their outdoor practices and patient admission. This is all due to the 'fear factor' prevailing among healthcare providers. Such actions stem from a feeling of insecurity among them due to a lack of protective gear and devices. But there are also positive examples whereabout many doctors, paramedics and lab technicians have kept many of the Surjer Hashi Clinics functional. 

It is only natural to expect that healthcare professionals will live up to the commitments they had subscribed to when they signed up to be a health professional. However, appreciation and recognition of their work could do much to boost the morale of this group. 

The government, meanwhile, is under pressure from the Middle Eastern countries to bring the remaining workers back, numbering about 100,000. Fortunately, they are living in countries which are not yet hotspots for the virus. Once they return, we must ensure a better management of the quarantine and isolation. 

The plight of the wage labourers and other vulnerables at the time of lockdowns is well known also. We are heartened to see many private citizens and civil society groups providing succour to them. However, many of these are done without proper management, creating new grounds for virus transmission. The government's plan to deliver food to individual homes is a welcome move but it has to ensure that the real needy get the support. In this, the government may wish to solicit participation of the NGOs who are known to have grassroots contacts without political affiliation or favour. It is important for the NGOs to bring their workers back to the field to participate in the fight, particularly in promoting social distancing—they have the potential to contribute immensely if they work in coordination. 

Finally, the government needs to be resolute and decisive in its policy actions. Whatever draconian route the measures may take, there is hardly any alternative to it if we wish to avert a big calamity. Ambiguity in policy implementation will only hasten the crisis.  Every crisis is also an opportunity and we should not let the current one to go to waste. This pandemic is a reminder to reconsider the functioning of our health systems and how we can make it more robust to in order to face major crises such as Covid-19 and the unfinished agenda of high mortality, morbidity, malnutrition and fertility. Can this crisis create enough enthusiasm for the government to work zealously towards universal health coverage?

The Bangladesh Health Watch is a civil society initiative, set up in 2006, to monitor progress in good health for all. The Secretariat of the Watch is hosted by BRAC James P Grant School of Public Health, BRAC University. Email: mushtaque.chowdhury@brac.net