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Opportunity For BD To Manage Corona

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07th-Apr-2020       
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Prof. Dr. Muzaherul Huq with Prof. Dr. Rano Mal Piryani :
Bangladesh is thickly populated country in South Asia with 170 million. First three confirmed cases of coronavirus disease (COVID-19) were reported on March 7, 2020. Two were imported cases (returned from Italy) and third was a family member of traveller (local). Government of Bangladesh orders quarantine for all international arrivals March 16, 2020. First COVID-19 death reported on March 17, 2020. As of 31 March, 2020, there are a total of 123 confirmed cases, 33 recovered, and 12 died. Bangladesh declared a lockdown from March 26 till April 11, 2020. The government deployed the armed forces and police to ensure that people maintain social distancing and quarantine to prevent spread of the deadly COVID-19.
Everyone now recognises how COVID-19 is transmitted and spread. As per WHO, COVID-19 spreads from person to person generally through droplets when an infected person speaks, cough or sneezes and other persons are in close contact within one-meter distance. Person may also get infected after touching eyes, nose and mouth once hands touched to contaminated surfaces or items. In this way COVID-19 infection transmits from person to person. Exact time COVID-19 survives on surfaces and items is not known. Given the right environmental conditions, COVID-19 virus can survive for long periods on certain surfaces and in fine aerosols that are sometimes produced during advanced medical procedures.
Around 80 percent of infected people have mild disease that passed unnoticed and quite number of people has no symptoms i.e. symptomless or just carrier. Around fifteen percent has moderate to severe disease requiring isolation and hospital care while approximately five percent need intensive care.    
From first three reported cases, it seems that infection is at second stage. Before lockdown from March 26, thousands of people returned to Bangladesh from COVID-19 affected countries. There is no proper tracing mechanism in place, so, it is difficult to say about the current burden of COVID-19 disease in Bangladesh.  
The question is "what is detected at this point in time" is an actual scenario or seeing just the tip of iceberg? We feel no one knows.
Quoting example of active cases in Hong Kong between February 15 and March 13 the active cases were around 60, then there was surge in cases and in following 13 days figure reached to 340 (March 26).  Bangladesh may possibly face same scenario in days and weeks to come.
There are no specific vaccines or treatments for COVID-19. However, there are clinical trials underway. Social distancing is one of the non-pharmacological methods controlling infectious disease. But in a densely populated country like Bangladesh, it is difficult to enforce social distancing in many places.
Bangladesh needs a total aggressive approach to contain the spread of the virus. The present limitation of tests needs to be expanded. Massive drive for testing all quarantined and suspected infected persons be started and done. More laboratories with Rt-PCR should be established all over Bangladesh to make the test available to its citizens. While lab facilities are extended more lab technicians be trained with necessary skills to support the labs which are very urgent.
 The lockdown be strictly maintained to keep the people confined at home.  Designated COVID hospitals to be made ready and equipped with all facilities of ventilators and ICU beds. Supply of PPE should be ensured for all health workers engaged in COVID hospitals. More ICU nurses be trained in ICU management.
It is wise to be proactive to continue social distancing wherever possible to promote practice of excellent personal hygiene habits (hand washing, coughing into tissue or elbow and avoiding touching eyes, nose, and mouth) and further strengthen trace and test, isolate and treat.
The quarantine mechanism should be more institutional rather than home quarantine which is better manageable for screening the suspects & testing. We are to exploit our windows of opportunities with true spirit. We can effectively fight the pandemic with all confidence but we must prepare ourselves with necessary logistics including health human resources with proper mobilization. Nation needs to be prepared too to be proactive with the government to consolidate all efforts to contain the present day crisis. It is expected that with the present day strategy, Bangladesh can and will make it contained.

(Prof. Dr. Rano Mal Piryani Nepal, Internal and Chest Medicine and Medical Education, Universal College of Medical Sciences Bhairahawa Nepal and Prof. Dr Muzaherul Huq Bangldesh, Former Regional Adviser, WHO SEARO)

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