MANDATORY lockdown in countries of the subcontinent have perhaps been the sole occasion, for more than 1.3 billion people in India, followed by 220 million Pakistanis and 160 million Bangladeshis, to stay locked up at home. Aided by available internet and technology, citizens have helped themselves to work from home and shop to meet their needs at online outlets.
All this exercise has proved to be a significant burden across societies where the old, the feeble and the ill had been exposed to some rough rides. Obviously, income for the people who worked on daily wages or were self-employed had been disrupted, with no savings and zero support in their efforts to fulfil their basic needs of food and shelter. As a consequence, many labourers and migrants stuck in closed cities have been left hungry, abandoned and stranded.
With the broken economy that has dwindled downwards, governments appeared to be loosening mobility restrictions. Lockdown by itself has never been a solution. It only bought us time to meet the goals of preparedness and gave us a way to prioritise them. The question lying ahead of us now is how to break the new status quo to get out of the lockdown. Some have often chided that it is like getting into a ‘chakravyuha’. We might be sucked into new, unknown forces, with no knowledge or skills to get out. A tool that can provide for an effective guidance on stepping out of lockdown is called the art of ‘surveillance’.
This term ‘surveillance’ means a systematic collection of data for action. Strong surveillance is, therefore, the need of the hour. It helps to monitor the extent of the circulation of the virus, SARS-CoV-2, in the general population. The World Health Organisation recommends implementing testing for COVID-19 via the existing national sentinel surveillance sites for influenza like illness and severe acute respiratory infection.
In rural areas, surveillance for influenza like illness can be done by conducting door-to-door visits, aided by health workers. Recognised volunteer groups can visit the households with a simple checklist of symptoms, providing clear-cut definitions for what constitutes a suspected case, a probable case, a confirmed case and contact is a must. By ensuring fast data reporting and analysis at the public health centres and district levels, we can detect new cases and identify clusters.
Having more cases is the reality that we need to face and not detecting is what has turned out to be dangerous. One can look at our infected, urban hot pockets to understand the importance of this. Nothing happens all of a sudden. A strong watch and ward system can detect cases early enough and prevent complications and deaths.
In the short term, the district administration can engage medical colleges and public health institutions to reinforce the surveillance mechanism in the country. Any organised work force of volunteers can be activated to assist in tracking and screening infected people. When we consider the huge population of Bangladesh — and the low human resource allocated for the healthcare system, it is essential to have a participatory surveillance where the public is also encouraged to self-report the symptoms. The goal is to detect and contain outbreaks among vulnerable populations, especially the elderly, cardiac patients, people with disabilities and children in orphanages, who will not be able to seek help by themselves.
Again in urban areas, it is important to engage civil society members, non-governmental organisations and other volunteers for strengthening the outbreak detection. Therefore, as an immediate measure, participation and coordination of multiple ministries and government bodies towards a common goal are important.
Preparing district action plans similar to the national immunisation plan must be the way forward with a robust review mechanism at multiple levels and with clear accountability for action. Adopting district strategies with a sharpened focus on high priority districts can help in addressing the needs of human resources, beds, high-flow oxygen, ventilators, isolation facilities and drugs.
Any death occurring anywhere in Bangladesh should be investigated whether it is due to COVID-19. Monitoring the trends in disease and death at district levels will help in evaluating the impact of the pandemic on the healthcare system and society. This will also help to monitor long-term epidemiologic trends and evolution of the COVID-19 coronavirus.
Also public health authorities in Bangladesh should review their local requirements and plan an adequately-sized work force of contact tracers. They should also involve private-sector providers and non-governmental organisations for screening services, with a clear segregation of affected areas. The capacity building of healthcare workers to conduct district self-assessments and healthcare workers for better communication have to be arranged online.
Citizens should be guided to implement and encourage such control measures like cough etiquette, physical distancing and seeking help in case of any symptoms. The information technology resource persons may be consulted to develop applications, as accomplished successfully in the southern Indian states. And these apps may well become the tools to convey messages of COVID-19 awareness.
Regular interaction with the community and their religious and other influential leaders will ease the process of spreading the message and contact tracing.
Public gatherings, museums and daycare centres will have to remain closed further. Wherever possible, remote working has to be encouraged and public transport should have a minimum number of passengers. People will have to be vigilant, wear masks, maintain social distancing and go out only for pressing reasons. Making use of the apps to track and maintain safe distance is helpful and its widespread installation must be encouraged.
The use of thermal cameras is needed to be enforced in public spaces and over-the-counter sales of antipyretics without prescription must be strictly prohibited. Wherever possible, the contact information of the person and the prescribed doctor must be tracked.
Many countries have come up with solutions such as face mask vending machines, staggered school days, wristbands that buzz if anyone comes too close.
Reversal to ‘normal’ or the pre-COVID-19 era is not going to happen any time soon. Physical distancing, maintaining cough etiquette and hand hygiene will have to become the new normal in society.
Finally, a temporary measure will only be reactive in nature. The long-term measure of public health emergency preparedness is the call for action now.
Nazarul Islam is a former educator based in Chicago.
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