2020 has been an unprecedented, historic and never experienced before year in human history. It has been a difficult year for all. Many had no means to earn an income during the lockdown and were unable to feed themselves or their family in Bangladesh. Travel restrictions, school closure, a series of lockdown, illnesses and isolation, anxiety and depression among all age groups have led to a rise in mental health disorder and created new barriers for people already suffering from mental illness and substance abuse disorders. For some, this past year seems to have lasted for a century; for many, this past year was their last. The COVID-19 outbreak came out as the most devastating and challenging crisis for public health in the contemporary world. And while we adjust to the new normal, we experience pandemic fatigue — a phenomenon explained by the World Health Organisation as a demotivation to follow recommended health protocols.
The year of the Spanish flu, 1918, lasted for about one to two years and it is estimated that about 500 million people or one-third of the world’s population became infected with this virus. The number of deaths was estimated to be at least 50 million worldwide. Since then, the COVID-19 pandemic has been the most devastating experience, although the death rate so far has been much lower, thanks to the modern anti-microbial that are used to combat the secondary bacterial infections caused by COVID-19 and the state of ICU care with modern mechanical ventilation. The overall standards of hygiene were lower 100 years ago. But interestingly, the advice given during that time is nearly identical to what we advise for COVID-19: masking, keeping away from sick people, and washing your hands, also no vaccine or antiviral agent was available then. And people did not have the scientific advancement then for vaccine development, which would have prevented transmission and decreased disease severity and mortality.
In the early 1980s, during the pre-HIV time, focus was shifted away from the infectious disease and emphasis was placed on the burden of non-communicable diseases in developed and developing countries. HIV came along as a surprise by the end of the 20th century and crushed the idea that infectious diseases can be controlled effectively, hence leading to the HIV epidemic, with 42,575,135 infections and 371,590 deaths as of today. The lessons we learn from this is to expect the unexpected and always be prepared.
Non-Pharmaceutical Interventions were effective in reducing the COVID-19 transmission. Among all of such interventions, studies have revealed that social distancing has been the most effective in comparison to other non-pharmaceutical interventions in containing the COVID-19 infection. Greek philosopher Aristotle said, ‘Man is by nature a social animal; an individual who is unsocial naturally and not accidentally is either beneath our notice or more than human. Society is something that precedes the individual’. So, social distancing through the last year has been very difficult and daunting, yet it is the best control measure as concluded by numerous studies. However, two or more synchronous non-pharmaceutical interventions are suggestive of being more effective than a single type of intervention.
Fast forward to the arrival of vaccine in Bangladesh, Runu Veronica Costa, senior staff nurse at the Kurmitola General Hospital in Dhaka, took the first ever shot of COVID-19 vaccine on January 27, 2020. The vaccine was made accessible to frontline health workers and those above the age of 40. The vaccine has been a positive breakthrough in Bangladesh, overcoming the challenges of vaccine hesitancy which were noticed initially. While Bangladesh did scramble after the COVID-19 outbreak to put into place effective testing facilities and subsequently increasing the testing capacity, the vaccine roll-out so far is comparatively going much smoothly. As of March 20, 4.76 million doses of vaccines have been administered, as per the number of people who have received at least one dose of COVID-19 vaccine, keeping to the ourworldindata.org, which has made Bangladesh ahead of countries like Spain, Poland and Canada in the global vaccination race. Despite this smooth roll-out of vaccines since January, an increase in the number of cases has been seen since late February, from 350 to an approximate number of 4,000 by the end of March. Can this sudden rise in the number of active cases be due to a high transmissible new variant?
The vaccine for COVID-19 was developed at a record speed never seen before. The process of developing a viable COVID-19 vaccine candidate may appear like it occurred at lightning speed — because it so did this time, ‘Fortunately for humanity, COVID-19 vaccine development occurred in the spirit of a relay race,’ said Gitanjali Pai, Infectious Disease News Editorial Board Member and an infectious disease physician at the Memorial Hospital and Physicians’ Clinic in Stilwell, Oklahoma, ‘Every player virtually snatched the baton from the previous player and sprinted ahead, without wasting a single moment’. It was noticed that worldwide priority was given to distribution of the vaccine and the vaccine roll out that has begun in Bangladesh was a light at the end of this tunnel. The purpose of vaccination has been to decrease the mortality rate and hospital admissions by giving the vulnerable group in the community the access to the jab and gradual progression towards the availability of the vaccine to the general population which would ultimately prevent transmission leading towards attaining herd immunity at some point. Although it looks like that over 70 per cent of the population will need to be immune to achieve herd immunity (though the exact figure needed is unknown). That is already an extremely high and difficult bar to clear, given the slow early distribution of the vaccines all over the world. The COVID-19 vaccines have only been administered since December 2020 and hence, the long-term effects are yet to be known. Studies will continue to evaluate their safety and effectiveness long into the future and these studies will also reveal how long the immunity offered by the vaccine lasts.
The pandemic has also given a reality check on the capacity of our health systems, access to healthcare facilities and efficiency of delivery of those services. The health crisis also has a deep social-ecological component and it, therefore, needs to be taken into account that social vulnerability and unequal access to knowledge, power and resources that exist in our communities play an important role. Not only do the health systems need to be resilient, a transformative change, rather than an incremental change, would have a strong potential to accelerate the change that is required. The concept of health system resilience should be extended to engage with the social and environment inequalities that health system both contribute to and shield against.
New Zealand may have left some lessons for us to learn from, science was prioritised and prompt adoption of non-pharmacological interventions was taken. Effective infection control and prevention strategies were put in place leading to only 26 deaths till date, according to the Worldometer.
This pandemic also gives us an understanding of the importance of the public health model in terms of controlling the disease. The medical model, which suggests that a drug may be provided to a patient by a doctor to cure the disease, may not give us a way forward from this pandemic. We need to collaborate with communities for a solution. In this case, the solution may not be the best in a scientific perspective but has everybody’s buy-in. Community engagement and building their trust is an integral component of a public health infrastructure to get a positive outcome and eventually to contain such pandemics in the future.
Looking forward from here, an early warning system on health that may help intervene at the right time before we experience an exponential growth of cases would be ideal. Public health awareness and access to credible source of information should be valued much more. We should be prepared for more variants of this virus to come and we should move forward, together, in the fight against COVID-19.
Dr Sahar Raza is a senior business development officer, Eminence Associates for Social Development.
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