Friday 18 September 2020 ,
Friday 18 September 2020 ,
Latest News
25 April, 2020 12:09:40 PM / LAST MODIFIED: 2 May, 2020 07:05:00 PM
Print

Withdrawal of Lockdown: how should we plan

Professor Be-Nazir Ahmed
Withdrawal of Lockdown: how should we plan

Lockdown has become an unprecedented intervention for prevention of transmission of Covid19 throughout the world. At present about 3 billion of 7.80 billion global population in 70 countries have been experiencing different forms of lockdown. This measure  was instituted by Chinese government following emergence of the novel corona virus in Wuhan and subsequently in other countries of the world, being now considered as one of the most effective interventions for preventing spread of Covid19. China could successfully halt the transmission of Covid19 in Wuhan and other parts of the country, at one point was assumed to be uncontrollable. Quite a good number of other countries have been able to control the menace of a century through lockdown at least for the time being.
In public health, the preventive non pharmaceutical measure of physical distancing for transmission interruption are ‘quarantine’ and ‘isolation’ for infectious diseases where man to man transmission tend to become fast and widespread. In quarantine, the person(s) suspected to have been exposed to the infection is(are) kept in isolation for the highest incubation period for that particular disease. In isolation, the person(s) with overt or covert detected infection is (are) treated separately or in cohort ( together) in separation for the highest period of communicability until and unless the patient cease to transmit the disease.

The quarantine and isolation may be facility, home or community based.

The lockdown is neither quarantine nor isolation, rather cruder form of physical distancing where other interventions for prevention of spread of an infectious disease are absent or ineffective. In general, a lockdown is an emergency protocol usually initiated by an authority that usually prevents people or information from leaving an area. A full lockdown usually means that people must stay where they are and may not enter or exit an area. During the last four months, different countries have applied lockdown in different ways and means and also in different names. Starting from a single house lockdown has been ranging through few houses, community, town, city, region or even the whole country. The duration has been varying from part of days, whole days, weeks and even months. The authoritarian forms take as closure, people’s curfew, formal curfew, limited distancing, strict distancing implemented through police, paramilitary or even military forces with application of punishment in the form of fines, imprisonments, shackling or even some amusing forms of social services.

Bangladesh has been maintaining a form of lockdown for around a month since 26 March 2020 after 18 days of the first reporting of Covid19 on 8 March. According to recent government notification it will continue up to 5 May 2020, after which there was will be gradual withdrawal of the lockdown. Now, why the country imposed the lockdown, though the number of reported cases was following a low horizontal curve of positive cases? It might have a connection with few incidences including late closure of international flights, noncompliance with institutional or even home quarantine, uncertainty regarding the magnitude of infections carried in by the immigrants workers from the affected countries, generation of insufficient evidences through laboratory diagnosis, insufficient preparation to handle probable bulk of patient surge and thereof growing insecurity among citizens.

Lockdown was probably the most important interventions decided upon and apparently proved to be worthy in curbing rapid widespread transmission of the infections in worries of gross inabilities for ‘trace, test and treat’ management of the case. There were some hiccups in planning and implementation of the lockdown like exodus of people to their sweet homes from the cities in festive mood and alluring garment workers from all over the country and again whipping them back. Through shutting down all sorts of internal transports, the lockdown in general was quite rigorous although people roam over in paras and mohollas creating concern of cautious people and attractive news items for media and also good topics for talk shows. In contrast to popular consensus of the ineffectiveness of the lockdown due to those breaches, as a public health specialist with long exposure, I am happy with performance of the lockdown in preventing intergeogrphic transmission. Though it was not meant for and was ineffective in intratransmission within the paras and mohollas.

As Bangladesh has been deciding  for withdrawing the lockdown, how should we plan?  The World Health Organisation (WHO)  released new guidance for governments looking for exit strategies beyond existing lockdown measures. For many countries currently under lockdowns which have crippled or stalled economies, the answer of when and how to ease restrictions has not been easily answered or forthcoming.

“We understand that these countries are now trying to assess when and how to ease these measures,” said WHO Director-General Tedros Adhanom Ghebreyesus. “The answer depends on what countries do while these wide measures are in place.” Six criteria were identified in WHO’s guidance document to ensure that governments would be able to manage a controlled and deliberate transition from community transmission to a steady state of low level or no transmission. Any government that wants to start lifting restrictions must first meet six conditions:

1. Transmission of Covid-19 is under control

2. Health systems and public health capacity are able to detect, test, isolate and quarantine every case and trace every contact

3. Hot spot risks are minimized in highly vulnerable places, such as nursing homes

4. Preventive measures such as physical distancing and hand washing in workplaces have been establised

5. Controlled and managed risk of new import cases from travellers

6. Populations are fully engaged, understand and empowered to live under a new state of “normality”

Has Bangladesh meet all the conditions set by WHO? Let’s analyse one by one.

1. Is transmission of Covid19 is under control? If we consider the curve representing the reported cases, then it becomes evident that the country is in exponential phase of Covid19 with consistent higher level compared to that of last one month on average 3 hundred daily case reporting with estimated high under reporting. The increasing number of districts reporting cases rather whispers further continued transmission. The increasing number of infections among healthcare givers and other service personnel who may serves as super spreaders transfixes the concern of sustained transmission until further effective interventions.

2. Are health  systems and public health capacity able to detect, test, isolate and quarantine every case and trace every contact? With certainty, it may be stated that the health system is not in a position to trace every case, test them all, do the full contact tracing of all the cases, ensure proper quarantine of those exposed and strict isolation of all the cases.

3. Are spot risks minimised in highly vulnerable places, such as nursing home? The country has not lot of nursing homes, so this condition may not be applicable. But the country could demonstrate commendable success in managing few hot spots arising out of import of cases resulting in clusters through effective lockdown with better overall management.

4. Have preventive measures such as physical distancing and hand washing in workplaces been established? The answer is in general no and it will take good efforts and time following opening of the work places that are presently shut to institute adequate hand washing. Maintaining expected physical distancing will almost be impossible due to congested working spaces.

5. Are risk of new import cases from travellers controlled and managed? If the past speaks the truth, then there will be high chance of ineffective control and management of new imported cases unless drastic measures are directed and supervised from the highest authority. The health has consistently demonstrated inefficiency in listing, follow up and proper quarantine of the travellers. Even the police and the army have to take lead role in tracing and quarantine of travellers.

6. Are populations fully engaged, understand and empowered to live under a new state of “normality”? That is a question to be test in coming days following exit from lockdown. If we take ‘understand’ as the first step, then it is yet to be started to make people aware through a scientific approach. The risk communications adopted throughout this pandemic were mostly not consistent with public health norms and locally contextualisation leading people to confusion and non compliance of preventive and protective measures like quarantine, social distancing and use of PPE. If this awareness raising and opinion building is not properly orchestrated engagement of the populations in compliance to required practice during normality will be at stake. The empowerment will be the last and effective step for sustained good and effective practice towards a free or controlled Covid19 infections.

The plans that may be adopted for withdrawal of lockdown may as follows. This should be maintained for further period until the disease surveillance demonstrates control of the transmission with enhanced evidences. Following that, the withdrawal should be gradual for the most important sector with risk free people judged through epidemiology and laboratory testing. The public health capacity should be significantly increased with involvement of huge number of public health specialists in leading preventive interventions like quarantine, isolation, physical and social distancing. The tracing capacity has to be scaled up to catch every exposed personnel and must not scape the strong public health network. The laboratory testing capacity has to be increased at a level that every public health demand may be full filled. Number of laboratory, diagnostic workforce, diversity of tests, standard, quality and uniformity have to uplifted. Highest efforts have to be taken to ensure adequate physical distancing in workplaces, during transport and at sleeping places and mandatory uses of face clothing during work, gathering and transport. Every workplace should have infection Control plan, guideline, SOP, and team along with regular exercise of infection control measures and be supervised by infection control team. There should be adequate standard PPE according to risk along with adequate washing facilities.

Public health team should ensure national infection control guideline in work place with power to apply infectious disease act 2018 with fine and if necessary imprisonment. Institutional quarantine has to be applied mandatorily for travellers coming from affected areas within or outside the country. The risk communications have to be standardised through communication and public health specialists to develop public opinion based on scientific attitudes rather than myth and empowerment for self informed decisions and practices.

The writer is an infectious disease specialist and a former chief scientific officer, IEDCR.

SH

 

 

 

 

Comments

Video
More Opinion Stories
Jamaica Kincaid's ‘Girl’ and a cricket-loving Bangladeshi mother While playing, a cricket-loving mother and her son got clicked by a journalist, and their pictures spread through social media since Saturday morning. The discussion started with a lovely playing scene, and it, soon, turned to the…

Copyright © All right reserved.

Editor : M. Shamsur Rahman

Published by the Editor on behalf of Independent Publications Limited at Media Printers, 446/H, Tejgaon I/A, Dhaka-1215.
Editorial, News & Commercial Offices : Beximco Media Complex, 149-150 Tejgaon I/A, Dhaka-1208, Bangladesh. GPO Box No. 934, Dhaka-1000.

Editor : M. Shamsur Rahman
Published by the Editor on behalf of Independent Publications Limited at Media Printers, 446/H, Tejgaon I/A, Dhaka-1215.
Editorial, News & Commercial Offices : Beximco Media Complex, 149-150 Tejgaon I/A, Dhaka-1208, Bangladesh. GPO Box No. 934, Dhaka-1000.

Disclaimer & Privacy Policy
....................................................
About Us
....................................................
Contact Us
....................................................
Advertisement
....................................................
Subscription

Powered by : Frog Hosting