Covid-19 cases and deaths are diverging for the first time. Here’s why

Over the last four weeks, the daily Covid-19 infection rate and the fatality rate have been going in opposite directions – although there has been a gradual reduction in new cases, the death rate has continued to soar.

The figures presented by the Directorate General of Health Services beg the question of whether the virus has been tamed or if, primarily, vulnerable people are being infected.

According to experts, neither of the possibilities match the reality. The non-representative data is instead the cumulative effect of a low number of tests and the public's lack of interest in both testing and hospital treatment, they think.

Increasingly more infected people have been staying at home, leaving hospital beds designated for Covid-19 treatment vacant. They neither test, nor seek the close supervision of physicians.

Such negligence often results in admission to a hospital at the eleventh hour when a patient's condition is critical.

Non-representative data

The country has entered the 28th week since the diagnosis of the first three Covid-19 cases by the Institute of Epidemiology, Disease Control and Research on March 8.

The daily death rate – calculated against the number of newly infected people – has risen to 1.41% this week from 1.32% in the middle of the 24th week.

Meanwhile, the daily infection rate–the percentage of daily tests that return positive – has gone downhill from about 21% to 12% during this time.

The hope raised by the lower number of infections is diminished by the higher number of fatalities.

Prof Ridwanur Rahman, head of Universal Medical College Research Centre, suggested that the official data does not reflect the impact of the novel coronavirus on the population.

Referring to developed parts of the world, he said at least a few hundred thousand people should have been tested every day in the country to find out the close-to-real infection rate.

For example, the United Kingdom tested more than 3.5 lakh samples each day between August 27 and September 2.

The nation with a 66.65 million population increased tests by 7% in that week from the previous week. And 9, 864 people tested positive in the week up to September 2, according to the UK Department of Health and Social Care.

Compared to the UK, the 12,000-15,000 tests being conducted daily in Bangladesh seem to be devoid of any purpose for a population as big as 161.4 million, argued Ridwan.

Even in neighbouring Nepal, close to 371 tests are conducted per million, but the rate is only 85 per million in Bangladesh.

Dr Ridwan said samples are sent to labs mainly from hospitals now since people have lost interest in testing voluntarily.

People are keen to test when they need a report for emergency medical interventions and to fly abroad, which again increases the likelihood of results coming back negative, unless they are asymptomatic cases of Covid-19. Such tests also pull down the infection rate.

The major reasons for not testing are the imposition of fees and the time it takes to get the report.

Hospitals see sudden rise in critical patients

Moreover, six months into the pandemic, people tend to brush aside the damage the virus is capable of inflicting on them and instead move on with their lives.

Dr Asadul Mazid Nomaan, resident doctor at Dhaka Medical College Hospital, told The Business Standard that those who were going to the hospital were getting admitted to the intensive care unit directly. Had they tested and sought treatment earlier, they could have been treated in the wards.

"Pressure has been mounting on the ICUs recently," Asadul said.

With patients' conditions worsening fast, treatment like plasma therapy has seen a sudden hike.

Dr Ashraful Huq, assistant professor of the blood transfusion department at the Sheikh Hasina Burn and Plastic Surgery Institute, who set up the first plasma bank in the country for treating Covid-19 patients, said the demand for plasma has suddenly increased a lot over the last two weeks.

"I receive requisitions for 12 to 14 bags of plasma every day, which means serious cases are on the rise," he said.

Doctors' dilemma

When patients in critical condition seek treatment, doctors find themselves undecided over how to help them.

The established treatment protocol often requires physicians to prescribe expensive antiviral drugs and steroids but they feel unsure in doing so without a test report, said HM Nazmul Ahsan, associate professor of medicine at Shaheed Suhrawardy Medical College and Hospital.

However, in an emergency, doctors evaluate what they need to do to save a patient's life.

According to Nazmul, people aged over 50 with pre-existing conditions – like diabetes, obesity, hypertension and chronic renal failure – make up the high-risk group.

"If an infected person with these conditions comes to us early – before they suffer breathing distress – there is a higher chance that we will be able to save them," he said.

Nazmul emphasised the importance of the immediate approval of rapid antigen tests that ensure quick results.

"We have received patients with a history of asthma and they delayed treatment because they misunderstood their symptoms," he said, adding that a quick result would have encouraged them to test.

Prof Ridwan said an inexpensive, rapid antigen test would easily enhance the testing capacity and help shed light on the true picture of the virus transmission in the country.

"People have lost faith in the epidemic control programme. If the prevention and control mechanism goes on to be like what it is now, more people in critical condition will die though we see the infection rate declining," he said.