Fooled by the lesser evils?

2012. A 53-year-old man approached a government hospital in Dhaka with severe flu and laboured breathing. He had reached Dhaka from New York with a stopover at Abu Dhabi a few days back.

Soon after, he developed flu-like symptoms and finally came to the hospital when his breathing became troubled. The doctors suspected something different from the seasonal flu and sent his blood sample to IEDCR.

The man was suspected to have MERS or the Middle East Respiratory Syndrome coronavirus. Testing, however, showed he was not positive for the virus and after spending time in the ICU he recuperated.

But MERS was not so kind to others elsewhere in the world when it first appeared in 2012. Probably infecting humans from camels, it affected only a handful of people, about 800, but the mortality rate was 34 percent.

No MERS patients were reported in Bangladesh after that one suspected but fortunately negative case.

In late December last year, Fazilatunnesa Bappy, a former Awami League lawmaker, was admitted at the BSMMU with fever and flu-like symptoms. Doctors identified her as H1N1 or swine flu infected. She died six days later.

But before that, as the dreaded swine flu, that also wreaked havoc in 1918 as the Spanish Flu, swept through the world once again in 2009, the same infection arrived on our shore in June the same year.

However, after striking down some few thousand people in Bangladesh it stopped, although globally H1N1 caused deaths of anything between 1.5 lakh and 5.75 lakh people in 12 months.

And before that in 2003, another pandemic spread across the world– SARS. Fortunately no cases of this viral respiratory illness were detected in Bangladesh.

Until 2016, the highly pathogenic avian flu or H5N1 affected only eight persons in Bangladesh.

It is likely that, relatively speaking,  these viral storms bypassing Bangladesh has left the country less prepared for the novel coronavirus when it started in China.

Early statements of physicians who claim to have been charged with preparing guidelines for the Covid-19 challenge prove that.

One top official of Bangladesh Medicine Society in early February said just as swine flu did not affect Bangladesh, coronavirus also will be of no concern. There were even assertions, however unfounded, that the virus won't survive the warm weather.

Many 'experts' began to claim that at 27 degree Celsius it would die off and Bangladesh would soon shake off its mild winter and the mercury would rise beyond the magic number to deliver us of this 'novel' virus.

So confident were the policymakers that they simply underestimated the necessity of travel ban or mandatory quarantine of passengers.

But in this underplaying of the virus threat, what might have been overlooked was the character of the previous germs.

For example SARS-CoV and MERS were certainly deadly but not fast spreading. SARS affected 26 countries and infected over 8,000, killing 774 people.  The casualty rate was 9.6 percent compared to Covid-19's mortality rate which differs from country to country with Belgium the highest at 14.67 percent to the Philippines at 6.53 percent.

MERS also had a high mortality rate of 34 percent but it did not spread as widely. Only 2,519 people were infected and 866 died.

This is mainly because these two germs were not easily transmitted. Unlike Covid-19 they needed much closer human to human contact for the germs to jump. One even needed to do something with the urine of camels to be infected with MERS and not many of us really get to see camels in our daily lives.

The other big difference is that Covid-19 infected persons start transmitting the disease even before they show signs of the infection. But in case of those other two viruses, the person starts spreading the disease from the moment they start exhibiting the symptoms of flu.

So people could get early warnings and quarantine the sick. Not so in the case of Covid-19.

And swine flu, despite its huge number of casualties, spread fast and yet was not as deadly as Covid-19. It was a much milder germ and had the highest estimated case fatality rate of less than 0.1 percent. In China it was seven times higher for Covid-19.

Case fatality rate means the proportion of people who die from a specified disease among all individuals diagnosed with the disease over a certain period of time.

There are more reasons why Covid-19 became so infectious – it has a reproductive number of 2 to 2.5, meaning one person can infect that many persons. Compared to it, the Spanish Flu had a much lesser reproductive number of 1.8.

A comparison of all pandemics also shows that the success to contain them depended on how fast countries intervened and for how long. It also depended on the combination of measures. The major measures to contain the epidemics were physical distancing and quarantine.

"Waiting until you can see that you have a problem is waiting too long," said Marc Lipstich, a professor of epidemiology and director for the Centre for Communicable Disease Dynamics at Harvard University.

Early interventions have major benefits. If the cases are controlled, the health care system is not burdened with emergency patients requiring intensive care, releasing scarce resources to be engaged in other urgent cases.

A comparison between the Chinese cities of Wuhan and Guangzhou shows the difference.

Wuhan was late by six weeks in taking actions such as physical distancing and quarantining after local transmission was observed. But Guangzhou acted within a week of transmission and had fewer infections and lower peaks, Marc Lipstich has shown.