Ignoring WHO advice: Staring into the abyss

For some of us the lockdown pain appears to be worse than the prospect of death by Covid-19. The restrictions required to enforce an effective lockdown to arrest the spread of the virus are, therefore, being eased formally and prematurely.

This exit plan, if there is any such plan at all, is in blatant disregard of the conditions set by the World Health Organisation for exiting from a lockdown.

Though the global health body announced that nothing can replace lockdown, on April 14, it set six conditions for easing lockdown restrictions to reduce the personal and economic pains being experienced by people across the world.

Any government that wants to start lifting restrictions, says the WHO chief, must first meet six conditions.

Let's see how the conditions are being met or ignored in Bangladesh.

The first condition says a country willing to ease the lockdown restrictions must have disease transmission under control. 

Nobody can realistically claim that the Covid-19 transmission is under control in Bangladesh. New cases of infections are rising everyday with no sign of the curve being flattened.

Yet, a few hundred RMG factories were permitted to reopen ten days ago, on April 26, in Dhaka, Gazipur and Narayanganj—the three areas declared by the health authorities as virus hotspots.

The lockdown declared in the form of general holidays was extended on May 5, Monday till May 16. The same day, the cabinet division announced that markets and shopping malls can be reopened on May 10 for the Eid shopping season, however, with the conditions that shoppers must maintain social distancing.

The same day the government also announced that small and cottage industries at district levels will be reopened gradually.

So the first condition is completely being ignored in officially lifting the lockdown restrictions.

If the first condition were to be met, a country willing to relax the restrictions must have a health system able to "detect, test, isolate and treat every case and trace every contact."

Our neglected healthcare system with all its weaknesses is not the one that can handle such a heavy task. It could not even ramp up testing in more than two months time. As it is unable to run large scale testings, it can not detect suspects and people who are asymptomatic and isolate them.

The quality of treatment of the Covid-19 patients has already been questioned. Currently, there is no contact tracing system. So there is no way to have a true picture of the pandemic which is so crucial in formulating a realistic pandemic fighting plan.    

If the first and the second conditions favour a country, it must meet the third condition which is minimizing the risks of vulnerability in hotspots. This condition has already been completely ignored by allowing the RMG factories to be reopened in virus hotspots such as Dhaka, Gazipur and Narayanganj.

The fourth condition focuses on establishing preventive measures in schools, workplaces and other essential places.

As schools and other educational institutions remain closed, there is no need to establish any preventive measure there.

But the factories that were allowed to be reopened ten days ago have no effective preventive measures to talk about. Reports published in the media show that health safety measures were overlooked in those workplaces.

Finally, the national committee on fighting the virus on Sunday asked the factories to have a medical team and check the health conditions of workers regularly. The question is: will the owners of the factories follow the guidelines? 

Managing the risk of importing new cases is the fifth condition set by the global health agency.

Our readiness and ability to meet this condition has been questioned much before. The authorities could not stop incoming flights from the pandemic affected countries even after the detection of infection cases in Bangladesh. It allowed returnees from affected countries to enter Bangladesh till the end of March.

Movement of people between the districts could not be controlled. People from affected districts travelled to other areas spreading the virus.

Till today, there is a lack of effective mechanism to control inter-district travels. 

Fighting the virus effectively depends largely on the citizens' compliance with health regulations and government directives. That is why the WHO, in the sixth condition, says that communities are to be fully educated, engaged and empowered to live under a new normal.

The attitude of the citizens in the prevailing situation shows the sixth condition is the most difficult one to meet.

The poor and low income people are either not well informed of the safety and health requirements for surviving in the pandemic or their economic pain is worse than the threat of the virus. They can not stay at home as that means to starve to death, and they are coming out of homes. They are seen in hordes in front of open market sale trucks, kitchen markets or in demonstrations demanding reopening of factories and their past due salaries.

The phenomenon of social stigma has also appeared as one of the major concerns in the dire situation. Health workers and virus positives are facing harassment and social ostracisation in many areas. All these events go on to show that people are not fully educated about the threats and ways to keep themselves safe and that they are not prepared to live under the new normal.

It is not clear if the country has a well-planned strategy to gradually lift the restrictions. A gradual and complete relaxation of the restriction is inevitable as Dr Maria Van Kerkhove, Technical Lead of the WHO Health Emergencies Programme, said: "We don't want to lurch from lockdown to nothing to lockdown to nothing. We need to have a much more stable exit strategy that allows us to move carefully and persistently away from lockdown."

The way the restrictions were relaxed here has prompted health experts to voice their concerns. They keep warning that the situation may worsen in the coming days putting extra-burden on the healthcare system that is struggling to treat patients and ramp up tests.

It is clear that the virus will not disappear tomorrow. Scientists and experts are warning, it may persist for two years until a vaccine is developed. It may take at least a year to have the vaccine if everything goes according to the plan of the medical scientists.

But, CNN in a recent report has not been so hopeful. It cited the examples of lack of vaccines for HIV/AIDs and Dengue despite decades-long efforts by researchers.

If the worse comes true, then the coronavirus could remain with us for many years. Life will not go back to what it was before the pandemic. It just might not go back to normal quickly.

Experts predict a permanent change in attitudes towards remote working, with working from home, at least on some days, becoming a standard way of life for white collar employees. Companies would be expected to shift their rotas so that offices are never full unnecessarily, said the CNN report.

Are we ready for the new normal?

Another option that remains unexplored is the concept of herd immunity which is reached when the majority of a given population, around 70 percent to 90 percent becomes immune to an infectious disease. This a radical medical concept which has its inherent risks. A country must have a strong health care system to try this radical measure. But our healthcare system is anything but.

Perhaps, we have opted for this radical concept, although not in a planned way, allowing RMG factories to resume their works and letting markets and shopping malls to be opened from May 10.

With big economies battling the pandemic, Sweden sets a seductive example by relying on herd immunity. It has allowed most businesses to stay open. Large public gatherings are banned but restaurants, bars and schools have stayed open, and social distancing is encouraged rather than enforced by police. But it has paid the price for taking this path. Sweden has the highest fatalities and case count per capita in Scandinavia.

However, the WHO is promoting the Swedish way of doing things. "Sweden represents a future model… if we wish to get back to a society in which we don't have lockdowns," said Mike Ryan, executive director of the WHO's health emergencies programme, praising the way Swedes are trusted to "self-regulate."

But what worked for Sweden may not work for others. The UK at one point was convinced it could avoid strict closures by relying on herd immunity. But it abandoned the idea, pointing out that it was unscientific.

Relying on herd immunity appears to be a gambling with the virus. It tests your immunity system. If you win the gamble, you are free from danger for the time being. If you fail, you pay the price heavily.