COVID-19: Update from Asif Saleh (20 June 2020)

June 21, 2020

Reading Time: 4 minutes

Confusion around zoning abounds as Bangladesh enters into its fourth month of the COVID-19 crisis. Now is the best time to reap the benefits of wearing masks. Read the latest on COVID-19.

Dear colleagues, partners and friends,

Mass confusion and curiosity about zoning, lack of adequate oxygen support for patients, and approval of the locally invented rapid testing kit dominated the headlines this last week.

The crisis in Bangladesh stepped into its fourth month. If there is one thing that can fundamentally articulate the response, it is confusion. Not only have the steps taken always one step behind and failed to appreciate the urgency, but inept crisis communication or the complete lack thereof made it infinitely worse. That was once again highlighted this week.

Zoning

It was disclosed to the media about 10 days ago that work was going on around zoning. However, nothing was communicated to the public in terms of how it would happen. Steady leaks around the draft plan started to emerge which made things even more confusing. Delays in implementing red zones are consequently causing confusion and panic.

The government has shortlisted a total of 45 areas in Dhaka under the red zone, according to recommendations by the national technical committee formed to tackle the spread of COVID-19. A zone will be declared red if 40 or more people per 100,000 in a unit tests positive in a 14 day period. The work on identifying the units in the urban space is ongoing. Outside of Dhaka, the three-coloured zones are now applicable down to union-level administrative locations.

The two new mayors of Dhaka stepped in to take part in the implementation more forcefully. I had a Facebook live event with the mayor of Dhaka North to understand and fill in the information gap on zoning. He shared his learning from the Rajabazar pilot, a small area in Dhaka, which came under red zoning. He mentioned that he will need support from all the stakeholders because he wants to ensure strict compliance once the zones get identified. He also mentioned that those in the neighborhood who are financially vulnerable would get free food support in red zones.

Community engagement

The role of community engagement has gotten a lot more traction within the policy-making circle and development partners this week. The notion of a trained community support team consisting of a community health care worker, a volunteer and a doctor to enforce local compliance of basic prevention, support home care with referral services for testing, and emergency hospital care has been discussed here before. BRAC will be implementing this effort in partnership with the United Nations Population Fund (UNFPA) and Food and Agriculture Organization (FAO) with initial support from the World Bank. Below is a picture of the first lot of community health care workers who are being trained. We will have more on this in our next update.

The update on the rapid testing kit evaluation

There was much confusion related to the Bangabandhu Sheikh Mujib Medical University Hospital (BSMMU) evaluation of the rapid testing kit of Gonoshasthaya Kendra. In absence of any decent testing availability, the country was fixated on the result of the trial. Antigen tests were already withdrawn by Gonoshasthaya Kendra. So the verdict was in for their antibody test kit.

The experts at BSMMU hospital have recommended that this antibody testing kit is used where PCR testing is not available and can be used to monitor the extent or seroprevalence of COVID-19 disease. However, this testing kit will still require a lab technician to collect the blood sample and do the testing. So the quick scalability across the country will still be a question mark in absence of qualified lab technicians.

The efficacy of antibody detection in these tests are 11% if testing is within one to seven days of infection, 40% from day eight to day 14, and 70% if done after 28 days. This goes over to the Directorate General of Drug Administration (DGDA) for final authorisation. In absence of a local alternative, importing antigen rapid testing kits is also very necessary at this point to diversify testing methods as the economy has reopened and factories and offices are in dire need to test people and get results quickly.

A stitch in time saves nine

Policy formulation needs to swiftly follow implementation during a crisis. We are losing precious time. With all the focus on zoning, masks did not get any attention this week. Public campaigns and communication has been missing, and so has been any plan on mass production and distribution. The current demand for masks rose up to 50-60 million per month, whereas the domestic production capacity of this vital commodity is currently at 6 million per month.

Internal modelling is showing that everyone wearing a relatively good quality mask can have the almost the same effect as that of a hard lockdown provided that it happens immediately, at this stage of the spread. From BRAC, we are mobilising our artisans to produce such masks. The scale of free mass production will require resource support. This would not only help the artisans but is also our best hope in reducing the spread. I talked about doing more rigorous modelling on masks in an opinion piece on 31 March with Dr Richard Cash. It seems now there is finally enough evidence on masks:

Read: How Exactly do you Catch Covid 19 – there is growing consensus (Wall Street Journal) and We need better masks (Harvard Business Review).

Let us ensure that we stitch these masks in time to save thousands!

Khichuri Index: Affordability is improving

In the fourth week of May, the average costs of the khichuri plates in the selected districts stood at BDT 67.81 (USD 0.80) for basic khichuri, BDT 73.35 (USD 0.86) for khichuri with vegetables and BDT 88.74 (USD 1.05) for khichuri with vegetables and egg. The cost for all decreased during May (from the first week to the fourth week), by 7%, 5% and 4% respectively.

Affordability is also slowly improving with the economy opening up and wages starting to increase. As wages start to improve in most of the districts and the prices of khichuri plates decline, affordability is slowly improving. The average affordability of khichuri with vegetables and egg now stands at 6.35 per plate for agricultural labourers, compared to 5.89 in April. See the report for more detail.

In other news

Migration experts fear a surge of return of migrant workers in upcoming months. Many will lose their jobs as economies of destination countries – mostly in the Middle East and Southeast Asia – are taking a hit. Returnees should be equipped with technical skills on business, management and marketing, on top of the loan schemes developed by the government

BRAC created a small emergency fund with partnerships from a number of other donors and announced a plan to support 7,250 returnees with cash from a BDT 3 crore fund (USD 353,451). The partners are: Royal Danish Embassy, Swiss Agency for Development and Cooperation, the EU-supported, IOM and BRAC-managed Prottasha project, Children for Investment Fund Foundation and BRAC UK.

See the full report here. If you want to see any particular issue covered, please let us know at covid19response@brac.net.

 

Asif Saleh is the Executive Director of BRAC Bangladesh.

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