Md Shafiqur Rahman :
Containment of Covid-19 is no ‘cookbook recipe’. Keeping the social context of Bangladesh, and the principles of epidemiology in mind, few of the modalities so far adopted need to be revised in the country for more effective and functional containment of the disease.If it is considered that ‘experience is the best teacher’, then based on the experience gained so far, some suggestion follow:
As the disease has no specific treatment nor any vaccine, management of a case is based on symptomatic approach. It is more important to ensure social safety from an infected case to decrease or slow down community transmission. This entails that when a case is found positive, contact details of the case must me noted, and the person must be brought under observation and monitoring network of health worker, other essential service providers, and community. The household or the workstation of the identified infected person is to be marked as red zone and not the whole area.
Besides, for halting or decreasing community transmission, lockdown of a large area is less important than pinpointed quarantine of the members of the household/workstation where a case has been identified. If possible, the patient should be shifted for hospital isolation, and the other asymptomatic members of the household/workstation be put under strict home quarantine. If home quarantine is not possible due to emotional expression or inadequate home facility, then institutional or community quarantine has to be arranged.
Applying epidemiological principles to interrupt the dynamics of Covid-19 transmission chain, the infected and suspected cases must use mask more strictly than other measures as the main route of exit of virus from infected person, and entry of virus to a susceptible person is the same, that is, respiratory route. The first and foremost is the use of standard face mask rather than gloves, hand sanitizer, face shield, gown, disinfecting tunnel…. The more personal protective equipment (PPE) are used the more is the spread if they are not adequately disinfected before reuse or discarding.
Regarding the quality of mask to be used by general people, it is advised to use three layered fabric mask that is washable and reusable. The one-time useable surgical mask is to be used by frontline health workers ensuring proper disposal. It is advisable for all frontline health workers to use the complete set of PPE (not only mask) taking care of disinfection and disposal.
It is often seen that a person using face mask pulls it down to the chin leaving nose and mouth exposed, or leaves it dangling from one ear. Again, it is seen that the face mask is pulled down and the nose, mouth or eyes are itched and the mask pulled back again. These practices do more harm than good. Now that using mask is gaining acceptance, the correct use of face mask and its care or disposal need to be communicated to the general people through mass media and health education messages.
There appears a misconception among general population that virus may enter the body through hands. Actually, virus may settle anywhere on objects, dress…while coughing and talking, and may be carried by hands to nose, eyes, or mouth, and so the importance of frequent hand washing. Increasing the practice of NOT touching nose, eyes, or mouth with hand/fingers is important.
All communicable diseases have period of communicability or infectiousness. Researches have shown that this period starts two days before the onset of disease symptoms for Covid-19. Hence, any exposed person in the incubation period may spread the disease when the person is apparently healthy but in the pathogenic stage. This stage is more dangerous as the person would be spreading the disease even before the person can suspect that he may be infected, whichonce again highlights the importance of use of face mask by one to all, particularly in pandemic situation.
Again, as per Center for Disease Control and Prevention (CDC), the period of infectiousness extends upto 10 day from the onset of symptoms, as evident from recent findings. So, a person coming in contact with infected person even on the 10th day will have to be put in quarantine for the longest possible incubation period of 14 days. Considering the periods of infectiousness and incubation, when a positive case is found in a household/workstation, the other members and contacts of that household/workstation should be advised to keep themselves confined to the house for at least 24 days (10 days of period of infectiousness plus14 days of incubation period). If this confinement is not done voluntarily by the household, then it may have to be strictly bolstered by government agencies. In either of the confinement situation, the government will also provide supply of necessities to the household. Affluent persons can pay for the cost of essentials provided, while the cost incurred by the poor will have to be borne by the government.
(Md Shafiqur Rahman, PhD, was an Associate Professor of Community Medicine and is currently working as a Consultant in the Directorate General of Health Services of Bangladesh. E-mail: [email protected])
