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20 March, 2020 12:57:43 PM

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Lessons and solidarity in facing the novel coronavirus

As the world goes into lockdown, the World Health Organisation’s China Report provides sober reading
Jaseem Ahmed
Lessons and solidarity in facing 
the novel coronavirus

In his novel The Scarlet Plague Jack London imagined a disease that struck so quickly that those infected died within minutes. Set in 2073, a “save yourself” mentality takes hold everywhere, humanity is defeated by the pandemic, civilization breaks down, and the few  survivors  live in  isolated, primitive communities.
The novel grips the reader with its account of heroic doctors and nurses who die whilst struggling to contain the disease, of infected mothers’ handing over their children to others in order to save them, of husbands and wives refusing to abandon each other and holding hands as they sit together, knowing they will die as their families and communities abandon them to try to escape from the rapidly expanding perimeter of infection. Cities go up in flames, violence and mayhem.
The above is drawn from a riveting work of fiction published in 1912. But what are the facts today?
We must begin with China which has engaged in a titanic struggle to stop contagion.
In the process, the country has demonstrated an astonishing organisational ability, and a willingness to draw on all of its material, financial, and human resources.  There has surely been great suffering across China, as well as uncounted acts of bravery (we are seeing something similar in Italy).   The heroic Dr. Li Wenliang, and his tragic fate, resonates with us all.  We can take comfort that he succeeded, ultimately, and his message was heard.
The resilience of its people, especially of those at the epicenter in Wuhan, and the government’s willingness to “do whatever it takes”, appear to have charted a path for China out of this grave crisis.
Things looked otherwise in the early days of the epidemic.   Many thought pieces by western China experts saw in the emergence of the virus - and in its spread  - confirmation of existential failings in the Chinese systems of governance.  Others have questioned the value of globalization, especially the interlinked system of supply and value chains centered on China.    

How do these initial assessments stand today?  

We can say the following. First, the rush to stockpile household goods and the emptying of supermarkets observed in the US, Australia and in Europe reflects a sense of widening chaos and panic.  To be sure, this is just a pale shadow of  the “save yourself” mentality that Jack London envisaged.   Yet it is both disturbing and understandable.  

Certainly, there must also have been a sense of panic in China at first, and perhaps even now. Although we have not seen anywhere in the world the scenes of apocalyptic violence or societal breakdown that feature in The Scarlet Plague, we are witnessing unilateral actions by governments in which international consultation mechanisms are sometimes  bypassed.

Second,  the surprising  perception that many  advanced nations were unprepared to address the epidemic in the most critical elements of a counter strategy:  for example, testing kits, screening at airports,  and in the number of hospital beds where specialist treatment can be

provided.  Third, a surreal sense is provided in the turnaround in relative perceptions of China and the United States, as provided by an eminent Harvard professor speaking on the BBC where he stressed that the capabilities in the US to address the crisis measured up to those of only a single province in China.

Then there is the remarkable failure to roll out testing kits in a timely fashion by the world renowned Centers for Disease Control and Prevention in Atlanta.

However,  the US has some history of seeming to fumble at the beginning of a crisis and then successfully bringing all of its un-matched capabilities to bear upon it.  Millions of testing kits are now said to be in the final production stage. Fourth, with the global economy growing at its slowest rate since the Global Financial Crisis (GFC), the pandemic will have a significant negative impact on demand.   World economic recovery will depend upon how quickly China can restart its economy.  The sooner China recovers from the epidemic, and the sooner other nations are able to learn from the Chinese experience, the better for all of us.  But, with its economy growing at only 6 percent per annum or less, we cannot expect from China the large stimulus it was able to provide to the global economy in 2003, after the SARs epidemic, when its annual growth rate was at 10 percent.  

Thus, a strong fiscal expansion will be needed from other major economies.   But economies that adopted fiscal austerity measures after the GFC will find it difficult to achieve quick results from a reversal of that policy.  A key issue is to help enterprises that are vulnerable to a cut-off of bank financing.

Finally, fifth,  we have a timely report by the staff of the World Health Organization (WHO) that presents a clear and concise picture of the gigantic and seemingly successful effort that China has exerted in the last few months to contain the   spread of the virus.   The issue now is to use the illumination provided by WHO - and others - to come to grips with what must be done, and the priorities therein.

The peak of the crisis is over in China. Fatalities are concentrated in Wuhan and in Hubei province; fatalities in the rest of China are a fraction of those in Hubei.   

China has displayed a capability of keeping infected people alive that other countries may struggle to match. The mortality rate may well be higher elsewhere in the world as countries struggle with finding the resources as well as a coherent strategy.

The “good news”, however, is that the core lessons from China are familiar.  The key issue is the identification of those infected, and the tracing of their contacts and the pathways of contagion.  This is exactly the centre piece of the successful response to the earlier Ebola crisis, where tracking and reporting was done by highly motivated individuals going door-to-door.  In China the tracking focused on family contacts and was aided by the use of big data and Artificial Intelligence to track the movements of individuals through their mobile phones.   

China’s approach will be infeasible for technical and privacy reasons in many countries.  However, one of the most effective responses has been South Korea where the law permits government’s access to GPS and other data by which potential infections have been tracked and treated. Others are using analytical and computational models to work out where those at risk are likely to cluster and to forecast their expected movements.

You do not need to have the capabilities of a surveillance state to recognize that large gatherings of people,  whether in conferences, or on pilgrimage or at places of worship, are potential centers of infection and contagion.  Who staff recommend emulating China in focusing on  “case finding, contact tracing, and suspension of public gatherings”. But this will be a more complex task outside of China than in it, where there was greater certainty about the origin of the virus.

The scale of China’s response is impressive, indeed daunting.  It established an extensive network of “fever hospitals” by closing off whole wings of existing hospitals, as well as by building new ones.  It worked at a vast scale to increase the number of beds for patients, and to buy ventilators, high-flow oxygen units, CTs and build labs for testing.

It went to extraordinary measures to keep people alive, including removing blood from patients and oxygenating the red blood cells, before re-injecting. It made testing and treatment free.

Distilling the China experience, the core elements of a counter-strategy are:  make sure everyone knows the symptoms - fever, shortness of breath and cough;   “find the cases, isolate the cases, and track their close contacts”; act to stop unnecessary gatherings of people;  develop quickly a surveillance system that provides the data needed for public health action.

The robustness of the public health infrastructure is critical.   WHO believes that the “ public health infrastructure to investigate cases, identify the close contacts, and then make sure they remain under surveillance. That’s 90 percent of the Chinese response.”

For lower income countries, the best strategy is to emulate China in stages, by establishing a core capability in selected hospitals and labs initially for testing and for treatment, and then work rapidly to scale up the network, depending on resource availability.  Grant funding from international sources will be essential in many countries.

China has been criticized for its lockdown of millions of citizens, although this has now been emulated by Italy for the whole country.

Draconian lockdowns do pose severe challenges for affected individuals and communities.  The conventional view against them is that they undermine the trust that is essential to effectively trace the disease and contain it.   But, in Italy there is evidence that people approve of the country wide lockdown; it has generated a sense of solidarity.   

A second issue is more problematic: draconian lockdowns result in not just hardship for many as they struggle to find income, food and sustenance – they also result in deaths that are unintended. Amongst the most vulnerable will be those without jobs, without official papers. This is the terrible tradeoff.  

Finally, in their report WHO staff stress the need for a spirit of solidarity, and cooperation across countries.  In Jack London’s novel the spirit of solidarity broke down early. Today, as the world goes into lockdown, signs of domestic solidarity have emerged in moving scenes of quarantined people joining in sing-alongs in both Italy and China.  

To paraphrase the great Harvard entomologist Edward O. Wilson:  selfish individuals always prevail over altruists, but a selfish society will wither away in competition with altruistic ones that stress cooperative behavior.  Professor Wilson was not simply writing about social communities of ants, but of the evolution of the human race.

This is a time for human empathy and sympathy, both within and across nations - and a time for international cooperation and collaboration. It is in our collective self interest not to abandon the weak and the poor, and not to abandon each other, regardless of nationality.  

The writer is former Secretary General, Islamic Financial

Services Board  

 

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Published by the Editor on behalf of Independent Publications Limited at Media Printers, 446/H, Tejgaon I/A, Dhaka-1215.
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Editor : M. Shamsur Rahman
Published by the Editor on behalf of Independent Publications Limited at Media Printers, 446/H, Tejgaon I/A, Dhaka-1215.
Editorial, News & Commercial Offices : Beximco Media Complex, 149-150 Tejgaon I/A, Dhaka-1208, Bangladesh. GPO Box No. 934, Dhaka-1000.

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