Dhaka: On the same day the Cabinet Division issued a circular on relaxing the shutdown, the Bangladesh government's very own National Technical Advisory Committee on May 28 warned of an explosion of cases if health and safety measures were not implemented strictly.

In mid-April, the government formed the 17-member advisory committee to tackle the outbreak of novel coronavirus in the country. Since then, it has been giving advice on different issues on fighting Covid-19.

"It has been seen that countries that lifted the lockdown before experiencing a definite reduction in the infection rate, experienced a rise in the infection rate," said a statement signed by its Chairperson Prof Dr Md Shahidullah and Member Secretary Prof Dr Meerjady Sabrina Flora.

Dr Shahidullah is a senior child specialist and president of Bangladesh Medical and Dental Council while Dr Flora is the director of Institute of Epidemiology, Disease Control and Research (IEDCR).

"Lifting the lockdown before strictly implementing the rules and requirements of preventing transmission will increase the number of positive patients and create pressure on the healthcare system," warned the statement.

The statement mentioned that the committee had previously given similar advice to the government on May 7.

"I see no possibility of the curve flattening," said Dr Iqbal Arsalan, a member of the committee.

"This is still unpredictable. People are going around without masks for example. People need to wear a two or three-layer cloth mask, that they will wash after every use.

"Physical distancing is being stressed upon. The law enforcers will try to maintain physical distancing, but soon the crowds will get out of control. We have seen this before Eid -- the law enforcers tried to disperse crowds, but failed to do so because they cannot jump on civilians with riot gear."

Talking to The Daily Star, he also said, "We do not have enough hospital beds, enough ventilators to deal with the crisis."

He talked about an impending transport crisis among office goers, since there has always been a shortage of transport, compared to the need.

"Even if buses have been instructed to operate at half their passenger capacity, what will happen when office goers will crowd into the buses?"

In addition, the government had formed an eight-member expert committee to supervise, monitor and support the coronavirus response, at the end of March. Its members have also advised the government on how to ease the lockdown -- but the government's current step sharply contrasts with that.

"We had asked the government to lift the lockdown phase-by-phase," said Prof Shah Monir Hossain, a member of the expert committee.

"We recommended that they identify the cluster areas and put those on complete lockdown, while easing certain other areas that are not seeing as many cases. We had asked the government not to allow reopening of markets before Eid, but they also had to think of the businesses.

"We had hoped to flatten the curve by the end of June, but that is probably not going to happen anymore because the number of coronavirus patients will increase."

While compliance is the key to controlling the transmission, it is a gargantuan task in the context of Bangladesh to enforce the rules of social distancing and other steps, said Prof Monir, also a former DG of DGHS.

Criticising the government and the committees for failing to plan a safe return to normal life, Prof Be-Nazir Ahmed, former director of disease control at the Ministry of Health and Family Welfare, said, "Lockdown is supposed to be lifted at some point but they need to devise a good mechanism. But we are not seeing it.

"For instance, an infected assistant to a bus driver will act as a super spreader of Covid-19 as he usually lifts and collects passengers. So, special measures are needed to be taken for both bus drivers and helpers, but we've not yet heard of anything like that."

Prof Be-Nazir too suggested that the government should have lifted the shutdown in phases from areas that are less affected.

Prof Muzaherul Huq, former adviser (Southeast Asia Region) of the World Health Organization (WHO) and president of Public Health Foundation of Bangladesh, explained further what "phase-wise" lifting of a lockdown could look like.

"Districts can be divided according to their number of cases. In those with under a hundred cases, the lockdown can be lifted, but that has to go hand-in-hand with strict quarantining of the cases and contact tracing.

"Districts containing between 100-300 cases can zoom into upazilas with clusters and maintain the lockdown there, while easing restrictions in other upazilas. Districts with over 300 cases have to be under complete lockdown."

The WHO has outlined six stages a country needs to reach before lifting the lockdown. These stages are: Disease transmission is under control; Health systems are able to "detect, test, isolate and treat every case and trace every contact"; Clusters are minimised in vulnerable places, such as nursing homes, schools and workplaces; and a second wave can be managed and communities are fully educated, engaged and empowered to live under a "new normal".

"We have not achieved these stages yet," said Dr Huq.

Meanwhile, Bangladesh Health Watch yesterday sent a press statement, signed by its head Dr Mushtaque Chowdhury, to the media along the same vein as WHO.

"The Watch believes that the social and scientific aspects of the planned 'reopening' on May 31, 2020 and its likely consequences have not been duly considered," the statement said.

It also said the government should take four steps to ease the lockdown.

"Monitor scientifically the effects of the reopening on disease incidences so that any negative outcome can easily and immediately be tracked and attended to for making strategic changes. The country has a number of important institutions which deal with data," it said.

"Strictly adhere, religiously implement and scale up the 3Ts [Test, Trace and Treat].

"Strengthen and empower the primary health care centres at community clinics, union centres and upazila health complexes. These should be the place of first call and should be equipped with the requisite facilities, including testing [at upazila level], contact tracing, isolation facilities and initial treatments."

HEALTH SAFETY DIRECTIVES

In a circular, the Health Service Division of the Ministry of Health and Family Welfare has directed all public and private offices to follow 12 health directives from now on.

Signed by Deputy Secretary Khandokar Zakir Hossain, the circular directed on disinfecting offices, their premises, streets and official transport and setting up thermal scanners or keeping thermometers to check body temperature.

It also suggested using each piece of surgical mask only once, reusing fabric masks after washing them properly, cleaning hands frequently, maintaining a distance of three feet from each other while eating food, and disinfecting toilet every time it is used.

It also directed the authorities to monitor whether people are following the health rules and to isolate any infected persons immediately.