1. Suppose you have encountered with an emergency event of deadly disease outbreak in a place.

There are lots of vulnerable people who might be the infected. As an emergency responder,
what are the major steps you should follow to resolve/reduce the risk?

Ans. The early identification of local outbreak is very difficult, because there are few cases, and
the identification time can be delayed by laboratory test that confirm a suspect. There are lots of
vulnerable people who might be the infected. As an emergency responder, I should follow some
major steps to resolve/reduce the risk. They are:

1. Detecting an outbreak and detection of newly infected people (case detection, contact tracing);
2. Implementing initial Infection Prevention and Control Measures (IPC) measures including
hand hygiene, respiratory hygiene, PPE, and isolation of symptomatic patients/residents.
3. Minimizing harmful practices (at individual and community levels) that can increase
susceptibility and exposure; and adopting protective practices (medical and nonmedical);
4. Seeking and providing health care as advised (in the household, community and health
facility);
5. Restrict symptomatic patients/residents to their room (with dedicated bathroom where
possible, meal tray service in room, etc.)
6. Re-integrating of survivors back into the community and to minimizing stigma;
7. Identifying and managing misinformation and rumors.

As an emergency responder, after the outbreak confirmation, I should make a team that will
identify the Outbreak case definition. As we are first responders, we will try to figure out the
following things:

• Well-defined clinical symptoms (with or without laboratory confirmation)

• Information relating to time (timing of onset of symptoms)
• Persons affected
• Place or location where the outbreak has or is occurring.

And the medical staff must collect information about the case:

• Begin of illness
• Signs and symptoms
• Laboratory tests have been conducted
• Where the patient lived the last day
• People who have had close contact with the patient

These processes can help to reduce the risk of a biohazard and can be managed in the beginning
stage.

2. What should be the major preparation for Bangladesh Govt. and relevant authorities in order
to reduce the vulnerabilities of the second wave of Corona Virus Outbreak in Bangladesh (prior
preparation)?

Ans. Bangladesh government made the “Bangladesh preparedness and response plan” (BPRP), a
documented policy regarding COVID-19 in July 2020. It outlines the objectives, planning
scenarios, areas of work and priority activities required for the Bangladesh health sector to scale
up its core capacities to prevent and quickly detect the spread of the virus, and characterize the
response and efficiently control the threats, in a coordinated manner and as required under the
International Health Regulations (2005). Bangladesh also updated its “INFECTIOUS DISEASES
(PREVENTION, CONTROL AND ELIMINATION) ACT, 2018” on communicable diseases.
Section 3(k) of the Act states “keep or quarantine any suspected person infected with an infectious
disease, at a specific hospital, temporary hospital, establishment or home”. This law empowers the
government in notification, isolation, quarantine, sample collection and testing in emerging
diseases.

The major preparation for Bangladesh Govt. and relevant authorities in order to reduce the
vulnerabilities of the second wave of Corona Virus Outbreak in Bangladesh are discussed below:

• There were below 200 beds for the Covid-19 patients in March which now stands at 11,459
until November 19. Dedicated ICU (intensive care unit) beds have been increased to over 550
from only four across the country. More beds need to be arranged.
• The number of oxygen cylinders now stands at 13,602, high flow nasal cannula 604, and
oxygen concentrator 395 which were almost not available in the first outbreak period. Govt.
has to be prepared with more cylinders for the second wave.
• The MoHFW has already recruited an additional 2000 doctors and 5000 nurses to start
addressing this situation, and the process is underway to recruit additional 2000 health
technicians. Additional innovative motivation schemes needed to be tested to improve the
human resource management in health.
• The Government must source enough protective gear for the healthcare workers who will have
to tackle COVID-19 patients in the frontline.
• Immediate nationwide case searching and identification should be initiated utilizing existing
community networks as well as telecom-based reporting via phone and hotlines.
• A novel Community Support Team intervention should be piloted so that individuals with
symptoms could be evaluated and those who meet the clinical criteria will be isolated at home
with their families with the full support of rapid response and community support teams. 6.
Healthcare worker training programs should be initiated for improving infection prevention
control and case management.
• Government's recent policy of "no mask, no service" and other directives, strict
implementation is key to braving the second wave.
• Among the preventive measures for COVID-19, including aggressive tracing of cases and
contacts, strict quarantine, and screening, as well as education to promote good hand hygiene
practices, should be put in place.
• The government should start preparations targeting those most vulnerable to economic shocks,
especially the new poor. Social protection programmes have to include returnee migrant
workers, garment workers and other vulnerable groups. The Government must address when
declaring any lockdown or emergency that may stay in place for 2 or more weeks. With help
from the armed forces, the Government may think about starting a “hygienic” rationing system
in case of locking down for a more extended period.
• Immediate expansion of testing labs to every district and major localities is urgently needed to
test every patient with symptoms, and millions of testing kits are necessary for conducting
aggressive detection of cases
• The molecular genetics, biochemistry, and molecular biology labs in the universities and
medical colleges across the country should be quickly transformed into COVID-19 case
detection labs.
• With help from the armed forces and trained volunteers, the schools could be turned into
quarantine centers.
• The Government will have to come forward to make sure that its marginal population has
access to proper hygiene, maybe by supplying free sanitizer and mobile washrooms.
• All offices and businesses, except medical centers, pharmacies, and groceries, should remain
closed until the situation mitigates. Home office laws should be imposed, whenever possible.
• Bangladesh must source a decent emergency support fund to help its workers, employers,
parents, marginal people, and hosted refugees. It has already received fast-track support of
USD 100 million from the World Bank; however, this is far from the actual amount needed for
this country of 180 million people

Preparedness is the key to addressing any health crisis, and so far, Bangladesh, as a lower-middle-
income country, has numerous limitations in restricting the spread of the virus.