Icddr,B: 61 Yrs of Glorious Service: From cholera to Covid

The birth of icddr,b almost coincided with the seventh cholera pandemic that according to the World Health Organisation began in South Asia in 1961.

Sixty-one years later, after successfully yanking off the cholera mortality rate from 50 percent to less than three, the health research institute in Bangladesh is faced with another pandemic: the Covid-19.

Back then, in 1960, Dhaka was Dacca, and icddr,b was called Pakistan-SEATO Cholera Research Laboratory.

SEATO or Southeast Asia Treaty Organisation was a multilateral organization that included Australia, France, New Zealand, Pakistan (including then East Pakistan, now Bangladesh), the Philippines, Thailand, the United Kingdom (including Hong Kong, North Borneo, and Sarawak), and the United States. It was dissolved in 1977.

In 1979, Donald Mackay, then deputy director of the Ross Institute at the London School of Hygiene and Tropical Medicine, wrote in the Tropical Doctor journal, “It [the cholera research laboratory] was set up under the guidance and leadership of a very great epidemiologist, the late Dr. Fred Soper, a man without any background of work in Asia and with no obvious interest in cholera.”

But Soper retired soon after, and it wasn’t until Robert A Phillips took over that icddr,b found the silver bullet to combat cholera — the oral saline solution of salt and sugar, known more commonly as Orsaline.

Phillips recognized that dehydration was the main problem of cholera. The New York Times reported in 1976 that he had realized it by “studying the biochemical composition of the stools of hundreds of victims of cholera, rather than concentrating on studies of the blood, as others had done.”

“Principally, as far as the non-scientific world was concerned, the production of these years was the perfection of the intravenous therapy for cholera [the Dacca 5: 4: 1 solution] and the emergence of the new concept of oral therapy, which was to have so profound an effect, not only on cholera therapy but on the therapy of diarrhoeal diseases generally,” wrote Mackay in the Tropical Doctor.

Scientists of what is now icddr,b began to develop an oral therapy in 1962.

The New York Times announced the development of the treatment in an article titled “Simple Cholera Treatment, a Salt Drink Developed” on September 28, 1970.

“The researchers found that the body could absorb the necessary electrolytes — sodium and chloride — when a sugar dextrose was added to the salt solution,” it said.

“Until the discovery that successful medical treatment involved replacing the quartz even gallons of fluid that a cholera victim can lose, and fatality rates in untreated cholera were as high as 80 percent in some epidemics,” reported the newspaper.

“Once doctors began using intravenous fluids, the mortality rate dropped precipitously. How low it fell — in some places to 1 percent — depending on the availability of ample supplies of intravenous solutions.

“The amounts required, however, make the costs prohibitive in many rural areas where cholera occurs today.”

Fast forward to 2021 and the world is fighting another pandemic, this time, borne by air instead of water.

As many as 85 separate research studies on Covid-19 are currently ongoing or in the pipeline. The lines of inquiry range from monitoring the circulation of SARS-CoV-2 in bats in Bangladesh, to the presence of Covid-19 antibodies among slum-dwellers.

But if there is one study done by icddr,b that matches in importance to that of the cholera pandemic, it is research on checking the long-term effects of Covid-19 on patients, according to Tahmeed Ahmed, executive director of icddr,b.

“We are researching on post-Covid complications during recovery. Such a systemic study has not been done before in the world. We are routinely following up with around 250 patients with different symptoms — mild, moderate, and critical. We ask them to report to the hospitals periodically. We screen them from head to toe. We do mental, psychiatric, neurological; check their hearts, lungs, livers, pancreases, and kidneys. We even do electrocardiograms and echocardiograms,” he explained.

Five months of follow-ups have been done, and it will continue till 18 months.

“We are coming across a lot of psychiatric problems. A lot of reports of insomnia and post-traumatic stress disorder are coming… We are studying a small group of healthy volunteers, who are non-Covid patients. We are seeing if they have the same symptoms. We have seen that Covid patients have more psychiatric issues,” said Tahmeed.

“There are a lot of cardiac problems like palpitation, breathing problems for which patients can’t climb stairs. We have seen diabetes worsening in these patients and have found the pancreas being affected. To detect that we are using a C-peptide test,” he said, adding that if they study this properly, they should be able to come up with recommendations.

In addition, the organization is looking at people’s T-Cell response to the virus. “Our population is different. We don’t have an aging population. We have a lot of urban informal settlers, where infection can spread rapidly, but the immune response too can develop quickly. Bangladeshis took all forms of antibiotics and drugs over the counter, and antiviral medicines were readily available. Whether these had an impact or not, we are trying to find out,” said Tahmeed.

From a handful of research testing out how to battle cholera, to an army of scientists battling Covid-19 across all entry points.

As Mackay had written in 1979, “It succeeds, and grows out of an organization to which the whole world is permanently indebted, for it produced techniques that have brought the mortality of cholera tumbling down.”