28 September 2020 Morbidity and Mortality o Weekly Update (MMWU) N 31 https://www.who.int/bangladesh/emergencies/coronavirus-disease-(covid-19)-update/

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Tested Confirmed Cases Recovered Dead Hotline

1,921,382 360,555 272,073 5,193 21.1 million

Test/1 million Daily New Cases Recovery Rate IFR% AR/1 million 11,282 1,407 74.6% 1.44 2,117

Laboratories PPE Stock PoE Screening

106 COVID-19 Labs 976,669 551,532

Last days 87,059 Samples 3,027,075 40,472

59.8% Inside Tests 130,604 7,029

11.8% Latest Test Positivity 1,583,244 376918

WHO Bangladesh COVID-19 Morbidity and Mortality Weekly Update (MMWU) 28 September 2020/Vol. No31

1. Coordination

On 23 September 2020, WHO updated ‘Emergency Global Supplies Catalogue (COVID-19)’. The items in the catalogue represent an initial prioritized selection of items and are subject to constant review (while the item costs are estimates only). The catalogue includes the equipment and supplies (Biomed, PPE and Diagnostics) for medical purpose with sample pictures. Full document: https://www.who.int/docs/default-source/coronaviruse/20200822-catalogue-v12.pdf

WHO is gathering the latest international multilingual scientific findings and knowledge on COVID-19. The global literature cited in the WHO COVID-19 database is updated daily (Monday through Friday) from searches of bibliographic databases, hand searching, and the addition of other expert-referred scientific articles. This database represents a comprehensive multilingual source of current literature on the topic. While it may not be comprehensive, new research is added regularly. The WHO evidence retrieval sub-group has begun collaboration with key partners to enrich the citations and build a more comprehensive database with inclusion of other content. The database is built by BIREME, the Specialized Center of PAHO/AMRO and part of the Regional Office’s Department of Evidence and Intelligence for Action in Health. For more information: https://www.who.int/emergencies/diseases/novel-coronavirus-2019/global- research-on-novel-coronavirus-2019-ncov

2. Surveillance and Laboratories

Between 8 March and 28 September 2020, according to the DGHS Press Release there were three hundred sixty thousand five hundred fifty-five (360,555) COVID-19 confirmed by rRT-PCR, including five thousand one hundred ninety-three (5,193) related deaths (IFR 1.44%)1.

The figure below is showing the daily distribution of reported confirmed COVID-19 cases and deaths, 08 March – 28 September 2020, Bangladesh.

4,500 135 Daily Cases 4,000 120 Daily Deaths 3,500 105 7 per. Mov. Avg. (Daily Cases) 3,000 90 7 per. Mov. Avg. (Daily Deaths) 2,500 75

2,000 60

1,500 45

1,000 30 (n=5,193) Deaths Number of Number of Cases Cases Number (N=360,555) of

500 15

0 0

08/03 12/04 10/05 17/05 14/06 21/06 19/07 23/08 20/09 27/09 15/03 22/03 29/03 05/04 19/04 26/04 03/05 24/05 31/05 07/06 28/06 05/07 12/07 26/07 02/08 09/08 16/08 30/08 06/09 13/09

In the reported week (epidemiological week 39), in comparison to the previous epidemiological week, the number of new weekly COVID-19 cases decreased by 10.2% (10,232 in week 39 and 11,396 in the previous week) while, the number of COVID-19 new weekly deaths increased by 7.8% (222 and 206 respectively), leading the IFR a little increase from 1.42% in epidemiological week 38 to 1.44% in the current week; the Case Fatality Ratio (CFR) decreased from 1.89 last week to 1.87 in the current week. Out of the total 360,555 COVID-19 cases registered as of 28 September 2020, 75.46% (272,073) recovered, 1.44% (5,193) died and 23.10% (83,289) are active cases.

1 IFR refers to ‘Infection Fatality Ratio’ which can describe the true severity of a disease https://www.who.int/news-room/commentaries/detail/estimating-mortality-from-covid-19

2 | P a g e WHO Bangladesh COVID-19 Morbidity and Mortality Weekly Update (MMWU) 28 September 2020/Vol. No31

The figure below is showing trend of daily confirmed COVID-19 cases and recovered cases, 08 March – 28 September 2020, Bangladesh.

5,000

Daily Recovery Daily Cases

4,000

3,000

2,000

Number of Cases Cases Number (N=360,555) of 1,000

0

05/04 19/04 10/05 24/05 07/06 28/06 12/07 16/08 30/08 08/03 15/03 22/03 29/03 12/04 26/04 03/05 17/05 31/05 14/06 21/06 05/07 19/07 26/07 02/08 09/08 23/08 06/09 13/09 20/09 27/09

In the epidemiological week 39, weekly average number of COVID-19 active cases decreased by 4.6%, in comparison to the previous week (89,289 and 85,212 respectively); during the same time, weekly recovery has decrease by 12.5% (15,922 and 13,926 respectively).

The figure below is showing status of confirmed COVID-19 cases, 08 March – 28 September 2020, Bangladesh.

400,000 Deaths (n=5,193) Active Cases (n=83,289) Recovered (n=272,073) 350,000

300,000

250,000

200,000

150,000

100,000 Number of Cases Cases Number (N=360,555) of

50,000

0

15/03 19/04 10/05 24/05 14/06 19/07 09/08 23/08 13/09 08/03 22/03 29/03 05/04 12/04 26/04 03/05 17/05 31/05 07/06 21/06 28/06 05/07 12/07 26/07 02/08 16/08 30/08 06/09 20/09 27/09

As of 28 September 2020, 26.7% cases were confirmed in people between 31 and 40 years old, 20.2% - in the age group of 21 to 30, 18.9% - 41 to 50 years and 15.2% in the age group between 51 and 60 years old. The highest death rate (31.3%) was reported in the age group of 61 to 70 years old, 27.9% in the older age group of 71 and above and 23.0% - in the age group between 51 and 60 years. Male represented 72% and 77% of the of total reported confirmed COVID- 19 cases and deaths respectively.

3 | P a g e WHO Bangladesh COVID-19 Morbidity and Mortality Weekly Update (MMWU) 28 September 2020/Vol. No31

The figure below is showing age-sex distribution of the COVID-19 confirmed cases and deaths, 28 September 2020, Bangladesh.

Cases Male Female Deaths

> 80 0.3% 6.0% 1.8% > 80 0.6% 71 - 80 2.1% 0.6% 16.4% 3.7% 71 - 80

61 - 70 5.4% 2.0% 24.4% 6.9% 61 - 70

51 - 60 11.2% 4.0% 18.1% 4.9% 51 - 60

41 - 50 13.9% 4.9% 7.5% 2.5% 41 - 50

31 - 40 20.2% 6.5% 3.4% 1.5% 31 - 40

21 - 30 13.5% 6.5% 0.9% 0.8% 21 - 30

11 - 20 2.7% 2.4% 0.4% 0.3% 11 - 20

0 - 10 72% 2.0% 1.3% 28% 77% 0.1% 0.2% 23% 0 - 10

40,000 30,000 20,000 10,000 10,000 20,000 1,200 900 600 300 0 300 600 0

The figure below is showing the weekly reported confirmed COVID-19 cases by division, 13 April – 27 September 2020, Bangladesh. 1,728 (47%)

30,000 Dhaka Chattogram Rangpur Barishal

25,000

20,000

15,000

Number Cases Number of 10,000

5,000

0

w23 w24 w25 w26 w35 w36 w37 w38 w16 w17 w18 w19 w20 w21 w22 w27 w28 w29 w30 w31 w32 w33 w34 w39

As of 21 September 2020, 63.4% of reported cases were from , 13.5% from Chattogram, Khulna - 6.0%, Rajshahi - 5.6%, Sylhet and Rangpur - 3.4%, Barishal - 2.3% and the lowest 1.8% from Mymensingh division. While, 49.7% of the reported death were from Dhaka division, 20.8% from Chattogram, Khulna - 8.3%, Rajshahi - 6.5%, Rangpur - 4.5%, Sylhet - 4.4%, Barishal - 3.7% and the lowest 2.1% from Mymensingh division.

4 | P a g e WHO Bangladesh COVID-19 Morbidity and Mortality Weekly Update (MMWU) 28 September 2020/Vol. No31

The figure below is showing the weekly reported confirmed COVID-19 deaths by division, 13 April – 27 September 2020, Bangladesh.

350 Dhaka Chattogram Khulna Rajshahi Rangpur Sylhet Barishal Mymensingh

300

250

200

150 Number Number Deathof 100

50

0

w23 w24 w25 w26 w35 w36 w37 w38 w16 w17 w18 w19 w20 w21 w22 w27 w28 w29 w30 w31 w32 w33 w34 w39

As on 28 September 2020, Bangladesh overall attack rate (AR) is 2,117 per 1 million and 100% (64/64) of districts with the total population of 170,306,468 people have reported confirmed COVID-19 cases. In the reported week (epidemiological week 39), COVID-19 weekly AR increased by 2.9% in comparison to the previous week (2,109 and 2,049 respectively).

The figure below is showing the daily increase in COVID-19 overall attack rate (AR) per 1,000,000, 08 March – 28 September 2020, Bangladesh.

30 Daily Increase 7 per. Mov. Avg. (Daily Increase) 25

20

15

10

5 Attack Rate per 1 million populationmillionRate 1 Attack per

0

15/03 29/03 19/04 03/05 24/05 07/06 28/06 12/07 02/08 06/09 08/03 22/03 05/04 12/04 26/04 10/05 17/05 31/05 14/06 21/06 05/07 19/07 26/07 09/08 16/08 23/08 30/08 13/09 20/09 27/09

According to the available data as on 28 September 2020, the highest AR continues to be observed in Dhaka division (5,366/1,000,000). Within the Dhaka division, Dhaka city has the highest AR (22,496/1,000,000) followed by Faridpur (3,144), Rajbari (2,454), Munshiganj (2,032), (1,931), Gopalganj (1,845), (1,346), Shariatpur (1,237), Madaripur (1,060), Manikganj (908), Narsingdi (874), Dhaka (District) (852), Kishoreganj (807) and the lowest AR 727 was reported from district.

5 | P a g e WHO Bangladesh COVID-19 Morbidity and Mortality Weekly Update (MMWU) 28 September 2020/Vol. No31

The 2nd highest COVID-19 AR is reported from Chattogram division (1,389/1,000,000). Within the division, Chattogram district reported the highest AR (2,075/1,000,000) followed by Cox's Bazar (1,733), Bandarban (1,677), Noakhali (1,348), Rangamati (1,264), Cumilla (1,169), Feni (1,093), Lakshmipur (1,039), Khagrachhari (933), Chandpur (802) and the lowest AR 730 was reported from district.

The 3rd highest AR in the country was reported from (1,156/1,000,00) while the highest AR district is Khulna (2,268/1,000,000) followed by Narail (1,561), Kushtia (1,397), Jashore (1,186), Chuadanga (1,065), Jhenaidah (914), Magura (841), Meherpur (776), Bagerhat (547) and the lowest 462 in .

Sylhet division has taken the 4th highest in the overall AR with (1,040/1,000,000) with the highest AR in (1,629/1,000,000) followed by Sunamganj (783), Maulvibazar (730) and the lowest 690 in .

Rajshahi division has overall AR 908/1,000,000 with the highest AR in Bogura district (1,892/1,000,000), followed by Rajshahi (1,606), Joypurhat (1,002), Sirajganj (589), Natore (507), Naogaon (420), Chapainawabganj (385) and having the lowest at 379/1,000,000.

In Barishal division the overall AR is 842/1,000,000 with the highest AR in Barishal district (1,282/1,000,000), while Barguna - 860, Jhalokathi -850, Pirojpur -814, Patuakhali -779 and the lowest AR 337 was reported from .

In the overall AR is 638/1,000,000 with the highest AR in district (963/1,000,000), followed by Rangpur (832), Thakurgaon (707), Lalmonirhat (577), Panchagarh (504), Nilphamari (494), Gaibandha (416) and the lowest AR 369 was reported from .

The lowest AR reported from Mymensingh division (490/1,000,000). having the highest AR of 608/1,000,000 followed by Jamalpur (570), Sherpur (282) and the lowest 272 in Netrakona district.

The figure below is showing the progression of Arrack Rate (per million) by division, 04 May – 28 September 2020, Bangladesh.

1,200 6,000 Barishal Khulna Mymensingh Rajshahi 1,000 5,000 Rangpur Sylhet Chattogram Dhaka 800 4,000

600 3,000

Attack Rate/Million Attack 400 2,000

200 1,000 & Chattogram Rate Dhaka Attack for

0 0

24/08 31/08 07/09 14/09 21/09 28/09 04/05 11/05 18/05 25/05 01/06 08/06 15/06 22/06 29/06 06/07 13/07 20/07 27/07 03/08 10/08 17/08

As of 28 September 2020, according to the DGHS Press Release 1,921,382 COVID-19 tests with the overall positivity rate of 18.77% (11.80% in last 24 hours) were conducted in Bangladesh by 106 laboratories; 61 laboratories (57.5%) in Dhaka city and 45 laboratories (42.5%) from outside Dhaka. Seven (07) new Labs joined in the network of COVID-19 testing laboratories since the last update; of them four (04) are within Dhaka (BRB Hospital Limited, Asgar Ali Hospital, Center for Medical Biotechnology, and Prescription Point) and three (03) are from outside Dhaka (Meherpur Chest

6 | P a g e WHO Bangladesh COVID-19 Morbidity and Mortality Weekly Update (MMWU) 28 September 2020/Vol. No31

Disease Hospital, Jahurul Islam Medical College and Hospital, and Regional Tuberculosis Reference Laboratory). Total 59.8% (1,149,800/1,921,382) of all samples were tested by laboratories in Dhaka.

The graph below is showing weekly cumulative number of COVID-19 tests, test positive and overall positivity rate, 08 March – 28 September 2020, Bangladesh.

2,000,000 40% 1.9 Million Cumulative Tests 1,800,000 As of 28 SEP 2020 35% Cumulative Cases 1,600,000 Overall +ve % 30% 1,400,000 25% 1,200,000

1,000,000 20%

800,000 15% 600,000 08 March 2020 Tests N = 1,921,382 10% 400,000 First Bangladesh case reported 5% 200,000 Positive N = 360,555 0% 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 Epi Week

The graph below is showing the comparison between the average number of samples tested and average number of confirmed COVID-19 cases, 08 March – 28 September 2020, Bangladesh.

20000 5,000 Cases - 7 days rolling average Tests - 7 days rolling average 16000 4,000

12000 3,000

8000 2,000 Number of Cases Cases Number (N=360555) of Number of Tests Tests (N=1921382) Number of 4000 1,000

0 -

22/03 29/03 05/04 07/06 14/06 21/06 23/08 30/08 06/09 08/03 15/03 12/04 19/04 26/04 03/05 10/05 17/05 24/05 31/05 28/06 05/07 12/07 19/07 26/07 02/08 09/08 16/08 13/09 20/09 27/09

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The map below is showing geographical distribution of test positivity, 28 September 2020, Bangladesh

8 | P a g e WHO Bangladesh COVID-19 Morbidity and Mortality Weekly Update (MMWU) 28 September 2020/Vol. No31

3. Point of Entry (PoE) and Quarantine

According to DGHS, as of 28 September 2020, the current institutional quarantine capacity in the country is represented by 629 centres across the 64 districts, which can receive 31,991 persons. A total of 34,320 individuals were placed in quarantine facilities and of them 29,711 (86.6%) have already been released. Over the same period, total of 80,924 individuals were isolated in designated health facilitates and of them 65,406 (80.8%) have been released.

The figure below is showing the number of cases, individuals were in quarantine and in hospital isolation, 03 May – 28 September 2020, Bangladesh.

5,000

Facility Qurantine Home Qurantine Cases

4,000

3,000

2,000 DailyNumber

1,000

0

24/05 07/06 21/06 26/07 09/08 23/08 06/09 03/05 10/05 17/05 31/05 14/06 28/06 05/07 12/07 19/07 02/08 16/08 30/08 13/09 20/09 27/09

In the reported week (epidemiological week 39), the number of international flights has increased by 1%, in comparison to the previous week (95 and 94 respectively) but the number of passengers decreased by 6.4% (16,742 and 17,882 respectively). In the reported week 245 individuals were sent to Institutional Quarantine after passenger screening at the Hazrat Shahjalal International Airport (HSIA).

The figure below is showing the weekly incoming international flights and number arrived of passengers, 27 April – 28 September 2020, Bangladesh.

110 22,000 Passenger through Airport 99 100 94 95 20,000 Facility Quarantine 88 90 85 Number of Flights 81 18,000 80 16,000 70 65 70 62 14,000 60 56 12,000 47 50 10,000 40 34 8,000 30 28 29 Number Flights Number of 30 23 21 23 6,000 19 17 20 13 13 4,000

10 2,000 Passengers/Facility Quarantine Number of

16,742 18,629 21,508 17,882

2,807 5,256 3,938 2,474 2,773 3,800 3,183 5,927

18,541

9,731

7,469

18,691

10,495

13,213 13,370

0 13,520 0

w18 w22 w26 w31 w35 w39 w20 w21 w23 w24 w25 w27 w28 w29 w30 w32 w33 w34 w36 w37 w38 w19

9 | P a g e WHO Bangladesh COVID-19 Morbidity and Mortality Weekly Update (MMWU) 28 September 2020/Vol. No31

4. Case Management and Infection Prevention & Control

According to DGHS, as of 28 September 2020, there are 11,605 general beds in the country of which 30% (3,437) in Dhaka city and 542 ICU of which 54% (292) in Dhaka city dedicated for COVID-19 treatment. Presently 22.6% of the general beds and 52.6% ICU are occupied all over the country.

The figure below is showing temporal comparison of Cases, Hospitalized cases and Recovered cases, 29 June – 27 September 2020, Bangladesh.

Cases Hospitalized Recovered Poly. (Cases) Poly. (Hospitalized) Poly. (Recovered) 30,000

25,000

20,000

15,000

10,000 Cases/Addmitted/Recovered 5,000

0 w27 w28 w29 w30 w31 w32 w33 w34 w35 w36 w37 w38 w39

The figure below is showing geographical comparison of Cases, Hospitalized cases, Recovered cases and Deaths, 08 March – 28 September 2020, Bangladesh.

1,000,000 Cases (N=347481) Recovered (n=273076) Hospitalized (n=63646) Death (n=5193)

100,000 220,345

10,000

46,866

2,581

21,545

19,910

12,147

11,977

8,313

1,081 6,378

1,000

431

175,687

336

Number Number Log in Scale

236

229

191

26,938

18,918

17,831

108

7,553

10,131

10,036 5,982

100

2,308 1,623 2,382 2,065

807 683

41,128 12,650 10 Dhaka Chattogram Khulna Rajshahi Sylhet Rangpur Barishal Mymensingh

WHO deployed International Consultant for Case Management is inspecting COVID-19 dedicated hospitals for perceiving comprehensive management of COVID-19 patients and IPC practices prevailing in the country. The consultant will identify various challenges for implementation of standard treatment guideline of COVID-19 and debrief the critical

10 | P a g e WHO Bangladesh COVID-19 Morbidity and Mortality Weekly Update (MMWU) 28 September 2020/Vol. No31 observations with facility management. A meeting held among IPC and Case Management pillar with the Director Hospital (the Pillar Lead) on the gaps revealed through assessment on facility readiness. Intensive coordination between partners to avoid overlapping of support activities and involvement of divisional health administration in enhancing training activities on IPC were identified as immediate requirements.

5. Risk Communication and Public Awareness

RCCE partners, under coordination of DGHS and UNICEF, continue the implementation of communication and community engagement activities aimed at increasing awareness and compliance with prevention measures against Coronavirus, especially mask wearing, observing hand hygiene and maintaining physical distancing. To further increase the compliance to protection measures, RCCE partners are intensifying safe practices campaigns through online and offline channels.

Following the Government issue of guidelines to prepare for schools reopening, RCCE partners have been engaged in developing specific communication materials aiming to increase awareness on measures that will ensure safety of students and school staff, once the schools are reopened. The materials are providing necessary information on essential prevention actions that need to be observed by students, families, teachers and schools administrators to reduce the risk of transmission.

Furthermore, RCCE partners continue to monitor information from online environment and the volume of misinformation on social media has decreased significantly in the last month. However downplaying risks and denial of COVID-19 persists in the comments sections of news articles and posts by the general public.

6. Useful links for more information

 WHO Bangladesh COVID-19 Situation Reports: https://www.who.int/bangladesh/emergencies/coronavirus-disease-(covid-19)-update/coronavirus-disease-(covid- 2019)-bangladesh-situation-reports  COVID-19 Situation in the WHO South-East Asia Region: https://experience.arcgis.com/experience/56d2642cb379485ebf78371e744b8c6a  WHO global Weekly Epidemiological Update and Weekly Operational Update: https://www.who.int/emergencies/diseases/novel-coronavirus-2019/situation-reports  WHO Bangladesh awareness and risk communication materials in Bengali: https://www.who.int/bangladesh/emergencies/coronavirus-disease-(covid-19)-update  COVID-19 WHO Online Training modules: https://openwho.org/channels/covid-19  COVID-19 updates from the Directorate General of Health Services, Ministry of Health and Family Welfare, Government of The People’s Republic of Bangladesh: https://dghs.gov.bd/index.php/en/component/content/article?id=5393  Institute of Epidemiology, Disease Control and Research (IEDCR): https://iedcr.gov.bd/covid-19/covid-19-situation-updates

Contact: Dr Bardan Jung Rana, WHO Representative to Bangladesh, [email protected] Hasan Mohiuddin Ahmed, NPO-Surveillance & Public Health Informatics, WHO-BAN, [email protected] 11 | P a g e