20 July 2020 Morbidity and Mortality o Weekly Update (MMWU) N 21

https://www.who.int/bangladesh/emergencies/coronavirus -disease-(covid-19)-update/

Photo Credit: Social Media,

Tested Confirmed Recovered Dead In this issue of COVID-19 Tested Confirmed Recovered Dead Hotline Morbidity and Mortality Weekly Update (MMWU) No 21 (13-20 July 2020):

 dashboard with key figures; 1,041,661 207,453 113,5588 2,668 17.0 million  detailed epidemiological

update on COVID-19 pandemic in Bangladesh; Test/1 million New Cases Recovery Rate CFR% AR/1 million  daily and weekly distribution of 6,116 2,928 54.7% 1.29% 1,218 COVID-19 cases and related

deaths; Laboratories PPE Stock PoE Screening  growth factor of daily COVID- 19 cases 80 COVID-19 Labs  daily distribution of COVID-19 1,211,545 376,170

cases and rolling three-days 7.1% average per division; %  gender and age distribution of Last days COVID-19 cases and deaths 87,775 Samples 6,363,659 28,019  overall and cumulative weekly attack rate and per division;

 death and recovery rates of 61.3% closed cases; Inside Tests 184,394 7,029  comparison data with selected countries in South East Asia; and 19.9%  floods update. Positive Tests 536,282 355,435

WHO Bangladesh COVID-19 Morbidity and Mortality Weekly Update (MMWU) 20 July 2020/Vol. No21

1. Highlights

As of 20 July 2020, according to the Institute of Epidemiology, Disease Control and Research (IEDCR), there are 207,453 confirmed COVID-19 cases1 in Bangladesh, including 2,668 related deaths; Case Fatality Rate (CFR) is 1.29%.

On 18 July 2020, the Civil Aviation Authority issued a circular No. 30.31.0000.112.42.001.20-23150 informing that any Bangladeshi citizen intending to depart for any international destination from any of the airport of Bangladesh should obtain “COVID-19 Test Certificate”. The circular referred to the relevant procedures to obtain COVID-19 test certificate established by the Health Service Division Bangladesh with the attached list of 16 approved hospitals/organizations in 8 divisions . The provisions will come into effect from 23 July 2020. Full document: www.caab.gov.bd.

On 18 July 2020, the Ministry of Foreign Affairs issued a circular No. 19.00.0000.530.68.000.20-549 informing that Diplomatic, Official and Laissez Passer holders posted in diplomatic missions in Bangladesh and their family members (including holders of ordinary passports) with valid visas will be exempted from the requirement of producing a COVID19 negative/COVID19 symptom free medical certificate. However, the diplomatic missions are advised to kindly ensure self-quarantine of their diplomats/employees if travelling to Bangladesh. Full document: https://mofa.gov.bd/

Floods that started on 30 June and heavy monsoon rain on 18 July with water from upstream sources causing slow- onset of severe flooding in low-lying areas have affected 18 . According to weather forecasts, the current floods might be the most prolonged since 1988, and it is unlikely that the water will start receding before the next month.

2. Coordination

On 10 July 2020, WHO published a new tool on Mass Gathering COVID-19 Risk Assessment tool, which covers three pillars: risk evaluation; risk mitigation; and risk communication. The tool has been updated to reflect new WHO guidance and new evidence on both COVID-19 and mass gatherings, as well as feedback from end-users. It provides guidance for authorities and event organizers planning mass gatherings during the current COVID-19 pandemic. Full document https://www.who.int/publications/i/item/10665-333185. This risk assessment should be used in conjunction with the Key planning recommendations for mass gatherings in the context of the current COVID-19 outbreak (Interim guidance) found on the WHO website: https://www.who.int/publications/i/item/key-planning-recommendations-for-mass- gatherings-in-the-context-of-the-current-covid-19-outbreak

WHO launched a global COVID-19 anonymized clinical data platform - the “COVID-19 Data Platform” - for state parties to share with WHO anonymized clinical data related to patients with suspected or confirmed infections with COVID-19. The anonymized COVID-19 data will be used by WHO for purposes of verification, assessment and assistance pursuant to the IHR (2005), including to inform the public health and clinical operation response in connection with the COVID- 19 outbreak. To preserve the security and confidentiality of the anonymized COVID-19 data, State Parties and other entities are respectfully requested to take all necessary measures to protect their respective log-in credentials and passwords to the COVID-19 Data Platform.

The Rapid Core Case Report Form is designed to collect data obtained through examination, interview and review of hospital notes. The data collection period is defined as the period from hospital admission to discharge, transfer, death, or continued hospitalization without possibility of continued data collection. Full document: https://www.who.int/publications/i/item/WHO-2019-nCoV-Clinical_CRF-2020.4 The Pregnancy Case Report Form is to be completed for pregnant women or recently pregnant women who delivered within 21 days from onset of symptoms. Full document: https://www.who.int/publications/i/item/WHO-2019-nCoV-Pregnancy_CRF-2020.5

1 WHO Bangladesh COVID-19 Situation Reports present official counts of confirmed COVID-19 as announced by the IEDCR on the indicated date. Difference in data between the WHO reports and other sources can result from using different cutoff times for the aggregation and reporting of the total number of new cases in the country.

2 | P a g e WHO Bangladesh COVID-19 Morbidity and Mortality Weekly Update (MMWU) 20 July 2020/Vol. No21

3. Surveillance and Laboratory

Between 8 March and 20 July 2020, according to the Institute of Epidemiology, Disease Control and Research (IEDCR) there were two-hundred-seven-thousand-four-hundred-fifty-three (207,453) COVID-19 confirmed by rt-PCR, including two-thousand-six-hundred-sixty-eight (2,668) related deaths (CFR 1.29%).

In the current week (epidemiological week 29), In comparison to the previous epidemiological week, the number of new weekly COVID-19 cases decreased by 14.9% (20,730 and 23,817 respectively) and the number of COVID-19 new weekly deaths decreased by 12.8% (266 and 315).

The figures below are showing the daily and weekly distribution of reported confirmed COVID-19 cases and deaths, 08 March – 20 July 2020, Bangladesh.

4,500 100 # Cases # Deaths Poly. ( # Cases ) Poly. ( # Deaths ) 80 3,000

60

1,500 40

Number of Cases Cases (N=207,453) Number of 0 20

15/03 05/04 10/05 31/05 21/06 22/03 29/03 12/04 19/04 26/04 03/05 17/05 24/05 07/06 14/06 28/06 05/07 12/07 19/07 08/03 0 -1,500

20

-3,000 40

-4,500 60 (n=2,668) Deaths Number of

30,000 350

# Cases Weekly Deaths 300 25,000

250 20,000

200 15,000

150

Weekly Cases Weekly Weekly Deaths Weekly 10,000 100

5,000 50

0 0 w10 w11 w12 w13 w14 w15 w16 w17 w18 w19 w20 w21 w22 w23 w24 w25 w26 w27 w28 w29

3 | P a g e WHO Bangladesh COVID-19 Morbidity and Mortality Weekly Update (MMWU) 20 July 2020/Vol. No21

Out of the total 207,453 COVID-19 cases registered as of 20 July 2020, 54.74% (113,558/207,453) - recovered, 1.29% (2,668) - died and 43.97% (91,227) are active cases.

The figure below is showing active vs recovered confirmed COVID-19 cases outcome per epidemiological week, 08 March – 20 July 2020, Bangladesh.

Epi Week 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 0 T 140 T Active cases = 91,227 10 T 120 T

20 T Thousands 100 T 30 T

40 T 80 T

50 T 60 T

60 T 40 T 70 T 20 T 80 T Recovered = 113,558 90 T 0 T

In the epidemiological week 29, the number of COVID-19 active cases decreased by 7.4%, in comparison to the previous week (3,130 and 3,361) and the number of recovered COVID-19 cases increased by 16.4% (18,030 and 20,989 respectively).

The figure below is showing the weekly outcomes of reported confirmed COVID-19 cases, 08 March – 20 July 2020, Bangladesh.

Weekly Recovery

100000 Weekly Active Weekly Deaths 3 per. Mov. Avg. (Weekly Recovery) 10000

3 per. Mov. Avg. ( Weekly Active )

16,641 14,557

3 per. Mov. Avg. (Weekly Deaths) 14,256

12,147

8,662

10,493

6,040 5,502

1000 3,952

3,361

3,130

2,858

2,426

1,741 501 501

100

315 315

300 300

274 274

266 266

292

283

238

22 22

170 152

10 19

100

57

54

51

32

25

6 6

4

10,650 16,898 20,989 18,028

1 1 1

3

26,347

2725 1471 2528 2880 4122 4823

37 48 12 14 55

9 1 1 2 1 w10 w11 w12 w13 w14 w15 w16 w17 w18 w19 w20 w21 w22 w23 w24 w25 w26 w27 w28 w29

As of 20 July 2020, there were 116,226 (56.0%) COVID-19 cases with known outcome (closed cases). Out of all closed cases, 97.7% (113,558/116,226) were cured and 2.3% (2,668) died. The recovery rate of 97% in the closed cases didn’t

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WHO Bangladesh COVID-19 Morbidity and Mortality Weekly Update (MMWU) 20 July 2020/Vol. No21 show any change since 16 June 2020. The death rate on closed cases in Bangladesh is lower than the 7.0% (609,118/9,351,815) global average as of 20 July 2020.

The figure below is showing the death and recovery rates over cumulative closed confirmed COVID-19 cases, 08 March – 20 July 2020, Bangladesh.

Death% Recovery% 100%

80%

60%

40%

20% Number of Closed Cases 226) Cases Closed (N=116, Number of

0%

08/03 12/04 19/04 26/04 31/05 07/06 19/07 15/03 22/03 29/03 05/04 03/05 10/05 17/05 24/05 14/06 21/06 28/06 05/07 12/07

According to the available data, 26.8% cases were confirmed in people between 31 and 40 years old, 21.0% - in the age group of 21 to 30, 18.7% - 41 to 50 years and 14.8% in the age group between 51 and 60 years old.

As of 20 July 2020, the highest death rate (29.9%) was reported in the age group of 61 to 70 years old, 24.8% in the age group between 51 and 60 years and 24.1% in the older age group of 71 and above. Male represented 72% and 79% of the of total reported confirmed COVID-19 cases and deaths respectively.

The table below is showing gender and age distribution of the reported confirmed COVID-19 cases and deaths 20 July 2020, Bangladesh.

Cases Male Female Deaths

> 80 0.6% 0.2% 4.3% 1.4% > 80

71 - 80 1.9% 0.6% 15.4% 2.9% 71 - 80

61 - 70 5.2% 1.9% 23.6% 6.3% 61 - 70

51 - 60 11.0% 3.8% 20.4% 4.4% 51 - 60

41 - 50 13.9% 4.8% 8.9% 2.1% 41 - 50

31 - 40 20.4% 6.4% 4.4% 1.9% 31 - 40

21 - 30 14.3% 6.7% 1.3% 1.0% 21 - 30

11 - 20 2.9% 2.4% 0.6% 0.5% 11 - 20

0 - 10 72% 1.7% 1.2% 28% 79% 0.1% 0.4% 21% 0 - 10 30 25 20 15 10 5 0 5 10 15 20 600 450 300 150 0 150 300 450 Thousands

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WHO Bangladesh COVID-19 Morbidity and Mortality Weekly Update (MMWU) 20 July 2020/Vol. No21

As of 20 July 2020, geographical distribution of confirmed reported COVID-19 cases was available on 100% of cases (207,453/207,453). Of all cases, 16.4% were reported from Chattogram division, 5.4% - from division, 4.8% - from division, 3.5% - from division, 2.6% - from and Rangpur divisions, and 2.2% from - division.

The figure below is showing the daily distribution of reported confirmed COVID-19 cases per division (except Dhaka), 16 April – 20 July 2020.

2,000 Chattogram Mymensingh Rangpur Sylhet Rajshahi Khulna Barishal 1,800

1,600

1,400

1,200

1,000

800 Number Cases Number of 600

400

200

-

16/04 06/05 21/05 26/05 10/06 30/06 15/07 21/04 26/04 01/05 11/05 16/05 31/05 05/06 15/06 20/06 25/06 05/07 10/07 20/07

Available data allows us to see how quickly the number of confirmed cases increased in different divisions in Bangladesh by looking at the case doubling time in each division. As of 20 July 2020, case doubling time is 9.8 days in , 11 days in Chattogram, between 12 to 14 days in Rajshahi, Khulna and Sylhet, Barisal and Rangpur at 15 days and 17 days for .

The figure below is showing the case-doubling time of COVID-19 confirmed cases in all divisions starting from the day each reported 100th confirmed cases, 20 July 2020, Bangladesh.

D1 D2 D3 D4 D5 D6 D7 D8 D9 100,000 BSL CTG DHK KLN D10 MYM RSH RNP SYT D12

10,000 D15

D20 Number Cases Number of 1,000 D40

100 0 10 20 30 40 50 60 70 80 90 100 Days since 100th Confirm Case

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WHO Bangladesh COVID-19 Morbidity and Mortality Weekly Update (MMWU) 20 July 2020/Vol. No21

Case doubling time has increased in Dhaka to 10 days in week 29. Cases are doubling in more than 10 but less than 12 days in Faridpur; , , Munshiganj, Madaripur and Gopalganj districts are in between 15 to 20 days.

The figure below is showing the growth of COVID-19 confirmed cases in all districts of Dhaka division starting from the day each reported 100th confirmed cases, 20 July 2020, Bangladesh.

D1 D2 D3 D4 D5 D6 D7 D8 D9 100,000 Dhaka City Faridpur Gazipur D10 Gopalganj Madaripur Munshiganj D12 Narayanganj

10,000 D15

D20 Number Cases Number of 1,000 D40

100 0 10 20 30 40 50 60 70 80 90 100 Days since 100th Confirm Case

In Chattogram division by 20 July 2020 case doubling time has increased in Chattogram from 9 days in the previous week to 11 days this week, Noakhali, Cox’s Bazar, Bandarban and Cumilla – 14 days, Feni and district – 15 days.

The figure below is showing the growth of COVID-19 confirmed cases in all districts of Chattogram division starting from the day each reported 100th confirmed cases, 20 July 2020, Bangladesh.

100,000 D1 D2 D3 D4 D5 D6 D7 D8 D9 D10

Bandarban Chattogram Cox's Bazar D12 Cumilla Feni Noakhali

10,000 Rangamati D15

D20

Number Number Cases of 1,000 D40

100 0 10 20 30 40 50 60 70 80 90 100 Days since 100th Confirm Case

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WHO Bangladesh COVID-19 Morbidity and Mortality Weekly Update (MMWU) 20 July 2020/Vol. No21

The figures below are showing the daily distribution of reported confirmed COVID-19 cases and rolling three- days average per division, 16 April – 20 July 2020, Bangladesh.

3,000 Dhaka 3 per. Mov. Avg. (Dhaka) 2,500

2,000

1,500

1,000

500

0

26/04 01/05 31/05 05/06 10/06 10/07 15/07 16/04 21/04 06/05 11/05 16/05 21/05 26/05 15/06 20/06 25/06 30/06 05/07 20/07

1,000 Chattogram 3 per. Mov. Avg. (Chattogram)

800

600

400

200

0

06/05 11/05 05/06 10/06 10/07 15/07 16/04 21/04 26/04 01/05 16/05 21/05 26/05 31/05 15/06 20/06 25/06 30/06 05/07 20/07

500 Rajshahi 3 per. Mov. Avg. (Rajshahi) 400

300

200

100

0

26/04 11/05 21/05 05/06 15/06 30/06 16/04 21/04 01/05 06/05 16/05 26/05 31/05 10/06 20/06 25/06 05/07 10/07 15/07 20/07

350 Khulna 3 per. Mov. Avg. (Khulna) 300

250

200

150

100

50

0

26/04 11/05 16/05 31/05 20/06 10/07 16/04 21/04 01/05 06/05 21/05 26/05 05/06 10/06 15/06 25/06 30/06 05/07 15/07 20/07

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WHO Bangladesh COVID-19 Morbidity and Mortality Weekly Update (MMWU) 20 July 2020/Vol. No21

300 Sylhet 3 per. Mov. Avg. (Sylhet) 250

200

150

100

50

0

16/04 21/04 26/05 31/05 05/07 10/07 15/07 26/04 01/05 06/05 11/05 16/05 21/05 05/06 10/06 15/06 20/06 25/06 30/06 20/07

300 Rangpur 3 per. Mov. Avg. (Rangpur) 250

200

150

100

50

0

16/04 26/04 06/05 31/05 10/06 20/06 01/05 11/05 16/05 21/05 26/05 05/06 15/06 25/06 30/06 05/07 10/07 15/07 20/07 21/04

200 Mymensingh 3 per. Mov. Avg. (Mymensingh)

150

100

50

0

16/04 26/04 06/05 16/05 20/07 21/04 01/05 11/05 21/05 26/05 31/05 05/06 10/06 15/06 20/06 25/06 30/06 05/07 10/07 15/07

200 Barishal 3 per. Mov. Avg. (Barishal)

150

100

50

0

10/07 21/04 26/04 01/05 06/05 11/05 16/05 21/05 26/05 31/05 05/06 10/06 15/06 20/06 25/06 30/06 05/07 15/07 20/07 16/04

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WHO Bangladesh COVID-19 Morbidity and Mortality Weekly Update (MMWU) 20 July 2020/Vol. No21

On 20 July, Bangladesh overall attack rate (AR) is 1,218.1 per 1 million (207,543/170,306,489) and 100% (64/64) of districts with the total population2 of 170,306,468 people have reported confirmed COVID-19 cases. In the reported week (epidemiological week 29), COVID-19 cumulative weekly AR increased by 10.2%, in comparison to the previous week (1,201 and 1,079 respectively).

The figure below is showing the cumulative weekly COVID-19 attack rate, 08 March – 20 July 2020, Bangladesh.

Attack Rate Poly. ( Attack Rate

TOT/C/M TOT/C/M ) 1,201

1,200

1,079 954

900

809 659

600

514

386 277

Weekly Attack RateAttack Weekly Millionper 300

197

131

86

56

32

14

4

0.3

0.1

1

0.01 0.02 0 w10 w11 w12 w13 w14 w15 w16 w17 w18 w19 w20 w21 w22 w23 w24 w25 w26 w27 w28 w29

According to the available data, the highest AR continues to be observed in the Dhaka division (3,182.6/1,000,000). Within the Dhaka division, Dhaka city has the highest AR (12,915.9/1,000,000) followed by Faridpur (1,758.4), Narayanganj (1,651.6), Munshiganj (1,504.8), Gazipur (1,006.8), Gopalganj (888.8), Madaripur (783.4), Rajbari (700.1), Shariatpur (673.2), Dhaka (District) (633.8), (620), Kishoreganj (537.9), (491.2) and the lowest AR 279 was reported from district.

The 2nd highest COVID-19 AR is reported from Chattogram division (913.3/1,000,000), the AR in all the 11 districts is over 500 per million. Within the division, Chattogram district reported the highest AR (1,435.5/1,000,000) followed by Cox's Bazar (1,166), Bandarban (1,104.2), Cumilla (771.3), Noakhali (747), Rangamati (725.2), Feni (644.9), Lakshmipur (587.4), Khagrachhari (582.8), (521.4) and the lowest AR 511.8 was reported from .

The 3rd highest AR in the country was reported from (551.7/1,000,000) with the highest AR in (814/100,0000) followed by (442.8), (419.5) and 366.2 in Maulvibazar district.

Barishal division has taken the fourth highest in the overall AR with 498.7/1,000,000 with the highest AR in Barishal district (790.4/1,000,000) followed by Jhalokathi (488.1), (483.2), (476.9), (398.9) and the lowest 210.4 in district.

In the overall AR is 488.6/1,000,00 while the highest AR district is (892.4/1,000,000) followed by Khulna (765.7), Magura (642.8), Meherpur (473.6), Narail (454.7), Chuadanga (406.8), Satkhira (380.7), Jashore (355.5), (283.7) and the lowest 222.9 in .

Rajshahi division has overall AR (465.8/1,000,000) with the highest AR in Bogura district (1,043.8/1000000), followed by Rajshahi (717.6), Joypurhat (581.3), Natore (386.1), (289.2), (225.3), Chapainawabganj (180.7) and districts is 95/1,000,000.

2 Source: Population projection from 2011 Census, Bangladesh Bureau of Statistics

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WHO Bangladesh COVID-19 Morbidity and Mortality Weekly Update (MMWU) 20 July 2020/Vol. No21

Although Mymensingh division reported an overall AR of 318.4/1,000,00, reported high AR (405/1000000), followed by Jamalpur (303.6), Netrakona (224.2), and (172.5).

The following figure is showing the COVID-19 attack rate per 1,000,000 population in selected divisions, 16 April - 20 July 2020, Bangladesh.

1000 CTG RNP KLN MYM BSL RSH SYT

800

600

400 Attack Rate/1,000,000 Attack 200

0

21/04 06/05 21/05 05/06 20/06 05/07 20/07 16/04 26/04 01/05 11/05 16/05 26/05 31/05 10/06 15/06 25/06 30/06 10/07 15/07

Growth factor (every day's new cases / new cases on the previous day) between 0 and 1 indicates a decline; when it is above 1 it signals an increase, and if is persistently above 1 this could signify exponential growth. Since the beginning of June 2020, the GF has been within the range of 0.8 – 1.2 and on 20 July 2020, it is 1.19.

The figure below is showing the Growth Factor of daily confirmed COVID-19 cases, 08 March – 20 July 2020, Bangladesh.

3.0

2.5

Growth Factor 2 2.0

1.5

Growth Growth Factor Growth factor 1 1.0

0.5

0.0

08/03 15/03 22/03 29/03 05/04 12/04 19/04 26/04 03/05 10/05 17/05 24/05 31/05 07/06 14/06 21/06 28/06 05/07 12/07 19/07

As of 20 July 2020, according to the IEDCR, 1,041,661 COVID-19 tests with the overall positivity rate of 19.92% were conducted in Bangladesh by 80 laboratories (46) laboratories in Dhaka city (58%) and (34) laboratories in outside Dhaka

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WHO Bangladesh COVID-19 Morbidity and Mortality Weekly Update (MMWU) 20 July 2020/Vol. No21

(42%). The latest laboratories, which have started the testing: in Dhaka - Sarkari Karmachari Hospital, Authentic Diagnostic & Consultation Limited and Popular Diagnostic Centre Ltd. 61.3% (638,258/1,041,661) of all samples were tested by laboratories in the Dhaka city, and 38.7% (403,403) - outside Dhaka.

COVID-19 testing coverage has been gradually increasing in Bangladesh, reaching 6,116/1,000,000: now almost reached Sri Lanka (6,416/1,000,000) but is lower than Thailand (8,648/1,000,000), (10,175/1,000,000), Nepal (21,536/1,000,000), Malaysia (27,473/1,000,000) and Maldives (124,338/1,000,000).

The correlation coefficient (R) is a statistical measure of the strength of the relationship between the relative movements of two variables. The values range between -1.0 and 1.0. A calculated number greater than 1.0 or less than -1.0 means that there was an error in the correlation measurement. A correlation of 1.0 shows a perfect positive correlation. Analyzing data showed that R between number of samples tested and number of confirmed COVID-19 cases is 0.985 (positive correlation).

The graphs below are showing the weekly and cumulative number of COVID-19 conducted tests and daily number of samples tested and number of daily confirmed COVID-19 cases, 08 March – 20 July 2020, Bangladesh.

1,100 T 1 Million 1,000 T As of 20 July 2020 115,865 900 T 87,775 94,462 800 T 118,033 700 T 110,699 600 T 103,478

500 T 89,057

400 T 65,347 68,175 300 T 08 March 2020 52,821 41,123 Tests N = 1,041,661 First Bangladesh case reported 34,845 200 T 22,764 6,577 14,172 100 T 368 786 1,774 234 Positive N = 207,453 0 T 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 Epi Week

21000 7000 # Daily Tests # Cases 18000 6000 Poly. (# Daily Tests) Poly. ( # Cases )

15000 5000

12000 4000

9000 3000

6000 2000

Number of Cases Cases Number (N=207,453) of Number of Tests Tests (N=1,041,661) Number of 3000 1000

0 0

05-04 19-04 24-05 07-06 12-07 08-03 15-03 22-03 29-03 12-04 26-04 03-05 10-05 17-05 31-05 14-06 21-06 28-06 05-07 19-07

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WHO Bangladesh COVID-19 Morbidity and Mortality Weekly Update (MMWU) 20 July 2020/Vol. No21

Available data allows us to see how quickly the number of confirmed cases increased in Bangladesh and some other countries in the WHO South-East Asia region: India, Indonesia, Thailand and Sri Lanka. As of 20 July 2020, the overall case doubling time in Bangladesh has slowed to 9.5 days this week (0.5 days less in comparison with the epidemiological week 28).

The figure below is showing the growth of COVID-19 confirmed cases in selected South East Asian countries starting from the day they reported 100th confirmed cases, 20 July 2020.

1000000 D1 D2 D3 D4 D5 D6 D7 India Indonesia D10 Malaysia Sri Lanka 100000 Thailand Bangladesh

D12 D15 10000

D20 Number Cases Number of 1000 D40

100 0 10 20 30 40 50 60 70 80 90 100 110 120 Days since 100th Confirm Case Available data allows us to see how quickly the number of confirmed deaths increased in Bangladesh and some other countries in the WHO South-East Asia region: India, Indonesia, Thailand and Sri Lanka. As of 20 July 2020, the death doubling time in Bangladesh is 13 days (1 day less in comparison with the previous epidemiological week).

The figure below is showing the growth of COVID-19 confirmed deaths in selected South East Asian countries starting from the day they reported 100th confirmed cases, 20 July 2020.

50000 D1 D2 D3 D4 D5 D6 D7 D8 India Indonesia D10 Malaysia Sri Lanka 5000 Thailand Bangladesh

D12 D15 500

Number DeathsNumber of D20

50 D40

5 0 10 20 30 40 50 60 70 80 90 100 110 120 Days since 5th Confirm Death

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WHO Bangladesh COVID-19 Morbidity and Mortality Weekly Update (MMWU) 20 July 2020/Vol. No21

4. Contact Tracing, Points of Entry (PoEs) and Quarantine

According to the Directorate General of Health Services (DGHS), as of 20 July 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 23,331 individuals were placed in quarantine facilities and of them 17,406 (74.6%) have been already released. The highest number of people (6,547) in quarantine facilities was reported on 24 April 2020 while presently, the number reduced to 5,925. Between 17 March to 20 July 2020, total 389,150 individuals were placed under home quarantine all the over the county and to date 86.3% (335,643/389,150) have been already released. Remaining 13.8% (53,507 individuals) are in home quarantine now.

By 20 July 2020, in total 42,970 individuals were isolated in designated health facilitates all over the country, of them 24,358 (56.7%) have been released, and 18,612 (43.3%) are presently in isolation facilities.

The figures below are showing the number of individuals in home quarantine and individuals in hospital isolation, 16 Mach – 20 July 2020, Bangladesh.

25,000 Presently in Facility Quarantine Total Facility Quarantined Total Facility Released

20,000

15,000

10,000

6,547 6,547

6,481 6,481

6,416 6,416

6,112 6,112

5,772 5,772

5,973

5,743

5,390 5,390

5,647

5,301 5,301

5,489

5,105 5,105

4,926 4,926

5,189

5,047

4,644 4,644

4,864

4,821

4,586

4,571

4,562

4,257 4,257

4,184 4,184

4,368

4,082 4,082

4,073 4,073

4,058 4,058

4,006 4,006

4,003 4,003

4,208

4,144

3,979

3,887

3,848

3,763

3,684

3,680

3,677 3,671

5,000 3,666

3,625

3,598

3,574

3,548

3,263 3,263

3,488

3,458

3,450

2,121 2,121

1,403 1,403

781 781

233 233

162 162

137 137 138

130 130

113 113

98 98

92 92

84 84

70 70

66 66 64 64

0

15/03 22/03 29/03 05/04 12/04 19/04 26/04 03/05 10/05 17/05 24/05 31/05 07/06 14/06 21/06 28/06 05/07 12/07 19/07

40,000 Presently in Isolation Hospital Isolation Released from Isolation 35,000

30,000

25,000

18,612

18,591

18,498

18,248 18,029

20,000 17,864

17,660

17,491

17,371

17,319

17,192

17,067

16,873

16,856

16,839

16,715

16,449

15,947

15,755

15,547

15,147

14,969

14,523

14,267

13,800

13,429 13,155

15,000 12,927

12,467

12,190

11,915

11,474

11,026

10,752

10,302

10,026

9,758

9,340

9,012

8,761 8,243

10,000 7,893

7,552

7,399

7,162

6,946

6,754

6,498

6,240

6,021

5,794

5,529

5,140

4,994

4,984

4,770

4,653

4,464

4,305

3,897 3,897

3,816 3,816

4,060

3,616 3,616

3,383 3,383

3,248 3,248

3,046 3,046

2,748 2,748 2,570 2,570

5,000 2,435

2,361 2,361

2,236 2,236

2,115 2,115

2,017 2,017

1,874 1,874

1,794 1,794

1,771 1,771 1,694 1,694

0

05/05 21/05 10/06 26/06 30/06 16/07 09/05 13/05 17/05 25/05 29/05 02/06 06/06 14/06 18/06 22/06 04/07 08/07 12/07 20/07

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WHO Bangladesh COVID-19 Morbidity and Mortality Weekly Update (MMWU) 20 July 2020/Vol. No21

5. Case Management and Infection Control

On 19 July, DGDA released the specifications and minimum testing parameters for the non-medical fabric masks for community use. This is a timely intervention as government has initiated a media campaign with development partner support on use of fabric masks by the general public. In Bangladesh, it remains a legal requirement that people use face- coverings in public areas, to limit the risks of infection, by limiting droplets. It is also an important part of socio-economic recovery, as people going back to work should adhere to mask-wearing, along with other preventive measures such as hand and respiratory hygiene, and physical distancing. The document is available on the DGDA website at http://www.dgda.gov.bd/index.php/news/item/58. The latest WHO interim advice on the use of masks in the context of COVID-19 is available at https://apps.who.int/iris/rest/bitstreams/1279750/retrieve.

DGDA initiated a series of virtual meetings with experts on setting the minimum acceptable specificity and sensitivity levels of rapid diagnostic test to detect SARS-CoV-2 antigens. On 9 June, WHO had extended the global call for expressions of interest for Emergency Use Listing to include Immunochromatographic (lateral flow) or Immuno-filtration (flow through) rapid diagnostic test to detect SARS-CoV-2 antigens. On 3 July the EUL pipeline was further expanded to antibody detection enzyme immunoassays (EIAs). Updates on the EUL pipeline are available online at https://www.who.int/diagnostics_laboratory/EUL/en/.

Upon the request from the DGHS, UN and other development partners have agreed to support health facilities preparedness and readiness assessment in COVID-19 and non-COVID-19 health facilities. The main purpose of the assessment was to understand the health system’s response to COVID-19 against a set of indicators in order to identify the critical gaps and where resource mobilization can be expedited to tackle the COVID-19 pandemic. The checklist was developed based on the WHO essential health commodities package and a similar checklist prepared by Pan American Health Organization (PAHO). Following the approval of comprehensive checklist by DGHS, a data-collection guideline was developed by a core technical team from supporting organisations, which was used for training of data collectors. Sixty data collectors - project-based staff of different development partners at district level, including surveillance immunization medical officers of WHO - were trained in three batches. DGHS sent out communication regarding the assessment to 120 health facilities, including medical college hospitals, specialized hospital, district hospital, Covid-19 designated hospitals including some private and NGO health facilities. The assessment was conducted at the facility level through interview, physical observation and document reviews using the checklist. Data collection was completed in 25 June. The partners who supported the assessment includes USAID, Save the Children, MTaPs, Concern -World Wide, iccdr,b, WHO, UNFPA & UNICEF. The contents of the checklist included status of local level response to COVID; health workforce capacity with regards to infection prevention and control (IPC) and case management; triage protocol implementation; status of essential health services; status and functionality of critical equipment and oxygen supply system and status of WASH and waste management. The results of assessment will be shared soon.

6. Risk Communication and Public Awareness

Risk Communication and Community Engagement (RCCE) partners continue to implement Mask Promotion and Prevention Campaign through a large variety of channels including social media, networks of NGOs, networks and faith leaders. Tools for monitoring the implementation of the campaigns have been developed and are currently implemented to assess the implementation of the campaign and its efficacy in both rural and urban settings.

A special emphasis is given to scale up communication regarding personal protection measures in observance of Eid celebration when big movement of people is expected between districts and divisions. In this regard’s messages have been developed for safe transportation and for limiting the potential of COVID-19 transmission. Also, for observing the Eid celebrations, RCCE partners have been develop messages based on the DGHS and WHO guidelines addressed to administrators, vendors and customers of cattle markets, spots that are traditionally generating crowded environments and where special messaging, display of information and enforcing measures are needed to avert infection hubs.

While focusing on personal and community protection messages, WHO continues to produce risk communication materials on stigma and discrimination for addressing increasing incidence of the issues in communities especially towards frontline responders, including health workers.

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WHO Bangladesh COVID-19 Morbidity and Mortality Weekly Update (MMWU) 20 July 2020/Vol. No21

7. Monsoon Floods Update:

The floods started on 30 June 2020, by 20 July fully or partially affected a total of 18 districts, including 60 and 280 unions. In the last 21 days, between 30 June - 20 July 2020, the National Health Emergency Operations Centre and Control Room of DGHS recorded a total of 4,609 cases reported from health facilities of affected districts; among which were 2,391 cases of Acute Watery Diarrhea (AWD), 607 case of Acute Respiratory Infection (ARI), 293 - skin diseases, 119 - injury cases, 116 - eye infections, 68 - near to drowning, 17 - lightning, 15 - snake-bite cases, and 983 other cases. The death toll during the same period was 78 (64 persons - from drowning, 8 -from lightning, 5 - from snake- bite, and 01 from Acute Watery Diarrhea). Considering the health impacts represented by the number of cases and deaths, the most affected districts are Kurigram, Jamalpur, , , Sirajganj, Tangail and Netrokona.

To coordinate response to the flood-affected districts with due consideration for COVID-19 situation, WHO and DGHS organized a special meeting with Divisional Directors of Dhaka, Mymensingh, Rangpur, Rajshahi and Sylhet, all Civil Surgeons and Health & Family Planning Officer (UHFPO) of the affected areas. The main issues discussed included status of the Emergency buffer stock, activation of mobile medical teams, reducing death due to drowning, management of snakebite issues in flood affected districts, etc. The main concern is that a shortage of safe drinking water, food and proper sanitation facilities would increase the probability of respiratory infections, communicable and water borne diseases.

To reduce morbidity and mortality due to the floods, the DGHS activated total 1,271 Mobile Medical Teams at local level, and some of them are working 24/7 to tackle the flood-related health problems. Pre- positioned emergency drugs of the medical buffer stock (antibiotic, IV saline, ORS, WPT, anti-snake venom etc.), mainly supported by WHO,

are being released to manage health problems, and will have to be Photo Credit: Social Media, Bangladesh replenished as soon as possible.

Health Cluster Co-Leads (DGHS and WHO) are monitoring the overall flood situation from the National Health Emergency Operations Centre and Control Room of DGHS. There has been no severe disease outbreak, and currently, there is no shortage of emergency drugs in flood affected districts. WHO Surveillance & Immunization Officers (SIMO) and Divisional Coordinators (DCs) are providing technical support to the District Civil Surgeon Offices and Divisional Director Offices in disease surveillance and coordination activities without hampering routine immunization activities.

8. Useful COVID-19 links:

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://www.who.int/southeastasia/outbreaks-and- emergencies/novel-coronavirus-2019

Latest global WHO Situation Report # 181 as of 19 July 2020: 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 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/home/5343-covid-19-update

Institute of Epidemiology, Disease Control and Research (IEDCR): https://www.iedcr.gov.bd/

Contact: Dr Bardan Jung Rana, WHO Representative to Bangladesh, [email protected] Dr Hammam El Sakka, Senior Medical Epidemiologist, Team Leader, WHE, COVID-19 IM, WHO-BAN, elsakkam@ who.int 16 | P a g e