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Battling the COVID-19 Pandemic: Is Bangladesh Prepared?

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Battling the COVID-19 Pandemic: Is Bangladesh Prepared? medRxiv preprint doi: https://doi.org/10.1101/2020.04.29.20084236; this version posted May 5, 2020. The copyright holder for this preprint (which was not certified by peer review) is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. It is made available under a CC-BY-ND 4.0 International license . Battling the COVID-19 Pandemic: Is Bangladesh Prepared? Md Hasinur Rahaman Khan1 Institute of Statistical Research and Training University of Dhaka, Dhaka 1000, Bangladesh and Tamanna Howlader Institute of Statistical Research and Training University of Dhaka, Dhaka 1000, Bangladesh and Md. Mazharul Islam Bangladesh Institute of Governance and Management Dhaka, Bangladesh Abstract Following detection of the first few COVID-19 cases in early March, Bangladesh has stepped up its efforts to strengthen capacity of the healthcare system to avert a crisis in the event of a surge in the number of cases. This paper sheds light on the preparedness of the healthcare system by examining the spatial distribution of isolation beds across districts and divisions, forecasting the number of ICU units that may be required in the short term and analyzing the availability of frontline healthcare workers to combat the pandemic. As of April 18, COVID-19 cases have been found in 53 of the 64 districts in Bangladesh with Dhaka District being the epicenter. Seventy-five percent of the cases have been identified in 5 neighboring districts, namely, Dhaka, Narayanganj, Gazipur, Narsingdi and Kishoreganj, which appear to form a spatial cluster. However, if one takes into account the population at risk, the prevalence appears to be highest in Narayanganj, followed by Dhaka, Gazipur, Narsingdi and Munshiganj. These regions may therefore 1Corresponding author, Email: [email protected]; phone: +8801725106661 NOTE: This preprint reports new research that has not been certified by peer review and should not be used to guide clinical practice. 1 medRxiv preprint doi: https://doi.org/10.1101/2020.04.29.20084236; this version posted May 5, 2020. The copyright holder for this preprint (which was not certified by peer review) is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. It is made available under a CC-BY-ND 4.0 International license . be flagged as the COVID-19 hotspots in Bangladesh. Among the eight divisions, preva- lence is highest in Dhaka Division followed by Mymensingh and Barishal. The number of cases per million exceeds the number of available isolation beds per million in the major hotspots indicating that there is a risk of the healthcare system becoming overwhelmed should the number of cases rise. This is especially true for Dhaka Division, where the ratio of COVID-19 patients to doctors appears to be alarmingly high. Mymensingh Di- vision also has a disproportionately small number of doctors relative to the number of COVID-19 patients. Using second order polynomial regression, the analysis predicts that even if all ICU beds are allocated to COVID-19 patients, Bangladesh may run out of ICU beds soon after May 4, 2020. We conclude that in spite of a significant increase in hospital capacity during 2005-15 and a 57 % rise in the number of doctors during the same period, the healthcare system in Bangladesh and Dhaka Division in particular, may not be fully prepared to handle the COVID-19 crisis. Thus, further steps need to be taken to flatten the curve and improve healthcare capacity. Keywords: Bangladesh; COVID-19 disease; Crisis management; Isolation beds, ICU beds. 1 Introduction Severe acute respiratory syndrome coronavirus (SARS-CoV-2), popularly known as COVID- 19 is an infectious disease that was first identified in December 2019 in Wuhan. This is a respiratory infectious disease that has become a global pandemic within one and half months of its outbreak in Wuhan. Bangladesh found the first three coronavirus cases on 8 March 2020 that was confirmed by the Institute of Epidemilogy, Disease Control and Research (IEDCR) (IEDCR, 2020) at a press conference. The cases included two men and one woman, who were aged between 20 and 35 years. On March 16, the country detected three more cases of COVID-19 taking the total number of infected people to 8. Bangladesh registered its first death due to the coronavirus on March 18. The country counted 2144 cases and 84 deaths till 18-th of April (IEDCR, 2020). The fatality rate is 3.9 which is the highest among South Asian countries and by this time over 21,000 tests have been performed. As of April 18 the situation is as follows: COVID-19 infections 2 medRxiv preprint doi: https://doi.org/10.1101/2020.04.29.20084236; this version posted May 5, 2020. The copyright holder for this preprint (which was not certified by peer review) is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. It is made available under a CC-BY-ND 4.0 International license . have already spread to 53 of the 64 districts; 6059 isolation beds are ready; 595 doctors, 546 nurses, 130 medical technologists and 350 other healthcare staff are allocated to treat COVID-19 patients (IEDCR, 2020). The burning question is, 'Are these preparations adequate to fight the pandemic in Bangladesh?' On March 7, when more that 100,000 people of 100 countries were affected by COVID- 19, the World Health Organization (WHO) declared COVID-19 as a global pandemic (Shaw et al., 2020). Since then, majority of countries have imposed travel bans and lockdown of cities to stop the spread of COVID-19 and healthcare systems have taken unprecedented measures to expand their capacities to handle the surge. For instance, on 3rd February, China started sanitizing its city streets, public places, parks etc and later they introduced QR code for all residence to separate infected and non-infected people. Immediately after the outbreak, Wuhan city of China built two hospitals (30 ICU units and 1000 patients capacity) and several mobile cabins within a short period of time to meet excessive demand of hospital beds (Gao & Yu, 2020)(Christopher et al., n.d.). Meanwhile, the Ministry of Foreign Affairs, South Korea introduced government- supported quarantine facility for the returnees and the Central Disaster and Safety Coun- termeasures Headquarters implemented isolation, environmental disinfection, large scale diagnosis and epidemiological investigation. In order to prevent shortage of protective masks, the government introduced a countrywide five-day rationing system. Moreover, they hired 724 doctors amid the pandemic situation and allocated COVID-19 patients to infectious disease designated hospitals and separated 254 public hospitals for treating other diseases (Shaw et al., 2020). COVID-19 pandemic has challenged global resource allocation and management sys- tem, especially in public health domain. The health professionals are threatened by the super-spreading behavior of novel Coronavirus; due to risk of infection while working in hospitals, large amount of protective equipment are in demand for both general people and health professionals. Although different countries have their own strategies to man- age potential resources, merely few countries afford allocating necessary manpower and protective equipment at the right place in time. The current situation is new in many of the countries whereas some have previous experiences of dealing with SARS outbreak. On 20 January 2020, Taiwan announced its logistic support having 1100 negative-pressure isolation rooms, 1.9 million surgical and 44 million N95 masks respectively. The govern- 3 medRxiv preprint doi: https://doi.org/10.1101/2020.04.29.20084236; this version posted May 5, 2020. The copyright holder for this preprint (which was not certified by peer review) is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. It is made available under a CC-BY-ND 4.0 International license . ment implemented distribution of protective equipment through national security card which prevented panic buying of people [Wang et al. (2020), Shaw et al. (2020), Wang et al. (2020)]. Taiwan implemented its previous SARS epidemic experience to tackle the challenge by implementing modified Traffic Control Bundling (TCB) tool which provided small infection rate among health professionals during SARS outbreak in 2003 (Schwartz et al., 2020). After mainland China, Europe has become the active center of COVID-19 { accord- ing to WHO's declaration as of 13 March 2020 whereas the first case was reported in France on 24 January 2020 (Spiteri et al., 2020). About 47 laboratories in 31 of total 44 European countries had diagnostic capacity of COVID-19 by 31 January 2020 with a minimum facility of 8275 tests per week [Spiteri et al. (2020), Reusken et al. (2020)]. Germany made its first COVID-19 crisis response by closing border with neighboring countries and prohibiting the export of medical logistics including mask and other pro- tective equipment (European Policy Institutes Network, 2020). The country has been expanding its intensive care facilities since January 2020, from 28000 intensive care beds to 40000 intensive care beds by far (Bennhold, 2020). On the other hand, Italy has suf- fered due to lack of effective measure and immediate response to the emergency, supply of protective equipment and inadequate medical stuffs. On March 11, one fifth of its ICU beds (1028 of 5200) were filled with COVID-19 patients (Remuzzi & Remuzzi, 2020). The country has total 5256 American Health Association (AHA) registered hospitals running with 534964 stuffs where 2704 of these hospitals provided ICU services through 96596 ICU beds. The Society of Critical Care Medicine advocates hospitals to implement a tiered staffing strategy during COVID-19 pandemic (Halpern et al., 2020). In recent days COVID-19 infection has been increasing in South Asian countries.
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