What worked and what didn’t in our handling of the pandemic
Bangladesh has been far more successful in managing Covid-19 than many of us feared. The war against new variants and revolutionary cases will continue until we achieve a critical mass in terms of vaccination. But for now, as we know from after the third wave and the lockdown for the past 19 months, a retrospective study to analyze the measures taken to avoid an expected humanitarian and economic crisis will help us recognize our strengths.
These observations were first presented at a panel discussion at Brown University on “Covid 19 in South Asia”, with Barkha Dutt representing India and Dr P. Saravanamuttu from Sri Lanka.
To date, 97. 2% of the total 1. 54 million showed that Covid cases have recovered. Our mortality rate is still 1. 76%. The actual number of cases is higher, not only because not enough testing has been done, but also because of the undetected asymptomatic cases around us.
So, that means our death rate was probably even lower? Maybe, maybe not — deaths from Covid like symptoms were reported from many districts — for instance in Satkhira at one point there were 446 deaths from Covid-like symptoms but only 80 were confirmed Covid cases.
It would have been ideal to keep a log of deaths from suspected Covid, confirmed Covid, long-Covid, and post- Covid complications for future reference. Interestingly, despite all these arguments, in 2020 Bangladesh’s total death rate was 5.541 which means, for every thousand people 5.5 people died; the number was 5.545 in 2019. Compared to the neighbouring countries, Bangladesh’s numbers are impressive.
What worked? Having worked on a2i 2020, I have witnessed that Covid-related decisions are based on the study of the methods of countries that have managed to control their epidemic, research into the movement of people, intelligent use of available resources. and expert clinical recommendation.
It was the concerted effort by the government, private and development sector that helped bend the curve every time. I am laying down some of the actions taken for the audience to come to their own conclusion.
The Three Waves and the Three Running of the Bulls
There is no doubt that confinements have damaged the chain of contagion. The established rules have been standardized with those of other countries: prohibition of all public gatherings; closure of educational institutions, offices and factories, restriction of intra/inter-district transportation, suspension of flights, etc. During the first wave, triggered by imported cases, the positivity rate of controls averaged 23%, and the general lockdown was only lifted when hotspot mapping was set to make certain granular restrictions.
A three-month smart generation came to a halt with the arrival of the beta variant in March 2020, when the test positivity rate hovered around 18% and a momentary lockdown was imposed. Soon after, a third strict lockdown was imposed due to the immediate spread of the Delta variant in border districts. The aim was to save Dhaka from the 15 red-light district districts of the Rajshahi, Khulna and Rangpur divisions. 465,183 cases were recorded in just 42 days of the third lockdown, while it took six months to triumph in 313,000 cases in 2020.
These figures and the test positivity rate of 28-31% are consistent with a Yale University report that, in an absolute setting, a user infected with Delta can infect another 3. 5 to four people, while a user infected with the original Sars-Cov2 would. extended to 2. 5 people.
Capacity increase in health care services
Lately we have 800 verification centers across the country, up from just five in Dhaka for the whole country in April 2020. RT-PCR accounts for 90% of all confirmatory checks. Out of a total of 140 RT-PCR verification centers, 86 are consistent. The government carries out immediate and free antigen tests in 545 centres and in addition to genetic tests in 51 centres. RT-PCR costs one hundred Tk at government centers and is free for marginalized people and, depending on personal services, costs between 3,000 and Tk. 4,500. The value of imported RT-PCR test kits has been reduced to 800 Tk, compared to the 3,000 Tk kit last year.
To date, more than 9. 4 million tests have been conducted, 74% of which have been conducted in government facilities. It is estimated that testing capacity is now 55,000 per day, and at the beginning of the pandemic, IEDCR was conducting 33 tests. consistent with the day.
In April 2020, we only had nine hospitals committed to Covid. Today, one hundred public hospitals and 39 personal hospitals across the country are treating Covid-19 patients. As of June 2020, only 69 of the government’s 218 intensive care beds were operational, while the national total was 381. As of September 2021, there were a maximum of 17,000 general care beds, 1,321 intensive care beds, and 856 HDU beds committed to remedying Covid patients. With Dhaka being the most densely populated city, 54% of all cases and 43% of all deaths are reported in Dhaka, which explains why 44% of all hospitals are also located in Dhaka.
The need for high-flow oxygen for Covid was known early on and a strategy was followed in June 2020 to install liquid oxygen tanks in all Covid hospitals to ensure uninterrupted supply through central pipes. Hospitals have larger oxygen source capacities from central oxygen tanks, oxygen. oxygen cylinders and concentrators. The PPE shortage has been addressed by intensifying local production and distribution through public and personal initiatives.
Health is an out-of-pocket expense and in private hospitals treatment of Covid patients can cost anywhere between Tk37,000 to Tk68,500 a day, depending on the care. This expense and more beds being available in government hospitals might explain the higher number of deaths (84% of total) reported from the government hospitals.
Our pharmaceutical industry should be given more popularity. 98% of all national medical desires are fulfilled through this industry. With the exception of Tocilizumab (Actemra), the immunomodulator used to decrease the cytokine storm, all other drugs aimed at controlling Covid-19 infection are manufactured locally. They have also expanded their services to help the government stockpile vaccines.
Government Stimulus Plans
Our Prime Minister has announced an across-the-board stimulus package of Rs 131 billion taka over the past 19 months. The first stimulus package of Rs 72,750 crore announced in April 2020, and a general stimulus of Rs 121,353 crore taka announced in November 2020. This represented 4. 3% of our GDP and 70% of it was distributed in April 2021. Taka. crore’s newest stimulus package of Rs 3. 2 billion was announced in July 2021.
The aim was to increase public expenditure through employment generation, focus on agriculture production, provide safety stimulus for industries by providing low interest rate credit facilities, and widen social safety coverage to protect the poor working in the informal sector with food support, direct cash transfer, and housing facilities.
Summary of the Government of Bangladesh and Bangladesh Bank Stimulus Packages
SN
Stimulus Packages
Package size (million BDT)
1
Special Wage Support Fund for Export-Oriented Manufacturing Workers
5 000
2
Working Capital Loans to Applicable Industries and Sectors
40 000
3
Working capital loans provided to SMEs. cottage industries
20,000
4
Expansion of the Export Development Fund (EDF)
12 750
5
Pre-Shipment Credit Refinance Scheme
5,000
6
Special rates for doctors, nurses and staff.
100
7
Health & Life Insurance
750
8
Free food distribution
2,500
9
WHO in BDT 10 in agreement with KG
770
10
Movement of money aimed at disabled people
1 258
11
Expansion of poverty benefit programmes
815
12
Homeless Housing Construction Grant
2 130
13
Additional procurement of paddy/rice (200 thousand metric tons)
860
14
Support for agricultural mechanization
3 220
15
Agricultural subsidy (for fertilizers)
9. 500
16
Agriculture Refinance Scheme
5,000
17
Refinance Program for Low-Income Professionals, Farms, and Small Businesses
3 000
18
Low-interest loans for poor rural farmers, expatriate migrant workers, youth and unemployed youth
3 200
19
Safety Net Program for Distressed Workers in the Export Industry
1 500
twenty
Interest suspension subsidy to banks from April to May 2020
2 000
21
Credit risk sharing programme for the SME sector
2 000
22
Artisanal, Micro, Small and Medium Enterprises (SMEs)
1 500
23
Disadvantaged elderly people, widows and female divorcees in 150 poverty-stricken upazillas
1 200
Total=
124 053
% of GDP =
4. 44
Sources: Ministry of Finance and Bangladesh Bank
Bangladesh Bank’s Actions in Response to the COVID-19 Pandemic
The network and the NGO sector
The United States and USAID have mobilized $96 million to help Bangladesh combat the pandemic; Donations from the United Kingdom, the World Bank and some other countries are also welcomed. BRAC leads the group of local NGOs and has supported another 100,000 people with cash grants; Its team of 50,000 physical workers has committed to training 4. 7 million people with Covid preventative knowledge. They also contribute to all aspects of fitness-related public research in Bangladesh.
Businesses, Americans, and humanitarian organizations have stepped up to give back to the community. Local elected officials and local governments ensured the distribution of rations and relief materials in the last stretch, in addition to food parcels. We have lost 106 law enforcement officers and 186 doctors to Covid. -19 in the line of duty. 100 MPs – almost a third of the House – have contracted Covid and, sadly, 4 of them have succumbed.
Harnessing ICT
We have 110 million cell phone users, 107 million have access to the internet, and 40% of cell phone users own a smartphone. Government and the personal sector have leveraged ICTs as a resilient tool to overcome lockdowns through e-commerce, e-health, e-banking, e-governance, and e-education. Among many others, the most vital services provided through ICTs during this pandemic are the “Surokkha” vaccine registration portal, the Corona 333 helpline, the virtual judicial formula (MyCourt), and telehealth services. and virtual classrooms.
The ICT business continuity plan approved by the Prime Minister for an uninterrupted network has facilitated online offices, grocery shopping, food ordering and delivery apps, mobile banking, online pharmacy, bill pay, telemedicine and entertainment.
ICT and private sector platforms
Servicio
The Corona Portal
Advice, services, updates and information related to Covid
Identification and mapping of high risk locations.
Zonal mapping of red, green and yellow areas.
Coronavirus awareness campaign
600 Types of Covid Awareness Content Promoted on Social Media
Ami Probashi App
Immunization Registration for Migrant Workers
Local Fans
Medtronic and Walton jointly manufactured PB 560 ventilators under ICT
Online courses, digital classroom, “virtual class” platform
Distance learning tool
Digital Mapping
130,000 places have been added to Google Map
High value online platforms
Food Panda, Shohoz, bKash, Mobile Banking, Pathao, Telemedicine Pulse, Chaldal, MeenaClick
Vaccine Procurement and Immunization Program
Bangladesh has ensured the protection of its citizens by approving vaccines that have obtained emergency use authorization from the FDA, the EU and the WHO, and aims to vaccinate an additional 117,856,000 people (80% of the population) free of charge. in the region to conclude a vaccine agreement from November 2020 with the Serum Institute of India.
Unfortunately, after India halted its vaccine exports, an era of crisis dragged on from April to June, despite a successful start in February. The Covax initiative has promised us 60 million vaccines in stages, and as part of that, the United States has donated one million Pfizer vaccines and 5. 5 million Moderna vaccines, Japan has donated more than 3 million AstraZeneca vaccines, and China has donated 3. 4 million Sinopharm vaccines.
Bangladesh is buying the majority of the vaccines from Sinopharm and proposing to package them locally. The vaccination program was made easy through the “Surokkha” app, which provides the vaccine certificate along with registration. The government’s strategy to vaccinate migrant workers going to Saudi Arabia and Kuwait with Pfizer and Moderna to avoid unnecessary, expensive quarantine is laudable. As schools reopen, the government plans to vaccinate the 12-18 age group with Pfizer and Moderna. Till date 12% of the target population is fully vaccinated and 18% is partially vaccinated.
What else could have worked?
Socio-economic impact
Wins and What’s Next
The biggest win is that each and every person we lost to Covid was given a dignified burial by our voluntary humanitarian organizations. We did not have any mass burial. The government, together with the private and development sectors, focused on ensuring food safety, continued economic activities to reduce unemployment, saved the industries contributing to the GDP, and broke the chain of infection to avoid horrors like in India.
When I had the opportunity to show this knowledge to a foreign community, the skillful moderator observed that the numbers in Bangladesh and the recoveries from epidemics so far cannot be attributed to vaccines as is the case in Israel or the UK, it is still simply because we had smart leadership, smart strategy and decided to have the conviction to come out stronger.
I hope this knowledge increases our confidence in our own abilities and yes, let’s keep the mask on.
Dr. Maliha Mannan Ahmed is the founder and CEO of Organikare. He holds an MBBS, an MBA, and a master’s degree in Healthcare Leadership.