Dear Editor,
Coronavirus disease 2019 (COVID-19), which 1storiginated in Wuhan, China, and has since spread around the world, a
global pandemic. As of May 30, 2020, 6,080,270 cases of COVID-19 have
been confirmed in more than 210 countries and territories and at least
368,066 deaths have been reported from around the world
(https://www.worldometers.info/coronavirus/). COVID-19 is now
establishing a foothold in impoverished, overpopulated and crowded
nations, such as Bangladesh. Although the health-care system in
Bangladesh has improved over the past few years, its preparedness for a
prompt and functional response to the COVID-19 outbreak is still
questionable as there is still a very poor healthcare management
system.1 After the first confirmed case of COVID-19
was publicized on 7th March, 2020 although the country
was supposedly carrying the virus for quite a longer period according to
specialists, Bangladesh may have gone through the most controversial
series of events in terms of their taking actions on the matter. The
country attempted to bypass the infection rate by promoting
self-cleanliness, avoiding physical contact and ordaining health
regulations only. However the total number of identified cases so far is
44,608 and total deaths have already crossed 610. Though the statistics
that were published by the authorities has been criticized and failed to
achieve faith by many people, the number of tests per million of people
is very low which is so far 10 /million people with only approximately
10000 tests/day now with a population of 180 million. There has been
severe mismanagement of COVID-19 sampling and tests and hence many
laboratories already saw contaminations and even though the number of
hospitalized patients has not been go high so far, a total of
approximately 1000 Doctors and healthcare nurses became infected with
SARS-CoV-2. The reasons for this is the poor healthcare management
system in Bangladesh with lack of appropriate safety measures including
appropriate PPE under the outbreak of such a highly infectious agent.
Controlling the pandemic in Bangladesh will be complicated by a diverse
set of problems, including high number of low-income population as well
as daily wagers, public health unawareness, capacity of hospitals
compared to the vast population, social corruptions and lack of
innovations. Among all these problems, most important concern is lack of
public awareness of COVID-19 and health literacy, exemplified by the
vast number of individuals with confirmed COVID-19. Furthermore, few
other traditional practices like shaking hands, hugging, community
gatherings in mosques, temples, local market, and the paucity of masks
and effective handwashing technique will aggravate the crisis. Although
like many Muslim majority countries, Muslims have been instructed to
pray at home, all of the mosques in Bangladesh remain
open.3
Moreover, Bangladesh’s developing economy and infrastructure relies
heavily on garments sectors. Because of this dependency, any government
imposed restrictions put in place will not be as effective and will play
vital role in viral transmission. Another concerning issue is the
shortage of health-care workers. There are only 3 hospital beds per
10,000 people, 1 skilled health professionals per 2000 people, and 1
nurse per 5000 individuals in Bangladesh4; physicians
are disproportionately distributed across the country, with 18.2
physicians per 10 000 people in urban areas and only 1.1 physicians per
10 000 in rural areas1 though this should be 22.8 per
10000 people according to WHO’s Global Health Workforce Alliance (WHO,
2020).5 Bangladesh is one of those few countries where
complete health care services are dominated by physicians while other
professionals like microbiologists, molecular biologists, pharmacists
and related experts are rarely considered for the service. With an
overall literacy rate of 72.89% in Bangladesh, community awareness of
imperative public health, sanitation, and hygiene practices and more
efficient infection prevention strategies must be placed. Another
important issue is that, high number of known COVID-19 comorbidity cases
exists and Bangladesh is still suffering many communicable and
non-communicable diseases like Diabetes, Cardiovascular diseases,
Hypertension, Stroke, Tuberculosis, Malaria, and dengue which may play
vital role in COVID-19 destruction in Bangladesh.6This
year 268 dengue cases have already been reported in Bangladesh, which is
already very high as the severe dengue outbreak that started in April,
2019, caused 179 deaths
(https://www.newagebd.net/article/103003/2-new-dengue-patients-detected-in-24hrs-dghs).
If Dengue cases rises sharply, it will make the situation worse with the
rising COVID-19 cases.
Thus the failure to put early restrictions of incoming flights from
COVID-19 affected countries and relatively slower response to put
country wide lockdowns have put Bangladesh in the present situation when
daily cases are consistently increasing. However, the vast number of
people in a small land will be at severe risk and without immediate
improvement of healthcare facilities with appropriate tests to isolate
the infected cases, such risks would grow higher and higher. Thus
appropriate measures should be taken immediately and we strongly rebuke
government powers to unite in a collaborative effort combining
physicians and all related professionals in the healthcare system to
address the serious risk posed by COVID-19 to Bangladesh.