When will Bangladesh’s curve peak?
After a month of corona-induced lockdown, Bangladesh's infection rates and death records are proportionally still lower than many other countries, according to official data. Credit must be given to the government for taking firm steps and the population deserves kudos for complying with the stiff restrictions. However, according to World Health Organization, the global situation hasn't reached a peak as yet. This is also true for Bangladesh, when it finds itself in stage 3 of the corona spread (out of 4 stages), while China, Europe and the USA are coming out of peak.
In order to understand the overall corona-driven situation of Bangladesh, we have identified a set of 11 indicators, distilled from global experience. The indicators set out below are either available in the public domain or can be calculated from available data. Generally, there is a dearth of data in Bangladesh and decisions taken in such circumstances could be seriously flawed. Let us put forward the health-related indicators in order to determine the timing of the "flattening of the curve" after the peaking of coronavirus infection cases.
Cumulated number of infections: Based on John Hopkins University's real-time online data, Bangladesh's infections figure (April 23) appears negligible (4,200) considering the population size in comparison with other affected comparable countries. It is even proportionately lower than that of Pakistan (11,000) and higher than India (23,000). Calculated per million Bangladesh, Pakistan and India have 25, 47 and 17 infections, respectively.
Cumulated number of deaths: The number of total deaths in Bangladesh (127) observed on April 23 appears much lower as in the case of number of infections (India: 721, Pakistan: 235).
Cumulated number of recoveries: The recovery rate is low (Bangladesh: 108, India: 5,012, and Pakistan: 1,378 based on data dated April 23), which is a source of huge concern.
Daily increase/decrease of infections: The daily infection increase data, which is widely published, provides significant information. If the number of daily increase over time rises steeply before peak is reached, it is a source of serious concern. In such a situation the healthcare system will come under huge pressure. Unfortunately, the data from April 16 to 23 indicates a steep upward rising curve, doubling the number of infected persons within about four days. It will be premature to draw any firm conclusion by just looking at the decreasing infection figures of three days (April 21-23). In comparison to India and Pakistan, the shape of the Bangladeshi curve is disturbing, even though the total number of infections remains low.
Mortality rate (cumulated deaths/cumulated infections * 100): The mortality rate illustrates the effectiveness of our healthcare system to diagnose, treat the infected, and save the not-yet affected. The data available so far (April 23) shows the mortality rate in Bangladesh is 3 percent, which is on the lower side (India: 3.1 percent and Pakistan: 2 percent).
Recovery rate (cumulated number of recoveries/cumulated number of infections *100): The recovery rate is much lower than the neighbouring countries (Pakistan: 21 percent and India: 22 percent) and one of the worst among the affected countries. This shows that that our healthcare system is already under stress, even at a time, when the total number of infections is relatively low.
Potential spread multiplier (number of household members who could be infected if one member is infected): This is not a reported indicator but created to reflect the reality in Bangladesh. It shows the extent of potential spread if one person is infected in a family. Unlike other heavily affected countries, where about 30 percent of households (e.g. USA) have only single member and an average family size of 2.4, Bangladeshi household size is around 5-6 (estimated), which includes a household aide. If one person is infected, it may affect others, assuming that these persons weren't tested on time and declared unaffected, healthcare service wasn't accessible, and family members didn't practice physical distancing given limited living space and social values. In the context of slums and refugee camps, the situation will be naturally worse, and the multiplier will be a bigger number. The existence of this multiplier could be one of the reasons behind the steep daily increase.
Access to tests: The percentage of people tested is considered to be an important tool to identify the infected cases. Countries with a high rate of testing, accurate counting of new cases and effective contact tracing have shown better results due to availability of accurate information. Bangladesh has conducted a total of 322,600 tests (198 tests per million) while India and Pakistan have conducted 362 and 563 tests per million, respectively. The limited number of tests undertaken casts doubts about the real picture of infections prevailing in Bangladesh.
Access to immediate healthcare services, if infected: What is the status of hospitals, which are expected to handle corona cases? Do they have test kits, PPE, and ventilators? The situation may be improving with new hospitals getting enlisted to deal with corona patients, but it is far from satisfactory. The relatively high mortality rate and low recovery rate in Bangladesh lead to the inference that the percentage of people who are infected and have access to suitable healthcare facilities is extremely low.
In the absence of reliable data, it is difficult to visualise a clear picture based on the aforementioned indicators. However, it can be deduced that Bangladesh is facing the prospect of a steep curve and that Bangladesh will not reach the peak soon—it will be weeks rather than days. Some experts fear that a huge spread of corona in Bangladesh cannot be ruled out, particularly due to the existence of this indicator—potential spread multiplier, as discussed above. We urge the policymakers to take cognisance of the aforementioned indicators when deciding on the duration of the lockdown period. They should also make the lockdown far more effective as news reports from different parts of the country draw a very disturbing picture. Will Bangladesh become another case of "too little too late"? Despite the fact that Bangladesh is caught between the rock (coronavirus) and the hard place (economic meltdown), political leadership has to step up and take some very tough and bold decisions before it is too late. Otherwise the sacrifice and sufferance of the last few weeks, particularly by the poor, will be in vain.
Manzoor Hasan, Barrister-at-Law, Executive Director, Centre for Peace & Justice, Brac University. Email: email@example.com. Dr Sanaul Mostafa, Senior Adviser in International Development, Ottawa, Canada. Email: firstname.lastname@example.org
The views and opinions expressed in this article are those of the authors and do not necessarily reflect the position of Brac University.