How will Bangladesh fare with the Coronavirus Pandemic?

I am a Bangladeshi-American live in Maryland, USA for 20 years. Maryland is only about 200 miles away from New York city, the epicenter of Coronavirus (Covid-19) pandemic. My own state has also been experiencing explosive epidemic, not as explosive as New York City but it has been dreadful.  As of May 1, 2020, USA had more than one million confirmed coronavirus cases and about 64,000 deaths. Public health experts noted concerns about shortage of tests, detection, and reporting of Covid-19 cases and deaths. By now, it has been general knowledge that both the numbers of Coronavirus cases and deaths are undercount. In early May, the numbers of cases and deaths reported from USA translated to about 3,300 confirmed cases and 193 deaths per million population. At that point my own state, Maryland had 3,766 confirmed cases and 197 deaths due to Coronavirus per million population.

It was scary, but I was all along being distressed about Bangladesh. Given inadequate sanitation and population density, Bangladesh could experience a devasting epidemic, but I was hoping that it would not be the case. In early April, the Institute for Health Metrics and Evaluation (IHME), an independent global health research center at the University of Washington, USA predicted that a significant number of US states would lack enough intensive care unit beds in their hospitals to deal with the wave of projected coronavirus cases in the coming days and weeks. The nationwide projected shortfall of ICU beds was 16,232. For all types of hospital beds, the projection said 140,823 beds will be needed nationwide. That is 36,654 more hospital beds of all kinds than are currently available in the USA. If that would have been the situation of USA, Bangladesh would not be able to handle a similar epidemic. Fortunately, Bangladesh so far has not experienced an epidemic as deadly as USA and so many European countries experienced. Yet, the Bangladesh health system had a major struggle for a variety of reasons in the face of the coronavirus pandemic.    

I was tracking the cases and deaths in Bangladesh. On May 1, 2020, Bangladesh reported about 25,000 cases and 370 deaths. That means at that point, Bangladesh had reported 153 cases and 2.2 deaths per million population. About 60% of the reported cases were from Dhaka city and about 80% from Dhaka division. I suspect, everyone will agree that the reported numbers of cases and deaths from Bangladesh were undercounts. To assess the extent of undercount of reported cases and deaths in Bangladesh, I decided to compare the Bangladesh case and death rates with India. As of early May, India had 73 cases and 2.3 deaths per million population. That suggested that the extent of undercount of Bangladesh numbers were perhaps as large as those of India. As of May 30, 2020, the reported number of cases and deaths due to Coronavirus in Bangladesh are 271 and 3.7 per million population. The reported number of cases and deaths due to Coronavirus are 132 and 3.8 per million population for India.

There is still a hope that Bangladesh may not experience an explosive epidemic. A few things may work in favor of Bangladesh. Both Bangladesh and India have a relatively young age structure with a median age of 28 years. In contrast, the median age in USA is 43 and it is 47.3 years in Italy. There was a report from the Massachusetts Institute of Technology (MIT)  in  March 2020 reporting that warm and humid weather may combat the spread of the coronavirus disease, arguing that Asian countries may not see a major transmission of the deadly infection. Afterall, Covid-19 is not the only Coronavirus disease. There are several are Coronaviruses in circulation, most of them cause mild disease. Severe acute respiratory syndrome (SARS) was also caused by Coronavirus, which was recognized as a global threat in early 2003, after first appearing in Southern China in November 2002. Between November 2002 and July 2003, a total of 8,098 people worldwide became sick with SARS that was accompanied by either pneumonia or respiratory distress syndrome, of those 774 died. Fortunately, SARS disappeared. An old study from 2011 reported that the SARS virus viability was rapidly lost at higher temperatures and higher relative humidity. This finding was the basis for the speculation why some Asian countries in tropical area including Malaysia, Indonesia and Thailand with high temperature and high relative humidity did not have major community outbreaks of SARS. There are other hypotheses yet to be tested. Fewer confirmed cases and a lower death toll have been reported in countries with universal BCG vaccination compared to countries without BCG vaccine. There are similar claims about polio vaccine. Researchers are testing whether decades-old vaccines for polio and tuberculosis could protect against Coronavirus infection. Fortunately, the coverage of BCG and polio vaccines in Bangladesh are very high.

It is possible that Bangladesh may not experience high transmissibility and fatality that many countries are experiencing. However, the pandemic is not yet over. Experts believe that Corona pandemic may not be over any time soon. Lately, Brazil has been devastated. A recent paper in the European Journal of Epidemiology based on modeling depicted a dismal picture for Bangladesh along with 15 other countries. The paper reported that Bangladesh may experience substantial number of deaths if there is no intervention. To-date, public health measures including personal protective measures (hand hygiene, respiratory etiquette), environmental measures, physical distancing measures, and travel-related measures have been the mainstay for controlling the coronavirus disease. Bangladesh has enforced these measures with varying degree of success. We all recognize that long-term measures are likely to have significant adverse economic and health consequences. Bangladesh decided to open-up. It is timely to remind all of us that WHO recommended that the decision to lift public health measures to Combat Coronavirus should be based on a risk assessment with a standard methodology to balance the risk of relaxing measures, capacity to detect a resurgence in cases, capacity to manage patients in health facilities, and ability to re-introduce public health and social measures, if needed.    

The writer is a Professor at the Department of International Health and Director, International Center for Maternal and Newborn Health at the Johns Hopkins Bloomberg School of Public Health, Baltimore, USA.