Bangladesh battles third wave of COVID-19

The current wave of COVID-19 has proved to be the deadliest in Bangladesh. The death count continues to climb, while confirmed cases have surpassed 1 million. The country registered nearly 14,000 new COVID-19 cases Monday — almost double the daily number recorded at the peak of a second wave in April.

Bangladesh imposed a lockdown at the beginning of this month and extended it until Wednesday as cases and fatalities continue to rise.

The government has attributed the spike in cases to the delta variant, which was first detected in India and is now fueling surges in many parts of the world. A recent study by Bangladesh’s Institute of Epidemiology, Disease Control and Research found that the variant accounted for 78% of sampled COVID-19 tests in June. It has now overwhelmed districts outside Dhaka, especially in the southern division of Khulna, which borders the Indian state of West Bengal.

But experts said this was not unexpected. Bangladesh has porous borders with India, making it inevitable that a more aggressive variant would cross over. While Bangladesh tried to seal its borders in late April, people still found a way to slip into the country. COVID-19 cases and deaths have been on the rise domestically since mid-May, and experts have been asking the government to tighten measures.

Global vaccine supply shortages and stalled deliveries have also meant the majority of the population is going without some kind of protection. Fewer than 3% of the country’s nearly 170 million people have been fully inoculated. After a pause, vaccinations have started again this month.

But the government could have imposed stricter measures and prepared better for the COVID-19 surge, experts said, adding that the country should also further invest in community awareness to reinforce public health measures.

Gaps in the response

In May, during Eid al-Fitr, a national public holiday in Bangladesh marking the end of Ramadan, thousands of people rushed to villages to be with their families, despite a national lockdown. Now, in the midst of another lockdown, the latest restriction measures still have too many holes, according to Muzaherul Huq, a leading public health expert and former regional adviser with the World Health Organization.

“When you lock your house, do you keep some doors open?” he asked, pointing to exemptions in the current lockdown, such as keeping ready-made garment factories open. Huq also said the government should have made sure that health facilities in certain areas were prepared and strengthened with enough beds and oxygen.

Now, treatment is not available at subdistrict hospitals, causing a delay in the provision of care and leading to more deaths.

Without primary treatment, “the death rate will inevitably increase, which is what’s happening right now,” Huq said, adding that contact-tracing and quarantine-related efforts have been missing in rural border areas.

The government could also have strengthened social protection schemes to incentivize low-income earners to stay home during the lockdown period.

“The government has failed in more than a year's time to plan a scheme of social protection and aid to low-income people and the garment industry workers. Even during restrictions, these people [left their] homes in a desperate need of livelihood,” wrote Ridwanul Hoque, a law professor at the University of Dhaka and a university fellow at Charles Darwin University’s Northern Institute in Australia, in an email to Devex. He said Bangladeshi authorities should give out subsidies and financial aid now so these people have an incentive to stay home.

Hoque warned that mass arrests of people violating current restrictions would only lead to more infections. Bangladesh has enforced repeated countrywide lockdowns since the coronavirus first emerged last year, but the latest restrictions have been the most stringent by far, with the army and other security forces patrolling the streets.

“Massive arrests are causing even greater danger. [Last week] over a thousand people were arrested, so they mingled with police, court staffers, and landed in jails — jeopardising lives of everyone else including the prison population,” he wrote.

Changing behaviors

Ensuring adherence to public health measures has been a challenge.

Morseda Chowdhury, director of health, nutrition, and population programming at BRAC, said “behavioral change hasn’t happened yet,” with people often putting on face masks only when they see police officers nearby. Regularly wearing a mask is particularly tough for those who work for long hours in a hot and humid environment, she said.

BRAC and 41 other NGOs have come together to help the government raise community awareness, and they have identified religious and other leaders in communities who can reinforce measures such as mask-wearing and social distancing. But, Chowdhury admits, changing behavior takes time.

“It's not easy to make any behavior change within ... 1 1/2 years,” she said.

Concerns over another surge

There is worry that the upcoming Eid al-Adha, a major Islamic celebration involving animal sacrifice that starts next week, will further drive cases. But the government is temporarily lifting the lockdown and easing restrictions beginning Thursday, with measures set to resume after the festival.

Authorities have sought to restrict cattle smuggling from India and large gatherings in cattle markets across the country, as part of efforts to limit movement at the border. The Commerce Ministry has only allowed digital purchases of cattle in the Dhaka metropolitan area.

Zahid Nazrul Chowdhury, the top health official in the northwestern Chapai Nawabganj district bordering West Bengal’s Malda and Murshidabad districts, said hospitals under him have started rapid antigen testing.

“We faced our hardest situation from May 25 to June 7. It was the most critical moment for us. But now the cases are decreasing,” he said.

Initially, subdistrict hospitals across Chapai Nawabganj reportedly struggled to provide patients with oxygen. But the health official said he now has an ample supply.

“In the main district hospital, the oxygen supply is sufficient at this moment. The hospital alone has 191 oxygen cylinders. Whenever the total reserve comes down below 50%, we make requisition and necessary supplies arrive. At this moment, we face no shortage of oxygen,” he said.

Only 99 people have entered Bangladesh from India through official border posts since May 19, he noted, and all of them were put under mandatory quarantine. Bordering areas are also under the direct supervision of the prime minister’s office, he said, with top bureaucrats including the prime minister’s principal secretary in regular contact with district-level civil surgeons like him, underscoring that the gravity of the situation has not escaped the central government.

But health experts remain worried. A former director of the Directorate General of Health Services, an agency of the country’s Health Ministry, told Bangladesh’s The Daily Star that easing the lockdown “will aggravate the crisis.”