Covid-19: Without government action, over 500,000 may die in Bangladesh

Over half a million people in Bangladesh could die from Covid-19 virus infection by the end of May 2020, unless the government takes steps to mitigate or suppress the disease, according to a report written by epidemiologists and public health academics from Brac University, North South University and Johns Hopkins University. The report has been shared in recent days with Bangladesh government policymakers.

According to the projections in the report, which was obtained by Netra News, “By the end of the epidemic [on May 28th], a total of 89,120,161 persons may have symptomatic infections, 3,037,393 persons may need hospitalization, 696,595 persons may need critical care in the intensive care unit and 507,442 people may die.”

In total, the report estimates that more than 133 million people in Bangladesh — 81% of the population — may get infected with Covid-19. However, the authors of the report do not set out what interventions the Bangladesh government could take to mitigate or suppress the disease or what effect these could have on reducing the projected number of cases and deaths.

This report on Bangladesh relies on a model developed by researchers of Imperial College in London, led by the prominent epidemiologist Neil Ferguson. The original Imperial College report spurred the British and US governments into announcing robust measures aimed at tackling the spread of Covid-19 in their respective countries.

On the basis of the model, adjusting for the age structure in Bangladesh which is relatively young, the authors found that “3.4% of symptomatic cases will need hospitalization, 22.9% of hospitalized cases will need critical care with ventilators and 0.38% of all cases (including both symptomatic and asymptomatic) or 0.57% of symptomatic cases will die.”

The report sets out the seriousness of the situation facing Bangladesh and how rapidly the situation could change for the worse. “As per our calculation, on the 31st March 2020, there may be 4,640 new symptomatic cases, 59 more persons in need of hospitalization, 12 new patients in need [of] critical care and 1 new death. The highest number of new symptomatic cases may occur on the 11th of May 2020 (14,189,833). On the 16th of May, 2020, a total of 483,618 cases may need hospitalization. A total of 110,913 persons may need critical care on the 14th of May and on the 26th of May, a total of 80,796 person may die.”

The paper’s authors have assumed that the epidemic in Bangladesh started on February 2nd 2020. By March 19th 2020, when the first death was reported, they estimate there were already 1,685 people with symptoms of the disease present within the country.

The authors acknowledge there are limitations to the report, but caution that, if anything, they may have underestimated the graveness of the situation. The age structure used in the Bangladesh modelling is based on 2011 census data but the authors think the actual proportion of population in the older age group is higher than the proportion set out in the census, “As the mortality from Covid-19 is higher among the elderly people, the actual infection-fatality ratio can be higher than the ratio reported here.”

In addition, the authors mention that the start date of this epidemic might have been earlier than February 2nd and as a result there could be more cases already present in the country.

“We should not think that we still have enough time to prepare ourselves before the epidemic hits us hard,” the report concludes.

The authors of the report are Malay K Mridha and Rina Rani Paul from BRAC University’s James P Grant School of Public Health, Dipak K Mitra from North South University’s Department of Public Health, Alain Labrique and Yifan Zhu from Johns Hopkins University’s Bloomberg School of Public Health.

When Netra News contacted the lead author of the report Malay K Mridha, he declined to provide further comments on the subject.

Until March 21st, Bangladeshi authorities have confirmed 24 cases of Covid-19, with two deaths. The first confirmed case of the virus in Bangladesh was on March 8th. Testing is currently only taking place at the Institute of Epidemiology, Disease Control and Research in Dhaka focusing on expatriates, their families, and people who came into close contact with them.●

[Update — March 23rd]

Following the publication of this report, Brac University issued a statement on March 22nd, noting that the university did not conduct, commission or publish “any research regarding the Covid-19 situation in Bangladesh. If any individual researcher publishes a paper without the knowledge and authorization of the dean, the school’s name shall not be associated with it. We have initiated an official investigation into the matter and appropriate disciplinary action will be taken.”

On March 23rd, Dipak Kumar Mitra of North South University issued a statement noting that “neither the Department of Public Health of North South University nor myself have commissioned, partnered or published this report. If any other institution or person published this paper without the knowledge and authorization of me and my institution (North South University), I and North South University will not take any responsibility.”

Earlier, Netra News spoke to one of the five researchers named in the report who said, “I am under tremendous pressure from many areas, so at this moment I can not talk. Let me absorb the situation, then, if you [give] me your email address, I can get back to you.”