Bangladesh’s closed case death rate is over 4 times that of India and 10 times higher than Sri Lanka — but how concerned should we be?

Is this Bangladesh’s most worrying Covid-19 statistic? David Bergman April 30, 2020

The most commonly discussed Covid-19 virus death rate in different countries is the ratio between the numbers of people who test positive for the virus and those who die. In Bangladesh, going by the official figures, this is 2.3%. A low number globally, which would get even lower, were there more testing.

Another discussed death rate concerns how many days it takes for the total number of deaths in a country to double. In Bangladesh, this is at present 12 days, and increasing. Again, this is a good figure compared, for example, to how the epidemic played out in the United States, when at its height, it doubled in about four days.

However, in its latest briefing report on the Covid-19 virus in Bangladesh, the World Health Organization has highlighted another death rate in the country which is of concern. That is, the high death rate in Bangladesh of “closed cases”.

A Covid-19 case is “closed” when a person who has tested positive for the virus either dies or recovers, and the “closed case death rate” refers to the proportion of those cases who die. In Bangladesh, as of April 30th, there is a closed case death rate of 51%. That is to say there are a total of 328 closed cases, of which 168 have died and 160 have recovered.

As the figure below shows, there have been more deaths than recoveries since mid-April.

WHO’s briefing note, “Covid-19 Situation Report #9” dated April 27th states this is a high number when compared to the global average of 20% and particularly so when contrasted to the rates in India and Thailand of 13% and 2% respectively.

In fact, according to the data collected on the Worldometer website, Bangladesh is right near the top of the global list of closed case death rates. Only Sweden and Norway (which do not officially report recovered cases) and Somalia are above it. Whilst Bangladesh is at 52%, the average in South Asia is 7%. Below are the close case death percentages in each of the South Asian Association for Regional Cooperation (Saarc) countries.

On the surface, the high closed case death rate in Bangladesh could be a very troubling figure indeed. It suggests that once a person tests positive for Covid-19, they are more likely than not to die. This could be for different reasons, for example, that compared to other countries, people in Bangladesh are more vulnerable to the virus because of pre-existing medical conditions or because the hospital care is nowhere near as good as other countries.

However, the figure could also be misleading.

One reason could be due to the limited testing in Bangladesh. For many weeks, the government’s health authorities had conducted only a very small number of tests done — until March 25th, less than a hundred a day — and it could be argued that only the most serious cases of infection were tested. As a result, it may be that the closed case death rate is not predictive of what will happen as testing levels increase involving a wider range of people.

Another reason could be that that recovery rate is much slower than the death rate — so it takes people much longer to recover from Covid-19, than to die from it. As a result, the numbers may be skewed, and it will take more time before the larger number of those who recover get included in the data. It is this explanation that was provided by Nasima Sultana, the Directorate General of Health Services (DGHS) additional director general when Netra News asked her about the death rate, “Those who are dying are severe cases and they are suffering from other diseases. Due to their co-morbidities, they are dying within 5-7 days. It takes a longer time to recover from Covid-19 and that is why the number of deaths is higher. .. We don’t believe that over 50% people will die if they [were] found positive for Covid-19 in Bangladesh.”

A third reason could be that the figure under-counts the number of total recoveries. In Bangladesh, as in other countries, after a person is tested positive, they are not always hospitalised. A significant number of those who test positive isolate at home or elsewhere. It is quite possible that whilst DGHS can count the patients who recover in hospital, it is less able to keep tabs on those confirmed cases who recover outside hospital. Assuming this to be so, when those numbers are added into the statistics, the closed case death rate will decline. Indeed, Nasima Sultana had earlier told the New Age newspaper that they are finding it difficult to communicate with those who are isolating at home, “We cannot conduct the two mandatory confirmatory tests to declare them free of infections as they are missing from our record.” (It is also possible, of course, that some of these people die at home – rather than recover – and these cases are not included in the total number of deaths.) However, even if it is the case that the number of recoveries only refers to those who had been hospitalised, the closed case death rate would suggest that once tested positive and admitted to hospital, a person only has a 50:50 chance of surviving — which in itself is a matter of concern.

WHO’s office in Bangladesh did not comment further on the closed case death rate. Bercaru Catalin-Constantin, its head of communications, said, “We don’t have any further comments on publications on our website. From our perspective, the issues and numbers are self-explanatory and this is why we don’t have any further comments.”

So where does that leave us? Though the closed death rate percentage is certainly concerning, there are also reasons to suggest that the rate may decline in the weeks ahead. Indeed, it is slowly declining now (as each day more recoveries are being announced than deaths) with the percentage slowly reducing from a high of 56 percent on April 17th. This, however, is a figure to keep one’s eyes on, because if levels of recovery do not increase significantly and the closed case death rate does not decline, Bangladesh has a serious problem.●

David Bergman (@TheDavidBergman) — a journalist based in Britain — is Editor, English of Netra News.

🔗 Covid-19: Situation report # 9

* An earlier version of the article mistakenly stated that the Bangladesh rate was 20 times that of Sri Lanka. It is in fact 10 times.