Bangla Tuesday, April 07, 2020

In the absence of interventions, 507,442 Bangladeshis might die of COVID-19

SAM SPECIAL-ENG-24-03-2020

A team of public health researchers from BRAC, North-South, and Johns Hopkins universities have predicted that if no steps are taken to stem the spread of COVID-19 in Bangladesh, 507,442 people may die by the time the threat ceases.

Malay K. Mridha, Dipak K Mitra, Alain Labrique, Yifan Zhu, Rina Rani Paul say in their short paper entitled: “COVID-19: Cases, hospitalization need, critical care need and mortality projections for Bangladesh” that by the end of the epidemic, 89,120,161 persons in Bangladesh’s population of 164 million may have symptomatic infections; 3,037,393 may need hospitalization; 696,595 may need critical care in the Intensive Care Unit; and 507,442 may die.

They 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 the symptomatic cases, will die.

The methodology adopted by the research team is primarily based on a publication by the Imperial College London COVID-19 Response Team. It is based on the following assumptions: (1) the mean incubation period is 5.1 days; (2) infectiousness starts 4.6 days after the entry of the virus; (3) the mean generation time is 6.5 days; (4) symptomatic cases are 67%; (5) the duration between onset of symptoms and hospitalization is 5 days; (6) the average length of hospital stays for patients without a need for critical care is 8 days; (7) the average length of hospital stays for patients including those in need of critical care is 10.4 days; (8) the proportion of population to be infected is 81%.

On 11th March 2020, the World Health Organization declared the COVID-19 outbreak as a ‘pandemic’. In Bangladesh, three cases of COVID-19 were identified on March 8. By March 19, 17 cases had been identified. From among them, one died and three recovered.

The epidemic started in Bangladesh with the entry of the primary case on February 2. By the day of the first death due to COVID-19, there were already 1,685 symptomatic cases in the country.

According to the model adopted, there could be 21,461 symptomatic cases by March 31. By that date, 275 cases might need hospitalization, 13 patients might need critical care and there could be a total of six deaths.

If no interventions aimed at mitigation or suppression are taken, people will continue to get infected till May 8, 2020.

In a grim prediction, the report says that 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 by the time the epidemic tapers off.

Limitations

However, the authors admit that their report has several limitations. But the reality may be more severe than the estimates in the report, they warn.

“We have an artificial start date, based on the death of one case on March 18, 2020. The actual number of deaths can be higher than the death detected on March 18, 2020. The age structure of the population is based on census data from 2011, but we think the proportion of the population in the older age group is higher than the proportion mentioned in this report. As mortality from COVID-19 is higher among the elderly people, the actual infection-fatality ratio can be higher than the ratio reported here,” they say.

“We also did not have any data to adjust our results for contextual factors e.g., population density, ambient temperature and population movement. Due to lack of data, we also assumed that, over time, the population from all age groups will be infected at the same rate,” the authors add.

The authors said that the report was prepared to impress upon the government the need for interventions aimed at the mitigation or suppression of COVID-19. Bangladesh should draw up plans to implement these interventions. Based on the report’s projections, Bangladesh’s policy-makers could estimate the future demands on the country’s health care system. The fact that the average length of hospital stays for COVID-19 patients is 10.4 days means that the country will need many more beds than what is available now. Time is of the essence, as the gaps to be filled are large.