Tackling the Pandemic COVID-19: the Bangladesh Perspective Running article: Tackling COVID-19 by Bangladesh

Md. Taimur Islam, Anup Kumar Talukder, Md. Nurealam Siddiqui , and Tofazzal Islam* Department of Pathobiology, Faculty of Veterinary Medicine and Animal Science, Bangabandhu Sheikh Mujibur Rahman Agricultural University, Gazipur 1706, Bangladesh 2 Department of Gynecology, Obstetrics & Reproductive Health, Faculty of Veterinary Medicine and Animal Science, Bangabandhu Sheikh Mujibur Rahman Agricultural University, Gazipur 1706, Bangladesh Department of Biochemistry and Molecular Biology, Bangabandhu Sheikh Mujibur Rahman Agricultural University, Gazipur 1706, Bangladesh Institute of Biotechnology and Genetic Engineering, Bangabandhu Sheikh Mujibur Rahman Agricultural University, Gazipur 1706, Bangladesh


INTRODUCTION
A cluster of patients of pneumonia with unknown etiology was first reported in the Wuhan city of Hubei Province in China in December 2019 (1-3). The initial symptoms were fever, cough, dyspnea, myalgia or fatigue, headache, hemoptysis, diarrhea and acute respiratory distress syndrome (ARDS) (4). The Wuhan is the most populated city in central China with a population of over 11 million (5,6). After a few days, Chinese health authorities confirmed that those cases were associated with a novel CoV (3). Eventually, the Chinese Centre for Disease Control and Prevention (CCDC) has identified the causative agent from throat swab samples on January 7, 2020, and named the pathogen as Severe Acute Respiratory Syndrome Coronavirus-2 (SARS-CoV-2). On the other side, the World Health Organization (WHO) named this disease as a coronavirus disease-19 (COVID-19) (6). The WHO has declared this ongoing outbreak of COVID-19 as a Public Health Emergency of International Concern on January 30, 2020. According to WHO, the countries with vulnerable health systems are at higher risk. As of April 18, 2020, the disease has infected at least 2,261,425 people and has resulted in at least 154,734 deaths globally.
The emergency committee of WHO has announced that the spread of COVID-19 could be discontinued by trace, early detection, isolation, prompt treatment (6). To date, more than 213 countries or territories have confirmed the occurrence of COVID-19 including Bangladesh (7). Bangladesh is one of the most vulnerable countries due to high population density (170 million people in 147,000 sq.km), poor health care systems and the weak economy. In recent years, Bangladesh's economy has been growing well with a GDP growth rate of more than 7.5%, however, 20% of the population is poor. Nevertheless, because of the rapid spread of the COVID-19, Bangladesh's economy has already started taking a big hit.
The nationwide shutdown has already suspended almost all economic activities except agriculture and made thousands of employments at risk. International trade orders, especially in ready-made garments industries, are being greatly canceled. While the richest, developed and the most powerful countries of the world have been struggling to fight against the COVID-19, failing to provide the necessary support and medical treatment to their patients. It is a now worrying question how is Bangladesh responding and tackling the pandemic Preprints (www.preprints.org) | NOT PEER-REVIEWED | Posted: 21 April 2020 doi:10.20944/preprints202004.0384.v1 4 COVID-19 with its relatively poor health management system. Several opinion papers have been published in different countries regarding the outbreak of COVID-19 (8,9). The present report aimed to focus our understanding of the biology of this novel CoV and describes how a resource-poor country Bangladesh is tackling this fearsome disease by adopting steps and stimulus packages.

RESPONSES OF BANGLADESH TO TACKLE COVID-19
On package is based on four main features: a) increase public expenditure; b) introduce fiscal packages; c) expand social security programs; and d) increase money supply. (ii) The stimulus package of the total amount of approximately USD 589 million to pump running capital into the agricultural sector to ensure food security. Besides, previously the government has allocated approximately USD 589 million to give subsidy to farmers aiming to increase agricultural production and to maintain national food and nutritional security. Major steps taken by the government of Bangladesh to tackle the COVID-19 are described briefly in Table 1.

MAJOR CHANLLENGES OF COVID-19 IN BANGLADESH
Though the government has taken some essential steps, such as restrictions on air and land travel, increasing public awareness, quarantine of the people who have returned to the country and other suspected people, promotion of self-isolation, social distancing, the lockdown of some areas, and the deployment of the law enforcement agencies and the army to motivate the people, and also a declaration of some stimulus packages for boosting the economy, many challenges are still remained to be addressed to effectively tackle this fearsome disease. The major challenges of addressing the COVID-19 in Bangladesh are briefly described as follows. Bangladesh. An extremely limited number of tests is increasing the chances of leaving a higher number of COVID-19 cases undetected in Bangladesh. It is highly recommended to increase the number of tests for suspected and asymptomatic people as soon as possible.
Besides this, all identified and suspected cases must be quarantined and treatment should be provided if needed. The government must need to include all research institutes, universities, and other organizations that have the laboratory facility to increase the number of tests for diagnosing COVID-19. Convenient and rapid test methods should be urgently introduced.

Lack of safety equipment:
There is inadequate supply of PPE, masks, hand gloves to the health service providers, which is one of the major constraints in providing treatment facilities. A significant lack of safety equipment is fuelling the concern for frontline health service providers like doctors and nurses. Collectively, the limitation of PPE and inadequate test facilities of real-time RT-PCR are the big challenges for Bangladesh. The government has to make available and import these protective gears immediately.

Lack of skilled human resources:
The use of real-time RT-PCR-based-assay to diagnose COVID-19 requires skilled human resources and sophisticated laboratory facilities. suspected cases need to be tested immediately.  The overall current situation of the health service system of Bangladesh has illustrated above, which clearly reflects the worsening situation of Bangladesh to tackle the fatal COVID-19 epidemic in the country.

CONCLUSION
The COVID-19 has been a serious problem already for Bangladesh in the last few weeks after its emergence on 8th March in the country. Essentially, the government has taken many timely initiatives such as diagnosis of suspected cases, quarantine of doubted people and isolation of infected patients, local or regional lockdown, increasing public awareness and social distancing with the announcement of many financial benefits for industries, agricultural production, and daily workers. However, testing the limited number of samples, scarcity of   2. ii) On the basis of bank-client relations, commercial banks will lend the working capital to concerned small and medium enterprises with their own funds. The interest rate of this loan will also be 9%. 4% loan will be paid by small and medium enterprises and the remaining 5% will be paid by the government to the concerned bank.
Package-3 1. i) Extending the Benefits of Export Development Fund (EDF) initiated Bangladesh Bank: Under the Block to Block LC, the current size of the EDF will be increased from USD 3.5 billion to USD 5 billion to increase the import of raw materials.
2. ii) As a result, an additional approximately USD 1,500 million will be added to the EDF fund, equivalent to USD 1.5 billion. The current interest rate for the EDF will be reduced from LIBOR (The London Inter-Bank Offered Rate) + 1.5% (which is actually 2.73%) to 2%.
Package-4 Bangladesh Bank will launch a new loan facility of approximately USD 589 million named Pre-shipment Credit Refinance Scheme. The interest rate of this loan will be 7%.