A Review on Present Scenario of COVID-19 in Bangladesh

The COVID-19 pandemic caused by SARS-CoV-2 has been showing a speedy growth in the number of infected patients with a remarkable mortality rate, thus it has become a worldwide public health concern. From March 8, 2020, the disease was confirmed to start spreading in Bangladesh. Since then, people got infected so exponentially that the country positions at the list of top infected countries in the world. Therefore, the objective of this comprehensive review was representing overall scenario of COVID-19 in different sectors of Bangladesh, particularly prioritizing the health sector. Up to 14 September 2020, 339,332 confirmed cases and 4,759 deaths were reported. An alarming fact is that while the global mutation rate of coronavirus is 7.23 % in average, the rate is 12.6 % in Bangladesh. Although the government ruled preventive strategies such as nationwide lockdown, social distancing, contact monitoring, quarantine and isolation, it was difficult to implement those due to lack of public awareness, inappropriate attitudes and so on. Moreover, the overburdened healthcare system had a weak response at initial stage because of insufficient healthcare facilities. Consequently, this pandemic affected severely Preprints (www.preprints.org) | NOT PEER-REVIEWED | Posted: 25 December 2020 doi:10.20944/preprints202012.0661.v1 © 2020 by the author(s). Distributed under a Creative Commons CC BY license. almost all the important sectors of the country, specifically the economy, agriculture and health sectors. Hence, focusing on healthcare system as well as maintaining social distance and other essential precautions can limit the spread of infection and help to alleviate the severity of the pandemic.

March 8, 2020 [16]. Immediately, the government declared a nationwide lockdownon March 22 for 10 days (March 26 to April 04) [17]. Government of Bangladesh (GoB)has agreed to deploy armed forces since 24 March to promote social distance and disease prevention [18]. Until the end of March, infectionwas low but experienced a steep increase in April [19]. The disease growth percentage in Bangladesh became the highest in Asia on April 11 [20]. On June 13, the number of cases in Bangladesh outpaced the number of cases in China [21], whereas on September 11, the total death number became 4,668 surpassing the total death number of China [22]. Moreover, different districts of the country experienced variable scenario in terms of COVID-19 cases ( Fig. 1 and Supplementary file 1).
Due to lockdown, the economy of Bangladesh has witnessed a drop of 6 %age pointsfrom 2019 [23]. Resource constraints and inadequate medical facilities, insufficient testing facilities, personal protective equipment (PPE) and other protection measures also created barriers to combat Covid-19. Besides, public awareness and attitude, social distancing challenges, price hike and natural disasters made the crisis more difficult. A study by the Bangladesh Council of Scientific and Industrial Research (BCSIR) revealed that the mutation rate of Coronavirus in Bangladesh was 12.6 %, while the present global average is 7.23 % [24].

Materials and Methods
The deadly COVID-19 is a recent outbreak, thus there is lack of availability of scientific publications from which we can collect information reflecting the ultimate impacts. For this In Bangladesh, COVID-19 is a humanitarian concern for public health. The crisis has triggered panic-buying, racism, and mistrust even in places where cases were not officially confirmed, or few cases were reported [25]. However, inconveniences and sufferings that appeared in Bangladesh during this pandemic situation are represented below:

Mass Panic among People
Though media portals transmitted substantial updates to mass individuals, it provoked negative consequences. For example, mass panic was highly visible even before announcing the first case from Bangladesh: breaking down of family relationships; patients and staff fleeing from a hospital after an immigrantwith flu-like symptoms was admitted [26]. Bangladesh also faced panic buying, terror, social stigma and hate during the lockdown.Mass panic is usually a consequence of misinformation, rumors, exaggeration and fake news circula ted in different social media platforms. Owing to the fear of infection, family doctors, clinics and hospitals in residential and remote areas werealso shut down.

Social Distancing Challenges
Implementation of the WHO recommended social distancing is difficult in congested regions, especially in marginal communities [27]. In a heavily populated country like Bangladesh, strict social isolation is very difficult to enforce. There are many factors, including close proximity of residents, lack of healthcare concern, inadequate preparation,etc. Maintaining adequate distance is a major challenge for the residents sharing common kitchen, toilets and corridors [28]. Among the 49.5 million economically active workers, there are a large% age of daily wage earnersfor whom the lockout is a curse. Besides, the garments industry, the second largest clothing supplier in 2017 with an earning of USD 29 billion, has been a significant obstacle against social distancing [29].

Public Awareness and Attitude towards Pandemic
Building Resources Across Communities (BRAC) survey (March 31 -April 05, 2020) revealed that around 40% of the respondents are unaware of avoiding infection [30]. Despite the lockdown, many of the people are disobeying the rules. Garment employees walked the streets for getting their unpaid wages [31]. Surprisingly, about 100,000 people attended a funeral of a famous Muslim cleric, rejecting calls from multiple places to retain physical distance and hygiene [32]. In print and online media, many other violations inside and outside the capital city are also reported, including excessive public meeting and roaming without excuse [33]. The risk is exacerbated by thousands of Bangladeshi returning from countries a ffected by COVID-19 [34].

Rohingya refugees
Bangladesh hosts about 1 million Myanmar Rohingya refugees, with approximately 626,500 residing inthe Kutupalong-Balukhali Expansion Site [35]. With more than 46,000 inhabitants per square kilometer, this location may be considered one of the densest settlements on earth [36].
The 84% refugees reported not having concern about water, sanitation and hygiene [37]. Every four out of ten children in the camps are afraid to die or lose a friend at COVID-19 [38]. On 9 April, GoB announced a lockdown in Cox's Bazar and directed prohibitions, but refugees are still arriving in Bangladesh [39]. Despite the preventive measures, first cases were detected in Rohingya camps on 14 May [40].

Effects on Economic Sector
Due to closing international borders,the scarcity of raw material sources and orders cancellationcreated a burden on Bangladesh. Readymade Garments Industry (RMG) got the attention because of the cancellation of nearly $3 billion worth of work-orders that may affect approximately 4 million people directly involved in this industry [41].Banks in Bangladesh were suffering before the pandemic; the situation is becoming vulnerable day by day.Most pharmaceuticals companies also experienced a slump in sales, except for a few top ones. Drugs were not sold much, with the exception of those for hyperacidity, fever and cold [42]. Besides, the prices of basic commodities increased at a noticeable rate because of some unscrupulous traders who raised prices.According to the SANEM forecast, the poverty rate in Bangladesh will increase from 20.5% to 40.9% if Covid-19 leads to a 25% decrease in family income.Consequently, the successes over the past two decades in alleviating poverty can fizzle out [43].

Effects on Agricultural Sector
Access to agricultural products, materials, markets and advisory services was restricted during the lockdown, which greatly impacted farming.Agricultural processing and trade faced problems with impaired production activities by quarantine measures and low consumer demand, particularly due to limited hotel, restaurant and coffee shop operations [44]. Owing to logistical bottlenecks, farmers are still facing difficulties with having mineral fertilizers, veterinary supplies, and machinery spare parts.The country's fish and dairy farmers are now bearing their brunt. Crab, shrimp and fish farmers faced export restrictions, resulting in major economic losses. Exports from Bangladesh constitute more than 70% of crabs in the Chinese market.The export ban in China is a big setback for the crab industry [45]. Additionally, the prices of fruits, cattle and other agricultural products are also dropping. According to the Food and Agriculture Organization (FAO),the pandemic is causing major economic downturns linked to rising of hunger.It is necessary to avoid any distortions in the supply chain during harvest and to ensure food security during the second half of the year while planting spring crops in May and June.

Health Sector
The public healthcare system in Bangladesh is overburdened. The country spends less than five % of its Gross domestic product (GDP) on health [46]. China, for example, has a per capita health spending 10 times that of Bangladesh.Health professionals complained of not having sufficient PPE, proper training and other healthcare facilities that created difficulties in coping with the outbreak. a) Quantity and Quality of COVID Test: According to IEDCR, on April 18, 2020, the rate of tests per million in Bangladesh was 124, holding the country among the worst performing nations, only above North Korea, Nigeria and Myanmar [47]. Then, with the increase of the number of tests, the number of positive cases increased quickly indicating that many of the patients were not tested and thus caused transmission excessively (Fig. 2). As number of positive cases raised, the death rate as well as the recovery rate showed upward trends (Fig. 3 & 4). As of September 14, a total of 1,742,696 tests were performed, reporting 339,332 confirmed cases, of which 243,155 completely recovered and 4,759 died. A total of 94 laboratories throughout t he country are performing tests. RT-PCR laboratory test is basically available in these labs.
Bangladesh faced a new challenge because, after retesting, false results have been revealed [48].
Health, the country has only six physicians, nurses and midwives for every 10,000 people [58].
Initially, private hospitals were reluctant to treat Covid-19 patients for the safety of other patients and a lack of training of medical personnel [59], thoughlater theystarted treating. Thus, the patients suffered due to a lack of treatment and the disease spread rapidly. However, the government agreed on April 27 to appoint 2,000 physicians and 6,000 nurses within a week and also 2,654 service providers, including lab attendants, helps, ward boys and conservancy workers for the next six months [60].

d) Drugs
There are no confirmed drugs, therapeuticsor vaccines available to treat COVID-19 effectively, though several research studies have been running worldwide since the first days. Initially, WHO concentrated on four potential therapies:an experimental compound named remdesivir; the chloroquine and hydroxychloroquine malaria drugs;a combination of lopinavir and ritonavir; and that same combination plus interferon-beta [61]. Next, Russiaapproved the anti-influenza vaccine, aviifavir [62], the European Medicines Agency (EMA) proposed remdesivirfor being approved [63], the UK experts claimed dexamethasone as a major breakthrough [64]. However, a major study including thousands of patients led by the University of Oxford showed hydroxychloroquine is ineffective [65] and studies involving animal models found that favipiravir had a very small effect [66].
While in Bangladesh, physicians have been prescribing multiple medications, including remdesivir and ivermectin [67]. After the UK news of dexamethasone,people in Bangladesh were in a mad rush to purchase the drug,which usuallybenefitedthe most severely illpatients requiring respiratory or ventilator support [68]. A Bangladeshi team headed by medical specialist Professor Tarek Alam reported pioneering findings of 100% recovery (60 of 60 patients) within 4 days using ivermectin, antiprotozoal medication and doxycycline as a drug mixture [69].On 17 June, Bangladesh released these two medications for a clinical trial of 72 infected patients aged between 40 and 65 years with moderate illness for less than 7 days. The results have been good so far, but it still requires detailed research [70].

e) Convalescent Plasma The rapy (CPT):
On 24 March 2020, the FDA approved physicians to use plasma obtained from recovered patients to treat seriously affected patients [71]. On May 6, at Evercare Hospital Dhakain Bangladesh, CPT was used to treat a COVID-19 patient for the first time [72]. Then, plasma therapy started to be used atan increased rate in the country. Dr.

MA Khan, head of the Hematology Department, Dhaka Medical College and Hospital (DMCH)
encouraged the use of CPT mentioning the therapy as harmless [73]. An online network launched by the GoBand a number of plasma banks also emerged across the country.

f) Vaccine
To launch the vaccine in Bangladesh, the ambitious efforts of Globe Biotech Ltd. attracted all because the company had successfully conducted a preliminary animal trial [74]. After successful two-phase animal trials in the pre-clinical stage, they were ready to initiate clinical trials of the homegrown vaccine [75].

Besides, Health Services Division Secretary Md Abdul
Mannan mentioned if the vaccine is developed anywhere worldwide, it will urgently be brought.
The government also invited the United States (US) to develop production plants for  vaccines in Bangladesh [76]. Recently, Beximco Pharmaceuticals Limited claimed to import the vaccine produced by British pharmaceutical company AstraZeneca [77].

Scope of Biotechnology in the Pandemic
Biotechnology has been changing the world through advances in agriculture, medicine, Particularly, emphasizing on the health sector, by increasing treatment facilities, providing sufficient safety equipments, scaling up testing capacity, special focusing on appreciated drugs such as aviifavir, remdesivir, dexamethasone, importing vaccines immediately at low cost if developed anywhere in the world and investment in COVID-19 research sectors, is highly recommended to reduce the demolishing impacts of the pandemic as well as to mitigate the aftereffects in Bangladesh. 299423467b48e9ecf6. 2020.
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