With inputs from Dr Monica Vasudev

1018: Minutes of Virtual Meeting of CMAAO NMAs on “CMAAO view on COVID-19 in Bangladesh”

25^th July, 2020, Saturday; 9.30 am-10.30 am

Participants

Member NMAs: Dr KK Aggarwal, President CMAAO; Dr Yeh Woei Chong, Singapore Chair CMAAO; Dr Marie Uzawa Urabe, Japan; Dr Ashraf Nizami, Pakistan; Dr Sajjad Qaisar, Pakistan;

Dr Md Jamaluddin Chowdhury, Bangladesh

Invitees: Dr Russell D’Souza, UNESCO Chair in Bioethics, Australia; Dr S Sharma, Editor IJCP Group

Dr Md Jamaluddin Chowdhury from the Bangladesh Medical Association presented data on the situation of COVID-19 in Bangladesh. This was followed by a discussion among the participating NMAs on COVID-19 status in Bangladesh.

COVID-19 Situation in Bangladesh - Health Perspective

Dr Md Jamaluddin Chowdhury, Bangladesh Medical Association

• Bangladesh is the most densely populated country of the world with a population density of 1116/sq km.
• The first case of COVID in the country was detected on 8^th
• So far, Bangladesh has done more than one million tests; the number of tests conducted per million is 6629.
• Bangladesh allows private facilities to conduct coronavirus test by their own RT PCR machine.
• However, the number of tests has reduced; the reason for this decline is not known; the cost of the test may have been a factor.
• Bangladesh has not started antigen test yet. Also, antibody testing has not been started for surveillance.
• Number of confirmed cases is 218658; number of deaths confirmed due to COVID-19 is 2836.
• Number of total deaths (documented or undocumented) indicate the total number of infected cases.
• Analysis of one month data from 25^thJune to 24^th July shows that the number of deaths (confirmed) is not so high and ranges between 35 and 50. But there may be some undocumented cases.
• The number of critical cases is reducing; the number of ICU beds dedicated for COVID-19 cases is 201; of these 133 are occupied.
• Initially there was a shortage of high flow nasal cannula; also, initially, private hospitals and clinics were not providing any service. Now they are giving service, both diagnostic and curative.
• Hydroxychloroquine is not being used for patients; ivermectin is also not advised in the national guideline, but the patients are taking the drug randomly.
• An ongoing trial is investigating the efficacy of combination of ivermectin and doxycycline for treatment of COVID-19 patients with the approval of Bangladesh Medical Research Council.
• Healthcare workers who have treated patients infected with COVID-19 have faced social stigma from local people.
• The number of doctors infected is 2229; the number of doctors deceased is 68.
• Supply of PPE is now satisfactory. Initially there was question about its quality.
• Contact tracing is going on but it is insufficient due to shortage of employees or volunteers.
• Wearing mask has recently been made compulsory by law.
• A 45-day lockdown was ordered in the country, but was not observed strictly. At present, no significant lockdown program is on implementation.
• Most of the confirmed cases are in the age group 21-40 years.
• The number of cases in females is 29% vs. 71% in males.
• The number of deaths in females is 23% vs. 77% in males.

Other key points from the discussion

• Countries in South Asia (India, Bangladesh, Pakistan, Sri Lanka, Nepal) should have similar data.
• Mortality in Bangladesh is 1.2-1.3%; mortality in Delhi is now 0.3%; a sero-surveillance study in Delhi has shown that 22.8% have developed antibodies. Because the mortality is low, people are not accepting the lockdown guidelines.
• Mortality in our countries should be 0.1-0.3%; the virus is not so deadly here.
• Less than 1% need ventilators; rest can be managed at home, nursing homes and smaller hospitals as long as there is facility for HFNC.
• Start early anticoagulant (LMWH); treat with tenecteplase if no improvement despite LMWH.
• All patients should identify Day zero. Measure SpO₂ on Day 3-6. If there is exertional dyspnea, this means there is pneumonia + clot; give antiviral + LMWH + steroids; all should recover.
• We need to build up AII rooms similar to countries like China, Hong Kong, Singapore, South Korea.
• Hydroxychloroquine has no role if steroids are given; role of antibiotics is to prevent secondary infection.
• Start pool test; if positive, then presume that all in the family are infected. Singapore allows pooled test with 64 samples at a time; Kerala allows 20 samples and ICMR allows 5 samples.
• A lockdown now is not the answer.
• In India, doctors are on duty for 7 days; they are not allowed to go home; they stay in a hotel for 5 days and are allowed to go home only if they test negative.
• Asymptomatic people are not actually asymptomatic. They may be missing atypical symptoms such as headache, single diarrhea, sore throat, nasal obstruction, etc. Even a single symptom can be COVID positive.
• Public should strictly follow the SOPs in their workplace.
• Undue interference by law has created confusion. The Supreme Court of India has given a decision that petitions against policy decisions regarding COVID-19 will not be entertained.
• Pakistan Medical Association has demanded home isolation with proper monitoring of the patients (by GPs/Family Practitioners), if the person has the capacity or resources to be isolated.
• In Singapore, enforcing of stay at home orders is done by security people, while medically, if people have illness, they are shifted out to a facility.
• Issues about stigmatization, ethics and interference in professional autonomy are very real. We have to be on alert about these.

Dr KK Aggarwal

President CMAAO, HCFI and Past National President IMA