20 July 2020

Morbidity and Mortality

Weekly Update (MMWU) No21
https://www.who.int/bangladesh/emergencies/coronavirus-disease-(covid-19)-update/

Photo Credit: Social Media, Bangladesh

Tested Confirmed Recovered Dead

In this issue of COVID-19 Tested Confirmed Recovered Dead Hotline
Morbidity and Mortality Weekly
Update (MMWU) No 21 (13-20
July 2020):

 dashboard with key figures;

1,041,661 207,453 113,5588 2,668 17.0 million
 detailed epidemiological
update on COVID-19 pandemic
in Bangladesh; Test/1 million New Cases Recovery Rate CFR% AR/1 million
 daily and weekly distribution of 6,116 2,928 54.7% 1.29% 1,218
COVID-19 cases and related
deaths;

 growth factor of daily COVID-

Laboratories PPE Stock PoE Screening
19 cases
80 COVID-19 Labs 1,211,545 376,170
 daily distribution of COVID-19
cases and rolling three-days
average per division; 7.1%
%
gender and age distribution of

Last days
COVID-19 cases and deaths
87,775 Samples 6,363,659 28,019
 overall and cumulative weekly
attack rate and per division;

 death and recovery rates of 61.3%

closed cases; Inside Dhaka
Tests 184,394 7,029
 comparison data with selected
countries in South East Asia;
and
19.9%
 floods update.
Positive Tests 536,282 355,435
WHO Bangladesh COVID-19 Morbidity and Mortality Weekly Update (MMWU) 20 July 2020/Vol. No21

1. Highlights

As of 20 July 2020, according to the Institute of Epidemiology, Disease Control and Research (IEDCR), there are
207,453 confirmed COVID-19 cases1 in Bangladesh, including 2,668 related deaths; Case Fatality Rate (CFR) is
1.29%.

On 18 July 2020, the Civil Aviation Authority issued a circular No. 30.31.0000.112.42.001.20-23150 informing that any
Bangladeshi citizen intending to depart for any international destination from any of the airport of Bangladesh should
obtain “COVID-19 Test Certificate”. The circular referred to the relevant procedures to obtain COVID-19 test certificate
established by the Health Service Division Bangladesh with the attached list of 16 approved hospitals/organizations in 8
divisions cities. The provisions will come into effect from 23 July 2020. Full document: www.caab.gov.bd.

On 18 July 2020, the Ministry of Foreign Affairs issued a circular No. 19.00.0000.530.68.000.20-549 informing that
Diplomatic, Official and Laissez Passer holders posted in diplomatic missions in Bangladesh and their family members
(including holders of ordinary passports) with valid visas will be exempted from the requirement of producing a
COVID19 negative/COVID19 symptom free medical certificate. However, the diplomatic missions are advised to
kindly ensure self-quarantine of their diplomats/employees if travelling to Bangladesh. Full document:
https://mofa.gov.bd/

Floods that started on 30 June and heavy monsoon rain on 18 July with water from upstream sources causing slow-
onset of severe flooding in low-lying areas have affected 18 districts. According to weather forecasts, the current floods
might be the most prolonged since 1988, and it is unlikely that the water will start receding before the next month.

2. Coordination

On 10 July 2020, WHO published a new tool on Mass Gathering COVID-19 Risk Assessment tool, which covers three
pillars: risk evaluation; risk mitigation; and risk communication. The tool has been updated to reflect new WHO guidance
and new evidence on both COVID-19 and mass gatherings, as well as feedback from end-users. It provides guidance for
authorities and event organizers planning mass gatherings during the current COVID -19 pandemic. Full document
https://www.who.int/publications/i/item/10665-333185. This risk assessment should be used in conjunction with the Key
planning recommendations for mass gatherings in the context of the current COVID-19 outbreak (Interim guidance)
found on the WHO website: https://www.who.int/publications/i/item/key-planning-recommendations-for-mass-
gatherings-in-the-context-of-the-current-covid-19-outbreak

WHO launched a global COVID-19 anonymized clinical data platform - the “COVID-19 Data Platform” - for state parties
to share with WHO anonymized clinical data related to patients with suspected or confirmed infections with COVID-19.
The anonymized COVID-19 data will be used by WHO for purposes of verification, assessment and assistance pursuant
to the IHR (2005), including to inform the public health and clinical operation response in connection with the COVID-
19 outbreak. To preserve the security and confidentiality of the anonymized COVID -19 data, State Parties and other
entities are respectfully requested to take all necessary measures to protect their respective log-in credentials and
passwords to the COVID-19 Data Platform.

The Rapid Core Case Report Form is designed to collect data obtained through examination, interview and review of
hospital notes. The data collection period is defined as the period from hospital admission to discharge, transfer, death,
or continued hospitalization without possibility of continued data collection. Full document:
https://www.who.int/publications/i/item/WHO-2019-nCoV-Clinical_CRF-2020.4 The Pregnancy Case Report Form is to
be completed for pregnant women or recently pregnant women who delivered within 21 days from onset of symptoms.
Full document: https://www.who.int/publications/i/item/WHO-2019-nCoV-Pregnancy_CRF-2020.5

1
WHO Bangladesh COVID-19 Situation Reports present official counts of confirmed COVID-19 as announced by the IEDCR on the
indicated date. Difference in data between the WHO reports and other sources can result from using different cutoff times for the
aggregation and reporting of the total number of new cases in the country.

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WHO Bangladesh COVID-19 Morbidity and Mortality Weekly Update (MMWU) 20 July 2020/Vol. No21

3. Surveillance and Laboratory

Between 8 March and 20 July 2020, according to the Institute of Epidemiology, Disease Control and Research (IEDCR)
there were two-hundred-seven-thousand-four-hundred-fifty-three (207,453) COVID-19 confirmed by rt-PCR, including
two-thousand-six-hundred-sixty-eight (2,668) related deaths (CFR 1.29%).

In the current week (epidemiological week 29), In comparison to the previous epidemiological week, the number of new
weekly COVID-19 cases decreased by 14.9% (20,730 and 23,817 respectively) and the number of COVID-19 new weekly
deaths decreased by 12.8% (266 and 315).

The figures below are showing the daily and weekly distribution of reported confirmed COVID-19 cases and
deaths, 08 March – 20 July 2020, Bangladesh.

4,500 100
Number of Cases (N=207,453)

# Cases # Deaths
Poly. ( # Cases ) Poly. ( # Deaths )
80
3,000

60

1,500
40

0 20

Number of Deaths (n=2,668)

15/03

05/04

10/05

31/05

21/06
08/03

22/03

29/03

12/04

19/04

26/04

03/05

17/05

24/05

07/06

14/06

28/06

05/07

12/07

19/07
0
-1,500

20

-3,000
40

-4,500 60

30,000 350

# Cases Weekly Deaths

300
25,000

250
20,000
Weekly Deaths
Weekly Cases

200
15,000
150

10,000
100

5,000
50

0 0
w10 w11 w12 w13 w14 w15 w16 w17 w18 w19 w20 w21 w22 w23 w24 w25 w26 w27 w28 w29

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WHO Bangladesh COVID-19 Morbidity and Mortality Weekly Update (MMWU) 20 July 2020/Vol. No21

Out of the total 207,453 COVID-19 cases registered as of 20 July 2020, 54.74% (113,558/207,453) - recovered, 1.29%
(2,668) - died and 43.97% (91,227) are active cases.

The figure below is showing active vs recovered confirmed COVID-19 cases outcome per epidemiological week,
08 March – 20 July 2020, Bangladesh.

Epi Week
10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29
0T 140 T

Thousands
Active cases = 91,227
10 T
120 T
20 T
100 T
30 T

40 T 80 T

50 T 60 T

60 T
40 T
70 T
20 T
80 T
Recovered = 113,558
90 T 0T

In the epidemiological week 29, the number of COVID-19 active cases decreased by 7.4%, in comparison to the previous
week (3,130 and 3,361) and the number of recovered COVID-19 cases increased by 16.4% (18,030 and 20,989
respectively).

The figure below is showing the weekly outcomes of reported confirmed COVID-19 cases, 08 March – 20 July
2020, Bangladesh.

Weekly Recovery

100000 Weekly Active

Weekly Deaths
3 per. Mov. Avg. (Weekly Recovery)
10000
16,641

3 per. Mov. Avg. ( Weekly Active )

14,557
14,256

12,147
10,493
8,662

3 per. Mov. Avg. (Weekly Deaths)

6,040

5,502
3,952

3,361

3,130
2,858

2,426

1000
1,741
501

100
315

300
274

266
292
283
238
170
152

10
22

100
19

57

54

51
32

10,650

16,898

20,989

18,028
25

26,347
2725

1471

2528

2880

4122

4823
6

37

48
12

14

55
4
1

9
1

1
2

1
w10 w11 w12 w13 w14 w15 w16 w17 w18 w19 w20 w21 w22 w23 w24 w25 w26 w27 w28 w29

As of 20 July 2020, there were 116,226 (56.0%) COVID-19 cases with known outcome (closed cases). Out of all closed
cases, 97.7% (113,558/116,226) were cured and 2.3% (2,668) died. The recovery rate of 97% in the closed cases didn’t

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WHO Bangladesh COVID-19 Morbidity and Mortality Weekly Update (MMWU) 20 July 2020/Vol. No21

show any change since 16 June 2020. The death rate on closed cases in Bangladesh is lower than the 7.0%
(609,118/9,351,815) global average as of 20 July 2020.

The figure below is showing the death and recovery rates over cumulative closed confirmed COVID -19 cases, 08
March – 20 July 2020, Bangladesh.

Death% Recovery%
100%
Number of Closed Cases (N=116, 226)

80%

60%

40%

20%

0%
08/03

15/03

22/03

29/03

05/04

12/04

19/04

26/04

03/05

10/05

17/05

24/05

31/05

07/06

14/06

21/06

28/06

05/07

12/07

19/07
According to the available data, 26.8% cases were confirmed in people between 31 and 40 years old, 21.0% - in the age
group of 21 to 30, 18.7% - 41 to 50 years and 14.8% in the age group between 51 and 60 years old.

As of 20 July 2020, the highest death rate (29.9%) was reported in the age group of 61 to 70 years old, 24.8% in the age
group between 51 and 60 years and 24.1% in the older age group of 71 and above. Male represented 72% and 79%
of the of total reported confirmed COVID-19 cases and deaths respectively.

The table below is showing gender and age distribution of the reported confirmed COVID-19 cases and deaths 20
July 2020, Bangladesh.

Cases Male Female Deaths

> 80 0.6% 0.2% 4.3% 1.4% > 80

71 - 80 1.9% 0.6% 15.4% 2.9% 71 - 80

61 - 70 5.2% 1.9% 23.6% 6.3% 61 - 70

51 - 60 11.0% 3.8% 20.4% 4.4% 51 - 60

41 - 50 13.9% 4.8% 8.9% 2.1% 41 - 50

31 - 40 20.4% 6.4% 4.4% 1.9% 31 - 40

21 - 30 14.3% 6.7% 1.3% 1.0% 21 - 30

11 - 20 2.9% 2.4% 0.6% 0.5% 11 - 20

0 - 10 1.7% 1.2% 28% 0.1% 0.4% 21% 0 - 10

72% 79%
30 25 20 15 10 5 0 5 10 15 20 600 450 300 150 0 150 300 450
Thousands

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WHO Bangladesh COVID-19 Morbidity and Mortality Weekly Update (MMWU) 20 July 2020/Vol. No21

As of 20 July 2020, geographical distribution of confirmed reported COVID-19 cases was available on 100% of cases
(207,453/207,453). Of all cases, 16.4% were reported from Chattogram division, 5.4% - from Rajshahi division, 4.8%
- from Khulna division, 3.5% - from Sylhet division, 2.6% - from Barisal and Rangpur divisions, and 2.2% from -
Mymensingh division.

The figure below is showing the daily distribution of reported confirmed COVID-19 cases per division (except
Dhaka), 16 April – 20 July 2020.

2,000
Chattogram Mymensingh Rangpur Sylhet Rajshahi Khulna Barishal
1,800

1,600

1,400
Number of Cases

1,200

1,000

800

600

400

200

-
16/04

06/05

21/05

26/05

10/06

30/06

15/07
21/04

26/04

01/05

11/05

16/05

31/05

05/06

15/06

20/06

25/06

05/07

10/07

20/07
Available data allows us to see how quickly the number of confirmed cases increased in different divisions in Bangladesh
by looking at the case doubling time in each division. As of 20 July 2020, case doubling time is 9.8 days in Dhaka
division, 11 days in Chattogram, between 12 to 14 days in Rajshahi, Khulna and Sylhet, Barisal and Rangpur at 15
days and 17 days for Mymensingh division.

The figure below is showing the case-doubling time of COVID-19 confirmed cases in all divisions starting from
the day each reported 100th confirmed cases, 20 July 2020, Bangladesh.

D1 D2 D3 D4 D5 D6 D7 D8 D9
100,000
BSL CTG DHK KLN D10
MYM RSH RNP SYT
D12
Number of Cases

10,000 D15

D20

1,000
D40

100
0 10 20 30 40 50 60 70 80 90 100
Days since 100th Confirm Case

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WHO Bangladesh COVID-19 Morbidity and Mortality Weekly Update (MMWU) 20 July 2020/Vol. No21

Case doubling time has increased in Dhaka city to 10 days in week 29. Cases are doubling in more than 10 but less than
12 days in Faridpur; Narayanganj, Gazipur, Munshiganj, Madaripur and Gopalganj districts are in between 15 to 20
days.

The figure below is showing the growth of COVID-19 confirmed cases in all districts of Dhaka division starting
from the day each reported 100th confirmed cases, 20 July 2020, Bangladesh.

D1 D2 D3 D4 D5 D6 D7 D8 D9
100,000
Dhaka City Faridpur Gazipur D10
Gopalganj Madaripur Munshiganj
D12
Narayanganj
Number of Cases

10,000 D15

D20

1,000
D40

100
0 10 20 30 40 50 60 70 80 90 100
Days since 100th Confirm Case

In Chattogram division by 20 July 2020 case doubling time has increased in Chattogram district from 9 days in the
previous week to 11 days this week, Noakhali, Cox’s Bazar, Bandarban and Cumilla – 14 days, Feni and Rangamati
district – 15 days.

The figure below is showing the growth of COVID-19 confirmed cases in all districts of Chattogram division
starting from the day each reported 100th confirmed cases, 20 July 2020, Bangladesh.

100,000
D1 D2 D3 D4 D5 D6 D7 D8 D9 D10
Bandarban Chattogram Cox's Bazar
D12
Cumilla Feni Noakhali

10,000 Rangamati D15

Number of Cases

D20

1,000

D40

100
0 10 20 30 40 50 60 70 80 90 100
Days since 100th Confirm Case

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WHO Bangladesh COVID-19 Morbidity and Mortality Weekly Update (MMWU) 20 July 2020/Vol. No21

The figures below are showing the daily distribution of reported confirmed COVID-19 cases and rolling three-
days average per division, 16 April – 20 July 2020, Bangladesh.
3,000
Dhaka 3 per. Mov. Avg. (Dhaka)
2,500

2,000

1,500

1,000

500

0
26/04

01/05

31/05

05/06

10/06

10/07

15/07
16/04

21/04

06/05

11/05

16/05

21/05

26/05

15/06

20/06

25/06

30/06

05/07

20/07
1,000
Chattogram 3 per. Mov. Avg. (Chattogram)
800

600

400

200

0
06/05

11/05

05/06

10/06

10/07

15/07
16/04

21/04

26/04

01/05

16/05

21/05

26/05

31/05

15/06

20/06

25/06

30/06

05/07

20/07
500
Rajshahi 3 per. Mov. Avg. (Rajshahi)
400

300

200

100

0
26/04

11/05

21/05

05/06

15/06

30/06
16/04

21/04

01/05

06/05

16/05

26/05

31/05

10/06

20/06

25/06

05/07

10/07

15/07

20/07

350
Khulna 3 per. Mov. Avg. (Khulna)
300

250

200

150

100

50

0
26/04

11/05

16/05

31/05

20/06

10/07
16/04

21/04

01/05

06/05

21/05

26/05

05/06

10/06

15/06

25/06

30/06

05/07

15/07

20/07

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 150
100
150
200
250
300
100
150
200
250
300

100
200

100
150
200
50
50

50

50
0

0
0

0
16/04 16/04 16/04 16/04

21/04 21/04 21/04 21/04

26/04 26/04 26/04 26/04

Sylhet

Barishal
Rangpur
01/05 01/05 01/05 01/05

Mymensingh
06/05 06/05 06/05 06/05

11/05 11/05 11/05 11/05

16/05 16/05 16/05 16/05

21/05 21/05 21/05 21/05

26/05 26/05 26/05 26/05

3 per. Mov. Avg. (Sylhet)

3 per. Mov. Avg. (Barishal)

31/05 31/05 31/05 31/05
3 per. Mov. Avg. (Rangpur)

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05/06 05/06 05/06 05/06

10/06 10/06 10/06 10/06

3 per. Mov. Avg. (Mymensingh)

WHO Bangladesh COVID-19 Morbidity and Mortality Weekly Update (MMWU)

15/06 15/06 15/06 15/06

20/06 20/06 20/06 20/06

25/06 25/06 25/06 25/06

30/06 30/06 30/06 30/06

05/07 05/07 05/07 05/07

10/07 10/07 10/07 10/07

15/07 15/07 15/07 15/07

20/07 20/07 20/07 20/07

20 July 2020/Vol. No21
WHO Bangladesh COVID-19 Morbidity and Mortality Weekly Update (MMWU) 20 July 2020/Vol. No21

On 20 July, Bangladesh overall attack rate (AR) is 1,218.1 per 1 million (207,543/170,306,489) and 100% (64/64) of
districts with the total population 2 of 170,306,468 people have reported confirmed COVID-19 cases. In the reported
week (epidemiological week 29), COVID-19 cumulative weekly AR increased by 10.2%, in comparison to the previous
week (1,201 and 1,079 respectively).

The figure below is showing the cumulative weekly COVID-19 attack rate, 08 March – 20 July 2020, Bangladesh.

Attack Rate Poly. ( Attack Rate

1,201
TOT/C/M TOT/C/M )

1,079
1,200
Weekly Attack Rate per Million

954
809
900

659
514
600

386
277
197
300 131
86
56
0.01

0.02

32
0.1

0.3

14
4
1

0
w10 w11 w12 w13 w14 w15 w16 w17 w18 w19 w20 w21 w22 w23 w24 w25 w26 w27 w28 w29

According to the available data, the highest AR continues to be observed in the Dhaka division (3,182.6/1,000,000).
Within the Dhaka division, Dhaka city has the highest AR (12,915.9/1,000,000) followed by Faridpur (1,758.4),
Narayanganj (1,651.6), Munshiganj (1,504.8), Gazipur (1,006.8), Gopalganj (888.8), Madaripur (783.4), Rajbari (700.1),
Shariatpur (673.2), Dhaka (District) (633.8), Narsingdi (620), Kishoreganj (537.9), Manikganj (491.2) and the lowest
AR 279 was reported from Tangail district.

The 2nd highest COVID-19 AR is reported from Chattogram division (913.3/1,000,000), the AR in all the 11 districts is
over 500 per million. Within the division, Chattogram district reported the highest AR (1,435.5/1,000,000) followed by
Cox's Bazar (1,166), Bandarban (1,104.2), Cumilla (771.3), Noakhali (747), Rangamati (725.2), Feni (644.9), Lakshmipur
(587.4), Khagrachhari (582.8), Brahmanbaria (521.4) and the lowest AR 511.8 was reported from Chandpur district.

The 3rd highest AR in the country was reported from Sylhet division (551.7/1,000,000) with the highest AR in Sylhet
district (814/100,0000) followed by Sunamganj (442.8), Habiganj (419.5) and 366.2 in Maulvibazar district.

Barishal division has taken the fourth highest in the overall AR with 498.7/1,000,000 with the highest AR in Barishal
district (790.4/1,000,000) followed by Jhalokathi (488.1), Barguna (483.2), Patuakhali (476.9), Pirojpur (398.9) and the
lowest 210.4 in Bhola district.

In Khulna division the overall AR is 488.6/1,000,00 while the highest AR district is Jhenaidah (892.4/1,000,000) followed
by Khulna (765.7), Magura (642.8), Meherpur (473.6), Narail (454.7), Chuadanga (406.8), Satkhira (380.7), Jashore
(355.5), Kushtia (283.7) and the lowest 222.9 in Bagerhat district.

Rajshahi division has overall AR (465.8/1,000,000) with the highest AR in Bogura district (1,043.8/1000000), followed
by Rajshahi (717.6), Joypurhat (581.3), Natore (386.1), Sirajganj (289.2), Pabna (225.3), Chapainawabganj (180.7) and
Naogaon districts is 95/1,000,000.

2
Source: Population projection from 2011 Census, Bangladesh Bureau of Statistics

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WHO Bangladesh COVID-19 Morbidity and Mortality Weekly Update (MMWU) 20 July 2020/Vol. No21

Although Mymensingh division reported an overall AR of 318.4/1,000,00, Mymensingh district reported high AR
(405/1000000), followed by Jamalpur (303.6), Netrakona (224.2), and Sherpur district (172.5).

The following figure is showing the COVID-19 attack rate per 1,000,000 population in selected divisions, 16 April
- 20 July 2020, Bangladesh.

1000
CTG RNP KLN MYM BSL RSH SYT

800
Attack Rate/1,000,000

600

400

200

0
21/04

06/05

21/05

05/06

20/06

05/07

20/07
16/04

26/04

01/05

11/05

16/05

26/05

31/05

10/06

15/06

25/06

30/06

10/07

15/07
Growth factor (every day's new cases / new cases on the previous day) between 0 and 1 indicates a decline; when it is
above 1 it signals an increase, and if is persistently above 1 this could signify exponential growth. Since the beginning
of June 2020, the GF has been within the range of 0.8 – 1.2 and on 20 July 2020, it is 1.19.

The figure below is showing the Growth Factor of daily confirmed COVID-19 cases, 08 March – 20 July 2020,
Bangladesh.

3.0

2.5

Growth Factor 2
2.0
Growth Factor

1.5

Growth factor 1
1.0

0.5

0.0
08/03

15/03

22/03

29/03

05/04

12/04

19/04

26/04

03/05

10/05

17/05

24/05

31/05

07/06

14/06

21/06

28/06

05/07

12/07

19/07

As of 20 July 2020, according to the IEDCR, 1,041,661 COVID-19 tests with the overall positivity rate of 19.92% were
conducted in Bangladesh by 80 laboratories (46) laboratories in Dhaka city (58%) and (34) laboratories in outside Dhaka

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WHO Bangladesh COVID-19 Morbidity and Mortality Weekly Update (MMWU) 20 July 2020/Vol. No21

(42%). The latest laboratories, which have started the testing: in Dhaka - Sarkari Karmachari Hospital, Authentic
Diagnostic & Consultation Limited and Popular Diagnostic Centre Ltd. 61.3% (638,258/1,041,661) of all samples were
tested by laboratories in the Dhaka city, and 38.7% (403,403) - outside Dhaka.

COVID-19 testing coverage has been gradually increasing in Bangladesh, reaching 6,116/1,000,000: now almost reached
Sri Lanka (6,416/1,000,000) but is lower than Thailand (8,648/1,000,000), India (10,175/1,000,000), Nepal
(21,536/1,000,000), Malaysia (27,473/1,000,000) and Maldives (124,338/1,000,000).

The correlation coefficient (R) is a statistical measure of the strength of the relationship between the relative movements
of two variables. The values range between -1.0 and 1.0. A calculated number greater than 1.0 or less than -1.0 means
that there was an error in the correlation measurement. A correlation of 1.0 shows a perfect positive correlation.
Analyzing data showed that R between number of samples tested and number of confirmed COVID-19 cases is 0.985
(positive correlation).

The graphs below are showing the weekly and cumulative number of COVID-19 conducted tests and daily number
of samples tested and number of daily confirmed COVID-19 cases, 08 March – 20 July 2020, Bangladesh.

1,100 T
1 Million
1,000 T As of 20 July 2020
115,865
87,775
900 T
94,462
800 T
118,033
700 T
110,699
600 T
103,478
500 T 89,057
400 T 65,347
68,175
300 T 08 March 2020 52,821
41,123 Tests N = 1,041,661
200 T First Bangladesh case reported 34,845
22,764
6,577 14,172
786 1,774
100 T 234 368
Positive N = 207,453
0T
10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29
Epi Week

21000 7000
# Daily Tests # Cases
18000 6000
Poly. (# Daily Tests) Poly. ( # Cases )
Number of Tests (N=1,041,661)

Number of Cases (N=207,453)

15000 5000

12000 4000

9000 3000

6000 2000

3000 1000

0 0
05-04

19-04

24-05

07-06

12-07
08-03

15-03

22-03

29-03

12-04

26-04

03-05

10-05

17-05

31-05

14-06

21-06

28-06

05-07

19-07

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WHO Bangladesh COVID-19 Morbidity and Mortality Weekly Update (MMWU) 20 July 2020/Vol. No21

Available data allows us to see how quickly the number of confirmed cases increased in Bangladesh and some other
countries in the WHO South-East Asia region: India, Indonesia, Thailand and Sri Lanka. As of 20 July 2020, the overall
case doubling time in Bangladesh has slowed to 9.5 days this week (0.5 days less in comparison with the epidemiological
week 28).

The figure below is showing the growth of COVID-19 confirmed cases in selected South East Asian countries
starting from the day they reported 100th confirmed cases, 20 July 2020.

1000000
D1 D2 D3 D4 D5 D6 D7
India Indonesia D10
Malaysia Sri Lanka
100000
Thailand Bangladesh

D15
Number of Cases

D12
10000
D20

1000 D40

100
0 10 20 30 40 50 60 70 80 90 100 110 120
Days since 100th Confirm Case

Available data allows us to see how quickly the number of confirmed deaths increased in Bangladesh and some other
countries in the WHO South-East Asia region: India, Indonesia, Thailand and Sri Lanka. As of 20 July 2020, the death
doubling time in Bangladesh is 13 days (1 day less in comparison with the previous epidemiological week).

The figure below is showing the growth of COVID-19 confirmed deaths in selected South East Asian countries
starting from the day they reported 100 th confirmed cases, 20 July 2020.

50000
D1 D2 D3 D4 D5 D6 D7 D8
India Indonesia D10
Malaysia Sri Lanka
5000
Number of Deaths

Thailand Bangladesh

D12 D15
500
D20

50 D40

5
0 10 20 30 40 50 60 70 80 90 100 110 120
Days since 5th Confirm Death

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WHO Bangladesh COVID-19 Morbidity and Mortality Weekly Update (MMWU) 20 July 2020/Vol. No21

4. Contact Tracing, Points of Entry (PoEs) and Quarantine

According to the Directorate General of Health Services (DGHS), as of 20 July 2020, the current institutional quarantine
capacity in the country is represented by 629 centres across the 64 districts, which can receive 31,991 persons. A total
of 23,331 individuals were placed in quarantine facilities and of them 17,406 (74.6%) have been already released. The
highest number of people (6,547) in quarantine facilities was reported on 24 April 2020 while presently, the number
reduced to 5,925. Between 17 March to 20 July 2020, total 389,150 individuals were placed under home quarantine all
the over the county and to date 86.3% (335,643/389,150) have been already released. Remaining 13.8% (53,507
individuals) are in home quarantine now.

By 20 July 2020, in total 42,970 individuals were isolated in designated health facilitates all over the country, of them
24,358 (56.7%) have been released, and 18,612 (43.3%) are presently in isolation facilities.

The figures below are showing the number of individuals in home quarantine and individuals in hospital
isolation, 16 Mach – 20 July 2020, Bangladesh.

25,000
Presently in Facility Quarantine Total Facility Quarantined Total Facility Released

20,000

15,000

10,000
6,547
6,481
6,416
6,112

5,772

5,973
5,743
5,390

5,647
5,301

5,489
5,105
4,926

5,189
5,047
4,644

4,864
4,821
4,586
4,571
4,562
4,257
4,184

4,368
4,082
4,073

4,058
4,006
4,003

4,208
4,144
3,979
3,887
3,848
3,763
3,684
3,680

3,677

3,671
3,666

3,625
3,598

3,574

3,548
3,263

3,488

3,458
3,450

5,000
2,121
1,403
781
233
162
138
137

130
113

98
92

84
70

66
64

0
15/03

22/03

29/03

05/04

12/04

19/04

26/04

03/05

10/05

17/05

24/05

31/05

07/06

14/06

21/06

28/06

05/07

12/07

40,000 19/07

Presently in Isolation Hospital Isolation Released from Isolation

35,000

30,000

25,000
18,612
18,591
18,498
18,248
18,029
17,864
17,660
17,491
17,371
17,319
17,192
17,067
16,873
16,856
16,839
16,715
16,449

20,000
15,947
15,755
15,547
15,147
14,969
14,523
14,267
13,800
13,429
13,155
12,927
12,467
12,190
11,915
11,474
11,026

15,000
10,752
10,302
10,026
9,758
9,340
9,012
8,761
8,243
7,893
7,552
7,399
7,162
6,946
6,754

10,000
6,498
6,240
6,021
5,794
5,529
5,140
4,994
4,984
4,770
4,653
4,464
4,305
3,897
3,816
4,060
3,616
3,383
3,248
3,046
2,748
2,570
2,435
2,361
2,236
2,115
2,017
1,874
1,794
1,771
1,694

5,000

0
05/05

21/05

10/06

26/06

30/06

16/07
09/05

13/05

17/05

25/05

29/05

02/06

06/06

14/06

18/06

22/06

04/07

08/07

12/07

20/07

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WHO Bangladesh COVID-19 Morbidity and Mortality Weekly Update (MMWU) 20 July 2020/Vol. No21

5. Case Management and Infection Control

On 19 July, DGDA released the specifications and minimum testing parameters for the non -medical fabric masks for
community use. This is a timely intervention as government has initiated a media campaign with development partner
support on use of fabric masks by the general public. In Bangladesh, it remains a legal requirement that people use face-
coverings in public areas, to limit the risks of infection, by limiting droplets. It is also an important part of socio -economic
recovery, as people going back to work should adhere to mask-wearing, along with other preventive measures such as
hand and respiratory hygiene, and physical distancing. The document is available on the DGDA website at
http://www.dgda.gov.bd/index.php/news/item/58. The latest WHO interim advice on the use of masks in the context of
COVID-19 is available at https://apps.who.int/iris/rest/bitstreams/1279750/retrieve.

DGDA initiated a series of virtual meetings with experts on setting the minimum acceptable specificity and sensitivity
levels of rapid diagnostic test to detect SARS-CoV-2 antigens. On 9 June, WHO had extended the global call for
expressions of interest for Emergency Use Listing to include Immunochromatographic (lateral flow) or Immuno-filtration
(flow through) rapid diagnostic test to detect SARS-CoV-2 antigens. On 3 July the EUL pipeline was further expanded to
antibody detection enzyme immunoassays (EIAs). Updates on the EUL pipeline are available online at
https://www.who.int/diagnostics_laboratory/EUL/en/.

Upon the request from the DGHS, UN and other development partners have agreed to support health facilities
preparedness and readiness assessment in COVID-19 and non-COVID-19 health facilities. The main purpose of the
assessment was to understand the health system’s response to COVID-19 against a set of indicators in order to identify
the critical gaps and where resource mobilization can be expedited to tackle the COVID-19 pandemic. The checklist was
developed based on the WHO essential health commodities package and a similar checklist prepared by Pan American
Health Organization (PAHO). Following the approval of comprehensive checklist by DGHS, a data-collection guideline
was developed by a core technical team from supporting organisations, which was used for training of data collectors.
Sixty data collectors - project-based staff of different development partners at district level, including surveillance
immunization medical officers of WHO - were trained in three batches. DGHS sent out communication regarding the
assessment to 120 health facilities, including medical college hospitals, specialized hospital, district hospital, Covid-19
designated hospitals including some private and NGO health facilities. The assessment was conducted at the facility level
through interview, physical observation and document reviews using the checklist. Data collection was completed in 25
June. The partners who supported the assessment includes USAID, Save the Children, MTaPs, Concern -World Wide,
iccdr,b, WHO, UNFPA & UNICEF. The contents of the checklist included status of local level response to COVID ; health
workforce capacity with regards to infection prevention and control (IPC) and case management; triage protocol
implementation; status of essential health services; status and functionality of critical equipment and oxygen supply
system and status of WASH and waste management. The results of assessment will be shared soon.

6. Risk Communication and Public Awareness

Risk Communication and Community Engagement (RCCE) partners continue to implement Mask Promotion and
Prevention Campaign through a large variety of channels including social media, networks of NGOs, community radio
networks and faith leaders. Tools for monitoring the implementation of the campaigns have been developed and are
currently implemented to assess the implementation of the campaign and its efficacy in both rural and urban settings.

A special emphasis is given to scale up communication regarding personal protection measures in observance of Eid
celebration when big movement of people is expected between districts and divisions. In this regard’s messages have
been developed for safe transportation and for limiting the potential of COVID-19 transmission. Also, for observing the
Eid celebrations, RCCE partners have been develop messages based on the DGHS and WHO guidelines addressed to
administrators, vendors and customers of cattle markets, spots that are traditionally generating crowded environments
and where special messaging, display of information and enforcing measures are needed to avert infection hubs.

While focusing on personal and community protection messages, WHO continues to produce risk communication
materials on stigma and discrimination for addressing increasing incidence of the issues in communities especially
towards frontline responders, including health workers.

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 WHO Bangladesh COVID-19 Morbidity and Mortality Weekly Update (MMWU) 20 July 2020/Vol. No21

7. Monsoon Floods Update:

The floods started on 30 June 2020, by 20 July fully or partially affected a total of 18 districts, including 60 Upazilas and
280 unions. In the last 21 days, between 30 June - 20 July 2020, the National Health Emergency Operations Centre and
Control Room of DGHS recorded a total of 4,609 cases reported from health facilities of affected districts; among which
were 2,391 cases of Acute Watery Diarrhea (AWD), 607 case of Acute Respiratory Infection (ARI), 293 - skin diseases,
119 - injury cases, 116 - eye infections, 68 - near to drowning, 17 - lightning, 15 - snake-bite cases, and 983 other
cases. The death toll during the same period was 78 (64 persons - from drowning, 8 -from lightning, 5 - from snake-
bite, and 01 from Acute Watery Diarrhea). Considering the health impacts represented by the number of cases and
deaths, the most affected districts are Kurigram, Jamalpur, Lalmonirhat, Gaibandha, Sirajganj, Tangail and Netrokona.

To coordinate response to the flood-affected districts with due

consideration for COVID-19 situation, WHO and DGHS organized a
special meeting with Divisional Directors of Dhaka, Mymensingh,
Rangpur, Rajshahi and Sylhet, all Civil Surgeons and Upazila Health &
Family Planning Officer (UHFPO) of the affected areas. The main issues
discussed included status of the Emergency buffer stock, activation of
mobile medical teams, reducing death due to drowning, management
of snakebite issues in flood affected districts, etc. The main concern is
that a shortage of safe drinking water, food and proper sanitation
facilities would increase the probability of respiratory infections,
communicable and water borne diseases.

To reduce morbidity and mortality due to the floods, the DGHS activated
total 1,271 Mobile Medical Teams at local level, and some of them are
working 24/7 to tackle the flood-related health problems. Pre-
positioned emergency drugs of the medical buffer stock (antibiotic, IV
saline, ORS, WPT, anti-snake venom etc.), mainly supported by WHO,
are being released to manage health problems, and will have to be Photo Credit: Social Media, Bangladesh
replenished as soon as possible.

Health Cluster Co-Leads (DGHS and WHO) are monitoring the overall flood situation from the National Health
Emergency Operations Centre and Control Room of DGHS. There has been no severe disease outbreak, and currently,
there is no shortage of emergency drugs in flood affected districts. WHO Surveillance & Immunization Officer s (SIMO)
and Divisional Coordinators (DCs) are providing technical support to the District Civil Surgeon Offices and Divisional
Director Offices in disease surveillance and coordination activities without hampering routine immunization activities .

8. Useful COVID-19 links:

WHO Bangladesh COVID-19 Situation Reports: https://www.who.int/bangladesh/emergencies/coronavirus-disease-

(covid-19)-update/coronavirus-disease-(covid-2019)-bangladesh-situation-reports

COVID-19 Situation in the WHO South-East Asia Region: https://www.who.int/southeastasia/outbreaks-and-

emergencies/novel-coronavirus-2019

Latest global WHO Situation Report # 181 as of 19 July 2020: https://www.who.int/emergencies/diseases/novel-

coronavirus-2019/situation-reports

WHO Bangladesh awareness and risk communication materials in Bengali:

https://www.who.int/bangladesh/emergencies/coronavirus-disease-(covid-19)-update

COVID-19 updates from the Directorate General of Health Services, Ministry of Health and Family Welfare, Government
of The People’s Republic of Bangladesh: https://dghs.gov.bd/index.php/en/home/5343-covid-19-update

Institute of Epidemiology, Disease Control and Research (IEDCR): https://www.iedcr.gov.bd/

Contact: Dr Bardan Jung Rana, WHO Representative to Bangladesh, ranab@who.int

Dr Hammam El Sakka, Senior Medical Epidemiologist, Team Leader, WHE, COVID-19 IM, WHO-BAN, elsakkam@who.int
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