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Abstract
To the Editor—The World Health Organization has emphasized the importance of diagnostic
testing in tracking and managing COVID-19, and most high-income economies have adopted
widespread population testing schemes. The United States now leads the way, with >370,000
tests performed as of March 26, 2020.
1
This level of testing starkly contrasts with low-income economies such as Bangladesh,
where an almost contrarian strategy seems to have been adopted that is arguably masking
the true national spread of the virus.
From the first reported case of COVID-19 in Bangladesh on March 8 until March 28,
1,068 samples were tested by the Institute of Epidemiology, Disease Control and Research
(IEDCR) in Dhaka.
2
The IEDCR was the sole institute in Bangladesh with testing facilities for COVID-19
until March 26, when a second facility was given testing rights. Centralized testing
in these underresourced public institutions has been unable to effectively respond
to the wave of suspected COVID-19 patients. Even at this initial stage with limited
confirmed cases, busy telephone hotlines and lack of timely testing for symptomatic
patients raised concerns regarding Bangladesh’s preparedness. In addition, the Bangladesh
government has not sought to proactively limit community transmission from primary
cases thus far. With a population of 161 million and a total of 1,169 ICU beds,
3
this inadequate strategy could potentially devastate Bangladesh’s health system with
multiple outbreaks.
This risk is compounded by thousands of Bangladeshi workers returning from COVID-19–struck
countries and poor adherence to self-quarantine recommendations due to limited education
and monitoring mechanisms. This situation is particularly problematic for Bangladesh
because a significant portion of returning workers (ie, significant sources of SARS-CoV-2)
reside in rural areas outside Dhaka and thus carry the virus to some of the most vulnerable
and ill-equipped communities. This situation was likely worsened by the government
declaring a 10-day holiday without travel restrictions from March 26 to April 5, which
encouraged millions of city workers to leave Dhaka and return to their rural communities.
4
We believe that Bangladesh has lacked coordinated policy decision and enforcement
measures to curtail COVID-19 transmission thus far. We urge policy makers to follow
WHO guidance and observe other countries’ experiences, which point to a strategy of
acting decisively, quickly, and early, well before case numbers reach a crisis level
for containment. We believe Bangladesh has not yet reached this point, so urgent implementation
of a coordinated policy may prevent a spike in cases that is likely to stretch Bangladesh’s
health system well beyond its capacity.
This is an Open Access article, distributed under the terms of the Creative Commons
Attribution licence (
http://creativecommons.org/licenses/by/4.0/), which permits unrestricted re-use, distribution, and reproduction in any medium,
provided the original work is properly cited.