Dr Shahriar Rozen, Dr Tahmid Kashem, Dr Jannatul Mawa

The new infectious variants of COVID-19 are menacing all around the world forcing many countries to impose lockdown-type measures. Although the pandemic was under control in Bangladesh a few months ago, the country is experiencing a sudden surge of infection in recent weeks, leading many to wonder if the government would be forced to impose lockdown-type measures in a desperate attempt to control the pandemic.

The alarming surge of new infection and hospitalisation is likely to continue in the coming weeks, due to the spread of the highly infectious new variants and reluctance of people to follow safety guidelines. According to the World Health Organisation, 62% of the dedicated ICU beds are occupied in Bangladesh, including 84% of the occupied ICUs in Dhaka city. The health system likely would be unable to serve the severely ill patients if the upward trend of infection continues for a few more weeks.

Data from different countries show that mass gatherings and indoor activities are among the major factors for spreading COVID-19. This is why all public gatherings and unnecessary movements should be prohibited immediately along with strict enforcement of laws. This should include a complete ban on all gatherings, social and recreational activities, closure of parks, recreational and community centres. Such a ban at this point will reduce the upward trend of the infection, which is essential for the safe operation of businesses to keep the economy functional.

Simply put, partial operation of businesses and commercial activities would be possible if all mass gatherings and unnecessary movements are immediately prohibited. If strict targeted measures are not enforced immediately on mass gatherings and violating public health measures, there will be no option other than total lockdown on all workplaces and activities in the coming weeks.

Recently, the government of Bangladesh has announced an 18-point directive to control the spread of the virus, but a number of them are voluntary guidelines. The directives lack clear mandates for the local governing body in taking restrictive measures, which may make it challenging to implement the policy direction at the local level.

The government should develop a robust matrix with defined parametres and clear mandates to promote a consistent approach to implementing the restrictions all over Bangladesh. Local governing bodies can take uniform decisions on restrictive measures within their local area based on the mandates outlined in the matrix.

Based on the lessons learnt from other countries, the government can adopt a risk-based matrix with defined parametres to implement targeted restrictive measures. The matrix can use hospitalisation/ICU admission rates and test positivity rate as parametres, which will indicate the current burden of the virus on the health system, as well as, the current level of transmission respectively.

The following matrix may be proposed to inform decision-making to control the pandemic in Bangladesh:

• Phase 1 (Restrict – 5-10% case positivity rate): Allow outdoor gatherings of up to 100 people and indoor gatherings of up to 50 people, allow businesses and commercial activities to operate with safety measures in place.

• Phase 2 (Control – 60% occupancy of the dedicated ICU units and 10-20% case positivity rate): prohibit all types of public gatherings, social and recreational activities; prohibit inter-district movement; allow businesses to operate under restrictions.

• Phase 3 (Lockdown – 80% occupancy of the dedicated ICU units and more than 20% case positivity rate with an upward pattern): Impose national lockdown for at least three weeks with a complete ban on non-essential travel, business, and public gatherings.

The government of Bangladesh has recently flagged 31 new districts as high contamination areas, which is undoubtedly worrying. Not prohibiting public gatherings and unnecessary movements will likely lead the country towards a complete lockdown. It is a great that the government has imposed a week-long lockdown. But the situation should be observed very carefully and law enforcement should be strict.

Dr Shahriar Rozen is a public health professional and policy analyst currently working in Canada. Email: rozen@ualberta.ca; Dr Tahmid Kashem is a public health professional and policy analyst currently working in Canada. Email: kashem@ualberta.ca; Dr Jannatul Mawa is an MPH Candidate at the University of Alberta, Canada. Email: mawa@ualberta.ca