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National Preparedness and Response Plan for COVID-19, Bangladesh

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Executive summary

COVID-19 is a novel corona virus that emerged in China in 2019. Coronaviruses are zoonotic viruses that circulate amongst animals and spill over to humans from time to time and have been causing illness ranging from mild symptoms to severe illness. On 7 January 2020, Chinese authorities confirmed COVID-19 and on 30 January 2020, the Director-General of WHO declared the COVID-19 outbreak a Public Health Emergency of International concern )PHEIC(. As of 16 March, 20201 , a total of 167,511 confirmed cases and 6,606 )CFR 4%( deaths in 152 countries. Few countries of South and South East Asia have reported COVID-19 with few cases reported from each of the countries. 16 March, 2020, eight )8( countries in South East Countries )Indonesia, Maldives, Bangladesh, Bhutan, Thailand, Sri Lanka,
Nepal and India( and Pakistan of South Asia have reported confirmed cases. as of 17 March 2020, 8 Bangladesh citizens diagnosed confirmed COVID-19 cases. Subsequently some other persons with history of exposure were quarantined. Few dozen samples were tested in Bangladesh for COVID-19 and all were found to be negative. As of 28th February 2020, there is no reported COVID-19 case in Bangladesh. WHO has assessed the risk emphasized that all countries should be prepared for containment, including active surveillance, early detection, isolation and case management, contact tracing and prevention of onward spread. It has been proven by numerous experiences that the ability to effectively respond to a ‘threat’ is strongly influenced by the extent to which such threats have been assessed in advance and prepared for with corresponding prevention and mitigation measures.
Preparedness planning for health emergencies aims to reduce the burden associated with the health threat in terms of mortality and morbidity, hospitalizations and demand for health care goods and services; to maintain essential services, protect vulnerable groups, minimize economic and social disturbance and enable a quick return to normal conditions. The goal of the plan is prevention and control of COVID-19 in Bangladesh to reduce impact on the health, wellbeing and economy of the country. The objective of the plan is the prevent entry of the disease in the country and in case of importation to prevent or limit local transmission. To facilitate planning and identify response levels, 6 country levels have been identified according to COVID19 infection status. Under each level, the risk assessment should be conducted to determine/maintain/change the response level.
To facilitate planning and identify response levels, 6 country levels have been identified according to COVID19 infection status. Under each level, the risk assessment should be conducted to determine/maintain/change the response level. During level 1, there is no case in the country, in level 2 there is imported case)s(, in level 3, there are limited local transmission and in level 4 there is wide spread local transmission. In level 5, there is decrease in transmission and the last stage is the recovery phases. The country will implement the activities under a national plan through committees from the national up to the upazila level with multisectoral involvement representing the relevant ministries and national and international organizations and development partners. The plan includes mechanism for developing surge capacity to manage the patients, to sustain essential services and to reduce social impact. The response strategy and actions will have to be continuously reviewed and adjusted as necessary to ensure efficient use of financial and human resources for the effective response to the outbreak, and to be reflective of any new information, R&D advances, good practices internationally and updated recommendations from WHO. Disease surveillance with response is an important component for prevention and control of transmission. The country has started screening at PoE and has successfully done quarantine of a large number of persons exposed to the epicenter of the disease Wuhan. The country will implement the plan through over 500 committees in the country. There will be Rapid Response Committees )RRC( along with RRT from national to upazila level responding to outbreak and overseeing quarantine and isolation at home, facilities or community. If warranted social distancing along with limiting or inhibiting social gathering including school closure will be instituted.
Though three hospitals of Dhaka city )Kurmitola, Kuwait Moitree and IDH( have been selected for managing the patients in isolation, but around 500 hospitals will be prepared for initial care of the COVId-19 patients with mild illness. Based on aggravation of the situation, high dependence service along with ICU facilities will be strengthened. Emphasis will be given for prevention of hospital acquired infection and protection of the care giver both at the health care facility, home and the community.
Emphasis will be given for prevention of catastrophic health expenditure with the principle of ‘No One is Left Behind’ and social and gender inclusion. Strong concerted efforts will be taken for risk communication nationally and locally using all media and means of IEC/BCC materials. In case of quarantine specially during community quarantine, measures will be taken to ensure basic needs of the people and security of property of people in general and the care givers through active involvement of the law enforcing agency. Sufficient budget allocation along with political commitment from the highest level will be of paramount importance for successful implementation of the plan.