Where is Bangladesh’s research on Covid-19?

Originally published in Dhaka Tribune on 15 June 2020

The first global case of Covid-19 caused by the novel coronavirus (SARS-CoV-2) was reported from Wuhan, China on December 31, 2019. Within 25 days of reporting the first case, the first publication reporting the background demographics, clinical presentation, and epidemiological data of the first 41 patients was published in China on January 24, 2020.

Scientists from different countries are pacing at an unparalleled speed to publish country-specific research data; many have even compiled data from several countries and published them as reviews or systematic reviews. Since January 2020, the number of research publications has been doubling every 14 days.

Strong research has no substitute

There are now  over 21,000 research papers on Covid-19 registered in the PubMed database, a comprehensive web portal for research articles. Many of these studies report the observational evidence regarding epidemiological characteristics of the disease identifying transmission dynamics, groups at risk, and the various factors involved, along with the possible role of non-pharmaceutical and pharmaceutical interventions to reduce mortality and morbidity.

If we look into South Asia, India reported its first Covid-19 case on January 31 and subsequently published a case series describing the clinical and epidemiological profile of its first 21 Covid-19 patients on April 10. Nepal reported its first Covid-19 case in its territory on January 23 and published data of its first case on February 27. This means high quality research data which aims to answer key questions in regard to how the outbreak is evolving within a specific country (including high and low-middle income countries) can be published during a pandemic.

Why do we need research data when the whole world is grappling with taming the pandemic? Research data has equal importance to clinical care. They are like diaries that keep credible account of the pandemic as it unfolds. This is the first real pandemic of our lifetime, which means there are many key questions we need to answer to understand this pandemic.

To answer these questions, we need country-specific credible published research data. While the pandemic is caused by the same novel corona virus in all parts of the world, the composition of Covid-19 cases differs between countries and regions. Country-specific research data helps policy-makers to refine pandemic preparedness plans, prioritize resource allocation, and target interventions for vulnerable populations.

It helps the physicians identify sub-groups of populations at increased risk and provide appropriate timely medical care. It also provides the opportunity to conduct post-mortem examinations of the country-specific mitigation and containment strategies once the pandemic is over to determine what worked and what did not. Most importantly, published research data help attract global research funding to address key gaps that will help prepare us better for future crises.

A woeful lack in Bangladesh

The first case of Covid-19 from Bangladesh was reported on March 8. Almost 100 days later, with close to 90,000 confirmed Covid-19 cases and about 1,200 deaths, we still do not have one research publication outlining the epidemiological and clinical profile of the Covid-19 cases in Bangladesh.

The live dashboard of IEDCR contains data on cumulative and daily case counts, death counts, distribution of cases, and deaths by gender, age, and districts. Important data related to characterization of Covid-19 cases such as socio-demographic profile, co-morbidities, contact history, clinical symptoms including mild, moderate, and severe cases, length of hospital stay, duration between symptoms onset to hospital presentation, number of patients requiring mechanical ventilation, length of stay in ICU, treatment protocols, and findings from laboratory investigations are missing from Bangladesh.

More than 30% of Covid-19 deaths in Bangladesh have occurred in people younger than 50 years of age — we need to investigate these deaths and understand the risk factors associated with these untimely deaths. Also, a large number of health care workers in Bangladesh have been infected and have died from Covid-19. There is critical need for data investigating the high infection and fatality rate among front-line workers.

Lastly, one of the most discussed issues is the prevalence of asymptomatic Covid-19 cases around the world. Globally, 18-30% people infected with SARS-COV-2 do not develop any clinical signs and symptoms. The prevalence of asymptomatic infection is skewed towards the younger population. Because Bangladesh has a younger population pyramid, data on prevalence of asymptomatic infection is crucial to design prevention strategies.

All these need to happen now in parallel to the country’s response to containing and mitigating the pandemic. Bangladesh has well-trained researchers and clinicians who are actively involved in medical research and with the current pandemic response.

This pandemic provides great opportunity for clinicians and researchers to join forces and publish high quality research data from Bangladesh. Some of the early key questions relating to how the pandemic is evolving in Bangladesh can be answered analyzing routinely collected data.  Moving forward, the research agenda for Bangladesh can be prioritized under three broad categories:

• Epidemiological research understanding the transmission dynamics of Covid-19 and identifying geographical hot-spots and populations at risk of developing severe disease and death
• Investigating which non-pharmaceutical interventions, including hand hygiene, face mask use, social distancing, and lockdown are most effective (and cost-effective) for Bangladesh
• Health system research determining how to improve health care access, optimize care for Covid-19 patients, and protect health care workers at the various levels of health care systems

Dr Nusrat Homaira is a Respiratory Epidemiologist and Senior Lecturer,  University of New South Wales, Sydney, Australia. Dr Najmul Haider is an Epidemiologist and Post-doctoral Researcher at Royal Veterinary College, University of London, United Kingdom.