With Covid-19 cases soaring in the country's frontier districts, possibly due to the spread of the highly contagious Indian variant, experts fear that Bangladesh may face its worst outbreak of the deadly virus at the end of June.

They said if the Indian variant, B.1.617, of the virus makes its way into other areas from the bordering districts, Bangladesh is likely to witness more than 20,000 cases a day in early July, raising the fatality rate sharply.

Lack of necessary oxygen supply and other healthcare facilities may aggravate the situation, according to the experts.

They suggested putting the frontier districts, particularly where the virus infection rate has already gone up, under strict lockdowns like Chapainawabganj and halting inter-district public transport services to contain the virus locally.

Besides, they said, the government should take adequate preparations in advance to face any grim situation like in India and Nepal by increasing the number of hospital beds, treatment facilities, equipment, setting up field hospitals and finding out potential sources for collecting necessary oxygen supplies.

Though the country's average Covid positivity rate was 8.15% on Monday (May 24), it was very high in different districts along the Indian border.

Chapainawabganj was the worst-hit district with 55% infection rate, forcing the local administration to enforce a seven-day strict lockdown. Besides, the positivity rate was over 40% in Rajshahi. The infection rate was also high in some other frontier districts like Satkhira, Jessore, Jhenaidah, Dinajpur, Meherpur, Chuadanga, Sylhet and Moulvibazar.

Talking to our sister newsagency UNB, Directorate General of Health Services spokesman Robed Amin said the deadly Indian variant has already entered the country and there could be a full-scale outbreak of the virus if it spreads across the country.

He said Covid-19 patients with Indian variants were found in bordering districts, including Chapainawabganj, Rajshahi and Jessore. "It's alarming news. As this variant spreads fast, the infection rate may continue to surge seriously, if people show apathy to masking up and abiding by health safety regulations."

Infectious disease expert Dr Be-Nazir Ahmed, a former director (disease control) at the DGHS, thinks the bordering districts are now seeing "a little bit of an outbreak" of the virus due to the prevalence of the Indian strain.

He said it is still difficult to say whether Bangladesh will witness a similar scenario like India. "We'll clearly understand the situation one or two weeks later. It depends on the level of the outbreak and the government's preventive measures."

"If we can contain the variant locally by enforcing strict lockdown before it spreads to major cities, we may not experience a dangerous situation like in India and Nepal," he said.

Dr Be-Nazir said India has been witnessing over 300,000 cases for several weeks, including over 15,000 in West Bengal. "Nepal has also been witnessing 8,000-9,000 cases mainly caused by the Indian variant. So, if this strain spreads across Bangladesh, we may record over 20,000 cases every day at the end of next month or early July."

"The daily cases may even increase to 40,000 if the government fails to take preventive measures by forcing people to wear masks and follow health safety guidelines."

Bangladesh Como Modelling Group (BCMG), a group of health experts from Bangladesh, the USA and Canada, also projected that the country will witness a serious spike in Coronavirus cases mid-June next or at the end of that month due to the holidaymakers travel rush before and after the recently celebrated Eid ul Fitr, along with the entry of the Indian variant.

Talking to UNB, Dr Abu Jamil Faisel, a member of BCMG, said they have submitted their projection to the DGHS on May 12 with some suggestions to control the situation.

He said they think Bangladesh may see over 10,000 cases a day at the end of June and it may continue to increase later if the virus outbreak cannot be controlled in bordering districts.

"Many trucks carrying mangoes are coming to Dhaka and other parts of the country from Rajshahi, Chapainawabganj and other adjoining districts. So, it will be difficult to control the spread of the upsurge of the Indian variant," he added.

Possible consequences

Dr Be-Nazir said if the country records over 10,000 cases for some weeks it will be difficult to control the situation as it does not have sufficient hospital beds, oxygen production, ICUs, doctors, nurses and other facilities and equipment to take care of such a huge number of patients.

He said the demand for oxygen was nearly 210 tons a day when Bangladesh reported over 7,000 cases for a few days in April. "So, when the cases will cross 20,000, we'll need at least 600 tons of oxygen a day to treat the Covid patients. So, oxygen will be the major worry for Bangladesh if the virus cases rise like in India. We'll also face lack of oxygen concentrators, high-flow nasal cannulas, oxygen masks, general and ICU beds and other necessary equipment."

What should be done?

"We first make our efforts to control the virus in the areas where it has already started spreading so that it can't reach other parts of the country. We must keep the border shut with strict monitoring until the situation gets normal in India," Dr Be-Nazir said. Besides, he said, the government should immediately make projections of some potential Covid-19 scenarios and get ready to tackle those.

"For example, if the government makes a projection that the cases may go up to 10,000 at the end of June, then it should work out plans about how to manage it. Now we have the Dhaka-centric Covid-19 management system. We can distribute it and prepare the upazila, district and divisional hospitals to tackle the situation," said Dr Benazir.

He said oxygen, high-flow nasal cannula oxygen concentrators should be there at the district hospital and central oxygen and sufficient ICU beds can be ensured at the divisional hospitals so that 95% patients get treatment in their own divisions or districts.

Besides, he said, the government should determine the oxygen demand if the situation becomes worse and take steps from now on to meet it by importing oxygen and increasing local production. "The government should now contact the countries from where it can import the oxygen when it is needed."

Dr Faisel said the government should now focus on the frontier areas and increase Covid tests and contact tracing extensively there to control the outbreak of the Indian variant.

Dr Robed Amin of DGHS said the government is making all-out efforts to make ready hospital beds and isolation centres to tackle any worse situation. "We've already increased central oxygen supply systems, high-flow nasal cannula, oxygen concentrators, masks and cylinders for ensuring uninterrupted supply of oxygen."

Besides, he said, the DGHS has already signed MoUs with some private companies, including Abul Khair Group, to supply their oxygen for medical use when there will be a crisis in the case of a spike in Covid cases.

He said Bangladesh has the capacity to produce nearly 200 tons of liquid and gas oxygen for the use of Covid-19 patients. "But there are many companies who produce oxygen for different industries. If they supply their major production of oxygen for medical treatment, then we'll be able to meet the daily demand for 600-700 tons. But if the demand increases to 1,000 tons a day, then we'll face a problem."

Besides, the government has a stock of 900 tons of oxygen to treat Covid-19 patients during the crisis period. Dr Robed said there are 1,069 ICU and 12,059 general beds dedicated to Covid patients across the country and 90% of them are now vacant.

What about vaccines?

Meanwhile, despite the government's all-out efforts to get the requisite number of Oxford-AstraZeneca vaccine doses to meet the immediate needs of those yet to get their second dose, there is no concrete outcome yet.

Apart from India, Bangladesh reached out to the United States and United Kingdom to get the AstraZeneca vaccine doses as close to 1.5 million people who have received their first AstraZeneca jabs are unlikely to get their second dose if the government does not receive vaccine doses from the countries it approached or from the COVAX facility.

Speaking of COVAX, it seems Bangladesh will receive a consignment of 106,000 doses of the Pfizer/BioNTech coronavirus vaccine under the global programme co-led by the World Health Organization and global vaccine alliance GAVI.

COVAX confirmed the development to Health Minister Zahid Maleque earlier this month. In line with that expectation, the Directorate General of Drug Administration (DGDA) has issued emergency use authorisation (EUA) to the Pfizer/BioNTech vaccine in the country this weeks.

The EUA was issued as per recommendation of the committee for the evaluation of drug, investigational drugs, vacciness and medical device in case of public health emergency, said a press release signed by Maj Gen Md Mahbubur Rahman, director general of DGDA. This is the fourth Covid-19 vaccine approved for emergency use in Bangladesh.

However, asked whether Bangladesh is getting AstraZeneca vaccine doses soon from the US, a spokesperson at the US Embassy in Dhaka was non-committal, saying the US President committed to providing 80 million doses of vaccine to support global needs by the end of June - but there is nothing specific yet on how many doses Bangladesh will get or when.

"We are working to provide the 80 million doses in the near future and are evaluating the supply and will then make a determination on distribution," he told UNB.

Bangladesh informally came to know that Bangladesh is not in the priority list, as the US does not see any crisis in Bangladesh considering the low number of deaths and cases.

The US Embassy spokesperson said the United States is committed to leading the global response to the COVID-19 pandemic.

"Our overarching aim is to end the pandemic as quickly as possible, and that requires getting as many people vaccinated as fast as possible," he said.

In addition to distributing the 80 million doses of vaccine, the United States is the largest single donor to the global vaccine initiative, COVAX, with $2 billion already donated and plans to provide another $2 billion through 2022.

"We will continue to work with and coordinate closely with COVAX and partner countries around the world to support global vaccination efforts," said the spokesperson.

Earlier, Foreign Minister Dr AK Abdul Momen wrote to US Secretary of State Antony J. Blinken seeking vaccine doses from them immediately.

After its request to the United States, Bangladesh urged the United Kingdom (UK) to help by providing vaccines to meet emergency needs as the second dose vaccination is disrupted in Bangladesh.

"I'm not asking for too much, I'm only asking for 1.6m AstraZeneca doses that they have, they should immediately disperse those to Bangladesh so these people can have their second dose," said the foreign minister.

When approached, a UK government spokesperson told UNB that the UK government does not have a role in the production or distribution of AstraZeneca's vaccines or their supply contracts. The spokesperson said the UK has played a leading role in championing global access to coronavirus vaccines.

The UK is one of the largest donors to COVAX, providing £548 million to deliver more than a billion vaccines to lower-middle income countries this year. So far, COVAX has already helped deliver vaccines to more than 120 countries and territories, over 70 of which are lower-income countries.

"Of the almost 1.5 billion vaccines which have been delivered across the world, more than 400 million doses of the Oxford/AstraZeneca vaccine have been given around the world, at cost," said the spokesperson adding that the UK Prime Minister has confirmed the UK will share the majority of any future surplus coronavirus vaccines from their supply with the COVAX pool, when these are available.

Foreign Minister Momen said the problem that Bangladesh is facing for ensuring the second dose could have been resolved easily if vaccine doses were available from the COVAX facility on time. He also wrote to Indian External Affairs Minister Dr S. Jaishankar apart from telephone conversation between them on vaccine issues.

"I told him (Jaishankar) to send 1.5 million Oxford-AstraZeneca doses to Bangladesh as a gift if there is any export bar," Dr Momen said.

A government source, however, said they are still hopeful of getting some vaccine doses from India in June to meet immediate needs.

Bangladesh entered into a deal with the Serum Institute of India (SII) to purchase 30 million doses of a potential vaccine being developed by AstraZeneca for Covid-19.

Bangladesh was supposed to get five million doses of vaccine per month as the SII and Bangladesh's Beximco Pharma signed the Memorandum of Understanding (MoU) for priority delivery of the vaccine doses.

Bangladesh sought at least 3 million doses of vaccine under the agreement to address the immediate demand in Bangladesh.

Bangladesh has so far received only 7 million of Oxford-AstraZeneca Covid-19 vaccine doses produced by Serum Institute of India (SII) through its contract. Bangladesh also received 3.3 million doses of vaccine as a bilateral partnership gift.

The British government, Oxford University and AstraZeneca, have invested in the research and came together to develop and deliver a vaccine at cost for everyone.

They expect to have surplus doses, but exactly when these will be available depends on a number of factors including the continued reliability of supply chains and whether new doses are needed to deal with variant strains or as a booster. The government officials said both the first dose and second dose vaccination will begin simultaneously in June as procuring vaccine doses from China is at the final stage.

The foreign minister said Bangladesh is at the final stage to procure vaccine doses from China. "It's at the final stage. All types of discussions are very positive."

The government is in discussion to procure 1 crore to 1.5 crore doses of vaccine from China for June, July and August with an initial consignment of 50 lakh doses. Dr Momen said China assured Bangladesh of providing vaccines ensuring its steady flow of supply.

The Cabinet Committee on Public Purchase on Thursday gave final approval to a proposal of the Health and Family Welfare Ministry to procure 1.5 crore Chinese Sinopharm Covid-19 vaccine. As per the approval, the Health Services Division of the Health and Family Welfare Ministry will procure a total of 15 million (1.5 crores) vaccine in the next three months-June, July and August.

Finance Minister AHM Mustafa Kamal presided over the Cabinet body meeting.

"Each month 5 million doses of vaccine will be imported from the Chinese firm", Dr Shahida Aktar, additional secretary to the Cabinet Division, told reporters while briefing on the outcomes of the cabinet body meeting.

Earlier on May 19, the Cabinet Committee on Economic Affairs (CCEA) gave its "in-principle approval" to a proposal of the Health Services Division to import Sinopharm Covid-19 vaccine.

The CCEA also approved "in principle" procurement of the Covid-19 vaccine from Russia in a meeting on April 28.

An official at the Directorate General of Health Services said the government at the highest level is trying to get vaccine doses for smooth conduct of vaccination drives across the country.

"I hope we will get the vaccines. You'll get both doses," he said, requesting all to wait with patience.