The flicker of hope that was still alive till a week ago - that Bangladesh could somehow manage to avoid the COVID-19 pandemic ravaging the rest of the world arriving on its shores - got well and truly extinguished with enhanced testing during the course of this past week. As of this Friday, Bangladesh has over 5 times the number of patients testing positive with the disease as it did a week ago. It should be noted at the outset that the number of tests being carried out is still not satisfactory - merely an improvement over last week. Now that it is clear that the number of positive cases we find is merely a function of testing, the government must immediately look to ramp it up even more. By the end of the week, (Thursday, April 9) we managed to get up to 1000 tests in a day. The focus should now be on working up to 5000 per day. It could mean the difference between saving and losing lives.

Economic fallout

The week got underway with the government announcing four fresh stimulus packages worth Tk 67,750 crore to enhance its efforts at overcoming the economic losses arising due to the coronavirus situation. Prime Minister Sheikh Hasina announced the packages at a press conference at her official residence Ganabhaban 12 days after she came up with the first stimulus packages of Tk 5,000 crore for the export-oriented sectors.

The overall size of the stimulus packages now stood at Tk 72,750 crore, nearly 2.52 per cent of the country's gross domestic product, said Hasina, adding that both local and export-oriented products deserved supports amid domestic and global economic crisis caused by COVID-19 that prompted a countrywide shutdown since March 26.

Of the fresh packages, Tk 30,000 crore announced for big industries and the service sector will be distributed by commercial banks as working capital loan at 9 per cent interest rate with the government providing 4.5 per cent in subsidy.

Under the second package worth Tk 20,000 crore, small and medium enterprises, including cottage industries, would also get working capital loan at 9 per cent interest rate with the government giving 5 per cent subsidy.

Besides, a Tk 12,750 crore package was earmarked under the Bangladesh Bank's Export Development Fund to facilitate raw materials imports under back-to-back Letter of Credit at 2 percent from 2.73 percent interest rate.

An amount of Tk 5,000 crore was made to facilitate the 'Pre-shipment Credit Refinance Scheme' at 7 percent interest rate.

Hasina noted that due to the global pandemic, measures to curb its spread had already started to leave a negative impact on the global economy.

She iterated that the huge pressure on the health services alongside unprec edented lockdown and stagnant communication led to an emergency situation. Not only supply but also consumption and investment in demand too witnessed a downward spiral.

'The International Monetary Fund has already declared that a global economic recession has begun while the stock markets across the globe have witnessed a fall of 28-34 per cent over the last few weeks,' she said.

Citing an estimation of the Organisation for Economic Cooperation and Development, she said, 'Global growth could come down to 1.5 per cent if the recession persists for long while a huge workforce across the globe is feared to lose their work.'

Hasina hoped that the country's economy would rebound if the stimulus packages could be implemented quickly. She warned that misappropriation and mismanagement of the fund would not be tolerated.

The prime minister said that the government simultaneously took four programmes under the work plan to be implemented in phases under categories such as immediate, short and long - increasing public expenditure, formulating a stimulus package, widening social safety net coverage and increasing monetary supply.

Sheikh Hasina elaborated the four programmes taken to cope with the possible economic impact of the coronavirus outbreak on the country. Generating employment will be given priority in public expenditure while foreign tours and lavish expenditures will be discouraged. Since the debt to GDP ratio of Bangladesh is much less (3 percent), so the higher public expenditure would not create any pressure on the macroeconomy of the country, she said.

She said that the coverage of the existing social safety net would be further widened to fulfil the basic needs of people living below the poverty line such as day labourers and people engaged in non-formal works.

Notable programmes include distributing food materials free of cost, selling rice at Tk 10 per kg, distributing cash among targeted communities, widening the coverage of the old-age allowance, widow allowance and allowance for the women oppressed by husbands to cent per cent at 100 most poverty-prone upazilas of the country, Hasina explained.

Other operations include speedy implementation of the programme to build houses for the homeless marking the birth centenary celebration of the country's founding president Sheikh Mujibur Rahman.

The prime minister said that steps would be taken to overcome the adverse impact on the economy. The Bangladesh Bank already reduced the Cash Reserve Ratio and repurchase agreement or REPO rate to boost the monetary supply which will continue in the future as per the necessity, she said. The prime minister also listed some of the impacts of the COVID-19 on Bangladesh economy.

Ill effects

The import cost and export earnings in this fiscal year have witnessed a 5 per cent fall compared to the same period of FY 2019, and this fall could further stretch at the end of FY 2020, she said.

There is a possibility of not getting private investment at a desired level due to the delay in implementation of the ongoing mega projects, establishment of the economic zones and also delay in implementation of the decision to reduce the bank interest rates, she said.

The novel coronavirus will have a negative impact on the service sector, especially hotel-restaurants, transport and the aviation sectors. Like other countries of the world, it will also have an adverse impact on the capital market, said the prime minister.

Due to the decline in global demand, the world fuel oil price has been reduced by over 50 per cent for which the inward remittance flow is also being affected, she said.

The Asian Development Bank in its estimation has said the economic loss of Bangladesh could extend up to $3.2 billion due to the coronavirus impact, but under the present circumstances, it is assumed that the extent of loss could be much more.

The purchasing capacity of the low-income people could be reduced as well as there could be disruption in the supply chain due to the long general holidays affecting the production of the SMEs and hindrance in the transport services.

The overall revenue collection in the current fiscal year is less compared to the budgetary target, and this could further increase the budget deficit at the end of the current fiscal year.

The driving forces for attaining over seven per cent growth on an average for three years and lastly 8.15 per cent growth in last fiscal year were strong domestic demand and supporting revenue and monetary policy.

'As a result, the GDP growth could decline due to the negative trend of the macroeconomic indicators,' Hasina said.

After the prime minister announced the packages, finance minister AHM Mustafa Kamal, finance ministry senior secretary Abdur Rouf Talukder and Bangladesh Bank governor Fazle Kabir explained the functioning process of the packages.

Abdur Rouf Talukder said that they made the groundwork for preparing this stimulus package integrating the fiscal and monetary policy as directed by the prime minister to face this unprecedented situation.

About the announced Tk 30,000 crore credit facility, he said normally a recipient repaid his or her loan taken as working capital in four to six months.

If the banks could manage this fund efficiently and the loan recipients repaid their loans in due time, then it would be possible to lend up-to Tk 60,000 crore in two phases in a year from the announced Tk 30,000 crore credit facility, he said. He also observed that it would be possible to access loans worth over Tk 135,000 crore from the stimulus package.

Running out of breath

As the number of cases continues to spike in Bangladesh, health experts have warned that the country's fight against the deadly virus may suffer a big blow due to acute shortage of ventilators and intensive care unit (ICU) staff in the case of a serious outbreak.

According to the experts, around 80 percent of COVID-19 patients do not need hospital admission. But five percent of such patients become critically ill as their lungs get so damaged that they can no longer breathe and suffer from acute respiratory distress, and this type of patients cannot be saved without intensive care involving ventilators.

For patients with the worst effects of the virus infection, they said a ventilator offers the best chance of survival by pushing air, with increased levels of oxygen, into the lungs of the patients and give them time to fight off the infection and recover.

According to Health Minister Zahid Maleque, the country has 550 ventilators and the government is in a process of procuring 380 more.

Taking to UNB, Bangabandhu Sheikh Mujib Medical University (BSMMU) Vice-Chancellor Prof Kanak Kanti Barua, Dhaka Medical College principal Prof Khan Abul Kalam Azad, medicine department head of Dhaka Community Medical College and Hospital (DCMCH), Prof Harun-or-Rashid, and Gonoshasthaya Kendra founder Dr Zafrullah Chowdhury said the country's existing ventilators are too inadequate to handle the regular patients, let alone the critical coronavirus-infected ones.

They suggested the government to immediately procure enough number ventilators from China and other countries where it is available, and train some anaesthetists and nurses to handle the serous patients at the ICU and put them on ventilator to boost the country's preparedness to tackle the pandemic.

Prof Kanak Kanti Barua said the country will surely face a shortage of ventilators if the outbreak goes to a level it has gone in some other countries.

He said the government should take steps for ensuring sufficient ventilators and ICU facilitates and trained manpower across the country as the number of coronavirus cases continue to grow.

"Many people are giving various hypothesis that coronavirus prevalence won't worsen in Bangladesh due to humidity in our weather. We shouldn't believe such unproven perception. We should get ready for dealing with the possible worst situation," he observed.

"We don't know how long this virus will prevail and how many people may get infected with it. So, we should increase our ICU beds and ventilators so that we can save lives from dying with acute respiratory problem being infected by the virus," the BSMMU VC observed.

He also said there are ventilators at many hospitals, but doctors will not be able to use all those for the corona patients as there are many other critical patients who also need that support. "We can't ignore the other patients to save the corona-infected ones. There's no alternative to increasing the number of ventilators and ICU beds to effectively deal with the coronavirus."

He said the post-operative system in all public and private hospitals can be equipped with ventilators and ICU facilities. "The government should also keep in touch with private hospitals so that those can also be used in case of any emergency."

He said 80 percent of corona patients need not to take admission to any hospitals as they can recover from it by remaining in isolation at home. "Around 10 percent patients need to get admission to hospitals and oxygen support or proper care at the ICUs while the rest need ventilator support as their lungs get damaged."

"If the number of patients rise alarmingly, we won't be able to save many lives without adequate ventilators and ICUs," the VC added.

Khan Abul Kalam Azad said, "We've the shortage of both ICU beds and ventilators. If the virus spreads badly, we 'll face serious difficulties in handling the critical patients."

He, however, said the government has taken initiatives to resolve this problem. "The Health Minister is working on it. The Prime Minister has already instructed to ensure at least 15 ICU beds and required ventilators at all the district hospitals. China has assured us of helping Bangladesh in this regard."

Dr Harun said the government hospitals have only 25 percent of the total ventilators the country has. "Around 75 percent ventilators are there at the private hospitals. The existing ventilators are very inadequate to handle badly-infected corona patients. Without access to ventilators, many patients will die if the outbreak takes a serious turn."

Dr Zafrullah said though there are nearly 600 ventilators in the country one-third of them are not functional. "These defective ventilators should be repaired as soon as possible."

Besides, he said, the hospitals designated for dealing with coronavirus patients are not equipped properly with sufficient ICU beds and ventilators for taking care of the patients.

Zafrullah said there is also a shortage of medical staff required to operate the ventilators and take care of patients at the ICUs. "Before placing a patient on a ventilator, anaesthetists and nurses need to perform some procedures. We don't have enough trained anaesthetists and nurses to do so.

He said some doctors and nurse can be given short training so that they can serve the patients at the ICUs and give them ventilator support when it is needed.

Meanwhile, Save the Children urgently called for international assistance to help Bangladesh meet a surge in demand for ventilators to cope with the COVID-19 outbreak and avert a humanitarian disaster in the country.

Most of the country's intensive care beds and ventilators are in major urban centers, including capital Dhaka, making it difficult for remote communities to access, it said.

"At present, it is difficult for Bangladesh to meet the expected surge in demand for ventilators to help respond to the COVID-19 outbreak," said Athena Rayburn, Save the Children's Rohingya Response Advocacy Manager.

"Ventilators and people trained to operate them are urgently needed to protect the host communities and Rohingya refugees to avert a humanitarian disaster. Children are at serious risk of not only contracting the virus, but also of being orphaned or neglected if family members become infected or die," Rayburn added.

Numbers spike

Bangladesh saw a big jump in the number of coronavirus cases, rising by 112 in the 24 hours till April 9, taking the total number of infected people to 330. Last Friday the number was just 61 Another person died from coronavirus in the country in the same 24 hours, raising the death toll to 21, according to Health Minister Zahid Maleque.Last Friday the number of deaths stood at 6.

"In the last 24 hours, we've identified an additional 112 people with coronavirus infection and one person died during the period," he said on Thursday, April 9. Joining the daily health bulletin broadcast from the Institute of Epidemiology, Disease Control and Research (IEDCR), the minister said as the number has spiked, the range of testing has also increased.

In the preceding 24 hours, 1,097 samples had been tested across the country. "We have to stay indoors, as experts suggest. Our Prime Minister has advised the same," said the minister. He also claimed that the country has ample supply of ventilators. "Our country has 550 ventilators and we've ordered 380 more. ICUs and ventilators are not the same."

The minister noted that a number of buildings are being set up as isolation units.

"A building owned by Bashundhara Group is being prepared as a 2000-bed isolation unit, a market in DNCC area will be prepared as another 1400-bed isolation unit," he said.

IEDCR director Prof Meerjady Sabrina Flora said everyone must stay indoors as the rate of infection has gone up significantly. "We've no other alternative to staying indoors to stop the spread," she said while sharing details about the infected people.

Of the 112 newly-affected people in the country, 70 are men and 42 are women said Prof Flora, adding that two-thirds of the total infected people are male.

"Among the 112 newly-infected ones, three are below 10 years, nine between 11 and 20 years, 25 between 21 and 30 years, 24 people between 31 and 40 years, 17 people between 41 and 50 years, 23 between 51 and 60 years, and 11 people are aged over 60 years," she added.

The only patient who died in the last 24 hours was a resident of Dhaka. "He was over 60 years," the IEDCR director said. She also said among the new patients, 62 people were affected in Dhaka and 13 in Narayanganj. The rest are from other districts.

Across the country, 1,486 people were sent to either home or institutional quarantine in the last 24 hours, said DGHS additional director general Dr Samia Tahmina.

Additional reporting by A.R. Jahangir