COVID-19 Impacts and PM&R Response in Bangladesh

(a) Iffat Islam Khan
(b) Taslim Uddin

In Bangladesh first case of COVID-19 was detected on 08th March 2020. As of 29th August 2020, there are 308,925 confirmed cases including 4,206 deaths with case fatality rate 1.4% and recovery rate 64.4% (1). Bangaldesh is a small country with about 165 million populations situated in the South East Asia (SEA). It is a lower-middle-income developing country with 15% of its population has some form of disability. It is the most densely populated country on the world and has the lowest ratios of health care workers and hospital beds to patients. It’s health system is poor with poor emergency treatment facilities, inadequate number of health care workers and has limited rehabilitation facilities (2). Bangladesh had few rehabilitation work forces with mal-distribution of the therapists and rehabilitation physicians at limited numbered institutes across the country. With the limited resources, great concerns were about the national preparedness including the testing capacity and mitigation process to adapt COVID-19 upsurge patients at the peak of the pandemic. The load was further burdened with the largest refugee camp on the world with the fear of mass casualties (3).

Here in this brief report, we present the COVID-19 impacts and physical rehabilitation medicine (PRM) response to this pandemic in Bangladesh.

Bangladesh health care delivery system in acute, post-acute and chronic care services were jeopardized by the COVID-19 pandemic. The misery of doctors and other frontline health care workers were surging with COVID-10 war. According to Bangladesh Medical Association (BMA) and Bangladesh Doctors’ Foundation (BDF) many physicians died due to the disease with about 7500 Health care workers including members of the rehabilitation team were infected by the corona virus (4). There were concerns of personal protective equipment (PPE) and safety procedures of these health care workers. With the imposition of the lockdown restrictions, Physical Medicine and Rehabilitation (PMR) research and academic schedule for residency and other post-graduate skilled development training courses were affected seriously. A recent publication on COVID-19 Bangladesh rehabilitation perspectives described the various ways of affecting the training programs including rehabilitation team meeting, bed side teaching, hands on skill developing programs, interactive and interventional residents’ group program (5). Country wide post graduate doctors of different specialties including rehabilitation medicine enrolled at course were also in anxiety about their future carrier plan as some of the course ending examinations are postponed and many of them are also affected by COVID-195.

Rehabilitation services are affected in a number of core areas including inpatient, outpatient (OPD) and community services; many of which were closed or suspended routine schedules. Services at Bangabandhu Sheikh Mujib Medical University (BSMMU) and other government, non-government centers were closed which adversely affected rehabilitation for long care of disable patients like stroke, traumatic brain injury or spinal cord injury.

In response to COVID-19 pandemic national policy, younger physiatrists, residents of Phase A, Phase B, Fellowship course students and trainees are joined with other acute care physicians in triaging, roster duties and clinical management protocol set by central administration. Telemedicine and virtual OPD consultation services were operated and supervised by the senior faculties of BSMMU. Bangladesh National PMR Society, South Asian Regional Cooperation (SAARC) Rehabilitation Forum, Asia Oceania Society of PMR (AOSPRM) and International Society of PRM (ISPRM) organized webinar was highly popular among the PMR residents across the country. Webinar based morning sessions, case presentations and online didactic classes are carried on with lot of prevailing anxieties and work burdens for the rehabilitation trainees and the Faculties.

As on August 29, 2020, number of COVID -19 recovered cases in Bangladesh were 198,863. Having past experience of other viral post infection complications including chikungunya (6), recently at BSMMU an exclusive multidisciplinary “Post-covid Follow-up Clinics” started for the COVID- 19 survivors to manage the complications including fatigue, cardio-respiratory, musculoskeletal and neurological disorders.

We expect the situation would be improved soon and the rehabilitation residents across the globe would be freed from social distancing, using tight breath holding –disfiguring masks that even hide the self-identity and would be able to move around the campus with eye contact chatting.

(a) Dr. Iffat Islam Khan, Resident Phase B, Department of PMR, BSMMU. ISPRM Ambassador, Bangladesh
(b) Professor Taslim Uddin, Chairman, Department of PMR, BSMMU. ISPRM National Society Representative . Email: taslimpmr@gmail.com

Reference;
1. World Health Organization: https://www.who. int/docs/default-source/searo/bangladesh/ covid-19-;who-bangladesh-situation-reports/ who-covid-19-update-20-20200713.pdf? sfvrsn=931a9b9d_2 accessed 29 August 2020.
2. Uddin T, Islam MT, Rathore F A, O’Connell C. Disability and rehabilitation medicine in Bangladesh: Current scenario and future perspectives. Year : 2019 | Volume: 2 | Issue Number: 4 | Page: 168-177. http://www.jisprm.org/citation.asp?issn=2349-7904;year=2019;volume=2;issue=4;spage=168;epage=177;aulast=Uddin;aid=IntJPhysRehabilMed_2019_2_4_168_272897
3. Islam MM, Yunus MY. The Lancet. June 25, 2020. https://doi.org/10.1016/ S2214-109X(20)30282-5
4. Jagonews. https://www.jagonews24.com/en/national/news/50748. Accessed August 29, 2020
5. Uddin, T., Islam, M. T., Rahim, H., Islam, M. J., Hossian, M. S., Hassan, M. I., Mamun, M. A., Hossain, M. S., Rahman, M. A., & Chobi, F. (2020). Rehabilitation Perspectives of COVID-19 Pandemic in Bangladesh. Journal of Bangladesh College of Physicians and Surgeons, 38, 76-81. https://doi.org/10.3329/jbcps.v38i0.47345
6. World Health Organization. https://www.who.int/news-room/fact-sheets/detail/chikungunya. Accessed August 30, 2020