Reducing the spread of coronavirus in Bangladesh

On 11 March 2020, the World Health Organization declared the COVID-19 outbreak as a global pandemic. With the number of global confirmed cases approaching one million and over 36,571 deaths, 202 countries, areas or territories with cases have all taken extreme action to enforce social distancing in an effort to reduce coronavirus transmission, including the governments of India, Bangladesh and Pakistan.


Effective strategies for controlling disease spread may have unintended consequences in low-income settings. For many residents, physical distancing is not possible. In Bangladesh, with one of the highest population densities in the world and where 87 per cent of the population is engaged in informal work, people need to work daily to provide essential support for their families. The healthcare systems across South Asia do not have sufficient facilities to provide advanced ventilator support for even 1 per cent of projected severe cases. The highest costs of both the lockdown measures and the disease itself will undoubtedly fall on those who are already poor and extremely vulnerable.


Despite the increasingly dire circumstances, there are a number of low-cost (or even free) and effective actions people can take today to prevent the spread of the coronavirus. Regular handwashing with soap reduces the spread of respiratory infections. In low-income communities, the high cost of soap can be a barrier to regular handwashing. Soapy water – a simple mixture of 30g of powdered detergent in any 1.5L recyclable bottle – is a low-cost alternative. Scrubbing hands with soapy water followed by a water rinse is just as effective as washing with soap and water yet is much less expensive than bar soap. Using recycled bottles allows for easy access near toilets and kitchens for communal use. Intensively promoting handwashing with soapy water, as well as installing handwashing stations with soapy water in communities and providing refills dramatically increases uptake. The more frequently people can wash their hands with soap and water the more they can reduce their risks.


Practicing good respiratory hygiene may also reduce the risk of coronavirus transmission. This means covering your mouth and nose with a tissue or your bent elbow when you cough or sneeze. Covering your nose and mouth when you cough or sneeze is part of the standard recommendations to reduce respiratory virus transmission by the World Health Organization. Interventions for schoolchildren in Dhaka and Mymensingh in Bangladesh that taught correct respiratory hygiene behavior and basics of respiratory disease transmission, along with targeted messaging to tap into social norms and approval, were successful at increasing proper respiratory hygiene. The strategies were also highly acceptable according to students who found that coughing/sneezing into upper elbows was simple and protected them and their classmates from germs.


Amidst the COVID-19 pandemic, face masks are in short supply. The World Health Organization and Centers for Disease Control and Prevention recommend that people who are coughing and sneezing should wear a medical mask in conjunction with hand hygiene to reduce the risk of transmission to others.


For most infectious diseases, we know that the higher the dose of the pathogen that people are exposed to, the more likely they are to develop severe illness. While the spread of this coronavirus is inevitable – especially in extremely crowded places such as low-income communities in South Asia – practicing good hygiene behaviours can reduce the risk of serious illness and help prevent transmission. 



Written by Dr Mahbubur Rahman (icddr,b), Professor Stephen P. Luby (Stanford University, USA), and Dr Richard Cash (Harvard University, USA).