As the coronavirus outbreak quickly surges worldwide, many countries are adopting non-therapeutic preventive measures, which include travel bans, remote office activities, country lockdown, and most importantly, social distancing. However, these measures face challenges in Bangladesh, a lower-middle-income economy with one of the world's densest populations. Social distancing is difficult in many areas of the country, and with the minimal resources the country has, it would be extremely challenging to implement the mitigation measures. Mobile sanitization facilities and temporary quarantine sites and healthcare facilities could help mitigate the impact of the pandemic at a local level. A prompt, supportive, and empathic collaboration between the Government, citizens, and health experts, along with international assistance, can enable the country to minimize the impact of the pandemic.
Introduction
With the outbreak of novel coronavirus-2 (nCoV-2) declared a pandemic and an international public health emergency by the World Health Organization (WHO), the entire world is working to address it. It is a rapidly evolving and emerging situation. In <5 months after the first emergence of the virus in December 2019, nearly two million people in 185 countries around the globe have been identified as confirmed cases of coronavirus disease 2019 (COVID-19) (1). Researchers across the world are working hard to understand better the biology of nCoV-2 and the epidemiology of the novel coronavirus disease-19 (COVID-19). The estimated basic reproductive number of the virus is significantly higher than many other infectious diseases, and this can potentially result in the capacity of health facilities becoming overwhelmed, even in the countries that have the most developed healthcare systems (2). An estimated 20% of cases lead to clinically serious and complex conditions. With some sporadic cases of serious illness in younger individuals, adults >60 years of age and with co-morbid conditions make up the most vulnerable group.
There are as yet no vaccines or antiviral drugs approved for the disease, and hence, non-therapeutic interventions to control the spread of the virus are the most effective measures to control the disease (3). Worldwide, billions of people are staying at home to minimize the transmission of the virus. Many countries are adopting preventive measures, e.g., remote office activities, international travel bans, mandatory lockdowns, and social distancing. Bangladesh, a lower-middle-income country and one of the world's most densely populated areas, is struggling to combat the spread of the disease. In this write-up, we briefly articulate the current scenario of COVID-19 in Bangladesh and provide some recommendations on how the country can combat this pandemic.This brings the PHE guidance in line with that from the RPS, which says that pharmacy staff working in community pharmacies and general practice should wear fluid-resistant surgical masks if they are unable to maintain a social distance of 2 metres from patients and staff, and emphasises that it is still important to try to maintain social distance when wearing surgical masks wherever possible. The RPS also advises that gloves, apron and surgical masks should be worn by staff in direct contact with a patient, for example, when a person is too unwell to go home and is being cared for in the designated isolation space.
On 5 June 2020, the DHSC announced that all staff in hospitals in England will have to wear surgical masks from 15 June 2020, regardless of the clinical area in which they work.
Guidance has been issued by pharmacy organisations on how community pharmacies in England can accept patient returns of unwanted medicines while minimising risk to pharmacy teams. Since coronaviruses can survive on certain surfaces for up to five days, it recommends that all returns should be double bagged and placed directly in waste medicines bins. Controlled Drugs should be double bagged and placed in the CD cabinet for five days before denaturing. A suggested procedure is detailed within the guidance.On 26 March 2020, the GPhC announced that the pharmacy pre-registration assessments for June and September 2020 have been postponed and will be rescheduled for the end of 2020, or early in 2021.
More than 6,200 pharmacy professionals who left the register within the past three years have been given temporary registrationso that they can to return to work during the COVID-19 pandemic, if they wish to do so. And in guidancepublished on 9 April 2020, final year pharmacy students were told they can join their arranged preregistration workplace ahead of the scheduled start date to help deal with the COVID-19 pandemic.
Will the government provide financial help during the pandemic?
The PSNC announced on 31 March 2020 that community pharmacies in England will be given cash advances totalling £300.0m over the next two months to help with cashflow during the pandemic, but no extra funding has been negotiated so far. Further advanced funding of £50m and £20m at the end of May 2020 and June 2020, respectively, has since been announced by the PSNC. As with the £300m previously announced, the £70m is not additional funding and will be reconciled in 2020/2021.
Advance payments have also been agreed for community pharmacies in Scotland and Wales.
Additional funding of an initial £5.6m was agreed in Scotland on 7 April 2020 to support unparalleled levels of activity within community pharmacy during the pandemic. The funding will cover equipment costs, adaptations to premises, additional staffing and locum fees.
On 2 April 2020, the government announced that it had written off £13.4bn of debt as part of a major financial reset for NHS providers.
How can cross-infection be prevented?
The WHO has created a range of infographics to illustrate how patients can protect themselves and others from getting sick; however, most of the advice is similar to what would be provided for colds and flu (see FigureA strict lockdown started in the UK on 23 March 2020, with people told to stay at home except to buy essential food and medicines, one form of exercise a day, any medical need, and travelling to and from essential work. Gatherings of more than two people in public was not allowed and all shops selling non-essential goods, libraries, playgrounds, outdoor gyms and places of worship closed. All social events, including weddings, baptisms and other ceremonies, but excluding funerals were cancelled.
A relaxation of the lockdown was announced by Johnson on 10 May 2020. The goverment published a 60-page ‘recovery strategy’ on 11 May 2020, which sets out the next phases of the UK’s response to the virus, including easing some social restrictions, getting people back to work and reopening schools.
What is happening with testing for COVID-19?
As of 6 September 2020, 17,619,897 antigen or antibody tests for COVID-19 had been processed in the UK. On 2 April 2020, health secretary Matt Hancock outlined plans to dramatically increase testing across the UK to 100,000 tests a day by the end of the month, a target that was initially met. The new target is 200,000 tests a day by the end of May 2020, which was exceeded on 30 May 2020.
Tests can now be accessed by anyone with symptoms via nhs.uk/coronavirus.
An NHS test and trace service was launched across England on 28 May 2020, with similar services starting in Scotland and Walesaround the same time. Anyone who tests positive for the virus is contacted to share information about their recent interactions. People identified as being in close contact with someone who tests positive will have to self-isolate for 14 days, regardless of whether they have symptoms.
Testing is also now available to care home staff and residents in England, and NHS workers where there is a clinical need, whether or not they have symptoms.
Pharmacy staff in England and Scotland should book tests online via gov.uk and they will be conducted at drive-through testing sites across the country, as well as via home testing kits.
Pharmacy staff in Wales with symptoms of COVID-19 are able to access testing through their Local Health Board.
The government has also announced the start of a new national antibody testing programme, with plans to provide antibody tests to NHS and care staff in England from the end of May 2020. Clinicians will also be able to request the tests for patients in both hospital and social care settings if they think it is appropriate..
As of 6 September 2020, there have been 347,152 confirmed cases of the virus in the UK and 41,551 of these have died (in all settings, within 28 days of the test).
This article gives a brief overview of the new virus and what to look out for, and will be updated weekly. It provides answers to the following questions:
Where has the new coronavirus come from?
What social distancing measures are being taken in the UK?
What is happening with testing for COVID-19?
What should I do if a patient thinks they have COVID-19?
What can I do to protect myself and my staff?
What about ‘business as usual’ during the pandemic?
Will the government provide financial help during the pandemic?
How can cross-infection be prevented?
Where can I find information on managing COVID-19 patients?
Is the coronavirus pandemic likely to precipitate medicines shortages?
Are there national clinical trials of potential drugs to treat covid-19?
What are coronaviruses?
SARS-CoV-2 belongs to a family of single-stranded RNA viruses known as coronaviridae, a common type of virus which affects mammals, birds and reptiles.
In humans, it commonly causes mild infections, similar to the common cold, and accounts for 10–30% of upper respiratory tract infections in adults[4]. More serious infections are rare, although coronaviruses can cause enteric and neurological disease[5]. The incubation period of a coronavirus varies but is generally up to two weeks[6].
Previous coronavirus outbreaks include Middle East respiratory syndrome (MERS), first reported in Saudi Arabia in September 2012, and severe acute respiratory syndrome (SARS), identified in southern China in 2003[7],[8]. MERS infected around 2,500 people and led to more than 850 deaths while SARS infected more than 8,000 people and resulted in nearly 800 deaths[9],[10]. The case fatality rates for these conditions were 35% and 10%, respectively.
SARS-CoV-2 is a new strain of coronavirus that has not been previously identified in humans. Although the incubation period of this strain is currently unknown, the United States Centers for Disease Control and Prevention indicate that symptoms may appear in as few as 2 days or as long as 14 days after exposure[6]. Chinese researchers have indicated that SARS-CoV-2 may be infectious during its incubation period[11].
The number of cases and deaths outside of China overtook those within it on 16 March 2020
Where has the new coronavirus come from?
It is currently unclear where the virus has come from. Originally, the virus was understood to have originated in a food market in Wuhan and subsequently spread from animal to human. Some research has claimed that the cross-species transmission may be between snake and human; however, this claim has been contested[12],[13].
Mammals such as camels and bats have been implicated in previous coronavirus outbreaks, but it is not yet clear the exact animal origin, if any, of SARS-CoV-2[14].
How contagious is COVID-19?
Increasing numbers of confirmed diagnoses, including in healthcare professionals, has indicated that person-to-person spread of SARS-CoV-2 is occurring[15]. The preliminary reproduction number (i.e. the average number of cases a single case generates over the course of its infectious period) is currently estimated to be between 1.4 to 2.5, meaning that each infected individual could infect between 1.4 and 2.5 people[16].
Similarly to other common respiratory tract infections, MERS and SARS are spread by respiratory droplets produced by an infected person when they sneeze or cough[17]. Measures to guard against the infection work under the current assumption that SARS-CoV-2 is spread in the same manner.
How is COVID-19 diagnosed?
As this coronavirus affects the respiratory tract, common presenting symptoms include fever and dry cough, with some patients presenting with respiratory symptoms (e.g. sore throat, nasal congestion, malaise, headache and myalgia) or even struggling for breath.
In severe cases, the coronavirus can cause pneumonia, severe acute respiratory syndrome, kidney failure and death[18].
The case definition for COVID-19 is based on symptoms regardless of travel history or contact with confirmed cases. Diagnosis is suspected in patients requiring admission to hospital with signs and symptoms of pneumonia, acute respiratory distress syndrome or influenza, and in those with a new, continuous cough or fever who are well enough to stay in the community (see Box 1). A new symptom, a loss or changed sense of normal smell or taste (anosmia), was added on 18 May 2020. A diagnostic test has been developed, and countries are quarantining suspected cases[19].
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