We extracted data from a total of 74 Bangladeshi patients with COVID-19 confirmed through RT-PCR as of April 30. The average age of all patients was 42.59±14.43 years, with a majority belonging to 31-50 years (41.90%). Data from the Institute of Epidemiology, Disease Control, and Research (IEDCR) revealed that 42% of the Bangladeshi COVID-19 cases were aged between 21 and 50 years.28 This age distribution of COVID-19 patients in Bangladesh is similar to that in India but differs from that in the USA, China, and Spain, countries among those hit hardest by the virus.29 This may be because the younger age group of Bangladesh was reluctant to obey government instruction and restriction, falsely thinking themselves immune against COVID19, and another reason could be the lower median age (27.1 years) compared to other countries.30
We observed a male predominance (77%) consistent with the COVID-19 status of Bangladesh (male 73%)28, indicating a strong gender discrepancy in COVID-19 case identification of the adult population in Bangladesh. This may be because of the social context of Bangladesh, where a man is the only wage earner of his family in most cases, and he needs more mobility compared to the female. An analytical report of Ahmed et al COVID-19 cases in Bangladesh stated that the underreporting of female patients even after infection due to shyness or social stigma is a challenge to focus, which might be a potential source of rapid disease transmission.31 However, studies from other countries also found a greater number of male patients with COVID-19 infection than female7,32-34 MERS-CoV and SARS-CoV had a similar pattern of sex distribution33,34, as different factors have been shown to account for the sex-based disparity in immune responses, including genetic factors and hormonal mediators.35
Among the participants, 29.7% had healthcare-related jobs, with the most common suspected place of contact being the workplace (48.6%). Ahmed et al. found 25.66% health workers among all COVID-19 cases of Bangladesh, ranking hospital physicians on top followed by nurses.31 Such exposure puts health workers at the greatest possible source of infection, demanding necessary protective steps to be taken to reduce the risk of infection.36 Furthermore, serum antibodies should be tested among health-care workers before and after their exposure to SARS-COV-2 for rapid identification of asymptomatic infections.1
In this study, 87.8% of participants were symptomatic, wherein the most commonly reported symptoms were fever, cough, breathlessness, myalgia, sore throat, and fatigue. Less commonly reported symptoms included nausea and/or vomiting, headache, runny nose, chest pain, diarrhea, ARDS, stuffy nose, conjunctivitis, and oral ulcer. Several studies also found similar clinical presentations, mostly fever, dry cough and dyspnea21,32,37, correlating clinical features between 2019-nCoV and previous beta coronavirus infections.1 Nevertheless, the complete range of clinical manifestations is not yet clear, as the reported symptoms show a wide variety ranging from mild to severe, even asymptomatic in many cases 38-41. We found that 12.2% of our study patients were asymptomatic, which is comparatively lower than that found in earlier cited studies. Only symptomatic patients and persons with a history of contact with confirmed COVID-19 cases are allowed to test for COVID-19 in Bangladesh, mostly due to the scarcity of RT-PCR testing kits and laboratory facilities43.
No drug regimen has been approved yet to treat infected cases37,44, although our national guideline for clinical management of COVID-19 promoted supportive and symptomatic treatment protocols along with judicial use of different modalities of drug regimen found to be effective by different trials.45 In this case series, more than half of the patients were treated with antibiotics followed by hydroxychloroquine. Antiviral and corticosteroids were given in fewer populations. Oxygenation was required in 6.8% of cases. We found a case-fatality rate of 5.41% out of 74 patients, though the rate is higher (30.8%) according to methods for estimating the case-fatality ratio for a novel, emerging infectious disease.46 However, in the early stage of a pandemic situation, the case-fatality rate is often overestimated, as case detection is mainly biased towards the more severe cases.47
Proper social distancing practice, putting up of mask and hand-washing was practiced by 87.8, 86.5, and 83.8% of the respondents, respectively. This high rate of awareness is mainly because of easy access to the information provided by the government and media about the virus since the very beginning of the outbreak as well as the fact they themselves contracted the disease. Another reason could be that 66.2% of the study participants held an academic degree, which is supported by the positive correlation observed between the level of education and knowledge regarding COVID-1948,49.
Among the study participants, 60 and 52.9% had anxiety and depression, respectively. Among those with anxiety, 59.5, 19.0 and 21.4% had mild, moderate, and severe anxiety, respectively, and among those with depression, 51.4, 37.8, 2.7 and 8.1% had mild, moderate, moderately severe and severe depression, respectively. A similar report was noticed in China, where a total of 53.8% respondents had psychological impact as a consequence of outbreak and suffered with moderate or severe degree; 16.5% reported moderate to severe depressive symptoms; 28.8% reported moderate to severe anxiety symptoms, and 8.1% reported moderate to severe stress levels. Although in public mental health terms, the main psychological impact to date is elevated rates of stress or anxiety, as new measures and impacts are introduced for mitigation of spread, especially quarantine, and its effects on many people’s usual activities, routines or livelihoods – levels of loneliness, depression, harmful alcohol and drug use, and self-harm or suicidal behavior are also expected to rise.50