Early modelling projections from renowned academic institutions suggested that a large-scale CoVID-19 outbreak was likely to take place in the world’s largest refugee camp, in Cox’s Bazar, with over 90% of the Rohingya population estimated to become infected within the first three months and thousands per day requiring hospitalization.
As the coronavirus pandemic was expected to vastly overwhelm the capacity of the existing health services, WHO rapidly engaged multiple UN and NGO partners in the planning and operationalization of specialized dedicated treatment centers and targeted clinical treatment options to mount an effective response to a possible CoVID-19 outbreak within the means feasible in the Cox’s Bazar context, by largely utilizing local capacity.
And while Cox’s Bazar presented an environment where the virus could spread rapidly - a densely populated and fragile setting where traditional measures to contain the virus aren’t feasible - nine months since the first Rohingya patient was found positive for CoVID-19, disease surveillance data backed up by good capacity for laboratory testing indicates that to date 366 refugees have tested positive for CoVID-19 and 10 have died.
To understand more about the transmission of SARS CoV-2 in the refugee camps, the Bangladesh Institute of Epidemiology and Disease Control Research (IEDCR) with support from WHO, UNHCR and partners including the Bangladesh Red Crescent Society (BDRCS/IFRC) and the UK Public Health Rapid Support Team/ London School of Hygiene and Tropical Medicine (UKPHRST/LSHTM), is currently conducting a seroprevalence study in all 34 camps to identify antibodies to the causative agent of CoVID-19.
The seroprevalence study aims to ascertain the population-level exposure to SARS-CoV-2 across the Rohingya refugee camps. To that end, trained teams are visiting randomly selected households and collecting a blood sample from one member of each family household. Based on WHO’s “UNITY protocol” for standardized sero-epidemiological investigations, the study aims to provide evidence-based information for the planning of the CoVID-19 response in 2021.The CoVID-19 Seroprevalence Study has started on 02 December 2020. Dr Fahmida Sultana, a supervisor from BDRCS and Nahida, a data collector from Food for the Hungry (FH), at Sheikh Hasina´s shelter at the Rohingya refugee camps. As a head of household, Sheikh Hasina is one of the first 1000 voluntary participants in the study. WHO Bangladesh/Tatiana Almeida
“Known to be more densely populated than many major cities in the world, the refugee camp in Cox’s Bazar is a setting where outbreaks can spread rapidly. However, against all odds, the number of confirmed cases of CoVID-19 among Rohingya remains much lower than initial estimates and the most-likely reasons behind that could be: low participation in testing early in the outbreak, under-reporting and a high proportion of mild disease among the camp population, which is quite young. In order to provide guidance on public health measures for partners’ response in 2021, we sure need a better understanding of the CoVID-19 seroprevalence among the refugee population”, explains Health Sector Coordinator in Cox’s Bazar, Dr Egmond Evers.
To date, the refugee camps registered 366 CoVID-19 confirmed cases out of 21 778 samples tested. The incidence rate is 42.2 per 100 000 people and the fatality rate of 2.8%. So far, 8.6% of the cases showed severe symptoms at the time of admission. WHO Bangladesh/Tatiana Almeida
“The Institute of Epidemiology and Disease Control Research (IEDCR) of the Government of Bangladesh has decided to conduct a seroprevalence survey among Forcibly Displaced Myanmar Nationals (FDMNs) with WHO support to detect antibodies developed following CoVID-19 infection. This will provide an estimate of the proportion of the FDMN population who have been in contact with the virus,” explains Director of IEDCR, Prof Tahmina Shirin.
“The findings of the first seroprevalence study in Bangladesh will provide important information for the future provision of healthcare services across the camps. It also serves to provide us with valuable lessons for a nationwide seroprevalence study, which will be undertaken shortly”, says Additional Director General (Planning & Development) DGHS, Dr Meerjady Sabrina Flora.
In preparation for the seroprevalence study in Cox’s Bazar, the Institute of Epidemiology and Disease Control Research (IEDCR) and the World Health Organization (WHO) conducted a training for 116 staff of the data and sample collection teams and organized sensitization sessions in the Rohingya refugee camps engaging Government and community representatives, including female leaders, Imams and Majhis to prepare the populations for informed and voluntary participation in the study.
Dr Asm Alamgir, IEDCR Principal Scientific Officer; Dr Adneen Moureen, IEDCR Field Laboratory; and Debashish Paul, WHO Laboratory Expert, at the training organized in November in preparation for the IEDCR led COVID-19 seroprevalence study. WHO Bangladesh/Tatiana Almeida
The CoVID-19 seroprevalence study was launched at a coordination meeting held in Cox’s Bazar on November 29th by representatives from IEDCR, WHO, UNHCR, BDRCS, FH, RI and BRAC. The meeting aimed to provide an overview of the study allowing time for discussions drawing on the experience of partner organizations in running activities in the camps.
Representing IEDCR, Senior Scientific Officer Dr Samsad Rabbani Khan gave a presentation outlining the planning and training required to prepare over 100 humanitarian health care workers to approach approximately 6200 households for participation in the study. On the occasion, Professor Dr Meerjady Sabrina Flora, the chief guest, mentioned the importance of the study for the people living in the refugee camp and for future prevalence studies across Bangladesh.
The CoVID-19 seroprevalence study was launched at a coordination meeting on November 29th allowing partners, including Government representatives, to share their views on the best way forward to successfully conduct the CoVID-19 seroprevalence study in Cox’s Bazar. WHO Bangladesh/Tatiana Almeida
WHO Head of Sub-Office, Dr Kai von Harbou, with IEDCR Principal Scientific Officer Dr Asm Alamgir; and Additional Director General DGHS, Dr Meerjady Sabrina Flora, at the seroprevalence study coordination meeting. WHO Bangladesh/Tatiana Almeida
“High quality public health research is pivotal to provide the evidence-base to understand, respond and control the COVID-19 pandemic. This serological study will give us much needed information on the extent of infection in the community and guide our response measures moving forward. It is another excellent example of the joint efforts of the government of Bangladesh, WHO and key humanitarian organizations to respond to this unprecedented public health emergency and ensure the well-being of the refugee and host populations in Cox’s Bazar”, concludes WHO Head of Sub-Office, Dr Kai von Harbou.
To support the seroprevalence study, WHO is coordinating daily operations, distributing necessary supplies to field teams (including PPE and sample collection tools), supporting the IEDCR Field Laboratory in the district and is undertaking real time monitoring of data as it comes in from teams.
Testing was initiated in the first week of December after deployment of ELISA kits for detection of antibodies against SARS CoV-2. As results become available, WHO will support IEDCR in conducting data analysis to inform necessary public health action in the field and provide lessons for similar contexts.
Sample collection from Rohingya participating voluntary is expected to be concluded by 31 December 2020. The results will be compiled by January 2021 to guide important public health decisions for the new year. WHO Bangladesh/Tatiana Almeida
In 2021, WHO will continue providing leadership, coordination, supportive supervision and collaborative support to all health partners and sectors responding to the COVID-19 emergency response in Cox’s Bazar.