In the complex setting of Cox’s Bazar, slowing down the spread of SARS-CoV-2 and ensuring quality health care for COVID-19 patients has been a challenge since the onset of the pandemic.
In March 2020, under the leadership and technical expertise of WHO, Health Sector partners established 14 Severe Acute Respiratory Infection Isolation and Treatment Centers (SARI ITCs) to provide quality clinical care and ensure the best chance of survival of COVID-19 patients in the Rohingya refugee camps and surrounding host communities. With a capacity of nearly 1200 beds, these facilities can provide treatment for mild, moderate and severe cases of COVID-19, including provision of oxygen.
Following the increase of positive cases recently registered in the district, these isolation and treatment centers have become instrumental in the joint public health strategy to fight the virus in Cox’s Bazar.
Dr Sachin Nanvit Desai, Clinical Director of the UNICEF/icddr,b SARI ITC and his team examining the medical history of a COVID-19 positive patient who presents mild symptoms. WHO Bangladesh/ Irene Gavieiro Agud
In recent weeks, the medical team at the UNICEF/icddr,b SARI ITC has been observing a decreasing number of patients seeking care in their dedicated isolation facility. However, while the number of people stepping through their doors is reducing, the percentage of those testing positive continue to rise, coinciding with the upward trend of COVID-19 cases recently registered in the country. “On average, we would normally see 80 to 100 patients a day. Now, since the lockdown and Ramadan started, this number has markedly reduced to 25 patients a day, but our positivity rate is pretty high. We are still getting three to four confirmed cases every day”, explains its Clinical Director, Dr Sachin Nanvit Desai.
Since October 2020, a total of 16,638 patients have been admitted to the Severe Acute Respiratory Infection Isolation and Treatment Centers (SARI ITCs) established in Cox’s Bazar, with most of them developing mild or moderate symptoms (85%), a smaller percentage of severe patients (14%) and some critical cases admitted (<1%).
The test positivity rate in Cox’s Bazar has considerably increased in the last weeks, reaching a total of 8,439 confirmed cases since the onset of the pandemic, of which 93% have been registered in the host community. This surge has also been reflected in the records of the SARI ITCs set up in the district, where the current bed isolation occupancy is 27%. From September 2020 to the end of February 2021, Dr Sachin and his team got 55 COVID-19 patients admitted in their facility, most of them developing mild or moderate symptoms. In April, this figure rises to 94 suspected and confirmed cases admitted, reaching the highest monthly case count.
Located at the heart of Teknaf, this isolation and treatment center was established one year ago as a result of the collective government and humanitarian efforts coordinated by WHO to fight the COVID-19 spread in the Rohingya refugee camps and nearby populations. Today, with a capacity of 60 functional beds –and the possibility to upgrade it to 100 beds in four different wards–, this SARI ITC has become a reference healthcare facility for those in the host community who cannot wait or afford to travel two and a half hours to seek medical help at the Cox’s Bazar Sadar Hospital.
“Our whole mentality since the very beginning has been: how do we have a SARI center that complements the existing facilities, especially the Teknaf Upazila Health Complex? We are an isolation center ready for any COVID-19 surge because we take infection prevention and control very seriously, but not forgetting that respiratory diseases will always be here”, recalls Dr Sachin.
WHO Infection Prevention and Control Specialist, Rebecca Rachel Apolot, conducts regular supportive supervision visits to all SARI ITCs in Cox’s Bazar to equip healthcare workers with preventive strategies against further spread of COVID-19. WHO Bangladesh/ Irene Gavieiro Agud
A similar approach is applied at the UNHCR/Relief International SARI ITC. “We admitted an increased number of COVID-19 positive patients since February 2021, with most of the patients coming from the host community due to our location outside the camps”, explains Dr Nazia Sultana, Team Lead of this isolation center. With a capacity of one hundred beds in five different wards, this COVID-19 treatment facility also provides maternity care services for the community and the refugees.
“Last week, we received a call from the camps seeking assistance for a 32-years-old Rohingya women who tested positive for COVID-19 and was in an advance stage of pregnancy. An ambulance brought her to our facility and our dedicated team helped her to give birth a healthy baby boy. They are now in isolation”, adds Dr Nazia Sultana.
When the COVID-19 outbreak started in Bangladesh, WHO and Heath Sector partners set up a referral pathway between partner-led centers and the existing government facilities to better coordinate efforts in Cox’s Bazar. This well-established referral system was also which brought 70-years-old patient Nazir Hossain to the UNICEF/icddr,b SARI ITC in early April. “My grandfather had a fever and was coughing, so we decided to go see a doctor at the Upazila Health Complex. In the flu corner, the doctor told us that the symptoms were similar to COVID-19, so that we should come here to give a sample. Two days later the test came out positive and my grandfather requested to be admitted in this facility, where he spent ten days in isolation”, says Nazir’s granddaughter, Razina Akter.
70-years-old discharged patient, Nazir Hossain, requested to be admitted at the SARI ITC in Teknaf after testing positive for COVID-19. WHO Bangladesh/ Irene Gavieiro Agud
As the majority of the Bangladeshi population living in Cox’s Bazar, Nazir and Razina do not have proper conditions at home to self-isolate, so these SARI ITCs become instrumental when it comes to receiving the best possible care and reducing the risk of getting their family members infected, while helping stop the community transmission. Unfortunately, the stigma and fears associated with infectious diseases, and in particular with the coronavirus, still make a large portion of the population reluctant to isolate in these specialized care centers. This is where risk communication and community engagement come in.
“Our team did a great job from the beginning; calling, explaining and educating the community. If we provide good care, people will come. Every day we deal with their concerns, and the percentage of positive patients coming for isolation has markedly improved”, says Dr Sachin emphasizing that: “We are not a prison. Sometimes a little bit of humanity and humility speaks volumes to the community”.
Since the establishment of the SARI ITCs in Cox’s Bazar, WHO has been encouraging health partners to develop new methods and strategies to foster community engagement and thus reduce their fears. In Ukhiya, Dr Nazia and her team devised some mechanisms to increase trust in the health care system and reduce the stigma associated with epidemic diseases.
Once a month, the medical team at this SARI ITC meets a Health Committee formed by key community members to update them about the COVID-19 situation at upazila level and receive feedback. This two-way communication helps them identify potential gaps and improve their health service delivery. Additionally, visitors can access a tablet and communicate with their admitted relatives via videocall. “It is extremely important to strengthen ties with the community. COVID-19 is a very new thing in the world and in Bangladesh, and we need to be close to the people to mitigate their fears”, adds Dr Nazia.
Despite all the efforts employed, convincing patients to complete their isolation period is still not an easy feat for the healthcare professionals at these health facilities. Jannatul Ferdous works as a nurse lead in the Food for the Hungry/UNHCR SARI ITC located at Camp 5 and deals every day with these situations, especially when it comes to female patients. “Many women want to leave the center before completing their isolation period to go back home and take care of their family”, explains Jannatul. In these cases, proper counseling with patients and relatives, and a supportive community network, become essential.
Dr Md Riad Arefin and his dedicated colleagues received a letter of appreciation from a discharged COVID-19 patient acknowledging the great work and personal treatment received by each of the healthcare workers at the SARI ITC. WHO Bangladesh/ Irene Gavieiro Agud
“The operation of SARI ITCs during this last year has demonstrated the transformative power of our continued capacity building and field monitoring. Despite the challenging and complex context of Cox’s Bazar, partners and healthcare workers have joined forces in an integrated response to ensure the best clinical care of COVID-19 patients in the refugee camps and surrounded communities. One year after the onset of the pandemic, these isolation and treatment centers are the solid evidence that quality and people-centered care can and must be provided for everyone, everywhere, beyond any pandemic”, says Dr Kai von Harbou, Head of WHO Emergency Sub-Office in Cox’s Bazar.
Following the recent increase in COVID-19 cases in Cox’s Bazar, WHO is mobilizing partners to scale up case management capacities for both host as well as refugee population. WHO Bangladesh/ Irene Gavieiro Agud