Uttar Tolarbagh Response: The First Localized Approach to Contain COVID-19 Spread in Dhaka City, Bangladesh, March 2020
Bangladesh reported its first case of COVID-19 on March 8, 2020. Up to early May, Bangladesh Field Epidemiology Training Program (FETP) fellows and graduates investigated every reported case to describe the scope and magnitude of the outbreak and to reduce transmission of COVID-19. When clusters of COVID-19 occurred, the fellows worked with local officials to implement innovative community interventions to prevent spread of COVID-19 in that community.
On March 20, a 73-year-old male with multiple comorbidities died from COVID-19. He was the second person in Bangladesh to die from COVID-19. He lived in Uttar Tolarbagh, which is close to the heart of Dhaka, the capital of Bangladesh. The community is about two square kilometers with 4,000 residents who live in 672 apartments in 40 buildings and a slum of 167 households. A brick wall forms the border of Uttar Tolarbagh and only one road passes through Uttar Tolarbagh.
His death was reported to the Institute of Epidemiology, Disease Control and Research (IEDCR) and Major Dr. Md. Faruk Ahmad, a Bangladesh FETP fellow, lead the outbreak investigation team of two FETP fellows, one anthropologist, and two medical technologists. The investigation team traced and quarantined 120 contacts from this death. They also collected samples from those who had symptoms. During the investigation, a 76-year-old male died in the community on March 22, 2020. He tested positive for COVID-19. The team found out that both patients joined each other at prayers at the same community mosques and were members of the mosque welfare committee.
On March 23, local officials, upon recommendation from the investigation team, closed the two entrance gates and restricted non-residents from entering the community. Since transmission was associated with a mosque, religious leaders ensured social distancing and restricted the participation of older and people with co-morbidities in the routine prayers. The floor of the mosque was cleaned twice daily. The local Member of Parliament supplied personal protective equipment (PPE), hand sanitizer, and a disinfectant spray machine to the security guard and cleaner of this community. Adequate daily necessities like rice, lentils, potatoes, oil, onions, biscuits, snacks, milk for babies, and coffee packs were provided to the people of the adjacent slum. The city office sprayed disinfectants on the road biweekly. Respective house committees took necessary hygiene measures including installing hand washing stations and spraying disinfectant on the exposed and frequently touched areas of houses. A few sellers of fresh vegetables, fish, chicken and meat were authorized to sell their goods in the community.
The outbreak investigation team was present in the community. The Resident Advisor of Bangladesh FETP, Dr. Mallick Masum Billah, supervised the FETP fellows during investigation. The team identified over 800 contacts and tested over 150 people with symptoms. All samples were tested in the virology laboratory of IEDCR. An additional 12 contacts in the community tested positive for COVID-19. Active searches in the community identified nine people who tested positive for COVID-19. Most people with COVID-19 were isolated in a tertiary care hospital and recovered. Four cases with the last case in Uttar Tolarbagh occurring on April 10, 2020. During the investigation, national lockdown was implemented since March 26, 2020. The investigation team established an event-based surveillance of reporting symptomatic cases through hotline from the community.
The combined efforts from Bangladesh FETP, health authorities, local administration and community leaders ensured the reporting of COVID-19 patients from April 11, 2020 to May 12, 2020. The national lockdown ended on May 31, 2020. The Ministry of Health and Family Welfare of Bangladesh identified the approach in Uttar Tolarbagh as a model and later developed a localized containment approach of red, yellow and green zones based on the rate of active cases in the community. From the experience of Uttar Tolarbagh, the FETP Course Director and Director of IEDCR, Professor Dr. Meerjady Sabrina Flora (who was later promoted to Additional Director General of Health Services) played a key role in developing and implementing this localized containment approach in several parts of Dhaka City and several sub-districts.