key: cord-1027229-ip9uuymt authors: Rahman, Md. Mostafizur; Bodrud-Doza, Md.; Shammi, Mashura; Md. Towfiqul Islam, Abu Reza; Moniruzzaman Khan, Abu Sadat title: COVID-19 pandemic, dengue epidemic, and climate change vulnerability in Bangladesh: Scenario assessment for strategic management and policy implications date: 2020-10-16 journal: Environ Res DOI: 10.1016/j.envres.2020.110303 sha: b93aa89025530cc424fc59aaaf86ae0bb679f1bb doc_id: 1027229 cord_uid: ip9uuymt Bangladesh is one of the most vulnerable countries to climate change impacts also struck by the COVID-19 pandemic. The lockdown measures were ineffective with no sign of flattening the curve. Therefore, the high risk of transmission is evident with an increasing number of affected people. Under this circumstance, a multiple hazards scenario can be developed in this country due to climatic hazards such as cyclones, floods, landslides, heat waves, and the outbreak of infectious diseases such as dengue, cholera, and diarrhoea. The country experiences simultaneously the global pandemic, exceptionally prolonged flood along with the recovery stage from the damages due to the cyclone (Amphan). Therefore, these multiple factors have been putting pressure on losing millions of homes, livelihoods, and agricultural crops. This study aimed to assess the potential impact of a simultaneous strike of climatic hazards and infectious disease outbreaks and their possible strategic management in Bangladesh under different scenarios. A mixed methodological approach was followed in this study including a questionnaire survey, in-depth discussion with experts, and extensive literature review to assess the multi-hazard scenario in a resource-limited setting with high population density. A set of statistical techniques were used to analyze the responses (n=1590) from different social groups (healthcare professionals, academicians, students, Government and NGO officials, and businessman) under three scenarios. The results revealed the high possibility of aggravating the impact of COVID-19 pandemic if there is a climatic hazard such as flood, cyclone have appeared. The majority of the respondents agreed that the situation will become more devastating if there is another outbreak of diseases such as dengue, cholera, and diarrhea. The poor and fragile healthcare system of this country cannot bear such unprecedented pressure. The lack of risk assessment and communication, lack of sectoral coordination might restrict the contingency plan of the government. Therefore, considering the unprecedented worst cases a stringent strategic plan for emergency response, short term and long-term management should have to be formulated. Resilience building through proactive planning and implementation of integrated, inclusive and sustainable strategies will be effective to ensure the health and socio-economic security for multi-hazard threats in the country. plan of the government. Therefore, considering the unprecedented worst cases a stringent 37 strategic plan for emergency response, short term and long-term management should have to be recent months (Damani, 2020) . About more than 300 peer-reviewed studies have been 93 demonstrated the extreme weathers worldwide and the potential impact from anthropogenic 94 activities for the induction of such events. Heatwaves are the major contributing events followed Therefore, food security, water availability, public health, agriculture, and livelihoods 162 vulnerability leads the people to below the poverty line, leading to unprecedented human 163 displacements and increased intergroup conflict (World Bank, 2018). 164 Amidst the traumatic situation of nation's anxiety and fear due to COVID-19 pandemic (Shammi 165 et al., 2020), the possibility of climate change induced disasters including tropical cyclone, 166 prolonged floods and its preparedness, the rising of dengue fevers cases and seasonal influenza, 167 and other forms of infections should not be overlooked in Bangladesh. This year the dengue 168 outbreak is thought to be more intense than the previous as expert's prediction and already the 169 reported cases are 3 to 4 times higher at the same time of the previous years (Dhaka Tribune, 170 2020) (Figure-4) . The monsoon season is very crucial for Bangladesh which is lasting from May 171 J o u r n a l P r e -p r o o f to August in terms of climatic hazards and infectious outbreak. Furthermore, the consequences of 172 disposal of used PPE without proper treatment in the landfill or the dumps unconventionally will 173 just arise more disease transmission and environmental disasters leaving the country at stake. 174 The major gap to visualize the actual risk of climatic hazards along with the pandemic is to get 175 satisfactory information on the COVID-19 and its tolls on life, goods, societies, and finance. Therefore, this study seeks to fill these gaps in the existing literature. In such a circumstance, this 177 study is, thus, planned to analyze the COVID-19 pandemic in the light with the unprecedented Bangladesh is a low-lying river deltaic country in South Asia with a unique hydrogeographic 186 setting and high population growth to make this nation more vulnerable . The country is geographically located in a vulnerable position to easily exposed to a set of 188 multiple natural hazards around the years. More specifically, from April, it usually exposes to preparedness. Thus, this study is designed to explore the potential challenges due to multi-hazard 194 exposure risk to tackle numerous socio-economic and health crisis in Bangladesh. Considering the impact of current COVID-19 outbreak, climate change vulnerability and dengue The prepared questionnaire with an introductory paragraph outlining the purpose of the study 216 J o u r n a l P r e -p r o o f was shared through Email, Facebook, LinkedIn, and WhatsApp with selective and relevant 217 people considering the purposive sampling method. The questionnaire survey was conducted 218 from 09 April to 20 April 2020. In addition, one to one in-depth discussion with sectoral experts were also done in this study. The The ratio of male to female participants was 3:1, while the composition of age groups was 44% 236 (18-25 years old), 41% (26-35 years old), and 15% (36-55 years old), respectively. However, 237 the average age of the respondents (n=1590) was 28.44 years (SD±6.51). More than half of the 238 participants were males (71%) and remaining (29%) females. Informed consent was obtained formally before data were amassed from the participants. All the 269 participants were informed before data collection about the specific objective of this study. Participants were able to complete the survey only once and were allowed to terminate the 271 survey at any time they desired. Based on the perception of the respondents in total, 67.9% of respondents in this study agreed 413 that the country will face another physiological shock due to dengue and other disease outbreak 414 during or after COVID19 situation with a mean value of 4.59±0.695, 75.5% agreed that the 415 health sector will face the double burden (Epidemic after Pandemic) which will disrupt its Moreover, for model 2 in the regression analysis, the results indicate that the health system will 437 be disrupted (OS2S2) due to the outbreak of COVID-19 and dengue. This will lead to the severe 438 socio-economic crisis (OS2S4) in Bangladesh (Table-S3 ). This means multiple stressors will be 439 developed with the outbreak of dengue along with the COVID-19 in Bangladesh. and physical health status of the country will decrease (OS3S11, r=0.633, p<0.01). Child 503 mortality rate will increase drastically (OS3S10) had a moderate correlation with social conflict, 504 illegal activities, gender-based violence and crimes will increase (OS3S12, r=0.660, p<0.01). For model 3 (Table-S3 The PC4 (Four) responsible for 9.114% of the total variance and was strongly loaded of the 599 education system will face an irreversible system loss and the total economy will be disrupted (Figure 7) . All the statements were categorized into four major classes: cluster-1(C1), 626 cluster-2 (C2), cluster-3(C3), and cluster-4(C4). C1 consisted of three sub-clusters of C1-A, B, 627 and C; C1-A composed of the country will face another physiological shock, and poverty level 628 will increase (OS1S1-S6). C1-B comprised of the country will face another physiological shock 629 and many people will die due to several health complications including COVID19-like pandemic 630 and dengue-like epidemic (OS2S1-S4). C1-C comprised of the health sector will face the double 631 burden (epidemic after pandemic) which will disrupt its system to provide health supports, and Wider socio-economic effects will likely continue for several months to years across the world 664 which will also significantly impact on the economy of Bangladesh. Both the import of 665 important goods and exports related to the ready-made garment sector and others extremely 666 likely be affected for income and employment, therefore the financial protection during an 667 outbreak is a matter of great concern. At the initial stage of the COVID-19 epidemic, out-of- • Vulnerable hotspots should be identified with proper preventive and response measures. • A comprehensive climate-based disease surveillance system can be initiated to ensure 741 minimum damage with quick recovery policy. • Climate-based disaster and health insurance system can be initiated. • Disease related data should be archived properly with maximize its accessibility. • Climate financing should reach to the most vulnerable and special research fund should 745 be allocated to study the impacts of climatic variations on public health. • There is a huge gap in the environmental diseases related study in Bangladesh, thus a 747 special focus should be created to strengthen understanding of this crucial issue. • Natural disaster, public health, and diseases related surveillance system and data should 749 be made available as real-time to facilitate disaster risk reduction steps. • Proactive, inclusive and integrated humanitarian response to the climatic extreme events 751 amid COVID-19 and implementation of context specific, effective, and sustainable 752 interventions for building resilience. • The long-term strategic plan can be integrated into Bangladesh delta plans (BDP 2100) 754 and National Adaptation Plan (NAP) for better strategic management. Finally, there is no alternative to strengthen the health care facilities and preparedness for the 756 potential humanitarian crisis. Whatever will be the scenario, emergency preparedness for initial 757 response and proper implementation of initiatives for resilience building must be ensured. 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