Heliyon 6 (2020) e04063

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Heliyon
journal homepage: www.cell.com/heliyon

Research article

COVID-19 pandemic, socioeconomic crisis and human stress in

resource-limited settings: A case from Bangladesh
Mashura Shammi a, Md. Bodrud-Doza b, Abu Reza Md. Towfiqul Islam c,
Md. Mostafizur Rahman a, *
a
Department of Environmental Sciences, Jahangirnagar University, Dhaka-1342, Bangladesh
b
Climate Change Programme, BRAC, Bangladesh
c
Department of Disaster Management, Begum Rokeya University, Rangpur-5400, Bangladesh

A R T I C L E I N F O A B S T R A C T

Keywords: Considering the population density, healthcare capacity, limited resources and existing poverty, environmental
Psychology factors, social structure, cultural norms, and already more than 18,863 people infected, the community trans-
COVID-19 mission of COVID-19 is happening fast. These exacerbated a complex fear among the public. The aim of this
Perception-based questionnaire
article is, therefore, to understand the public perception of socioeconomic crisis and human stress in resource-
Principal component analysis (PCA)
limited settings of Bangladesh during the COVID-19 outbreak.
Linear regression model
Social panic The sample comprised of 1066 Bangladeshi participants. Principal component analysis (PCA) was considered to
Social conflict design a standardized scale to measure the mental stress and socioeconomic crisis, one-way ANOVA and t-test
were conducted to perceive different demographic risk groups; multiple linear regression was applied to estimate
the statistically significant association between each component, and classical test theory (CTT) analysis was
applied to examine the reliability of each item according to the components to develop a composite score.
Without safeguarding the fundamental needs for the vulnerable ultra-poor group can undeniably cause the
socioeconomic crisis and mental stress due to the COVID-19 lockdown. It has further created unemployment,
deprivation, hunger, and social conflicts. The weak governance in the fragile healthcare system exacerbates the
general public's anxiety as the COVID-19 testing facilities are centered around in the urban areas, a long serial to
be tested, minimum or no treatment facilities in the dedicated hospital units for COVID-19 patients are the chief
observations hampered along with the disruption of other critical healthcare services. One-way ANOVA and t-test
confirmed food and nutritional deficiency among the vulnerable poorest section due to loss of livelihood. Also,
different emergency service provider professions such as doctors, healthcare staff, police forces, volunteer or-
ganizations at the frontline, and bankers are at higher risk of infection and subsequently mentally stressed. Proper
risk assessment of the pandemic and dependable risk communications to risk groups, multi-sectoral management
taskforce development, transparency, and good governance with inter-ministerial coordination is required along
with strengthening healthcare capacity was suggested to reduce mental and social stress causing a socioeconomic
crisis of COVID-19 outbreak. Moreover, relief for the low-income population, proper biomedical waste man-
agement through incineration, and preparation for the possible natural disasters such as flood, cyclones, and
another infectious disease such as dengue was suggested. Finally, this assessment process could help the gov-
ernment and policymakers to judge the public perceptions to deal with COVID-19 pandemic in densely populated
lower-middle-income and limited-resource countries like Bangladesh.

1. Introduction into larger chains of spread in many countries resulting in the widespread
transmission consequently across the globe affecting all the continents
The World Health Organization (WHO) announced COVID-19 as a (Anderson et al., 2020). The fatality case of COVID-19 risk is around 1%
global pandemic on March 11, 2020. The disease has advanced into a and that it can kill healthy adults, as well as the elderly people with,
pandemic, started with small chains of spreading, further culminating existing health problems (Gates, 2020). According to Worldometers

* Corresponding author.
E-mail address: [email protected] (Md.M. Rahman).

https://doi.org/10.1016/j.heliyon.2020.e04063
Received 6 April 2020; Received in revised form 15 May 2020; Accepted 20 May 2020
2405-8440/© 2020 The Author(s). Published by Elsevier Ltd. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-
nc-nd/4.0/).
M. Shammi et al. Heliyon 6 (2020) e04063

(2020), 14 May 2020, with the total coronavirus cases rising to 4,490, Institute of Epidemiology, Disease Control and Research (IEDCR) is
958, and total deaths 301,616, USA is the worst affected country from the the research institute under the Ministry of Health responsible for
COVID-19 pandemic with 86,098 deaths. It took 67 days from the first COVID-19 surveillance in Bangladesh, first confirmed the COVID-19 case
reported of COVID-19 to reach 100,000 cases, 11 days for the second on 7 March 2020, followed by a nationwide lockdown of all educational
100,000, and just four days for the third 100,000 (WHO, 2020a,b). The institutes, government and private offices, and industries from 26 March.
accelerating spread of the COVID-19 and its outcomes around the world The government of Bangladesh (GoB) deployed armed forces from 24
has led people to fear, panic, concern, and anxiety (Ahorsu et al., 2020), March to facilitate the social-distancing and prevention of the disease.
panic buying of surgical masks (Wang et al., 2020), stigma, depression, Emergency healthcare services and law enforcement services were
racism, and xenophobia. Besides, as there is no medication and vacci- exempted from this announcement. Nevertheless, just after the
nation yet, wrong use of disinfectant liquids, methyl alcohols, garlic, announcement of lockdown, more than 11 million people left Dhaka to
lemon tea is amongst the many misinformation to cure COVID-19. be in their home districts and commenced the risk of COVID-19 infection
Moreover, the fear of infection, quarantine, social isolation, a lack of to the entire 64 districts in Bangladesh. On 15 May 2020, with 20,065
self-care even leads individuals to suicide. Predictably, any contagious confirmed cases, 298 deaths (Figure 1) Bangladesh is within the top 30
epidemic outbreak has deleterious effects on individuals and society affected country. With only 41 labs located in the urban areas, it is not
(Duan and Zhu, 2020). easy to be tested for COVID-19 and often the tests are done after the

Figure 1. Map of the study area showing number of COVID-19 confirmed patient (Data source: IEDCR).

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M. Shammi et al. Heliyon 6 (2020) e04063

patients had expired. Moreover, at present Bangladesh has 1,169 ICU 2. Methodology
beds, totalling to 0.72 beds/100,000 citizens. Of these 432 beds are in
government hospitals and 737 in private hospitals. Likewise, there are 2.1. Study procedure
only 550 ventilators in the country (IEDCR, 2020).
Amidst the lockdown of the COVID-19 pandemic, Bangladesh also has Considering the impact of COVID-19 outbreak in Bangladesh, this
been facing other epidemics of panic buying, social stigma, fear, and study identifies several relevant and possible items based on the country's
hatred. The primary healthcare treatments in the hospitals and private situation analysis based on the print and electronic media, and literature
clinics were disrupted in the lockdown. Moreover, many emergency review. We drafted the questionnaire considering demographic charac-
service providers such as frontline doctors, healthcare staffs, caregivers, teristics, individual mental health condition (MH), the health system in
police and armed forces, bankers and government authority were infec- Bangladesh (HSB), governance and political issues (GPI), government
ted, isolated and even died. Private practitioners, clinics, and hospitals in decisions and impacts (GDI), socioeconomic issues (SEI), immediate
suburban and rural areas were shut down due to the fear of infection. emerging issues (IEI) and enduring emerging issues (EEI). A total of 49
Moreover, the healthcare workers who have treated the patients and items was considered in the drafted questionnaires to get people's
infected have been socially hatred and stigmatized. Besides, the deceased perception of the COVID-19 outbreak in Bangladesh. Furthermore, expert
was even denied burial in the local graveyards which are basic human consultation was considered to set and validate these 49 items.
rights and, in most cases, handled by the government authority (TBS, Bangladesh has witnessed a boom in internet usage due to the fast-
2020a). The price hike of the daily necessities was observed due to low growing mobile internet and the government's push for digitalization.
supply and shopkeepers and suppliers stopped working fearing infection. There are 99.428 million internet users in February 2020 according to
Middle-income, lower-income and daily-wedge earners fell into a severe the Bangladesh Telecommunication Regulatory Commission (BTRC,
financial shortfall due to loss of jobs, incomes. With their last savings 2020). Google Form based online questionnaire was prepared to conduct
spent, they are plunged to be ultra-poor. the survey. An online database of target participants was prepared by
Considering the population density, environmental factors, social reviewing the relevant websites and online social platforms of different
structure, cultural norms, healthcare capacity, and poverty in groups in Bangladesh, considering their Bangladeshi citizenship, age
Bangladesh, it is certainly hard to lockdown millions of people. Besides, above 18 years, current activities, occupation, social responsibilities, and
Bangladesh hosts the largest refugee camps in Cox's Bazar which is also engagement related to COVID19 response, socioeconomic sector,
about to embrace the COVID-19 pandemic, where, it will have cata- country-level planning, and policymaking. The prepared questionnaire
strophic outcomes (Hopman et al., 2020). Despite the precautions taken with an introductory paragraph outlining the purpose of the study was
by the government and other international aid bodies, on 14 May 2020, shared through Email, Facebook, LinkedIn, and WhatsApp with selective
the Coronavirus cases were detected in Cox's Bazar Rohingya camps and relevant people considering the purposive sampling method. The
(TBS, 2020b). Moreover, miscommunication among the government questionnaire survey was conducted from 28 March to 30 March 2020.
ministries, policymakers, advisers and the country's apex trade organi- The inclusion of the respondents was different social groups like
zations such as Federation of Bangladesh Chambers of Commerce and university faculty and scholars, Government officials, development
Industries (FBCCI) and the trade organization of the ready-made garment worker or practitioner, doctors, engineers and technologists, youth
(RMG) manufacturers Bangladesh Garment Manufacturers and Exporters leaders and students, businessmen and industry officials, banking and
Association (BGMEA) led industry workers to return to the industrial finance corporates, researchers, and others. The answers to the survey
districts due to the message of reopening at least two times first on 4th questionnaires are the voluntary basis. Data from 1082 respondents were
April and later on 11th April. To save their jobs, thousands of RMG collected via a nationwide online survey method, but following the
workers travelled back to Dhaka and its surrounding districts on foot, in a removal of incomplete 16 questionnaires, 1066 were retained for this
truck, or covered vans without social distancing while ensuring further study. A five-point (1–5) Likert scale was employed to test whether each
transmission. The district of Dhaka and its Upazilas Savar and Ashulia, understands the statement descriptions that ranged from strongly
Gazipur, Narayanganj, and Chittagong remained the highest infected disagree to strongly agree with the statements (Table S1).
clusters of COVID-19 infection (IEDCR, 2020). The latest extension
period declared by the GoB is until 30 May 2020. Yet the RMG factories
and other industrial operations resumed from 26 April 2020. Moreover, 2.2. Data analysis
as the biggest Muslim festival Eid-Ul-Fitr approaches, mass people are
gathering in the shopping centres despite the risk of spreading human Employing the Statistical Package for the Social Science (SPSS) v.
transmission. It is utterly depicting the scenario of overlooking risks of 25.0, datasets were analyzed for Principal component analysis (PCA),
the pandemic by unaware citizens while social anxiety and fear of the one-way ANOVA and t-Test, multiple linear regression, and classical test
pandemic in concerned citizens. Both should be immediately dealt with theory (CTT). PCA is considered in this study to design a standardized
by the Government along with the alliance groups with proper risk scale to measure the socioeconomic crisis and mental stress in
communication. Bangladesh due to the COVID-19 outbreak. PCA is one of the population
Moreover, the possibility of natural disasters such as tropical cy- data reduction techniques that indicate each potentiality of variables and
clones, flooding, and landslide preparedness, the rising of dengue fevers, their significance level in a huge sample size. Before conducting the PCA,
and other infections are potentially overlooked. Furthermore, the con- Kaiser-Maier -Olkin (KMO) and Bartlett's sphericity tests were applied to
sequences of disposal of used personal protective equipment (PPE) confirm the necessity of this analysis. The results of the KMO >0.5 (the
without proper treatment in the landfill will just arise more disease KMO value was 0.903 in this research) and the significance of Bartlett's
transmission and environmental disasters leaving the country at stake. In sphericity test at p < 0.01 verified our datasets to be fitted for the PCA
these circumstances, this study was therefore designed to analyze so- (Islam et al., 2020). The number of factors chosen was based on the
cioeconomic crisis and mental stress in resource-limited settings of Kaiser's normalization principle, where the only factors with
Bangladesh due to the COVID-19 outbreak. This assessment might be eigenvalues>1.0 were regarded. PCA results were used to find how many
useful for the government and policymakers of countries with a similar components are to be retained as well as how many items in each of those
socioeconomic and cultural structure like Bangladesh. components are to be retained.

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M. Shammi et al. Heliyon 6 (2020) e04063

Furthermore, the test of association between each principal compo- (SD  10.05), and the participants had, on average, 12.5 years of formal
nent and the demographic characteristic of the respondents were per- education (SD  8.1). More than half of the participants were males (n ¼
formed to see how people of different demographic status to perceive 661; 61.5%) and remaining (n ¼ 405; 38.5%) females. Nearby, 60% of
socioeconomic crisis and mental stress using the one-way ANOVA and t- the youth group was mostly students as Bangladesh is a youth dividend
test. Moreover, multiple linear regression was applied to estimate the country and they are the most dynamic groups of the society as well as
statistically significant association between each component. dynamic on online platforms. The rest of the 40% were from various
Classical Test Theory (CTT) analysis was applied to examine the professions of doctors and health workers, civil service officials, non-
reliability of each item according to the components to develop a com- government officials, teachers and scholars, policymakers, researchers,
posite score. Cronbach's alpha was employed to test the consistency and and businessmen (Table S1).
reliability of the factor loadings in this study (DeVellis, 1991). Descrip-
tive statistics (e.g., Mean, Standard Deviation, Variance, Skewness, and
3.2. Relationships among demographic characteristics, socioeconomic
Kurtosis) of respondents perceived socioeconomic crisis and mental
components, and mental stress
stress was considered based on the developed composite score for the
entire scale. The hierarchical cluster analysis (HCA) and Pearson's cor-
The scree plot (Figure 2) shows that a total of eight components can
relation coefficient was applied for identifying the relationships among
be retained (determined by components with eigenvalues greater than
all-composite items.
1). Items with factor loadings (items loading on a component) less than
0.5 were omitted from the analysis and analysis repeated on the
2.3. Ethics statement remaining items until a perfect scale was developed (Hair et al., 2014).
We inspected the loadings of the items on each component and omitted a
The consent of participants was taken, and they remained anony- total of 12 items (have not met the 0.5-factor loading requirement) from
mous. We have applied for the ethical clearance to the ethical clearance the questionnaire. The scores of the items that loaded well on each
authority of Jahangirnagar University, Bangladesh. The studies involving component are represented in Table 1.
participants of this questionnaire was reviewed by the Department of The loading scores were demarcated into three groups of weak
Public Health and Informatics and permit to conduct this study. (0.50–0.30), moderate (0.75–0.51), and strong (>0.75) respectively (Liu
et al., 2003; Bodrud-Doza et al., 2016; Islam et al., 2017). The PC1 (First)
3. Results elucidated 8.85% of the variance as it encompassed a confidence level of
moderate positive loading, depicts the weakness of healthcare system in
3.1. Demographic information Bangladesh including lack of trained doctors and health professionals to
deal with the COVID-19 (HSB1: 0.651); lack of health facilities to combat
According to the survey results, the ratio of male to female partici- the COVID-19 outbreak in Bangladesh (HSB2: 0.74); lack of health
pants was 3:2, whereas the composition of age groups were 75.2% infrastructure to deal with COVID-19 (HSB3:0.745); severe lack of
(18–30 years old), 16.7% (31–40 years old), 6.7% (41–50 years old), biomedical waste management facilities in Bangladesh (HSB4: 0.683);
1.1% (51–60 years old) and 0.3% (>60 years old), respectively. The lack of COVID-19 testing facility in Bangladesh (HSB5:0.69); and lack of
young people responded more maybe because of their frequent access to budget or financial support to respond to this outbreak (HSB6:0.536). All
the internet depending on the socioeconomic structure of Bangladesh. the elements of the statement (HSB) showed moderate loading score
However, the average age of the participants (n ¼ 1066) was 27.80 years revealing the fragility of the healthcare system of Bangladesh in dealing

Figure 2. Scree plots of the eigenvalues of PCA.

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M. Shammi et al. Heliyon 6 (2020) e04063

Table 1. Retained items after principle component analysis.

Sector Items PC1 PC2 PC3 PC4 PC5 PC6 PC7 PC8
Demographic Age 0.047 -0.033 -0.045 0.009 -0.056 0.042 -0.007 0.893
characteristics Occupation 0.019 -0.027 -0.001 0.057 0.031 0.027 -0.017 0.883
Individual Mental I am most afraid 0.112 -0.005 0.029 0.24 0.758 0.074 -0.057 0.034
health condition (MH) of coronavirus recent
outbreak in
Bangladesh (MH1)
I am afraid of getting 0.033 0.04 0.062 0.148 0.838 0.032 -0.049 0.055
coronavirus (MH2)
I am afraid of losing my 0.055 0.063 0.076 0.13 0.788 0.074 -0.091 -0.06
life or my relatives' life
due to this outbreak (MH3)
All the news and numbers 0.117 0.114 0.097 0.049 0.624 0.086 0.039 -0.046
of COVID-19 in different
media increasing my
tension (MH4)
Health system in There is a lack of trained 0.651 0.03 0.099 0.011 0.034 -0.014 -0.022 -0.042
Bangladesh (HSB) doctors and health professional
to deal with the COVID-19 (HSB1)
There is a lack of health 0.74 0.079 0.103 0.214 0.092 0.215 -0.079 0.05
facilities to combat the COVID-19
outbreak in Bangladesh (HSB2)
There is a lack of health 0.745 0.068 0.144 0.202 0.099 0.111 -0.056 0.026
infrastructure to deal with
COVID-19 (HSB3)
There is a severe lack of 0.683 0.11 0.138 0.21 0.055 0.229 -0.077 0.022
bio-medical waste management
facilities in Bangladesh (HSB4)
There is a lack of COVID-19 0.69 0.133 0.032 0.216 0.041 0.274 -0.038 -0.015
testing facility in Bangladesh (HSB5)
There is a lack of budget or 0.536 0.255 0.137 -0.033 0.124 -0.217 0.004 0.104
financial support to response
to this outbreak (HSB6)
Governance and Bangladesh government can -0.164 0.003 -0.128 0.008 -0.028 0.114 0.563 -0.102
Political issues (GPI) deal with this outbreak (GPI1)
Government is taking this -0.007 -0.036 -0.018 -0.13 -0.063 0.112 0.819 0.032
outbreak seriously to deal with (GPI2)
Government is taking proper -0.07 -0.051 0.012 -0.138 -0.046 -0.04 0.811 0.055
decisions in the right time (GPI3)
Government is involving other 0.03 -0.024 0.009 -0.028 -0.006 0.025 0.748 -0.005
sector actors to combat the
COVID-19 outbreak (GPI4)
Government decisions Government need support from the 0.203 -0.006 0.092 0.254 0.033 0.627 0.216 -0.06
and impacts (GDI) people to reduce the impact
of COVID-19 (GDI1)
Government need to formulate 0.235 0.131 0.036 0.338 0.043 0.592 0.02 -0.064
a policy and action plan and
implement it immediately (GDI2)
Shut down or lockdown of 0.064 0.042 0.051 0.079 0.191 0.585 0.067 0.08
regular activities is a good
decision to reduce the chance of
infection of COVID-19 (GDI3)
Shut down or lockdown or social 0.051 0.362 0.333 0.005 0.04 0.513 0.082 0.094
distancing will have an economic
and social impact in future (GDI4)
The formal and informal business 0.075 0.376 0.387 0.003 0.023 0.543 -0.032 0.14
will be hampered (GDI5)
Socio-economic Most of the poor people living 0.081 0.586 0.155 0.051 0.034 0.203 0.045 -0.01
issues (SEI) in urban areas have to leave
due to not having any options
for income (SEI1)
Many people will lose their 0.016 0.681 0.192 0.171 0.056 0.163 -0.053 0.101
livelihood/jobs at a time (SEI2)
There will be less supply of basic 0.096 0.734 0.154 0.084 0.044 -0.085 0 -0.134
goods/products for daily use (SEI3)
Price of most of the basic products 0.11 0.665 0.116 0.073 0.006 0.11 -0.114 -0.048
will be higher than usual (SEI4)
Poor people will suffer food and 0.128 0.576 0.211 0.127 0.002 0.365 -0.075 -0.088
nutritional deficiency (SEI5)
There is a chance of social conflict 0.119 0.62 0.128 0.12 0.126 -0.103 0.016 0.051
due to this outbreak (SEI6)

(continued on next page)

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Table 1 (continued )
Sector Items PC1 PC2 PC3 PC4 PC5 PC6 PC7 PC8
Immediate emerging There is a chance of community 0.099 0.141 0.12 0.688 0.15 0.054 -0.034 0.093
issues (IEI) transmission of COVID-19
in Bangladesh (IEI1)
A huge number of people 0.072 0.141 0.13 0.701 0.279 -0.014 -0.084 0.03
will be infected (IEI2)
There is a chance of not 0.218 0.13 0.144 0.661 0.066 0.23 -0.185 0.017
detecting most of the infected
patients due to lack of health
facilities leads to undermining
the actual infected case (IEI3)
There is a chance to increase 0.233 0.105 0.244 0.694 0.125 0.228 -0.092 -0.027
in the number of death for not
having proper health facilities (IEI4)
Lack of bio-medical waste 0.234 0.111 0.269 0.581 0.162 0.201 -0.037 -0.048
management facilities in Bangladesh
will create more problem (IEI5)
Enduring emerging If any disaster (flood, cyclone etc.) occur 0.199 0.123 0.548 0.299 0.056 0.215 -0.073 -0.013
issues (EEI) after the COVID-19 situation then it
will create a double burden to
the country (EEI1)
There is a chance of severe food scarcity 0.165 0.227 0.648 0.147 0.103 -0.119 0.028 -0.14
due to these events (COVID-19 þ
Disasters) in the country (EEI2)
High possibility of huge 0.127 0.187 0.805 0.099 0.094 0.159 -0.048 0.03
economical loss (EEI3)
High possibility of increasing the 0.091 0.296 0.732 0.169 0.088 0.123 -0.039 0.003
poverty level (EEI4)
High possibility of severe socio- 0.153 0.265 0.699 0.254 0.044 0.168 -0.071 0.018
economic and health crisis (EEI5)
Varimax Rotation Eigenvalues 3.275 3.265 3.126 3.012 2.58 2.436 2.389 1.736
Sums of Squared % of Variance 8.852 8.824 8.45 8.14 6.974 6.584 6.456 4.692
Loadings
Cumulative % 8.852 17.676 26.125 34.265 41.239 47.823 54.28 58.971

Bold denotes significance at >0.5.

with COVID-19 pandemic, for instance very low ratio of intensive care example, small business will lose their regular customers due to shutting
unit (ICU) beds to population, limited or centralized COVID-19 testing down their business (GDI5:0.376).
facilities along with bias in selecting the test candidates, low test rate, The PC3 (Third) explained 8.45% of the variance which was strong
lack or a substandard quality of personal protective equipment (PPE) for positive loaded with enduring emerging issues (EEI: 0.548 to 0.805). The
the caregivers, lack of institutional isolation units, and very poor coor- major EEIs were stated here as occurring any further natural disasters
dination in health management systems, etc. such as flood and tropical cyclone (EEI1: 0.548) and their burden on food
Afterwards, the PC2 (Second) elucidated 8.82% of the total variance, security (EEI2: 0.648), mounted economic loss (EEI3: 0.805) due to
and it was moderately positive loaded with the socioeconomic issues damages of business and industrial chains both locally and globally, these
(SEI), including the risk of poor people from urban areas forced to tem- may put further stress as elevating poverty level (EEI4: 0.732) followed
porary migration while having no options for income along with the by a chance of inducing severe socioeconomic and health crisis (EEI5:
chance of inducing social conflicts due to this outbreak; restriction of 0.699).
basic supplies including foods; price hikes of commodities, losing jobs Furthermore, PC4 (Fourth) elucidated 8.14% of the variance and was
(SEI1-6: 0.576–0.734). However, weak but positively loaded socioeco- moderate positive loaded of immediate emerging issues (IEI: 0.581 to
nomic issues such as shut down or lockdown or social distancing might 0.701). This sector covered very important elements of COVID-19
have an economic and social impact in the future (GDI4; 0.362) along pandemic in Bangladesh including the chance of community trans-
with the small formal and informal business will also be hampered. For mission (IEI1: 0.688), huge infection potentials (IEI2: 0.701), but this

Table 2. Test of association between each component and the demographic characteristic using T-test.

t df Sig. (2-tailed) Mean Difference 95% Confidence Interval of the Difference

Lower Upper
PC1 4.926 36 0 0.18881 0.1111 0.2665
PC2 5.215 36 0 0.19492 0.1191 0.2707
PC3 5.066 36 0 0.18757 0.1125 0.2627
PC4 5.006 36 0 0.18278 0.1087 0.2568
PC5 3.622 36 0.001 0.13649 0.0601 0.2129
PC6 4.763 36 0 0.15951 0.0916 0.2274
PC7 1.326 36 0.193 0.05481 -0.029 0.1387
PC8 1.472 36 0.15 0.05159 -0.0195 0.1227

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M. Shammi et al. Heliyon 6 (2020) e04063

Table 3. Estimated model of multiple regression.

Model-1: Dependent Variable: MH1 (R ¼ 0.991, R Square ¼ 0.975)

Unstandardized Coefficients Standardized Coefficients t Sig. 95.0% Confidence Interval for B

B Std. Error Beta Lower Bound Upper Bound

(Constant) -0.009 0.02 -0.453 0.669 -0.06 0.042
MH2 0.897 0.055 0.976 16.179 0 0.754 1.039
IEI3 0.17 0.065 0.157 2.597 0.048 0.002 0.338
Model-2: Dependent Variable: HSB6 (R¼1, R Square¼ 1)
(Constant) 0.085 0 3087.118 0 0.084 0.085
HSB1 0.86 0 0.893 2436.454 0 0.856 0.865
GDI1 -0.401 0 -0.392 -1583.19 0 -0.404 -0.397
SEI1 0.73 0.001 0.633 1256.524 0.001 0.723 0.738
SEI5 -0.497 0.001 -0.51 -863.253 0.001 -0.504 -0.489
GPI3 -0.06 0 -0.082 -324.713 0.002 -0.062 -0.057
HSB2 -0.037 0 -0.041 -96.705 0.007 -0.042 -0.032
Model-3: Dependent Variable: GDI1 (R¼1, R Square¼ 1)
(Constant) 0.087 0 364.433 0.002 0.084 0.09
GDI2 0.712 0 0.707 2025.783 0 0.707 0.716
GPI2 0.153 0 0.214 560.211 0.001 0.149 0.156
SEI6 -0.903 0.002 -0.883 -500.629 0.001 -0.926 -0.88
SEI3 0.503 0.001 0.625 376.743 0.002 0.486 0.52
GDI3 0.081 0 0.069 313.709 0.002 0.077 0.084
EEI5 0.023 0 0.025 74.962 0.008 0.019 0.026
Modle-4: Dependent Variable: SEI5 (R¼0.997, R Square¼ 0.993)
(Constant) -0.076 0.014 -5.529 0.005 -0.114 -0.038
SEI1 0.997 0.049 0.841 20.43 0 0.862 1.133
GDI2 0.304 0.045 0.287 6.731 0.003 0.178 0.429
EEI1 0.225 0.049 0.195 4.585 0.01 0.089 0.361
Model-5: Dependent Variable: IEI2 (R¼1, R Square¼ 1)
(Constant) -0.05 0 -1261.6 0.001 -0.05 -0.049
IEI1 1.07 0 0.956 10993.03 0 1.068 1.071
MH4 0.274 0 0.229 600.686 0.001 0.269 0.28
GDI3 -0.089 0 -0.066 -1241.36 0.001 -0.09 -0.088
EEI4 0.042 0 0.042 887.841 0.001 0.041 0.043
HSB1 -0.023 0 -0.021 -422.45 0.002 -0.024 -0.022
MH3 0.014 0 0.016 41.82 0.015 0.01 0.019
Model-6: Dependent Variable: EEI5 (R¼0.996, R Square¼ 0.993)
(Constant) -0.001 0.011 -0.045 0.966 -0.03 0.029
EEI4 0.623 0.076 0.645 8.23 0 0.428 0.818
EEI1 0.46 0.094 0.383 4.889 0.005 0.218 0.702

huge number of infection might not be reported due to lack of health Bangladesh (MH1), fear of getting coronavirus infection (MH2), and
facilities which ultimately undermine the actual cases (IEI3: 0.661), the afraid of losing life or relatives' life due to this outbreak (MH3) (MHI1-
lack of health facilities further trigger the chance of a high number of 3:0.758-0.838); and a moderate positive loading of all the news and
deaths due to infection (IEI4: 0.694), and the poor facility of biomedical numbers of COVID-19 in different media increasing tension and anxiety
waste management might be a risk factor for further virus transmission (MH4: 0.624). This result indicates the mental health burden in
(IEI5: 0.581) through an unconventional pathway in Bangladesh. Bangladesh due to COVID-19. Thus the question arises: What should be
While, PC5 (Fifth) explained 6.97% of the total variances, and it the role of the GoB during the global pandemic to safeguard its citizens?
showed strong positive loadings with mental health issues (MH: 0.624 to The following PC6 (Sixth) might produce some indication regarding
0.838) such as people are afraid of coronavirus recent outbreak in the question, which accounted for 6.58% of the variance. The PC6 was

Table 4. Cronbach's alpha value for composite score development.

Cronbach's Alpha N of Items

Individual Mental health condition (MH) 0.79 4
Health system in Bangladesh (HSB) 0.783 6
Governance and Political issues (GPI) 0.742 4
Government decisions and impacts (GDI) 0.719 5
Socio-economic issues (SEI) 0.78 6
Immediate emerging issues (IEI) 0.821 5
Enduring emerging issues (EEI) 0.839 5

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M. Shammi et al. Heliyon 6 (2020) e04063

Table 5. Descriptive overview of respondents on psychosocial, and socio-economic crisis due to COVID-19 pandemic in Bangladesh.

Mean Std. Error of Mean Median Mode Std. Deviation Variance Skewness Kurtosis Minimum Maximum
Individual Mental health condition (MH) 4.04 0.03 4.25 5 0.83 0.69 -1.04 0.94 1 5
Health system in Bangladesh (HSB) 4.47 0.02 4.67 5 0.61 0.37 -2.28 7.93 1 5
Governance and Political issues (GPI) 2.63 0.03 2.50 2.25 0.91 0.83 0.29 -0.38 1 5
Government decisions and impacts (GDI) 4.56 0.02 4.60 5 0.51 0.26 -2.70 12.53 1 5
Socio-economic issues (SEI) 4.28 0.02 4.33 5 0.62 0.39 -1.30 2.93 1 5
Immediate emerging issues (IEI) 4.44 0.02 4.60 5 0.61 0.37 -1.75 5.11 1 5
Enduring emerging issues (EEI) 4.49 0.02 4.60 5 0.58 0.33 -1.49 3.28 1 5

moderate but positively loaded of the government decision and impacts 3.4. Strategy, actions and individual role in public wellbeing and
issues (GDI: 0.513 to 0.627), including the government need supports socioeconomic crisis
from the people to reduce the impact of COVID-19 (GDI1: 0.627) and also
need to formulate a strong policy and action plan, and implement it The multiple linear regression model was applied to estimate the
immediately (GDI2: 0.592); also moderate positively loaded of the gov- individual mental health condition (MH) performance in model 1
ernment decision and impact issues (GDI3-5: 0.513–0.585). These de- (Table 3). The results indicate that the independent variable MH2 and
cisions were declared without a proper strategy of implementation and IEI3 was statistically significant and had a positive influence on MH1
exit plan that might lead to huge mismanagement during the partial (dependent Variable). From this model, it was found that coronavirus
lockdown period in Bangladesh. This lack of coordination in policy outbreak, lack of testing capacity undermining the actual cases with a
formulation further linked with the PC7 (Seventh), elucidated 6.46% of lack of health facilities are inducing individual mental stress.
the total variances and were strong positive loading of the government For model 2, the results indicate that HSB1 and SEI1 had a positive
and political issues (GPI: 0.563 to 0.819). The loading elements were as impact whereas GDI1, SEI5, GPI3, HSB2 had a negative impact on HSB6.
follows: the capacity of dealing with the pandemic (GPI1: 0.563); seri- From this model, it is found that lack of budget or financial support has
ousness in dealing with it (GPI2: 0.819); timely decision taking (GPI3: created constrained to COVID-19 response and created a scarcity of
0.811); involvement of other stakeholders properly (GPI4: 0.748). These trained health professionals, which enforced to shut down the regular
are very crucial elements in terms of COVID-19 pandemic management, activities in the urban areas and poor people lose their income options.
therefore failing to address this issue might produce huge aftermath. Due to this, people are suffering food and nutritional deficiency and the
Finally, the PC8 (eighth) elucidated 4.692% of the total variances and government is not getting proper support from the people to reduce the
strongly loaded with demographic characteristics such as age (0.893) and impact of the COVID-19 outbreak. Not having a proper response plan
occupation (0.883). with the budget was not a good decision of the government, which
created a lack of health facilities to combat this outbreak in Bangladesh.
3.3. Professional risk groups of socioeconomic crisis and mental stress For model 3, GDI2, GPI2, SEI6, SEI3, GDI3, and EEI5 were statistically
significant and had a significant effect on GDI1. This model depicts the
Results of t-Test and one-way ANOVA showed that all PCs exhibited a role of general people to assist the implementation of government actions
strong association among them except for PC7 (Governance and Political against COVID-19 in Bangladesh such as the implementation of proper
issues) and PC8 (demographic characteristics) (Table 2). However, a lockdown and social distancing, relief supports to the poor people, pre-
One-way ANOVA test between 35 items and the age and occupation of venting potential socioeconomic burden, and ensuring the safeguard of
the participants were conducted which is presented in Table S2 and S3. A the country.
strong association between age and MH3, MH4, and EEI2 were found For model 4, GDI2 and EEI1 were statistically significant and had a
which represents that different age groups are afraid of getting corona- significant effect on SEI5. This means a strong coordinated strategy is
virus and losing their lives due to this outbreak. Also, climate change warranted to tackle such unprecedented events as Bangladesh is one of
vulnerability and possible dengue outbreak in the country are creating the vulnerable countries in the world. Especially, the months from April
mental stress among different age groups. Furthermore, a strong associ- to September is especially important in terms of natural disaster
ation between occupation and HSB1, SEI3, SEI5, and EEI2 represents that vulnerability in Bangladesh.
there is lack of trained health professional in the country, a supply of For model 5, IEI1, MH4, GDI3, EEI4, HSB1, MH3 were statistically
basic products will be reduced due to lockdown and fewer supplies, and significant and had a substantial effect on IEI2. This model can be suit-
poor people will suffer food and nutritional deficiency due to loss of able to explain the most potential risk factors for the negative impacts of
livelihood. Also, different professions such as doctors, police, and banker COVID-19 pandemic in Bangladesh including mental health and poverty.
are at higher risk of infection. For model 6, EEI4 and EEI1 were statistically significant and had a
significant effect on EEI5. This unprecedented chain of events could be a

Table 6. Correlation matrix of people's perception.

MH HSB GPI GDI SEI IEI EEI

MH 1
HSB .254** 1
GPI -.117** -.148** 1
GDI .235** .384** .083** 1
SEI .205** .349** -.100** .447** 1
IEI .426** .465** -.225** .475** .390** 1
EEI .267** .417** -.124** .482** .561** .527** 1
**
Correlation is significant at the 0.01 level (2-tailed).

8
M. Shammi et al. Heliyon 6 (2020) e04063

Figure 3. Dendrogram showing the clustering of people's perceptions on COVID-19 outbreak in Bangladesh.

potential threat to the COVID-19 response and rehabilitation efforts by implement partial lockdown in the country. However, this lockdown for a
the GoB. However, there was significant evidence (R2¼ >0.97) that the long time might not be carried out rather it become loosen day by day
independent variables in the proposed models adequately described in due to many socioeconomic factors and pressure from the industrial
the influence of dependent variables (Table 3). sectors in Bangladesh. With a mean value of 4.28  0.02 for the socio-
economic issues (SEI) that represents the poor and marginalized people
will suffer a lot due to the COVID-19 outbreak in Bangladesh. Besides,
3.5. Descriptive overview of governance, perceived socioeconomic crisis
with a mean value of 4.44  0.02 for the immediate emerging issues
and mental stress
(IEI), it can be summarized as: the number of infections and death will
increase due to the fragile heal care system and improper biowaste
CTT analysis was applied to examine the reliability of each item ac-
management. Some mismanagement in the industrial stakeholders and
cording to the components to develop a composite score. The Cronbach's
lack of coordination among the responsible national COVID-19 response
alpha values varied from 0.719 to 0.839 (>0.70), indicating that a
committee already happened in Bangladesh. Furthermore, with a mean
composite score for the entire scale can be generated to have a descrip-
value of 4.49  0.02 for enduring emerging issues (EEI), there is a change
tive overview of respondents' perceived mental stress, and socioeconomic
of sever health and socioeconomic crisis if climate change-induced di-
crisis (Table 4). On the scale of 1–5 (strongly disagree to strongly agree),
sasters and dengue outbreak happen in the same year. For instance, the
for an individual mental health condition (MH), it was found that the
early flash flood might bring sufferings for the poor people and farmers of
composite mean is 4.04  0.03 which represents that the participants are
Bangladesh. Which in turn, puts excessive stress on the food security
mentally stressed and afraid of COVID-19 outbreak in Bangladesh
issue of the country.
(Table 5). The source of such stresses and fears might be linked to factors
The individual mental health (MH) had a statistically positive sig-
such as fragile healthcare systems with poor management, low test rates,
nificant correlation with other issues (MH vs HSB, SEI, IEI, GDI, EEI) and
weak medical infrastructures, weakness in planning, and implementation
their correlation values ranged from 0.205 to 426 while MH had a sta-
of the COVID-19 response strategy by the GoB. The following further
tistically negative significant correlation with GPI (r ¼ -0.117, p < 0.01)
sectors results indicate the correctness of the claims as to the case of the
(Table 6). The GPI had a statistically negative relationship with other
health system in Bangladesh, with a mean of 4.47  0.02 represents that
issues (GPI vs SEI, IEI, EEI, MH) and their correlation values varied from
the health systems in Bangladesh are very fragile to combat the COVID-
-0.10 to -0.225 whereas the GPI had a significant positive relationship
19 spread in Bangladesh. The weak coordination is consenting to gov-
with GDI (r ¼ 0.083, p < 0.01). The moderate significant correlation was
ernment political issues (GPI), with a mean of 2.63  0.03 represents that
observed between pairs e.g., SEI vs EEI (r ¼ 0.561, p < 0.01), and EEI vs
the government is not taking a proper decision at the right time to reduce
IEI (r ¼ 0.527, p < 0.01). The weak positive significant correlation was
the effect of this pandemic. In summary, respondents had negative
identified between pairs such as HSB vs GDI (r ¼ 0.384, p < 0.01), EEI vs
viewpoints about the government is taking a proper decision in the
GDI (r ¼ 0.482, p < 0.01), and SEI vs HSB (r ¼ 0.349, p < 0.01). These
pandemic.
results indicate a diversified nature of the peoples' perception regarding
For government decisions and impacts (GDI), with a mean of 4.56 
the COVID-19 management and response in Bangladesh.
0.02 represent that the government's decision to lock down the activities
Further, the cluster analysis detected the total status of regional
was right. Also, the lockdown of activities created economic impacts.
variations, and how socioeconomic and environmental crises influence
Despite the huge future economic burden, the GoB took the challenge to

9
M. Shammi et al. Heliyon 6 (2020) e04063

further mental stress development (Figure 3). All the parameters were and anxiety and issues of a mental health crisis that have been mostly
classified into two major groups: cluster-1(C1), and cluster-2 (C2). C1 overlooked. At the individual level and the government level, proper risk
composed of socioeconomic issues (SEI), enduring emergency issues communication is required. Special attention should be given to combat
(EEI), government decision and impact issue (GDI), immediate emer- child and women abuse. Necessary action should be proposed for the
gency issue (IEI), the health system in Bangladesh (HSB) and individual post-recovery phase, suicide prevention, and mental health management
mental health (MH). C2 consisted of government political issues (GPI). It (Duan and Zhu, 2020; Gunnell et al., 2020; Mamun et al., 2020). Several
can be concluded that all the issues depend on governance and political cases of suicide were reported due to the fear and stress of COVID-19
aspects in Bangladesh. infection symptoms, job-loss, sudden fall to extreme poverty, economic
crisis, hunger, and unable to cope with social hatred. This kind of trau-
4. Discussion matic situation should be dealt with immediately by the government
through proper community counselling.
4.1. Strengthening healthcare system Small children are highly vulnerable to abuse if parent(s)/caregivers
are quarantined. Moreover, with limited or no outdoor activities and no
The remarkable interferences and ventures in public health by the schooling makes them mentally stressed. Moreover, to maintain family
governmental authority can control a pandemic where good governance hygiene in the pandemic, the burden just increases on the women along
and good functional policy in the healthcare system exists. Tight lock- with her regular household activities. Likewise, it escalated family con-
down, mass people quarantine, increased testing facilities, government flicts between men and women arising from physical and mental assault
stimulus packages, faster policy intervention and implementation have towards women. Students are also vulnerable to mental pressure as their
prevented COVID-19 virus from spreading transmission between humans education life is extended and posing an uncertain future caused by the
in China, Hong Kong, South Korea, Vietnam, Taiwan, Singapore well to pandemic. The Shutdown of all educational institutions may increase
date, despite initial cases (Anderson et al., 2020; Zhang et al., 2020). The hatred and mentally depressed young which should be dealt with proper
experiences gathered from across the globe, indicates that the plans.
patient-management decisions, early diagnosis, and rapid testing and
detection are urgent in COVID-19 pandemic management (Binnicker, 4.3. Backing up emergency service providers
2020). There is no doubt that the number of infections and death from
COVID-19 increases where a fragile and corrupt healthcare system exists. In any successful governance, a competent early warning system and
So far, the fatality rate due to the COVID-19 is 1.52% in Bangladesh efficient analysis of the situation, interpretation, sharing, and use of
(WHO, 2020a,b). However, the reported case numbers are given by the relevant evidence and epidemiological knowledge is required (Gu and Li,
Bangladesh Government certainly underestimates the actual number of 2020). In particular, epidemiological outcomes need to be informed on
infected persons given the shortages or unavailability of test kits (Ebra- time so that they can be accurately evaluated and explained to the gen-
him et al., 2020). The laboratory facilities for testing are only accessible eral people (Xiao and Torok, 2020). The low quality and an inadequate
in the urban areas and 33 testing laboratories are still a few numbers in a number of personal protective equipment (PPE) along with insufficient
country of 165 million population. The fear of getting the virus-infected training to use PPE caused doctors and healthcare professionals infected
along with the administrative procedure of testing and reluctance of across the country. Already 11% of the doctors and healthcare workers
other private clinics and hospitals to admit patients is a sign of weak are infected with COVID-19. Moreover, members of Bangladesh police,
governance in the healthcare of Bangladesh. In this scenario, other crit- armed forces, and rapid action battalion (RAB) along with other security
ical care patients are denied admittances, negligence, and often left to die agencies who have been jointly working to ensure social distancing
without treatments. After the detection of the first COVID-19 case in across the country are at high risk of being infected. Already 914 mem-
Bangladesh, at least 929 þ death cases having COVID-19 like symptoms bers of security forces have been infected with several reported deaths.
were reported in the different national daily newspapers until 10 May Besides, bankers, RMG factory workers, businessmen, shop keepers, daily
2020, which is 3 times higher than the reported deaths by the GoB. This wedge earners are at higher risk of infection.
indicates a serious level of community transmission is occurring in
Bangladesh. 4.4. Inclusive plan to protect the vulnerable communities amidst the
Decentralization of testing and strengthening treatment facilities are pandemic and upcoming environmental disasters
therefore required for the healthcare systems to combat the pandemic
and the treatment should reach in rural areas. The urban-rural disparity Societies where underserved communities exist, they strongly fear
in the facilities should be reduced as the rural practitioners and health- government information and politics. The ultra-poor are often being left
care workers are equally at the risk of the pandemic. Moreover, the out of the relief program during the disasters. Public risk communica-
administrative procedure of the deceased to burial put another confusion tions are therefore needed to let people know about the mental and social
and religious fear in the minds of the common people as the victims to risk of elderly, children, people with special needs, disabled as they are
COVID-19 are buried without Muslim funeral procedures of baths and the susceptible to mental stress, and other disasters.
presence of family members and relatives. In this scenario, it is impera- It should be mentioned here that government plans on pandemic
tive to deal with the peoples' fear and anxiety by the government. Proper control, risk alleviation, and social management must be as inclusive as
information should be circulated to get the people out of confusion. possible. An inclusive commitment means responding to COVID-19
Media partnerships should be created to prevent societal fear (Hopman pandemic in a way that is sensitive to the most vulnerable commu-
et al., 2020). nities, including ultra-poor, daily wedge earners, homeless people, un-
employed, indigenous communities, immigrant communities, people
4.2. Taking intervention in mental stress and social conflict counselling with disabilities, and certain frontline healthcare workers and emergency
responders. Prison centres, nursing homes, orphanages, homeless shel-
By quick administrative action and raising awareness in individuals ters, and refugee camps can be a focus for disease outbreaks; people in
for social-distancing and stringent steps were taken to manage the spread such settings often have inadequate access to basic healthcare and
of disease by cancelling thousands of activities of social gatherings in comorbidities that increase the risk of serious illness (Berger et al., 2020).
offices, clubs, classrooms, reception centres, transport services, travel Moreover, the government should take proper strategy to protect the
restrictions, contact tracing leaving the countries in complete lockdown agricultural farmers and their crops amidst the pandemic to strengthen
(Hopman et al., 2020; Cohen and Kupferschmidt, 2020). Yet weeks of the food security of the country and maintain the supply chain to
being in isolation, quarantine, physical trauma creates further loneliness consumers.

10
M. Shammi et al. Heliyon 6 (2020) e04063

As a country of climate change vulnerability, there might be some A. R. M. Towfiqul Islam: Performed the experiments; Analyzed and
additional risk factors of occurring natural disasters such as tropical cy- interpreted the data; Contributed reagents, materials, analysis tools or
clones, flash floods which may add further tolls for the country. More- data.
over, the shutdown of all kinds of business centres except groceries, M. Mostafizur Rahman: Conceived and designed the experiments;
pharmacies, and other daily necessities puts stress on the country's Performed the experiments; Wrote the paper.
economy and financial burden. With RMG factories and other industrial
production resumed from 26 April, another infectious outbreak of
Funding statement
dengue along with critical level community transmission of coronavirus
might have a cumulative/synergistic negative impact on the public
This research did not receive any specific grant from funding agencies
health systems in Bangladesh. In this situation factory operation should
in the public, commercial, or not-for-profit sectors.
be maintained with minimum social distancing; water, sanitation, and
hygiene (WASH) kit; occupational health and safety guideline, and good
healthcare management. BGMEA should be the monitoring body and Competing interest statement
draw safety protocols to protect the workers while maintaining public
safety. The authors declare no conflict of interest.

5. Concluding remarks Additional information

This perception-based study tried to visualize the mental stresses as Supplementary content related to this article has been published
well as the socioeconomic crisis due to the COVID-19 pandemic in online at https://doi.org/10.1016/j.heliyon.2020.e04063.
Bangladesh. It can be undoubtedly established that mental stress due to
the COVID-19 is because of the lockdown without ensuring the funda-
Acknowledgements
mental needs of the vulnerable ones. The weak governance in the
healthcare systems and the facilities further exacerbates the general
The authors would like to acknowledge all the frontline doctors
public's anxiety. The urban COVID-19 testing facilities, long serial to be
fighting this pandemic and all the researchers cited in the references.
tested, lowest facilities in the dedicated hospital units for COVID-19
Also, the authors are gratefull to all the participants in this study.
patients hampered the other critical patients to get healthcare services.
It was a good decision by the government to recruit 6000 doctors and
References
nurses to combat this pandemic. The government needs to take decisions
to implement testing facilities for both public and private clinical labo- Ahorsu, D.K., Lin, C.-Y., Imani, V., Saffari, M., Griffiths, M.D., Pakpour, A.H., 2020. The
ratories all over Bangladesh. As with the COVID-19 outbreak, other fear of COVID-19 scale: development and initial validation. Int. J. Ment. Health
critical care patients and infectious diseases such as dengue testing are Addiction.
Anderson, R.M., Heesterbeek, H., Klinkenberg, D., Hollingsworth, T.D., 2020. How will
being affected and patients are being deprived. It is also timely steps that country-based mitigation measures influence the course of the COVID-19 epidemic?
the government starts measures on dengue testing as well to all the Lancet 395 (10228), 931–934.
COVID-19 patients. BTRC, 2020. Internet Subscribers in Bangladesh February, 2020. http://www.btrc.g
ov.bd/content/internet-subscribers-bangladesh-february-2020.
However, numerous mental wellbeing and socioeconomic factors that Berger, Z.D., Evans, N.G., Phelan, A.L., Silverman, R.D., 2020. Covid-19: control measures
have been identified in the study are already threatening public with fear must be equitable and inclusive. BMJ 368, m1141.
and anxiety can be considered for the upcoming threat due to COVID-19 Binnicker, M.J., 2020. Emergence of a novel coronavirus disease (COVID-19) and the
importance of diagnostic testing: why partnership between clinical laboratories,
in Bangladesh are as follows; risk of community transmission, healthcare
public health agencies, and industry is essential to control the outbreak. Clin. Chem.
capacity, governance coordination and transparency, relief for the low- Bodrud-Doza, M., Islam, A.R.M.T., Ahmed, F., Das, S., Saha, N., Rahman, M.S., 2016.
income population, proper biomedical waste management through Characterization of groundwater quality using water evaluation indices, multivariate
statistics and geostatistics in central Bangladesh. Water Sci. 33 (1), 19–40.
incineration, and preparation for the possible natural disasters. The
Cohen, J., Kupferschmidt, K., 2020. Countries test tactics in ‘war’ against COVID-19.
recommendations collected in the perception study can be summarized Science 367 (6484), 1287–1288.
as to increase COVID-test rate and medical facilities. The strengthening DeVellis, R.F., 1991. Scale Development: Theory and Applications. SAGE Publications,
and decentralization of the COVID-19 medical facilities and treatment Newbury Park, CA.
Duan, L., Zhu, G., 2020. Psychological interventions for people affected by the COVID-19
are especially important for all 64 districts as the disease spread to entire epidemic. Lancet Psychol. 7 (4), 300–302.
Bangladesh. Besides, proper risk assessment and dependable risk com- Ebrahim, S.H., Ahmed, Q.A., Gozzer, E., Schlagenhauf, P., Memish, Z.A., 2020. Covid-19
munications, multi-sectoral management taskforce development, take and community mitigation strategies in a pandemic. BMJ 368, m1066.
Gates, B., 2020. Responding to Covid-19 — a once-in-a-Century pandemic? N. Engl. J.
care of biomedical waste, ensure basic supports to the people who need, Med. 2003762.
and good governance was suggested to reduce mental and social stress Gu, E., Li, L., 2020. Crippled community governance and suppressed scientific/
causing a socioeconomic crisis of COVID-19 outbreak in Bangladesh. professional communities: a critical assessment of failed early warning for the
COVID-19 outbreak in China. J. Chin. Govern 1–18.
Finally, this assessment process could help the government and policy- Gunnell, D., Appleby, L., Arensman, E., Hawton, K., John, A., Kapur, N., Yip, P.S.F., 2020.
makers to judge the public perceptions in an emergency situation to deal Suicide risk and prevention during the COVID-19 pandemic. Lancet Psychol.
with COVID-19 pandemic in densely populated lower-middle-income Hair, J.F., Black, W.C., Babin, B.J., Anderson, R.E., 2014. Multivariate Data Analysis.
Pearson Education limited.
countries like Bangladesh.
Hopman, J., Allegranzi, B., Mehtar, S., 2020. Managing COVID-19 in low- and middle-
income countries. JAMA.
Declarations IEDCR/DGHS/GoB, 2020. Coronavirus COVID-19 Dashboard, p. 2020. http://103.247.2
38.81/webportal/pages/covid19.php?fbclid¼IwAR0fvp1tINehCpQfHn8c6lCqw
qMmjNncdLdhNqYLIsMAhaSxD2nM4Jd043Y.
Author contribution statement Islam, A.R.M.T., Mamun, A.A., Zahid, A., Rahman, M.M., 2020. Simultaneous comparison
of modified-integrated water quality and entropy weighted indices: implication for
M. Shammi: Conceived and designed the experiments; Analyzed and safe drinking water in the coastal region of Bangladesh. Ecol. Indicat. 113, 106229.
Islam, A.R.M.T., Ahmed, N., Bodrud-Doza, M., Chu, R., 2017. Characterizing groundwater
interpreted the data; Wrote the paper. quality ranks for drinking purposes in Sylhet district, Bangladesh, using entropy
M. Bodrud-Doza: Conceived and designed the experiments; Per- method, spatial autocorrelation index, and geostatistics. Environ. Sci. Pollut. Res. 24
formed the experiments; Analyzed and interpreted the data; Contributed (34), 26350–26374.
Liu, C.W., Lin, K.H., Kuo, Y.M., 2003. Application of factor analysis in the assessment of
reagents, materials, analysis tools or data. groundwater quality in a Blackfoot disease area in Taiwan. Sci. Total Environ. 313 (1-
3), 77–89.

11
M. Shammi et al. Heliyon 6 (2020) e04063

Mamun, M.A., Siddique, A.B., Sikder, M.T., Griffiths, M.D., 2020. Student suicide risk and WHO, 2020a. Coronavirus Disease 2019 (COVID-19) Situation Report 51.
gender: a retrospective study from Bangladeshi press reports. Int. J. Ment. Health https://www.who.int/docs/default-source/coronaviruse/situation-
Addiction. reports/20200311-sitrep-51-covid-19.pdf?sfvrsn¼1ba62e57_10 access. (Accessed 30
TBS, 2020a. Fear, Hatred and Stigmatization Grip Bangladesh amid Covid-19 outbreak. March 2020).
In: Archived Newspaper the Business Standard. https://tbsnews.net/thoughts WHO, 2020b. Coronavirus Disease 2019 (COVID-19) Situation Report 63.
/fear-hatred-and-stigmatization-grip-bangladesh-amid-covid-19-outbreak-61129. https://www.who.int/docs/default-source/coronaviruse/situation-reports
(Accessed 26 March 2020). /20200323-sitrep-63-covid-19.pdf?sfvrsn¼b617302d_4 access. (Accessed 30 March
TBS, 2020b. Coronavirus Cases Detected in Cox's Bazar Rohingya camps. In: Archived 2020).
Newspaper the Business Standard. https://tbsnews.net/coronavirus-chronicle/bang Worldometers, 2020. COVID-19 Coronavirus Pandemic. https://www.worldometer
ladesh-says-coronavirus-detected-rohingya-refugee-camp-81490?fbclid¼Iw s.info/coronavirus/.
AR024QrrPPYSK_9WzfaMpTHCJu7hemZ1UzFpAQaKnyBxyQ7QV-YoJOTQjGY. Xiao, Y., Torok, M.E., 2020. Taking the right measures to control COVID-19. Lancet Infect.
(Accessed 15 May 2020). Dis.
Wang, G., Zhang, Y., Zhao, J., Zhang, J., Jiang, F., 2020. Mitigate the effects of home Zhang, S., Wang, Z., Chang, R., Wang, H., Xu, C., Yu, X., Tsamlag, L., Dong, Y., Wang, H.,
confinement on children during the COVID-19 outbreak. Lancet 395 (10228), Cai, Y., 2020. COVID-19 containment: China provides important lessons for global
945–947. response. Front. Med.

12