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Objectives In this study we compared two predictions of COVID-19 cases in the Kingdom Saudi Arabia (KSA) using pre-and post-relaxation of lockdown period data to provide an insight regarding rational exit strategies. We also applied these projections to understand economic costs versus health benefit of lockdown measures. Methods We analyzed open access data on COVID-19 cases from March 6 to January 16, 2021 in the KSA. To understand the epidemic projection during the pre- and post-lockdown period, we used two types of modeling: the SIR model, and the time series model. We also estimated the costs and benefits of lockdown- QALY gained compared to the costs of lockdown considering the payment threshold of the Government. Results Prediction using lockdown period data suggested that the epidemic might slow down significantly after 109 thousand cases and end on October 6, 2020. However, analysis with latest data after easing lockdown measures suggested that epidemic might be close to an end on October 28, 2021 with 358 thousand cases. The peak has also been shifted from May 18, 2020 to Jun 24, 2020. While earlier model predicted a steady growth in mid-June, the revised model with latest data predicted it in mid-August. In addition, we estimated that 4986 lives would have been saved if lockdown continued but the cost per life saved would be more than $378 thousand, which is way above not only the KSA threshold, but also the threshold of any other highly advanced economies such as the UK and the USA. Conclusions Our results suggest that relaxation of lockdown measures negatively impacts the epidemic. However, considering the negative impact of prolong lockdown measures on health and economy, countries must decide on the best timing and strategy to exit from such measures to safely return to normal life with minimum loss of lives and economy considering its economic and health systems' capacity. Instead of focusing only on health, a balanced approach taking economy under consideration is recommended.

The COVID-19 pandemic has been a major health concern in Bangladesh until very recently. Although the Bangladesh government has employed various infection control strategies, more targeted Non-Pharmaceutical interventions (NPIs), including school closure, mask-wearing, hand washing, and social distancing have gained special attention. Despite significant long-term adverse effects of school closures, authorities have opted to keep schools closed to curb the spread of COVID-19 infection. However, there is limited knowledge about the impact of reopening schools alongside other NPI measures on the course of the epidemic. In this study, we implemented a mathematical modeling framework developed by the CoMo Consortium to explore the impact of NPIs on the dynamics of the COVID-19 outbreak and deaths for Bangladesh. For robustness, the results of prediction models are then validated through model calibration with incidence and mortality data and using external sources. Hypothetical projections are made under alternative NPIs where we compare the impact of current NPIs with school closures versus enhanced NPIs with school openings. Results suggest that enhanced NPIs with schools opened may have lower COVID-19 related prevalence and deaths. This finding indicates that enhanced NPIs and school openings may mitigate the long-term negative impacts of COVID-19 in low- and middle-income countries. Potential shortcomings and ways to improve the research are also discussed.

Dexamethasone can reduce mortality in hospitalised COVID-19 patients needing oxygen and ventilation by 18% and 36%, respectively. Here, we estimate the potential number of lives saved and life years gained if this treatment were to be rolled out in the UK and globally, as well as the cost-effectiveness of implementing this intervention. Assuming SARS-CoV-2 exposure levels of 5% to 15%, we estimate that, for the UK, approximately 12,000 (4,250 - 27,000) lives could be saved between July and December 2020. Assuming that dexamethasone has a similar effect size in settings where access to oxygen therapies is limited, this would translate into approximately 650,000 (240,000 - 1,400,000) lives saved globally over the same time period. If dexamethasone acts differently in these settings, the impact could be less than half of this value. To estimate the full potential of dexamethasone in the global fight against COVID-19, it is essential to perform clinical research in settings with limited access to oxygen and/or ventilators, for example in low- and middle-income countries. Dexamethasone has been shown to have survival benefits for critically ill patients hospitalised with COVID-19 in the UK. Here, the authors estimated the number of lives that could be saved through a UK and global roll out of the drug and demonstrate that it is a cost-effective option.

Childhood pneumonia affects an estimated 18% of under-five children in Bangladesh. Urban slum-dwellers face challenges in healthcare-seeking. This study examined the factors influencing the healthcare-seeking for childhood pneumonia among under-two children in urban slums in Bangladesh. The study examined influence of children’s characteristics (age, sex, number of ARI/pneumonia symptoms, and duration of symptoms), maternal factors (age, education, and working status), and household characteristics (number of household members, wealth quintile, sex of household heads, age of household heads). The outcome variable was receiving care from a qualified medical provider for childhood pneumonia or pneumonia-like symptoms within 14 days before the collection of surveillance data. The research utilized data from the Urban Health and Demographic Surveillance System, which included 155,000 people from five slums in Dhaka and Gazipur City Corporation areas. Overall, 753 out of 4,679 (16%) children under two years of age were included in this study, all of whom had ARI/pneumonia-like symptoms. The mean age of these children was 11.4 months, and 50% were boys. Of them, 350 (46%) sought care from local pharmacies, while 37% sought care from medically trained providers. Logistic regression analyses indicated that children with multiple symptoms (AOR: 2.32, 95% CI: 1.71–3.14) and illness duration over seven days (AOR: 2.61, 95% CI: 1.51–4.51) had higher odds of receiving care from a medically trained provider. Higher maternal education compared to no formal education, having five or more household members compared to four or fewer, household heads aged 40–49 years compared to those under 25 years, a longer duration of living in the slum (more than 10 years compared to less than five years), and belonging to the richest wealth quintile compared to the poorest were protective factors for care-seeking from qualified providers. Further research is required to understand the context for designing appropriate interventions and comprehensive policies for improved child health regarding ARI/pneumonia-like symptoms.

The extent of tobacco cultivation remains substantially high in Bangladesh, which is the 12th largest tobacco producer in the world. Using data from a household survey of current, former, and never tobacco farmers, based on a multi-stage stratified sampling design with a mix of purposive and random sampling of households, this study estimated the financial and economic profitability per acre of land used for tobacco cultivation. The environmental effects of tobacco cultivation on land and water resources were estimated using laboratory tests of sample water and soil collected from tobacco-cultivating and non-tobacco cultivating areas. The study finds that tobacco cultivation turns into a losing concern when the opportunity costs of unpaid family labour and other owned resources, and the health effects of tobacco cultivation are included. Tobacco cultivation poses a significantly high environmental cost that causes a net loss to society. Nevertheless, the availability of unpaid family labour and the options of advanced credit as well as a buy back guarantee from the tobacco companies attract farmers to engage in and continue tobacco cultivation. Therefore, supply side interventions to curb the tobacco epidemic in Bangladesh need to address major drivers of tobacco cultivation to correct the wrong incentives and motivate tobacco farmers to switch to alternative livelihood options.

A Correction to this paper has been published: https://doi.org/10.1038/s41467-021-22038-x.