With Covid-19 cases continuing to surge, hospitals with critical care treatment facilities in Bangladesh, particularly in Dhaka, are struggling with capacity issues every single day.
In the last two weeks, the number of cases reported crossed the 2,000-mark daily, except for only four days, whereas the number of confirmed deaths was over 30 during the same period, except for only three days.
With patients continuing to flock to hospitals, demands for intensive care for the admission of critical patients are also on the rise.
The number of Intensive Care Unit (ICU) admissions crossed the 300-mark for the first time on November 21; and since then, over 300 ICU beds have continued to remain occupied except for only four days.
The situation in Dhaka is more critical as three in every four ICU beds were found occupied in Dhaka as of Saturday. Healthcare experts attributed the situation to the rise in the number of critical patients and lack of intensive care facilities in the districts as being behind the sudden surge of ICU beds in Dhaka hospitals.
Three in every five ICU beds occupied
At least 59% of ICU beds dedicated for coronavirus patients were found occupied as of Saturday morning.
Of the total 578 beds dedicated for Covid-19 patients, 342 were occupied with patients, according to the latest data from the Directorate General of Health Services (DGHS).
In Dhaka, however, 75% of the beds were occupied as only 79 of them against a dedicated 316 beds were vacant as of Saturday.
Among the 17 Dhaka hospitals offering ICU beds for Covid-19 patients, five of them had no ICU beds available.
Bangladesh has long suffered from an ICU crisis, with many district hospitals lacking ICUs. Similar problems have been reported in many public and private medical college hospitals.
The World Health Organization (WHO) says 15-20% of Covid-19 cases require hospitalization, with around 15% of cases showing severe symptoms and 5% requiring intensive care.
Mad rush for ICUs in Dhaka
Patients are visiting one hospital after another in search of intensive care beds for their near and dear ones infected with coronavirus.
Authorities at government hospitals say they receive phone calls every day from people inquiring about ICU beds. However, the answers for most of them remain negative.
Currently, a total of 17 hospitals – eight public and nine private – are offering ICU facilities.
People usually prefer visiting government hospitals for critical care treatment because of low costs and better facilities available. But only 15 beds were available at government hospitals as of the filing of this report at 3pm on Saturday.
In the face of a huge rush of patients, all 10 ICU beds at Kurmitola General Hospital, 16 beds at Kuwait Bangladesh Friendship Hospital, 14 beds at Mugda Medical College Hospital and 16 beds at Bangabandhu Sheikh Mujib Medical University (BSMMU) are occupied.
Only two beds out of 22 beds were available at Dhaka Medical College Hospital (Unit 2) and Burn Unit while 10 out of 15 ICU beds were occupied at Rajarbagh Police Hospital, DGHS data show.
Six out of ten beds were available at Sheikh Russel Gastroliver Hospital and two out of six beds were available at Sarkari Karmachari Hospital in Fulbaria of Dhaka.
There is no dedicated ICU for Covid-19 patients at the Infectious Diseases Hospital and Shaheed Suhrawardy Medical College and Hospital (SSMCH) in Dhaka.
Private hospitals
No ICU beds at Bangladesh Specialized Hospital were free as of Saturday.
One out of ten ICU beds were occupied at Anwar Khan Modern Medical College Hospital, 27 out of 31 ICUs at Asgar Ali Hospital, two out of six beds at IBN Sina Hospital, 19 out of 25 beds at Square Hospital, 14 out of 22 at United Hospital, 18 out of 20 beds at Evercare Hospital, 24 out of 56 at Impulse Hospital, and 14 out of 21 beds at AMZ Hospital were occupied, according to the latest data.
High flow of oxygen crucial for treatment
Healthcare experts said the lack of ICU beds at district hospitals was a major reason for the heavy pressure of patients at ICUs in Dhaka.
They also blamed inadequate preparations by the government ahead of a possible second wave of Covid-19 in the country for the poor management of intensive care facilities.
“Patients continue to come to Dhaka because of the lack of ICUs in the districts. If the health authorities had followed the directives of Prime Minister Sheikh Hasina on setting up ICUs in districts, the situation would not have been this poor by now,” Prof Nazrul Islam, a member of the National Technical Advisory Committee on Covid-19 (NTAC-Covid-19), told Dhaka Tribune.
Nazrul Islam, a former vice chancellor of BSMMU, opined that the lack of central oxygen supply in districts, even after over eight months of Covid-19 transmission in the country, would take a heavy toll on patients if the health authorities did not act immediately.
Expressing similar views, epidemiologist Mushtaq Hussain said that there was no alternative to expanding critical care facilities, where they were already available.
“Setting up new ICU units will not solve the crisis as it involves manpower and training. First, the number of ICU beds need to be increased at hospitals where already critical services are being offered, particularly in divisional cities so that people do not need to travel to Dhaka for treatment,” said Mushtaq, an advisor to the Institute of Epidemiology Disease Control And Research (IEDCR).
He also put emphasis on adding some ICUs from non-Covid facilities to ensure critical care treatment.
“The government excluded three Covid-19 hospitals from providing services in September because of having fewer Covid-19 patients. Now is the time to add them for services as the ICU beds and ventilators prepared for those hospitals now remain idle,” he said.
The hospitals are – Dhaka Mohanagar Hospital, Lalkuthi Hospital, and Bashundhara Covid-19 hospital.
“If patients can be advised via telemedicine on the phone regularly, the pressure on hospitals will fall. When a patient comes to hospital in a critical stage, what he needs first is high flow oxygen support. The high flow oxygen support can help many patients get proper treatment without being taken to ICU,” he said.
The expert, however, said without central oxygen support, which is absent in most districts, high flow oxygen support will not be possible.
As of Saturday morning, 13,668 oxygen cylinders, 613 high flow nasal cannula, and 403 oxygen concentrators were available in Bangladesh for Covid-19 patients, DGHS data show.
When asked, Habibur Rahman, director of Management Information System (MIS) at DGHS, claimed the directorate was working on managing more ICU beds at dedicated hospitals and setting up central oxygen supply facilities at district hospitals.
A decision has been made to re-open the Covid-19 dedicated hospitals – which were closed due to low numbers of patients earlier – to accommodate more patients and offer services, he added.
Meanwhile, Health and Family Welfare Minister Zahid Maleque on November 29 asked the Bangladesh Private Medical College Association (BPMCA) to increase the number of dedicated Covid-19 beds by 20% as part of efforts to fight the second wave of the coronavirus.