There is no intensive care unit (ICU) in the 31 districts with high risk of coronavirus transmission. Ten months ago, the prime minister issued directives for ICU's to be set up at the general hospitals in every district. Public health experts are blaming the negligence of the health department for the failure in setting up these ICU's even 10 months after the orders.
According to the health bulletin of the Directorate General of Health Services (DGHS) on Wednesday, 11 of the 31 districts with higher infection rate are in Dhaka division. For the last one week, the number of infected persons and casualties has been highest in Dhaka. Among the 249 people, who died in the last week, 178 are from Dhaka.
However, six among the 11 districts in this division with higher infection rate do not have ICU facilities. These districts are – Tangail, Madaripur, Shariatpur, Narsingdi, Rajbari and Munshiganj.
A total of 31 people have died in the Chattogram division in the last week. Noakhali, Chandpur, Laxmipur and Brahmanbaria districts in this division are at the risk of higher transmission of coronavirus. However, there are no ICU facilities in these districts.
Same is the case in Narail and Jessore in Khulna division, Naogaon and Natore in Rajshahi division and Nilphamari in Rangpur district. All these districts are at the risk of higher transmission of coronavirus infection. In the last week, 15 people in Rajshahi division, 11 in Khulna division and three in Rangpur division have died of coronavirus.
Critical patients are being transferred to other districts
At present, some 376 coronavirus patients are undergoing treatment in Narsingdi district. A total of 110 beds have been allocated for these patients at different hospitals. The number of admitted patients was 27 last Tuesday. There is no ICU facility in any of the hospitals in the district. There are two high flow nasal cannulas in this district.
ANM Mizanur Rahman, resident medical officer (RMO) of Narsingdi district hospital, said that if there was enough trained personnel and ICU facilities in the district, they could provide better service to the coronavirus patients. The patients are coming at the last moment. At that point, they do not have anything to do in most of the cases.
Seeking anonymity, health officials of two districts said that most of the patients are receiving treatment at home. The patients are admitted to hospitals only if they have any complications such as breathing problems. But due to the absence of ICUs and ventilators, they have to transfer the patients to other districts.
The number of new patients has been rising for some days. The graph is very high in Barishal region. In each of the six districts in Barishal, the number of new patients has become more than double within a week. But there are only 12 ICU beds in the entire division. Six people have died last week in this division.
Jhalakathi General Hospital’s RMO Jafar Ali Dewan told Prothom Alo that they do not have any ICU facility in the hospital. The critical patients are being transferred to Barishal Sher-e-Bangla Medical College.
In many cases, high flow nasal cannulas are more important for the patients than the ICUs. The hospitals need to have enough high flow nasal cannulas. At least four of the 31 high risk districts for coronavirus do not have any high flow nasal cannula. In most of the districts the number of high flow nasal cannulas varies from one to five. There are 715 high flow nasal cannulas in the country, according to the DGHS.
Health minister Zahid Maleque held a meeting this week with the representatives of private medical colleges and hospitals regarding increasing the beds and facilities in the hospitals. He said further 2,000 high flow nasal cannulas have been sent to the hospitals in different districts including Dhaka.
Mentioning that there is no more space in the hospitals to accommodate the coronavirus patients, the health minister said that if the number of the patients continues to rise, there is no benefit in increasing beds. If 5,000 new patients are detected daily and they come to hospital, it will not be possible to accommodate them even if we convert the whole country into hospitals. He also advised to seek treatment in the nearby districts.
ICU crisis in Dhaka
According to the data of the DGHS, 103 of the 108 ICU beds in the 10 government-run Covid dedicated hospitals are occupied at present. There was no unoccupied ICU bed in Kuwait Bangladesh Friendship Government Hospital, Kurmitola General Hospital, Government Employee Hospital, Dhaka Medical College Hospital, and Bangbandhu Sheikh Mujib Medical University on Wednesday. There were two unoccupied ICU beds Rajarbagh Police Hospital and Sheikh Russel National Gastro Liver Institute & Hospital and one in Mugda Medical College Hospital.
Rubel Hasan is a resident of Mirpur. His father-in-law is infected with coronavirus. He was admitted to a hospital in Mirpur, but there was no ICU bed in there. Despite contacting different government and private hospitals of Dhaka, he could not find an unoccupied ICU bed.
Speaking to Prothom Alo, he said, “I have been desperately looking for an ICU bed since morning. But there was no unoccupied ICU bed in any of the hospitals. Later, I admitted my father-in-law to the ICU of a hospital in Malibagh.”
A physician of coronavirus units in two hospitals in Dhaka told Prothom Alo that there is no unoccupied ICU bed but the demand is high. Most of the time, around 15 to 20 patients are waiting for an ICU bed. Relatives of the patient are desperate for ICU beds. The physicians have become helpless. There is no benefit in referring them to another hospital as the situation is the same there too.
Apart from ICU beds, the demand for general beds has also increased. There are 2,511 general beds for the coronavirus patients in Dhaka under the government maintenance and 2,246 of them have been occupied.
There are 275 general beds in the Kurmitola General Hospital. Some 421 patients were admitted in the hospital yesterday, which means 146 more patients than the capacity. Rajarbag Police Hospital also had 11 more coronavirus patients than its capacity.
Instructions not implemented even after 10 months
On 2 June last year, prime minister Sheikh Hasina directed to set up ICU in every district hospital. Besides, she directed for the installation of ventilators and expanded oxygen supply systems in the hospital. She also directed necessary equipment to be procured. Earlier on 27 April last year, the prime minister said that ICUs will be set up in every district.
Robed Amin, the spokesperson of the DGHS and the line director of Noncommunicable Diseases Control (NCDC) department, told Prothom Alo that it is possible to arrange the equipment and beds for setting up ICUs at district level within a week. But trained physicians and nurses are needed to run an ICU facility. There is a lack of manpower to run ICU facilities at district level.
Ventilation is very important for the treatment of Covid-19 patients in critical condition. According to the World Health Organisation (WHO), 40 per cent of the patients generate mild symptoms, 40 per cent patients exhibit moderate symptoms and 5 per cent of the patients face critical conditions.
Patients in critical condition and many of the patients with moderate symptoms need to be hospitalised. Most of the critical patients need ventilation and ICU facilities.
Nazrul Islam, former vice-chancellor of Bangabandhu Sheikh Mujib Medical University and a member of the National Technical Advisory Committee on Covid-19, told Prothom Alo that there was a significant shortfall in the activities of the health ministry. They could not set up ICUs in the district hospitals even after the prime minister's directive. It was possible to install ICUs in 10 months. The health ministry did not pay any attention to the treatment of coronavirus patients at all.
*This report appeared in the print and online editions of Prothom Alo and has been rewritten in English by Ashish Basu