Bangladesh, US physicians discuss Covid-19 case management

An e-mentoring platform for physicians, designed to aid Covid-19 responders, on Tuesday organized a virtual discussion to share the best practices in Covid-19 case management.

The webinar, which is the first of a two-part webinar series between medical universities in Bangladesh and the United States, was organized jointly by the Directorate General of Health Services of Bangladesh, with support from the United States Agency for International Development (USAID), and the US-based platform called Extension for Community Healthcare Outcome (ECHO).

During the webinar, physicians from the University of Michigan and Dhaka Medical College Hospital (DMCH) exchanged their experiences and discussed non-ICU based Covid-19 case management.

Physicians made three presentations on case studies and their treatment of Covid-19 patients. 

Dr Christopher A Smith, MD, clinical assistant professor at the University of Michigan, presented his case study “Covid-19 in America: a clinical case review”, where he said nearly 50% of Covid-19 recovered patients come back to the hospital to screen for post Covid-19 conditions and most of them have to take treatment for lung diseases.

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According to him, they follow up with patients over phone till two-three weeks after recovery and have found that problems emerge during this time.

In a review of studies reporting bacterial co-infections in patients with Covid-19, Lansbury et al reported that the proportion of co-infection in ICU patients was 14%, compared to a proportion of 4% in studies which grouped ICU and floor-status together.

At the same time, 3.5% of all patients hospitalized with Covid-19 have a community-onset bacterial co-infection and 11% of patients have been admitted directly to the ICU. And 15% of hospitalized patients developed a secondary bacterial infection, like clinical symptoms or pneumonia symptoms.

Addressing the webinar, experts from DMCH said Bangladesh had no data about how many Covid-19 recovered patients get post Covid-19 treatment for pulmonary diseases yet. But they presented some cases where they found patients coming back for diagnosis of post Covid-19 problems.

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DMCH Prof Dr Md Hafiz Sardar, head of the Department of Medicine, and Dr Saima Azad, indoor medical officer of DMCH, made two presentations.

Dr Saima Azad said that after recovering in July 2020, a middle-aged patient returned to normal life. While leading a very healthy life, 15 days after the recovery, she came from Bogra and was admitted to Dhaka Medical College Hospital. She developed lower limb weakness and became unable to walk. 

Dr Smith dwelt on what kind of drugs could be applied to a non-ICU patient based on the American experience.

Many of those drugs are not available in all pharmacies of Bangladesh and many are very expensive. However, the medical authorities  are providing treatment according to their resources, based on a patient’s condition from mild to critical.

e-Mentoring platform

The e-mentoring platform will deliver Covid-19 case management learning to doctors in public and private health facilities across Bangladesh at a time when the country apprehends a second wave of Covid-19 infections.

US Ambassador to Bangladesh Earl Miller, in his comments, noted that this e-mentoring platform was developed five months ago to deliver Covid-19 case management learning to doctors of about 40 public and private health facilities which had been selected as learner hospitals in Bangladesh. Nearly 15,000 doctors are expected to benefit directly from this learning program.

Brigadier General Dr Md. Nazmul Haque, director of Dhaka Medical College Hospital, said that the learning would be helpful as physicians would get to know about the changing medical system of another country and how its treatment was changing in the context of the Covid-19 situation. 

“We hope to find solutions to many problems by sharing our case studies with the USA,” he expected.

Dr Abul Bashar Mohammad Khurshid Alam, director general of the Directorate General of Health Services and Professor Dr Md Titu Miah, principal of Dhaka Medical College (Host) also attended the webinar.