Officials fear that circumstances ahead may be worse than 2020, especially with ventilation support
The three major cities of the country, Dhaka, Chittagong and Sylhet, saw the highest number of Covid-19 infections last year, and it is no surprise that the numbers are now spiking again in these cities.
The rising cases have the health authorities worried that they will soon run out of Intensive Care Units (ICUs) as most of them are already full, especially with younger patients this year.
According to the Directorate General of Health Services (DGHS), eight government hospitals in Dhaka have 103 ICU beds and 92 of those are already taken, while at the private hospitals, out of 267 available units, 210 are occupied by critical ill patients.
In Chittagong, of the 25 government hospital ICUs, some 15 have been occupied and in private hospitals, 20 out of 25 ICUs are occupied, according to the DGHS.
The Sylhet office of the DGHS said 10 beds functioning in the city were occupied.
The health directors of divisional offices at Dhaka, Chittagong and Sylhet said they feared that circumstances ahead might be worse than last year, in terms of providing patients with ventilation support.
They are trying to increase the number of ICUs, ventilators and High Flow Nasal Cannula to save critically ill patients.
The divisional offices at Rangpur, Rajshahi, Khulna, Mymensingh and Barisal said that if the transmission rate remained the same as last year, they might be able to tackle the situation. However, if the rate went up, they feared things would get out of control.
The director of Dhaka Medical College Hospital (DMCH), Brig Gen Nazmul Haque, told Dhaka Tribune that the hospital had received a high number of Covid-19 patients in the last few days.
“We are forced to give people appointments for ICU beds now,” he added. There was a fire at the ICU unit at the hospital on March 18, severely lowering its capacity.
DMCH has 750 general beds for the treatment of the Covid-19 patients along with 20 ICUs and HDUs, and all of them are currently occupied because, as the DMCH director said, more patients with flu-like symptoms have been arriving, which has forced the on-duty doctors to work longer hours.
There are, however, slight discrepancies in the number of ICUs hospitals say they have as opposed to the number of IUCs the DGHS says they have. According to the DGHS, there are 237 ICUs in Bangladesh, discounting Dhaka and Chittagong. However, the data provided by divisional health offices say that there are 260 ICUs available for Covid-19 patients.
Kurmitola General Hospital in Dhaka has been forced to admit more patients than the number of facilities it has. DGHS data note that 393 people were admitted in the hospital against 275 general beds.
All 10 ICU beds of the hospital are also occupied.
Private hospitals in the city also have made it known that over three-fourths of the ICUs at their hospitals are occupied.
In Chittagong, all 10 ICU beds of 250-bed General Hospital have been occupied, while five of the 10 ICU beds at Chittagong Medical College Hospital are occupied.
What is causing the surge in infections?
The health authorities blamed a lack of adherence to Covid-19 precautions, such as not wearing masks in public and gathering in large crowds, for the surge in infections.
When infection rates were low, even as late as this February, over 1 million tourists flocked to Cox’s Bazar over the long weekend of February 21.
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Chittagong Divisional Director of the DGHS Dr Hasan Shahriar Kabir said: “People are just ignoring the health guidelines.”
Meanwhile, another possible cause of more ICU admissions is the fact that the new UK variant was identified in Bangladesh in January but was only disclosed to the public in March.
Professor Tahmina Shirin, director of the Institute of Epidemiology, Disease Control and Research (IEDCR), told BBC that the variant was first identified among passengers returning from the UK in early January. She, however, did not answer why this information was not disclosed earlier.
The first passenger to be detected with the new variant landed at Hazrat Shahjalal International Airport in Dhaka from the UK. It was also found among passengers landing at Osmani International Airport in Sylhet.
The British Medical Association in their peer reviewed journal said the UK Covid variant was 64% more deadlier than the original strain and more contagious.
Noted virologist and member of the national technical advisory committee to tackle Covid-19, Prof Nazrul Islam, said: “It is a fact that the UK variant was detected in Bangladesh in January, which is contributing to the rise in the virus. But I think a new strong variant may appear in Bangladesh like in South Africa through unique mutations of the virus. We should look into the matter.”
He also said: “Only 21 districts outside Dhaka city-- mostly those with medical colleges-- in the country have ICU facilities. As the new variant is more infectious, the government should ensure a minimum number of ICUs in every district.
Public health expert MH Chowdhury (Lenin), chairman of the medicine department at Health and Hope Hospital, said the coronavirus was now spreading faster than the previous wave, infecting younger people more.
Division and city
Districts with ICUs
Narayanganj 10 Manikganj 2
6 are being repaired in Sylhet
Kushtia 10 HDU
* ICUs will be taken from private hospital under contract in Munshiganj
“Systematic studies and genome sequencing are now necessary to know which variants are now actively prevailing in the country. It’s also necessary to know whether new mutations make the virus more dangerous or easily transmittable,” he added.
32 unique mutations found
Amid a sudden upsurge in coronavirus cases, health experts fear that a highly transmissible variant of the deadly virus might have appeared in Bangladesh through mutations, said a UNB report on March 22.
The report added that experts were of the opinion that comprehensive studies and genome sequencing were necessary to examine whether the mutations had led to the new variant contributing to the upsurge in Covid-19 cases in Bangladesh.
Meanwhile, a team of Bangladeshi researchers in collaboration with Monash University in Malaysia found that coronavirus mutated 4,604 times in Bangladesh from April to December last year.
Examining 371 genome sequences of the virus, they found 34 unique mutations in Bangladesh.
The researchers emphasized conducting more research on the unique mutations as they think any of them could be deadlier and be the cause of the recent spike in the virus cases.
Following the upsurge in Covid-19, the Health Ministry on March 22 issued a circular asking five government hospitals, including one makeshift hospital, in Dhaka to be prepared to keep Covid-19 patients.
This would allow the government to avail over 2,200 general beds at hospitals and isolation centres. It would also readily add some 10 ICUs.
Health Minister Zahid Maleque said Covid-19 was mostly spreading in Bangladesh from all the tourist spots and the authorities were trying to limit gatherings there. He said that Dhaka had seen an upsurge of patients, but the condition outside Dhaka was not the same.
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“Beds for Covid-19 patients are being increased in many hospitals in Dhaka; around 3,000 beds will be added. The isolation centre in the northern part of the city is being converted into a hospital. Moreover, the vaccination drive is underway. Vaccines help increase immunity but one can still contract the virus,” he warned.
A meeting was held virtually by the DGHS with its unit officers where the director general (DG) of DGHS asked officials to increase the number of ICUs, oxygen supply equipment, and so on.
Confirming the matter, Dhaka Division Health Director Dr Belal Hossain said having no ICUs in some small districts would not make things difficult as all of the districts had High Flow Nasal Canulla, ventilator and every Covid-19 dedicated hospital had a central oxygen supply system. So, in case of oxygen saturation the local health unit is prepared.
At the meeting, attended by all DCs, DIGs, SPs and medical college principals, the directives to deploy more manpower at the Covid-19 dedicated hospitals had been given, said Mymensingh Health Director Shah Alam.
According to the divisional directors, they are installing or repairing some 70 ICUs for future use.
A source at Central Medical Stores Depot (CMSD) told Dhaka Tribune: “Now we have less than 350 canulla; the rest are distributed. We also had more than 700 ventilators, now we have around 160. The rest have been distributed.”
Our DMCH Correspondent Aminul Islam Babu, Sylhet Correspondent Serajul Islam, Comilla Correspondent Masud Alam, Narayanganj Correspondent Shamima Rita, and Khulna Correspondent Hedait Hossain Molla contributed to this report