Districts still lack ICU beds as Covid surges with winter

Highlights:

• Many critical patients from districts around the capital are coming to hospitals in divisional headquarters and Dhaka city
• Three Covid-19 hospitals in Dhaka have no ICU beds empty
• 15-16 patients on average wait for admission against a single ICU bed in a Dhaka hospital dedicated for Covid-19 treatment
• Health directorate officials say ICU beds could not be set up at district hospitals due to manpower crisis

Both the Covid-19 infections rate and number of critical patients are surging across the country with the approach of winter. But an acute shortage of intensive care units (ICU) and medical personnel in districts might crush the entire healthcare system, doctors fear.

Critical Covid-19 patients who require ICU facility are currently being referred to divisional headquarters and the capital from districts. But healthcare facilities dedicated for Covid treatment in divisional towns and the capital said they have no ICU beds empty.

The health directorate Sunday said three Covid-19 hospitals in Dhaka had no ICU beds empty.

"An ICU bed gets vacant when a patient leaves after recovery or dies. Nowadays we rarely have any bed empty," a physician of a Covid-19 dedicated hospital in Dhaka said.

"Now 15-16 patients wait for admission against a single ICU bed, and the pressure of critical patients is increasing every day," added the doctor, preferring anonymity.

Doctors label elderly people with the virus infection as critical patients. Also, patients with underlying comorbid factors, breathing issues, kidney infections, cardiac issues and brain hemorrhage are also considered critical cases.

In June and again in October, the prime minister directed the authorities to prepare district hospitals with ICU facilities to tackle Covid-19 patients' rush in winter.

But the reality is that most district hospitals treating Covid-19 patients still do not have ICU units, and high-flow oxygen supply.

Dr Asadul Mazid Nomaan, an anesthesiologist to the Covid-19 ICU unit of Dhaka Medical College Hospital, told The Business Standard that the queue for ICU is getting bigger every day.

He said many critical patients from districts around the capital are coming to the hospital. But they cannot be provided with necessary treatments owing to the accommodation shortage.

Under the World Bank's Covid-19 Emergency Response and Pandemic Preparedness project, each district will have a 5-bed ICU unit. The Tk135.64 crore project has estimated Tk2.12 crore ICU unit installation cost for each district.

Referring to the project, Additional Secretary (Development) to health ministry Saidur Rahman claimed that the project is going on in full swing. He said they are hopeful about the completion of the project soon.

According to the health directorate, there are 578 ICU beds in public and private hospitals for Covid-19 patients across the country. Of them, there are 316 beds in Dhaka and 43 beds in Chattogram. Other hospitals across the country have the remaining 219 beds – mostly in divisional headquarters.

Professor Nazrul Islam, noted virologist and former vice-chancellor of Bangabandhu Sheikh Mujib Medical University, said, "Without proper treatment, critical patients are succumbing to virus infection at hospitals. Most government hospitals do not have high flow oxygen and ICU beds. People are not getting treatment Even after going to the divisional cities and the capital since the beds are not empty."

He commented that the ICU units were not set up complying with the directive of the prime minister. "Even the instructions of the Prime Minister are not being implemented," said Prof Nazrul.

He called for necessary steps including setting up ICU beds in district level hospitals to reduce deaths.

Meanwhile, health directorate officials said ICU beds could not be set up at district hospitals due to the manpower crisis. 

"We have adequate ICU beds and ventilators. But we cannot set up those at rural hospitals due to a lack of skilled manpower. The number of anesthesiologists in the country is low, and the lengthy recruitment process is delaying their appointment,"   health directorate Director General Prof Dr ABM Khurshid Alam told TBS.

He added, "The ministry has instructed us to bring one medical officer from each district to Dhaka for training on anesthesia so that they can return to districts and run the ICU."

Dr Farid Hossain Miah, director (hospitals and clinics) at the health directorate told TBS, "We are working as per the instructions of the prime minister. In the meantime, we have set up central oxygen plants in 59 hospitals. Work is underway at 65 hospitals more."

Terming the health directorate remark on manpower shortage wrong, Dr Debabrata Banik, president of the Bangladesh Society of Anesthesiologists, told TBS that more than 1,000 anesthesiologists are now working in the private sector. The government can provide ICU services to critically ill patients by recruiting 500 of them on an emergency basis.

"We have been discussing with the government since last April to appoint the anesthesiologists. But the government has not taken any initiative yet," he added.