ICU INEQUITY: Time lost, lives too

When Hafizur Rahman was admitted to the General Hospital in Pabna with coronavirus-like symptoms on Friday afternoon in rapidly deteriorating condition, access to an oxygen cylinder was his only hope as there was no ICU support in the district.

The 47-year-old needed an ICU as he had visible symptoms of acute respiratory distress and high fever, said Dr Abul Hossain, assistant director of the hospital.

Doctors soon advised he be taken to Rajshahi city.

"He had been gasping for air. We put him on oxygen, but his condition was still deteriorating. He urgently needed a ventilator in an ICU, but we had none," said Dr Hossain.

An ICU equipped with ventilators is available nowhere in Pabna district, he added.

Hafizur, a 47-year secretary of Ataikula Union Parishad, had no other option but to embark on an uncertain journey of more than 100km to Rajshahi Medical College Hospital (RMCH).

When he reached RMCH at 10:00pm on Friday, he was put on oxygen once again. An hour later, when his condition wasn't improving, the doctors decided to take him to the ICU.

He died on the stretcher while being taken to the ICU, said doctors and his relatives.

"All our way to Rajshahi, he had been crying for oxygen in a broken voice," said Hafizur's wife Mamtaz Rahman Joly.

"He was repeatedly telling us, 'Give me oxygen, I am dying without air. Take me back to Pabna, I was better with oxygen there. Can't you see I'm dying without oxygen?'" she said yesterday, sobbing over the phone.

"If there was an ICU available in Pabna, I could have saved my husband."

Hafizur, secretary of Ataikula Union Parishad, is a tragic example of how Covid-19 patients outside cities have been suffering due to the lack of ICUs at the district level.

While he was suffering because there was no ICU in Pabna, at least ten ICU beds were lying vacant at RMCH's 15-bed ICU.

A total of 49 people died of Covid-19 in Rajshahi division, as of Monday, while the number of the affected was 3,274.

According to an RMCH spokesman, at least 44 persons died at the hospital till yesterday with coronavirus or showing the symptoms. Of them, eight were confirmed cases while rest 36 were asymptotic.

Some of them were brought from other districts at their last stages after they suffered due to the lack of ICU facilitates in their respective districts.

For Covid-19 patients in the eight districts in Rajshahi division, the Directorate General of Health Services arranged 23 ICU beds -- with an additional four from June 25 onwards -- in hospitals of Rajshahi and Bogura.

No separate ICU beds have been arranged for six other districts -- Joypurhat, Pabna, Sirajganj, Chapainawabganj, Naogaon and Natore.

Like Hafizur, critical Covid-19 patients or those showing symptoms from these districts are being taken to either Rajshahi or Bogura if they require ICU support.

"The arrangement of ICUs is not sufficient in comparison with the increasing numbers of the affected and deaths. But we're managing anyhow," said Dr Gopendra Nath Achariya, director of Rajshahi divisional health services.

Since the beginning of the outbreak in March, local health authorities had raised concerns and placed separate demands for ICUs due to the rising number of coronavirus patients, he said.

The government is considering setting up ICU beds in every district, said Dr Gopendra, divisional health director.

SAMPLE COLLECTION 'ON HOLD'

Hafizur, for example, fell sick on June 10, said his relatives. His sample was collected in Pabna on June 14, but his test results were still not available as of yesterday. Samples from Pabna are mostly sent to Rajshahi.

Other than scarce ICU facilities, inadequate testing have forced health authorities to withhold sample collection in Rajshahi district.

The entire division has four public RT-PCR labs available -- with testing capacity of 564 samples a day.

But the daily collection of samples from eight districts of the division amounts to more than 1,500, said Dr Gopendra.

In an official order on June 18, Rajshahi's civil surgeon suspended sample collection from all nine upazilas in Rajshahi district for five days.

The order was given after RMCH authorities sent a letter saying that they could not bear the load of testing unless sample collection is stopped for five days, said Rajshahi Civil Surgeon Dr Enamul Haque.

"Despite the notice, we had to collect some 50 samples on an urgent basis, but we could not have those samples tested yet."

Health authorities in Naogaon collect 600 samples a week, but are sending these to Dhaka to be tested as Rajshahi was unable to take these samples, said Dr Md Akteruzzaman, civil surgeon of Naogaon.

Health authorities in Rajshahi are receiving samples from Chapainawabganj, but are sending these on to Dhaka for testing since June 12, said the district's civil surgeon Dr Zahid Nazrul Chowdhury.

Testing of nearly 300 samples that were sent to Rajshahi a week ago are still pending, said Dr Mizanur Rahman, Natore's civil surgeon.

DELAY IN TESTING

Delays in testing are causing general panic as some Covid-19 patients are not quarantined until the test results come back positive, said health officials.

Asymptomatic Covid-19 patients, who generally need at least two follow-up tests to see whether they are coronavirus-free, remain uncertain of their status.

This can have an impact on their mental health, said doctors.

Mansur Rahman, 38, of Rajshahi's Charghat upazila, tested positive for Covid-19 on June 6, six days after giving his sample. He had no symptoms and was advised to stay at home.

However, he could not be tested again since then, said Ashiqur Rahman, the upazila health officer.

"We didn't collect his sample again as we were being repeatedly asked to selectively collect samples."

Mansur had already been tested once and he was asymptomatic, so his was deemed non-urgent.

On Sunday, his 20th day of home quarantine, Mansur, who worked as a driver for the Rooppur Power Plant Project, considered that he had overcome the virus, said Ashiqur, quoting his family members. He even went out.

He died suddenly yesterday morning, from unknown reasons.