Treating Covid-19 patients at all hospitals: Experts fear wider transmission

When the government directed all the public and private hospitals with more than 50 beds to take measures for treating Covid-19 patients, some health experts said the initiative can spread transmission further.

They said the initiative can increase the risk of "cross-contamination" and "hospital infection" as many hospitals do not have proper infection control systems and patient safety measures.

The experts said the hospital authorities should ensure a proper infection control system first before going to introduce both Covid-19 and non-Covid-19 treatment.

They called for a separate set of manpower and equipment for each section to control cross-contamination.

The health ministry on May 24 issued a circular asking all government and private hospitals and clinics to take separate initiative for treating both Covid-19 and non-Covid-19 patients at the same hospitals.

The circular said the directive was given following the advice of health experts and proposal of Directorate General of Health Services (DGHS).

It also mentioned that public health experts at DGHS, observing Covid-19 treatment in different countries, suggested that treatment of both groups of patients should be given at separate parts of the same hospital.

There are some 2,200 government and 5,500 private hospitals and clinics across the country. But there are over a dozen dedicated hospitals in Dhaka and one dedicated hospital in each of the divisions except Barishal for treating Covid-19 patients currently.

Besides, at district and upazila levels, the government hospitals have isolation centres where Covid-19 and suspected Covid-19 patients are being provided treatment.

WHAT EXPERTS SAY?

Prof Muzaherul Huq, former Southeast Asia regional director of World Health Organization, said such a move would increase the risk of "contact infection" and hospital infection, meaning a non-Covid-19 patient can get infected at the hospital.

"Hospital infection control systems in our country and other countries are not the same. Here, the infection control system at hospitals is very poor and there is very little measure for patient safety," he said.

If a separate hospital is not possible, Covid-19 and non-Covid-19 sections of a hospital should be kept separated strictly and there should be separate health workers for each section, he said. Besides, safety measures at hospitals should be beefed up and strong monitoring should be at place, he added.

Infectious diseases specialist Prof Ridwanur Rahman also echoed him.

He said it would not be possible for many private clinics to ensure separate facilities for patients. A separate section with healthcare providers and testing facilities must be ensured before introducing treatment of both patients, otherwise "cross-contamination" will increase, he said.

Nirupam Das, chief administrator of Bangladesh Doctors' Foundation, said 866 doctors got infected with Covid-19 till yesterday, of which eight died.

The initiative may increase people's scope for Covid-19 treatment, especially the suspected Covid-19 patients, but it may increase infection of doctors and health workers if they are not properly protected, Nirupam said.

Bangladesh Private Medical College Association President Mubin Khan said the instruction to introduce Covid-19 treatment at all hospitals is not right. The government could have instructed those hospitals that have two buildings or necessary infrastructure for ensuring separate sections.

"The wholesale decision may warrant disaster," he said, adding, "The government should have taken the decision through discussing with all the stakeholders but we were not aware about it." The government should reconsider the decision, he added.

He said among 69 private medical colleges, two are providing Covid-19 treatment dedicatedly while three or four will start the treatment soon.

WHAT MINISTRY, DGHS EXPERT SAY

Dr Liaquat Ali, a medical scientist and member of the government expert panel, said they have given the suggestion to treat Covid-19 at all "mainstream" hospitals as "we don't have the capacity to avail treatment for all Covid-19 patients at the dedicated hospitals."

He said they have also suggested proper screening of all patients and create separate zones for Covid-19 treatment and for ensuring proper infection prevention measures. "We gave the suggestion for ensuring integrated Covid-19 treatment like other countries in the world," he said.

Contacted, Habibur Rahman Khan, additional secretary (administration wing) to Health Services Division, said hospitals with more than 50 beds must have separate wards and it is possible to control infection if patients are treated at separate wards.

He said doctors and health staffers at both Covid-19 and non-Covid-19 sections use Personal Protective Equipment (PPE) now for protection and when they will formally start treating coronavirus patients, they would take more precautionary measures.

"Covid-19 treatment at all hospitals will start ensuring proper infection control measures. The government is providing PPE at government hospitals," said Habibur, also the chief of the health ministry's media cell.

Besides, the authorities of private hospitals would provide their doctors and staffers with PPE as they would take treatment cost from the Covid-19 patients as usual, he added.