Hospitals for Covid-19 Treatment: Not all ICUs functional

The intensive care units for coronavirus patients have yet to become functional in many of the 17 hospitals dedicated to Covic-19 treatment, even a month and a half after the authorities reported the first case in the country.

While ventilators have been installed in most of the hospitals, infrastructural development, oxygen supply and other necessary equipment are still required for the ICUs to be operational, according to a DGHS letter sent to the health ministry on April 18.

The Daily Star obtained a copy of the letter, which names the 17 hospitals, saying initiatives have been taken to set up the ICUs for treatment of Covid-19 patients at these facilities.   

Though ventilators have been allocated for the hospitals, 12 types of equipment are needed for the smooth operations of the ICUs, it reads.

Contacted yesterday, Sirajul Islam, additional secretary (hospital) of the health ministry, said, "We received the letter and we have written to the Central Medical Store Depot (CMSD) to purchase the necessary equipment."

The CMSD runs under the ministry's Health Services Division and procures medicine and equipment through bidding.

The additional secretary further said the equipment needed for the ICUs will be installed soon. He, however, could not say exactly when that will be.

"Such equipment is not easily available but we are trying our best," he added.

The Directorate General of Health Services (DGHS) data shows public and private hospitals currently have 508 and 737 ICU beds respectively.

A fully-functioning ICU is necessary to ensure close monitoring and life-saving treatment for Covid-19 patients, experts say.

The ventilators, which are integral parts of ICUs, blow oxygen into the lungs of patients suffering from severe pulmonary stress. They are essential for saving the lives of the sickest COVID-19 patient as coronavirus attacks the respiratory system. 

According to the WHO-China joint mission report released last month, five percent of people diagnosed with Covid-19 require artificial respiration and another 15 percent need to breathe in highly concentrated oxygen -- meaning around 20 percent of the patients need ICU care.

Although the authorities are assuring all that adequate measures have been taken in this regard, the real picture is still far from satisfactory.

Mahanagar General Hospital at Nayabazar in Dhaka, for example, was allotted five ICU beds with ventilators, but the authorities are yet to install these.

"There were no ICU facilities here and that's why it is taking time to make the room ready for ICU. It will take 10 to 12 more days to complete the installation," said Ashraful Hasan, resident physician of the hospital, on Friday.

The DGHS letter states that 50 ICU beds are required to start the ICU services in the 17 hospitals.

Also needed at these hospitals are 90 patient monitors, 34 pulse oximeters, 17 ABG machines with glucose and lactate, 28 external defibrillators, 30 12-channel ECG machines, 34 portable ventilators, 30 air conditioners of five-tonne capacity, 30 dehumidifiers, and 85 oxygen cylinders. Syringe pumps and suction machines round out the list.

The pulse oximeter, for example, measures a patient's oxygen levels -- if it reads under 90 percent, the patient must be given oxygen support. Suction machines help to clear the airflow when patients cannot cough up secretions on their own.

Excepting the portable ventilator, all of these are basic equipment for an ICU, said Dr Debasish Kumar Saha, assistant professor at Birdem General Hospital and a critical care expert.

"Without these basic equipment, an ICU cannot operate properly," he said.

SITUATION OUTSIDE DHAKA

Shaheed Shamsuddin Ahmed Hospital is the only dedicated hospital for coronavirus patients in Sylhet division. Currently, it has two ventilators to treat critically ill patients.

Nine more ICU beds with ventilators will be installed at the hospital and four additional ventilators will be kept as backups, said Dr Anisur Rahman, assistant director (disease control) of the divisional health office.

There is no other ICU dedicated for Covid-19 patients in entire Sylhet division.

Rajshahi Medical College Hospital's ICU has dedicated all its 15 beds for coronavirus patients. Five more beds with negative air-pressure and an automatic disinfection process are likely to be added soon.

This facility is dedicated for patients from all eight districts of Rajshahi division.

"There is an ICU crisis across the world and Bangladesh is no exception. The work of completing the ICUs is going on and as all the equipment has to be imported, that's why we cannot set up an ICU overnight, even if we wish to," said Nasima Sultana, additional director general (administration) of DGHS.

Besides, there is a crisis of manpower for treating ICU patients, she told The Daily Star on Saturday.

"The Society of Anaesthetists is working with us and they are looking for manpower to work in these ICUs."

As of yesterday, the number of positive cases of, and deaths due to, coronavirus continue to climb in the country with 155 dead and 6,462 infected.

Experts say things may take a turn for the worse in the coming days if the country does not take immediate steps to ramp up its healthcare facilities with necessary equipment to treat incoming patients.