Let's take the example of Sufia Khatun, 65, a resident of Dhanmondi in the capital. She had suffered a heart attack in 2018 and saw doctors both in Bangladesh and India and was on medication prescribed by a cardiologist in Delhi. Torsemide was working well.
"She used to buy the medicine from Kolkata, as it was not available in Bangladesh. However, its stock ran out in April amid the lockdown. She died on July 19," said Dr Kamruzzaman, a physician at the Bangladesh Medical College Hospital and son-in-law of Sufia Khatun.
Though she went through checkups during the pandemic, there were times when finding an appropriate consultant was impossible as they declined to see patients due to the fear of Covid-19 infection, he said.
"Panic attack due to the pandemic may also be a factor in her death," Dr Kamruzzaman said.
Prof Sharmeen Yasmeen, chairperson of the Public Health Foundation of Bangladesh (PHFB), said many cardiac patients feared going to the doctors, while hospitals too denied admission and consultation.
"Many cardiac patients died though they did not have Covid. Again, many died, having suffered heart attack after Covid infection," she said. And, the suffering of the patients has been acute during the lockdown, which has been relaxed now, but the woes are not over yet.
Ayub Khan, 52, of Demra in the capital has been suffering from heart diseases for the last four years and was on medication. Since April this year, his health condition has deteriorated.
"I was feeling acute chest pain, but could not go to any hospital. A doctor in Demra gave me medicine, but said I need hospitalisation. It was not possible due to lockdown, however," said Ayub, a former contractor, who is now unable to work because of heart problems.
His relatives contacted the National Institute of Cardiovascular Diseases (NICVD), the only specialised public hospital for cardiac care, before the Eid-ul Azha late July. Authorities asked them to contact after Eid. Eventually, he was admitted to the NICVD on September 12.
"Doctors told me I need angiogram, but I am yet to get a serial," Ayub told The Daily Star, lying in the corridor of the third floor of NICVD in the city's Sher-e-Bangla Nagar area, on September 21. Even the corridor of the hospital was packed with patients and their relatives.
"Oftentimes, they yell at us asking why we are here," said Amina Begum, wife of Ayub.
Prof Dr Mir Jamal Uddin, director at the NICVD, said the hospital did not conduct angiogram or schedule operations for two months since the lockdown, except in the case of emergency patients.
"It's because a lot of our doctors, nurses and staff were infected with Covid-19 – a total of 260 as of now," he said. The services began opening up in full swing after Eid and now there are 700-800 patients admitted at the 424-bed hospital.
"We are now unable to provide beds to all. We also cannot deny any patients treatment because many of those coming here are not able to go to the private hospitals that are expensive," Prof Jamal Uddin said.
In pre-Covid times, he said, it used to take less than a week for a patient to get a serial for angiogram, a type of X-ray imaging to check the heart's blood vessels, but now it takes about two weeks.
The NICVD director said the pandemic is a new experience for all, especially the health workers, who themselves had to face it as frontline fighters, making it extremely challenging for them to cope with it.
Many of the private hospitals often denied admission to patients even with critical conditions without Covid-19 negative certificates. Then again, it was not easy to get a Covid test done – a situation that has led to many unexpected deaths and worsened the situation of cardiac patients, health experts said.
A beacon of hope
Against all odds, the National Heart Foundation Hospital & Research Institute (NHFHRI) stood tall, treating cardiac patients throughout the pandemic.
"Like others, we too were panicked and ill-prepared in the beginning," said Prof Dr Fazilatunnesa Malik, chief consultant cardiologist at the NHFHRI.
However, she said, as health personnel, it was their primary objective to provide healthcare under any emergency. "Our main challenge then was protecting our staff, doctors and nurses. So, we instantly decided to arrange the best PPE."
In the beginning, the number of patients, especially those out of Dhaka, declined. Those who came were very sick. The 480-bed non-profit hospital specialising in heart treatment did not deny any patient treatment (regardless of whether they had a negative Covid-19 certificate or not).
Prof Fazilatunnesa said the whole sixth floor of the hospital building was turned into an isolation unit. The suspected Covid patients were first accommodated at the isolation ward, and after Covid tests, they were sent to the Covid ward if found positive. The government agencies involved in coronavirus tests were also helpful.
She said they never closed the cath lab and continued to conduct angiogram and angioplasty, a procedure to restore blood flow through the artery.
She said they have brought down working hours and allowed two to three days' rest a week for the health personnel. The hospital arranged separate rooms for them in the hospital for sanitisation and changing clothes before going home and after coming to the hospital. They also maintained isolation at home.
"This has worked well. We are still following the same," Prof Fazilatunnesa said, adding, "It was possible because we are a non-profit and can take quick decisions. We don't need to hold a physical meeting, rather a meeting on Viber is enough for us to make a decision."
Prof Sharmeen Yasmeen of PHFB lauded National Heart Foundation Hospital's innovative way of serving under emergency.
"We are speaking of mostly curative healthcare. The pandemic has taught us a lesson – we need to develop immunity," she said.
For that to happen, lifestyle should change. That includes regular physical exercise, avoiding smoking, alcohol and oily and junk food containing trans-fat, she said.
Prof Fazilatunnesa Malik agreed. "We need to do a lot more for health promotion and behavioural change for a healthy life. It will prevent a lot of diseases."