We may soon run out of hospital beds, ICUs and oxygen

Bangladesh has just passed the deadliest month (July) of the pandemic since it began last year. July surpassed every other month in terms of daily positivity, deaths and sufferings, and also in terms of not adhering to the lockdown. 

The country had on average 10,000 reported cases and over 200 deaths daily. In July, we incurred one-third of the country's total Covid-19 deaths in a single month.  

But this statistic does not capture the whole picture of the Covid-19 menace that affected different spheres of the lives of the people of the country. Let's shed some light on those effects, where we stand today and what is to come.

The month of July 2021 was the deadliest primarily because of the Delta, the most transmissible variant so far. It has already affected over hundred countries in the world, evading even the community immunity achieved through high coverage of vaccines in few developed countries of the world. 

A recent survey shows that the Delta variant is currently the only active variant in Bangladesh. Interestingly, this variant entered Bangladesh only last May, but already it is absolutely dominating the whole country. 

Back then, the UK variant was also active, and it was also highly transmissible. And because of its highly contagious nature, it is affecting more than one or even all members (100%) of a family and surging ahead despite the lockdown, although imposed belatedly.

 In the past, we saw the start of the transmission in cities and then moving on to the rural areas, but now transmission is happening both in rural areas and in the city in parallel, with the transmission often starting in the villages. 

Earlier, whenever the transmission rate saw a spike, we could somehow manage it because our health care system in the cities is far better than that in the rural areas. As the Delta variant now has taken over the rural areas, our health system has suffered a real jolt. 

For example, Gaibandha has been passing through a great ordeal. Patients are everywhere. Gaibandha lacks ICU facilities and high-flow nasal cannula. There are no medicine consultants and only a few medical officers and support staff, like cleaners. In short, everything is scarce. 

When I visited the Sadar Hospital of Gaibandha, I encountered a complete mess with doctors exhausted, and the superintendent at a loss about what to do. Though we have ample doctors with sufficient specialists for our Covid-19 units in Dhaka, many of the rural districts are struggling a lot due to lack of healthcare personnel. By my estimation, many district or even divisional level towns of the country are in the same state.

Now let's focus on the Covid-19-infected patients. Who are the people taking treatment in these hospitals? Mostly the poor, aged and illiterate people of the rural areas. Also, these people are unjabbed and have been deprived throughout the earlier vaccine campaign due to the barriers of digital registration process, vaccination centres being established far away from their residences, and also ignorance about the requirement to vaccinate. 

This digital registration was unnecessary but no one bothered to listen. As a result, a big chunk of our rural population remained unvaccinated, and now they are facing the menace of the infection and even death. 

Sadly, these patients are not even conscious of their status of infection; trying to ignore the decline in oxygen saturation and by the time they come to the hospitals, they are often in a critical state, which makes  their management and survival extremely difficult. 

Also, the treatment is an extra burden for the poor and marginalised people. They are facing catastrophic health expenditures while bearing the cost of medical tests, medicines and transportation. As a result, it is eventually pushing them further below the poverty line.

Covid-19's impact cannot be measured by just the number of positive cases or deaths anymore. It has affected us in multi-dimensional ways and continues to change our economic and socio-political situation. 

To overcome this, the government is trying newer and multidimensional approaches. However, none of these could be properly implemented, and even lockdown, in the recent past, has not brought forth the expected decline in infection and deaths. 

But why is our current situation like this?

We recently had a few super-spreading events: Eid al-Adha and cattle haat, and for those events, the government had to ease the lockdown for a few days. That may have hindered the achievement of the previous lockdown. 

After Eid, though the lockdown has been imposed again, we did not notice any significant change in infection rate or death numbers. Also, reopening the garment and other export-oriented industries may have added fuel to the burning Covid19 situation. It seems like the garment sector is operating as an independent wing. 

The reported numbers that we are getting are not the real picture of our country; it may be two to three times higher. Neither is the lockdown maintained properly, nor are we getting the expected results of this lockdown. In this situation, what can be done? Are we going to accept the fate of India, Indonesia or Vietnam?

I am worried after analysing the current situation, because it seems uncontrollable now. Our city hospitals are occupied almost to full capacity. Sooner, we will not have any hospital seats or ICU and may face a grave lack of oxygen. 

As a result, we might have to depend on industrial oxygen. But who knows if it will usher in another havoc, like black fungus? A black fungus case has already been detected in recent times. 

If things keep going on like this, the government might have to impose an even stricter lockdown again. But would that be a viable decision for us? I am not sure. 

Are we ready to face the damage to our socio-political, economic and healthcare system? We need a huge budget to support our patients to afford treatment, for our hospitals to recruit more medical officers, health care specialists and frontliners.

There should be a national discussion on this, where our public health specialists, development sector experts, and members of parliament are present. We should focus on our drawbacks in those talks and how to counter it, in order to curb the transmission rate and bring it down to 5%.

The sooner we make these decisions and start working on them, the better it will be.

Be-Nazir Ahmed, Former Director of Disease Control at Directorate General of Health Services. Illustration: TBS

Prof Dr Be-Nazir Ahmed is the former Director (Disease Control) of DGHS