Young and sick by Covid

Over the last couple of weeks, Covid-19 has posed more challenges to Dr Fatema Ahmed in the intensive care unit of the capital's Birdem General Hospital. And the one thing that is on the top of her mind is how to counsel young patients and their family members so they can cooperate and get the best outcome of the treatment.

As the third wave sweeps across the country with an explosion of Covid infections, people aged below 30 years are falling severely ill in large numbers with the coronavirus, a sign that clearly stands out from the previous two waves of the pandemic.

"They were never admitted to hospital before – let alone to an intensive care unit. So, when they are attached to machines, such as a high-flow nasal cannula, they get panicked," said Dr Fatema, a critical care specialist at Birdem.

"They can sense how critical their health condition is when even a wiggle disrupts their oxygen flow, and they start gasping," she added.

Healthcare providers say they have seen younger people equally affected as elderly critical patients though they have no history of diabetes, hypertension and other comorbidities.

Lungs of people aged 20-50 with seemingly good health have been affected as much as 80%. Most of them survive, while a few do not even respond to treatment.

As has been the case for elderly patients, most of these younger patients are from outside Dhaka and the bordering districts.

Doctors are alarmed by the recent rise in younger patients with critical Covid symptoms. More contagious Delta variant is suspected to have affected this population.

The Directorate General of Health Services recorded 254 deaths of people between 21 and 50 years over the past week while the figure was only 48 a month ago.

The new wave is proving wrong the notion that young people with strong immunity can fight well against the coronavirus, said AKM Akhtaruzzaman, chairman of the anaesthesia and intensive care medicine at Bangabandhu Sheikh Mujib Medical University (BSMMU).

On Wednesday, the 20-bed ICU of the BSMMU had 16 patients from outside Dhaka, with four below 30, he said.

"On average, 10-12% of patients are very young whereas we dealt with only aged people in the previous two waves," Akhtaruzzaman said. The recovery period has also gone up to two-three weeks from 7-10 days, he added.

Infections and deaths will climb up further if transmission is not checked, doctors say. If more and more people in Dhaka also get infected, the healthcare system will become overwhelmed soon.

Already, there is a mounting pressure on ICUs in Dhaka. The data of the health directorate shows that 15 of 27 Covid dedicated facilities - both public and private - in the capital did not have any vacant ICU bed on Wednesday. 

Kurmitola General Hospital, Sheikh Russel National Gastroliver Institute & Hospital, Dhaka Medical College Hospital, Mugda Medical College and Hospital, BSMMU and Shaheed Suhrawardy Medical College and Hospital have been treating critical patients to their full capacity for more than a week. 

There is a queue of 20-25 patients there against each ICU bed.  

The inadequacy of healthcare services in other districts is the main reason behind the rush of patients to the capital. By the time, Covid patients reach here, their health condition turns critical.   

"Whether they will survive sometimes depends on how much they were deprived of oxygen during the journey," said Fatema Ahmed of Birdem where 90% of patients in its 31-bed Covid ICU were from Sirajganj, Jamalpur, Shariatpur, Rajshahi and Naogaon. 

Dr Shoman Aniruddha, an anesthesiologist at the Mugda hospital, said patients had come from outside Dhaka when their condition deteriorated after receiving treatment in a facility for seven to eight days.   

"Treatment facility in Dhaka is better developed than anywhere else. Here doctors have also gained experience tackling the previous two waves, hence the crowd of patients."   

Many patients died before doctors could begin treatment, said a senior doctor serving at the ICU of the Kurmitola hospital, requesting for anonymity. He feared that the recovery rate, if the data of the unit were analysed, would be lower in June and July than in the previous months. 

Treating young patients to health is more challenging.

They remain restless and fall into depression in hospital, said Dr Fatema. They have to be frequently told in what position they should lie, that they should eat to regain strength and immunity, and that focusing on health is more important than when to leave hospital.

"Food and willingness to recover are significant. That is what we keep repeating throughout the treatment. Family members also get shaken up. We have to constantly find a way to keep them calm before the patients."