Chattogram in dire need of high flow nasal cannulas, ICU beds

Abu Bakar, a resident of Chattogram's Zamal Khan area, began suffering from breathing difficulties and his oxygen saturation level dropped below 90 percent on Friday.

His family and friends tried to get a bed at a government hospital, but could not find any vacancy. They later managed to get Bakar admitted to a private hospital, and doctors put him on high-flow oxygen as his saturation level dropped below 70 percent. 

Bakar urgently needed oxygen with a flow rate of more than 30 litres per minute. However, the hospital only has the capacity to supply oxygen at flow rate of up to 25-30 litres per minute at its intensive care unit (ICU) and high dependency unit (HDU). 

So, Bakar needs a high flow nasal cannula (HFNC). For the last five days, Bakar's family had been trying to get a bed at a facility with HFNC support, but to no avail. He continues to fight for his life at a private hospital ill-equipped to treat him.

In Chattogram, there are only seven HFNCs at two government hospitals – Chattogram Medical College Hospital and Chattogram General Hospital. Additionally, there are 21 HFNCs at private hospitals and two charitable facilities throughout the port city.

The city not only faces a dire need for HFNCs, but also requires significantly more general and ICU beds at its hospitals. There are hardly any beds to admit more patients in Chattogram, as the local hospitals are currently overflowing with them.

Yasmin Begum, wife of Abu Bakar, told The Business Standard, "We went to all the hospitals in the city and it took us around five hours to get my husband admitted to a facility. Our struggle then resumed as we began searching for a HFNC or an ICU bed.

"We are yet to manage it, because every hospital has turned us away. However, we were lucky enough to manage an HDU bed on Tuesday."

She added, "At the hospital, some are praying for the recovery of the patients, and some are praying for patients to pass away so that more beds become available."

Munia Moon, a non-governmental organisation (NGO) worker, described her experience, "My father was admitted to a hospital with Covid-19 last week. The doctors recommended high flow oxygen or intensive care unit support for him, but we could not manage it in time. 

"My father died two days after being hospitalised."

More HFNCs have become essential in the port city, as doctors are now recommending high flow oxygen support to a growing number of critical Covid-19 patients.

Dr Abdur Rab Masum, medicine specialist of Chattogram General Hospital, said, "Covid-19 patients need high flow oxygen. Using HFNCs, we can provide 70-80 litres of oxygen per minute to patients, while the flow rate of the central oxygen line or a cylinder is only 15 litres per minute.

"So, there is now a huge demand for high flow nasal cannulas for Covid-19 patients."

According to Chattogram District Civil Surgeon Dr Sheikh Fazle Rabbi, around 400 beds, including 17 ICU beds and seven HFNCs, have been prepared for Covid-19 patients at Chattogram Medical College Hospital (CMCH), Chattogram General Hospital (CGH), the Bangladesh Institute of Tropical and Infectious Diseases Hospital (BITID), Holy Crescent Hospital and Railway Hospital.

On Wednesday, the CMCH said they have so far admitted around 250 patients against the capacity of 100 beds. Meanwhile, the CGH has admitted around 200 patients against its capacity of 150 beds. 

Responding to a query, Dr Mostafa Jamal of the CGH's Covid-19 unit, said, "We need at least 20 HFNCs, but have only three. We did not have any HFNCs until May this year, and we received them as a donation."

Dr Aftabul Islam, deputy director of the CMCH, said, "We are struggling with the increasing number of patients every day. Moreover, we have only four HFNCs and seven ICU beds, though at least 50 patients need those services.

"Every day we are getting a huge number of requests for HFNCs and ICU beds from patients, and we have no choice but to turn them away due to our limited capacity."

Additionally, the BITID, Holy Crescent Hospital and Railway Hospital do not have any HFNCs whatsoever.

According to the Chattogram Private Hospitals and Lab Owners Association, there are around 15 HFNC and 121 ICU beds at private hospitals in the port city. 

Of them, four are at Surgiscope Hospital, three at Max Hospital, three at Metropolitan, two are at CSCR, two at Parkview and one at National Hospital. Additionally, two charitable hospitals – Chattogram Field Hospital and Maa-O-Shishu Hospital have two and four HFNCs, respectively.

There are also allegations that hospitals are refusing to admit patients despite having beds available. However, private hospitals are also grappling with the shortage of available beds for patients, the association said. 

Liakat Ali Khan, general secretary of the association said, "We have to deal with all types of patients. No hospital is turning away Covid-19 patients now. There is a shortage of beds as the number of patients is increasing."

Chattogram is home to over six million people, and 6,979 among them are infected with the novel coronavirus. The official death toll is 152 as of Wednesday. 

According to doctors, around 20 percent of the Covid-19 infected need emergency support such as oxygen, ICU and ventilators.