Covid-19 Hospitals: ICU beds lie unused

When Gazi Sabiha Chowdhury, a 70-year-old heart and kidney patient from Sreemangal, fell in the bathroom on May 31, her family felt something ominous was going to happen.

They rushed her to Sreemangal Upazila Health Complex. As her condition worsened, doctors at the health complex referred her to Moulvibazar 250-bed District Sadar Hospital for better treatment.

But doctors at the hospital said she was in dire need of Intensive Care Unit (ICU) support and so she must be taken to Sylhet immediately.

Worried, her family members rushed her to seven private medical college hospitals in Sylhet city, but none of them took her in. They either said their ICU beds were occupied or they needed the patient's Covid-19 test report first. 

Sabiha died that day.

"We begged for an ICU bed but no one helped us. When she needed oxygen, two hospitals even refused to provide us with an oxygen cylinder," Mazharul Islam, a relative of Sabiha, told this newspaper on Tuesday.

Sabiha's case is not an isolated one as many, including critical Covid-19 patients, are suffering, while some are dying, due to the lack of ICU support, according to media reports.

But when the situation is so dire, a government data shows that a number of ICU beds in hospitals, dedicated to treating Covid-19 patients, remain unused.

There are 106 such dedicated facilities -- both government and private -- across the country which can treat 14,610 Covid-19 patients with 379 ICU beds and 106 dialysis beds, according to the Directorate General of Health Services (DGHS).

But during the last 20 days, from June 6 to Jun 25, only 78 of them were used daily on an average, data from the DGHS shows.

On June 11, the highest 99 ICUs were used while the lowest 41 ICUs were used on June 22, it said.

Another data, from the control room of DGHS, says 177 patients were in ICU beds across the country yesterday.

Currently, government hospitals across the country have a total of 749 ICU beds. Of those, 190 ICU beds have been set up at 17 government hospitals meant for coronavirus patients, according to DGHS data.

According to different studies, around 20 percent of the Covid-19 infected patients require hospital admission. These patients usually need oxygen therapy and some of the critical ones need ICU support.

A total of 4,652 people were admitted to these hospitals as of yesterday, according to DGHS.

SHORTAGE OF MANPOWER

Shortage of trained manpower is one of the reasons why ICU beds remain unoccupied, said officials.

Take Kuwait-Bangladesh Maitree Government Hospital in the capital for an example.

The hospital dedicated to treating Covid-19 cannot operate all its 26 ICU beds due to manpower crisis.

With the existing manpower, the hospital is now using 16 ICUs, Dr Shehab Uddin, its superintendent, told The Daily Star.

To operate an ICU, a critical care medical specialist is necessary, but the country has extreme dearth of such specialists, he said, adding that there are only 13 such specialists in the country.

Although anesthesiologists can operate an ICU, the number of anesthesiologists is also low, he said.

"We have sought necessary manpower to operate the ICUs, but the problem is that there is a crisis of skilled manpower in this field," he said.

Public health experts said the reason behind the current situation could be the fact that all the ICUs were not functional or yet to be operational.

Besides, people find it hard to get ICU due to unavailability of data on vacancies in the Covid-19 hospitals, they added.

Of the ICU beds, a total of 218 were in the Covid-19 hospitals or hospital units in Dhaka city while the rest in the Covid-19 hospitals or hospital units elsewhere.

"If the average use is only 78, then why are many people not getting ICU support in time? The authorities should answer the question clearly," Prof Nazrul Islam, a member of the National Technical Advisory Committee (NTAC) on finding ways to prevent the spread of the virus, told The Daily Star.

Since its inception on April 18, the NTAC has been stressing on increasing ICU facilities in the Covid-19 hospitals.

Sources in the DGHS said some of the ICUs in such hospitals were not installed properly due to shortage of time. As a result, those have not been made operational yet.

Even Bangladesh Medical Association (BMA) in a letter to the health minister on June 20 mentioned the issue of installing ICUs "unscientifically".

Besides, a portion of the ICU beds are also kept reserved for VIPs, said a DGHS official, requesting anonymity.

A Transparency International Bangladesh (TIB) study, published on June 15, found less than 140 ICUs in these facilities were functional.

To ensure people's access to information about the Covid-19 bed vacancy, the NTAC suggested the DGHS make the data available online.

This was not done till last night.

"Since April, we have been suggesting adopting a mechanism to make people informed about the available ICU beds. That has not been implemented yet," Dr Mohammad Shahidullah, president of NTAC, told The Daily Star.

Talking on the issue, Dr Habibur Rahman, director of Management Information System unit of the DGHS, said, "These are the daily figures of all government and private Covid-19 hospitals. Usually, data from around 20 percent of these hospitals are not updated regularly."

Contacted, Prof Abul Kalam Azad, director general of DGHS, said patients may not go to the "right hospitals where ICU beds are available".

"Sometimes I was told why people are not getting beds in hospitals. But I see beds are vacant. So it is a matter to see which hospitals people are going to and whether ICU facility is available there," he said.

Prof Azad said, "It will not be [right] if you say less [use of ICU]. There are many vacant beds and ICUs in the [Covid-19] hospitals. I do not know why people are saying this ... And it would not be right to admit people to ICU forcefully."

He said they were focusing on ensuring oxygen supplies in the hospitals to "save lives".