The country's health sector looks ill-equipped to tackle a massive surge in Covid cases or anything close to the situation in India.

Though there have been some improvements in management capacity over the last year, experts say it is far from enough.

The government is yet to set up ICU facilities in 29 district-level public hospitals while the number of daily Covid-19 tests is still inadequate.

Besides, most of the 421 upazila health complexes lack the necessary human resources and life-saving equipment like high-flow oxygen supply, crucial to treating critical Covid-19 patients.

Although the country has been experiencing a decreasing trend in daily infection rate and death since mid-April, it has started rising steeply again in the last three days -- 1,608 new cases yesterday from 261 on May 15.

Experts warned that there is no room for complacency as the four mutated coronavirus "variants of concern" -- especially the Indian one -- have already spread in the country.

Besides, any new mutated variant can turn deadly in the days to come while the uncertainty over the mass Covid-19 vaccine inoculation drive has left the nation barely protected, they said.

"We are still almost there where we were a year ago," Prof Ridwanur Rahman, an infectious disease specialist told The Daily Star recently.

"Many district-level hospitals are yet to get a central oxygen supply system. The antigen-based testing has not been introduced massively. The daily number of tests is too little yet," he also said.

Prof Dr ABM Khurshid Alam, director general of the Directorate General of Health Services (DGHS), however, said otherwise.

"While we had nothing at the beginning, we have 7,000 beds for Covid-19 patients right now. If the number of patients rises to 21,000, then what can we do? So, we have to take customised preparations -- measures based on the situation," he said.

When the World Health Organisation (WHO) advised countries to take steps after Covid-19 cases first emerged in the Chinese city of Wuhan in December 2019, DGHS kept 15 beds preserved at the Kurmitola General Hospital.

By the end of February 2020, the government turned the Kuwait-Bangladesh Friendship Hospital in Dhaka into the first Covid-19 dedicated hospital in the country. Besides, the health directorate directed all district-level hospitals to prepare an isolation unit with five beds.

In over one year, the number of beds and full-fledged Covid-19 public hospitals or hospital units has multiplied.

As of yesterday, there were 11,991 general and 1,171 ICU beds for Covid-19 patients in public and private hospitals across the country.

Of them, 3,440 general and 374 ICU beds are in 15 hospitals in Dhaka city while 432 general and 33 ICU beds in four hospitals in Chattogram city.

But the shortage of doctors, nurses and other staffers in hospitals is also a pressing issue yet to be addressed properly, both health officials and experts said.

CONCERN OVER OXYGEN SUPPLY

When the pandemic hit the country in March last year, there was no central oxygen supply system in almost all district-level hospitals, except in a few medical college hospitals.

However, by the end of April, the installation of the central oxygen supply system was completed in 73 hospitals. The process is ongoing in 61 other hospitals, according to Farid Hossain Miah, director of hospitals at DGHS.

Health officials said a total of 134 district-level hospitals will be equipped with a central oxygen supply system by June this year.

In one year till yesterday, the number of high-flow nasal cannula has been increased to 1,609 in public hospitals across the country.

Of these, 486 are in Covid-dedicated public hospitals or units in Dhaka city with 46 in Chattogram city.  Besides, 395 are in 27 private hospitals in Dhaka and four in Chattogram.

The rest of the country had the remaining 699 high-flow nasal cannulas, according to DGHS data.

"We have been hearing such numbers since the beginning. The progress is too little. If we cannot decentralise hospital services, we cannot say the preparation is satisfactory," Prof Ridwanur Rahman said.

India reported 4,529 deaths in the last 24 hours, the highest so far in a day, according to media reports last night.

Earlier, considering the situation of the neighbouring country, DGHS on May 4 asked the Central Medicine Store Depot (CMSD) to import 40 oxygen generators as early as possible. The proposal will need a nod from the cabinet's purchase committee, according to officials.

 After following a meeting of The Cabinet Committee on Economic Affairs yesterday, Finance Minister AHM Mostafa Kamal said, "It was the duty of the health ministry to take initiatives at the right time but they didn't."

He added, "As we had no experience, we have to take speedy steps now. Considering the Covid-19 situation, we have approved the direct purchase of 40 oxygen generator machines by the CMSD."

According to health officials, each generator is capable of supplying high-flow oxygen to 100 patients simultaneously for 24 hours.

Talking to the media recently, Health Minister Zahid Maleque said, "Normally, we need 70-80 tonnes of oxygen in hospitals daily. During the recent second-wave peak of Covid-19 cases, the demand increased to 210 tonnes daily. But we have 220 tonnes domestic production capacity daily."

He also said the government has stocked 1,350 tonnes liquid oxygen considering India's recent oxygen shortage due to the recent virus surge.

TESTING STILL INADEQUATE

Since the government started testing suspected coronavirus cases from January 21 last year, the number of daily tests crossed 30,000 last month for the first time. Last week, however, it was below 20,000 daily on average.

Otherwise, the number of daily tests was around 15,000 every day, which too decreased to its lowest in January and February this year.

Bangladesh has so far done 35 tests per 1,000 people -- the lowest even among South Asian countries. Meanwhile, the Maldives has done 1,471 tests per 1,000, according to ourworldindata.org.

Among other South Asian countries, Bhutan is in second position with 966 tests per 1,000 people, India third with 226, Sri Lanka fourth with 149, Nepal fifth with 95, and Pakistan sixth with 56 tests.

"The number of tests is too little. When you are not doing adequate tests, it means you are hiding cases. The transmission cannot be controlled in this way. We have seen untested patients coming in the Covid-19 hospitals during the recent spike," Prof Ridwanur Rahman said said.

The government has taken too much time to allow antigen tests and yet it is not available everywhere, he added. 

The number of antigen tests is on an average 300 daily.

In case of transmission control, however, the government has failed to act in an organised way since the beginning, experts said.

Prof Nazrul Islam, member of the National Technical Advisory Committee (NTAC) on Covid-19, told The Daily Star, "The hospital capacity is not adequate yet. We have seen many patients dying amid the lack of oxygen and ICU support during the latest surge. As we are fearing another surge -- especially due to the Indian variant, it is not possible to tackle the situation with this preparation.

"As the district hospitals are not well-equipped -- particularly with central oxygen supply system -- patients rush to Dhaka. This is not well-managed at all. The government has to address it."

About oxygen capacity, he said, "Increasing oxygen stock from private industries is not a solution. We have to increase production."

He also stressed increasing daily testing capacity.