Act now or hospitals may get overrun: experts

The simultaneous outbreak of three viral diseases -- Covid-19, dengue and chikungunya -- may overwhelm the country's healthcare system unless the authorities take swift and coordinated actions, warn experts.

At least 22 people died from Covid and 18 more from dengue over the last one month, with chikungunya resurfacing in the country after nearly eight years.

Covid-related deaths were reported mostly in Dhaka and Chattogram divisions, while the majority of dengue fatalities occurred in Dhaka and Barishal divisions. Chikungunya cases remain concentrated in the capital.

Health experts and officials said the next two to three months will be crucial, and the authorities should prepare a comprehensive, disease-specific plan for the most affected areas.

SURGE IN COVID CASES

A total of 569 Covid cases have been detected since January 1. Of them, around 72 percent were reported last month, shows data from the Directorate General of Health Services (DGHS).

All 22 Covid-related deaths, reported so far this year, occurred last month, and the first one was recorded on June 5.

The deaths follow a sharp rise in infection rate in May. Of the 1,409 samples tested that month, 9.51 percent were positive for Covid -- the highest since January 2023, according to the Institute of Epidemiology, Disease Control and Research (IEDCR).

Two new SARS-CoV-2 Omicron subvariants -- XFG and XFC -- were detected for the first time at Chattogram Medical College Hospital in April, shows a hospital-based influenza surveillance study conducted jointly by icddr,b and IEDCR.

Mustafizur Rahman, head of the virology laboratory at icddr,b, said the two are sub-variants of JN-1, which is already present in Bangladesh. Their transmission capacity is relatively high. This is why infections are spreading.

"But there is nothing to worry too much about it. The transmission rate was almost the same during the same period last year, but it didn't receive much attention due to other pressing issues at that time," he told The Daily Star.

He suggested vaccinating vulnerable people, including the elderly, pregnant women and those with medical conditions, to reduce the risk of fatality.

Bangladesh recorded the first Covid case on March 8, 2020, and the first death from the virus was reported 10 days later. Since then, the country has seen 20.52 lakh cases and 29,521 deaths, with 2021 being the deadliest year.

DENGUE

At least 10,296 dengue cases were reported since January, and around 58 percent of them were recorded last month, shows DGHS data.

Around 45 percent of the total cases were reported in Barishal division, as Borguna turned into a dengue hotspot with 2,746 hospital admissions since January.

Out of 42 deaths from dengue this year, 19 occurred in June. And the highest number of deaths -- 21 -- were reported in Dhaka city, followed by 11 in Barishal division.

The number of daily admissions at hospitals shot up to 314 on June 30 from 124 on June 1.

Entomologist Prof Kabirul Bashar said the trend shows a geometric rise in cases that were three times higher than those reported in May.

"If this trend continues, cases could increase four to five times this month and even tenfold by August compared to May," he said.

CHIKUNGUNYA

Another mosquito-borne disease, chikungunya, has made a comeback in Dhaka after eight years.

From January 1 to May 28, at least 337 suspected chikungunya cases were reported, and 153 of those were confirmed by RT-PCR tests, according to the IEDCR.

The viral disease causes fever; severe joint pain and headache; muscle pain; and rash.

In the first three weeks of June, chikungunya was detected in 140 out of 171 patients who went through RT-PCR testing at icddr,b diagnostic laboratories.

Chikungunya cases were confirmed for the first time in Rajshahi and Chapainawabganj in 2008. Three years later, some cases were reported in Dhaka's Dohar upazila. In 2017, Dhaka and 16 other districts saw a major outbreak of the viral disease, according to the IEDCR.

WHAT EXPERTS AND AUTHORITIES SAY

Covid and chikungunya cases remain concentrated in Dhaka, while Dengue is now more prevalent in Barishal division than in Dhaka, said Fazle Rabbi Chowdhury, an associate professor at the internal medicine department of Bangladesh Medical University.

"These diseases haven't yet overwhelmed inpatient units at hospitals. But they are definitely putting pressure on outpatient departments, as patients of these viral diseases are primarily treated there."

He further said that if both dengue and Covid cases continue to rise, hospitals in Dhaka could come under strain. "There should be adequate preparations, along with preventive measures."

Rabbi, also a member of aWHO expert panel on dengue, recommended that hospitals set up dedicated units to prevent the spread of viral infections among patients already admitted there.

District and upazila hospitals should provide doctors with training based on the latest guideline on dengue treatment, enabling them to deal with patients at local hospitals, instead of referring them to healthcare facilities in Dhaka.

He also stressed the need for ensuring an adequate supply of antiviral medicines at hospitals.

Prof Md Sayedur Rahman, special assistant to the chief adviser for the health ministry, said local government bodies are primarily responsible for vector control, but many of them remained non-functional over the past year.

Water stagnation contributed to the rise in dengue cases in many areas of several coastal districts. "Delayed admission is the main reason behind fatalities. Otherwise, our preparations are quite adequate," he told this newspaper.

"The next two months are very crucial for us. It is our responsibility to ensure treatment, and we are preparing a plan accordingly," he said, adding that the government has been supplying necessary test kits, oxygen cylinders, and medicines to hospitals.

While chikungunya is not usually fatal, the other two viral diseases could turn deadly, he noted. "We will come under pressure. Unfortunately, outbreaks of these diseases occurred simultaneously. But preparations are well underway."