Medical frontliners suffering the brunt

The novel coronavirus, which has so far infected 2,948 people across the country, is beginning to take a toll on those who are on the frontline of the fight against it: the doctors.

At least 170 doctors of different government, private and specialised hospitals were infected with Covid-19 till 11:00am yesterday, according to Bangladesh Doctors' Foundation (BDF), a platform of around one lakh doctors and medical students.

"Two of them are now in ICU [intensive care unit]," Nirupam Das, chief administrator of the BDF, told The Daily Star yesterday.

Besides, at least 130 nurses and other health staffers have been infected with the virus, he said, adding that some 400 doctors are kept under institutional and home quarantine.

As per the official count of Covid-19 patients in Bangladesh till Sunday, 12.21 percent are doctors and other health workers compared to 11 percent in the US and 8.7 percent in Italy, the epicentres of the pandemic, Nirupam pointed out.

In India, 6.2 percent of the coronavirus patients are physicians and health workers, he mentioned.

The main reasons behind the high rate of infection among doctors and other health workers in Bangladesh are "poor quality" of personal protective equipment (PPE) provided to doctors, community transmission and patients' concealment of Covid-19 symptoms, he noted.

Many patients are now being deprived of healthcare services as a good number of doctors have been infected and scores others remain in quarantine. Besides, the wards of the hospitals where these doctors worked have been closed.

"If the government does not take immediate steps to protect them, the challenge of containing the spread of the virus would be stiffer."

"WE ARE WORRIED"

The healthcare professionals involved in the fight against Covid-19 are worried about their exposure to the virus.

"We are at risk of being infected any time," a doctor of the dermatology department at Bangabandhu Sheikh Mujib Medical University, told this newspaper, seeking anonymity.

Doctors have serious doubts about the quality of PPEs, especially masks, provided by the authorities concerned, said the physician.

But what is more dangerous is that many Covid-19 patients are hiding information while seeking treatment at hospitals or private clinics, he said.

"As doctors, we are ready to provide treatment, but the authorities have to ensure our safety…"

There are many examples where patients hid information and thereby infected healthcare workers with the virus.

On April 14 afternoon, a 50-year-old patient with severe cardiac problems went to Ibrahim Cardiac Hospital in the capital.

After investigation, the emergency healthcare team gave the patient ventilation support. At night when the doctors got the X-ray result, they found in the patient's lung damages believed to be caused by Covid-19, and decided to run a Covid-19 test on the patient.

"Our doctors asked the patient's attendants whether the patient came into contact with any possible carries of the virus. But the attendants kept refusing. They hid from us that the patient had already been tested positive for Covid-19," Prof Dr MA Rashid, a cardiac expert and the chief executive of the hospital, told this newspaper yesterday.

The patient died on the way to Kurmitola General Hospital that night.

Now, a total of seven doctors and seven nurses who attended the patient are in home quarantine.

WHAT EXPERTS SAY

Experts say the patients are hiding information mainly because there is a lack of proper arrangements for treating Covid-19 patients. Besides, there is no standard guideline on patient management for the hospitals across the country.

"Patients fear that they would not get treatment if they tell doctors or nurses that they have Covid-19 symptoms," Prof Rashid said.

He further said all the government and private hospitals across the country need to be brought under a centralised system at this trying time.

"In Bangladesh, 65 to 70 percent healthcare services are provided by private hospitals. It will be impossible to deal with this emergency situation unless they are involved in the process."

He further said the retired physicians and the doctors who now don't have jobs need to be prepared as reserve force. "If more doctors are infected, they will fill the gap."

Prof Muzaherul Huq, former adviser (Southeast Asia Region) of the World Health Organisation, said health safety of doctors, nurses and other health workers have to be ensured first to contain the spread of the virus and save lives.

To ensure that, hospitals must be made germ-free, and quality PPEs, including masks that meet N95 standard, must be provided to doctors, nurses and other health workers.

He suggested that the authorities should divide all hospitals into two categories -- Covid-19 and non-Covid-19.

When a patient will go to a hospital, he or she has to undergo an antibody test. If found positive, PCR test must be conducted on the patient for conformation.

If the test result confirms that the patient is infected with the virus, he or she should immediately be sent to a specific hospital treating Covid-19 patients, he added.

Muzaherul also mentioned that the doctors and health workers who will work in emergency units of non-Covid-19 hospitals have to be given standard safety gears.

INFECTION AMONG DOCTORS

Of the doctors infected with the virus, 120 are from different government hospitals, 34 from private hospitals, eight from Bangabandhu Sheikh Mujib Medical University and the rest from other specialised hospitals, said the BDF based on information collected from the officials concerned.

Most of the doctors -- 143 -- are in Dhaka Division while seven each are in Mymensingh and Chattogram divisions, six in Barishal, three each in Rangpur and Khulna.

Only one doctor -- Md Moyeen Uddin, assistant professor at Sylhet MAG Osmani Medical College Hospital -- got infected with the virus in Sylhet Division. He died on April 15.

According to the BDF, 25 of the doctors are from Sir Salimullah Medical College and Mitford Hospital in the capital, and 14 each from Narayanganj Sadar Hospital and

Sheikh Fazilatunnesa Mujib Memorial KPJ Specialized Hospital and Nursing College.

WHAT AUTHORITIES SAY

Contacted, Habibur Rahman Khan, additional secretary (admin wing) of the Health Services Division of the health and family welfare ministry, blamed some patients' tendency to hide information about Covid-19 symptoms for the large number of doctors getting infected with the virus.

"This is the reason why the doctors treating patients at general hospitals were affected the most, not the ones working at the hospitals for Covid-19 patients," he told this newspaper.

About the allegation of poor quality of PPEs, he said the PPEs provided by the government are "up to the mark". But taking advantage of the situation, some factories are producing "low quality" PPEs which were provided to doctors by many individuals.

He also mentioned that the health minister had already warned that action would be taken against those factories.

ENSURE SAFETY: DHE

Doctors for Health and Environment, an association of doctors, placed a nine-point demand that includes ensuring safety of doctors and other health workers.

In a statement yesterday, the organisation said though the government got enough time to contain the spread of Covid-19, "negligence" and a lack of understanding about the severity of the pandemic are the key reasons behind this "dire situation".

The organisation said it has been giving suggestions to the government from the beginning, but those went unheeded.

It alleged that doctors and other health workers have been deprived of necessary safety gears, resulting in infection among around 200 doctors.

Many people, including doctors, are facing harassment for portraying the real picture of the shortage of safety gears, it mentioned urging the authorities to take steps to stop it.

The platform also demanded that the government take measures to curb corruption in procurement and distribution ofmedical equipment and relief materials.