Faced with the challenge of treating coronavirus patients as well as general ones under the same roof, Rajshahi Medical College Hospital has become a Covid-19 hotspot.

In the 11 days till yesterday, the hospital authorities transferred at least 251 patients to the Covid unit from different wards, according to the RMCH data.

Those patients were admitted to the hospital with various diseases, but subsequently tested positive for the virus and then transferred to the Covid unit, which also accommodates patients with coronavirus-like symptoms.

The data shows that in those 11 days, 23 patients on average were transferred to the Covid unit daily, with the highest 38 transferred on Thursday.

The figure is alarming.

Healthcare professionals at the RMCH said it happened because of the limited scope of screening and testing of patients upon arrival at the hospital, lack of awareness among patients and general disregard for the health rules by their attendants as well as hospital staffers.

Yousuf Ali, for example, was found infected with Covid on Wednesday night after receiving treatment at a nephrology ward for a week.

The 50-year-old was admitted with kidney and diabetic issues on June 10 and was shifted to the Covid unit on Thursday, his son-in-law Hazrat Ali told The Daily Star.

"His samples were tested [for Covid-19] when he developed fever and coughs after staying in the hospital for a week," Ali said.

Zahirul Islam, 35, was among the three patients at neurosurgery ward-8 who tested Covid-19 positive on Wednesday night.

His wife Happy Khatun said her husband was admitted to the hospital three weeks ago with paralysis in the lower part of his body after falling from a mango tree in Chapainawabganj's Bholahat upazila.

The medicine wards witnessed the most transfers of patients to the Covid unit, said Prof Md Khalilur Rahman, head of the department.

"Most patients who come to our wards are asymptomatic. Sometimes, they come with diarrhoea or abdominal pain, and ultimately many of them are found to be infected with the virus."

He said the word "alarming" has ceased to have any meaning for them.

"We're already in an alarming situation."

Associate Professor Md Rais Uddin, head of the cardiology department, said screening out infected patients at the point of entry into the hospital could have prevented such a situation.

The 1200-bed public hospital with 56 wards treat patients from eight districts of Rajshahi division and also from those of Khulna division.

Since the pandemic hit the country in March last year, the biggest healthcare facility of the northern region opened a Covid unit and gradually expanded it.

The RMCH Covid unit now has 309 beds in 11 wards to tackle the influx of coronavirus patients from the bordering districts. It has also dedicated its 20-bed ICU unit to treat critical Covid patients.

A RISING DEATH TREND

Since March last year, at least 866 patients -- 236 of whom Covid positive -- died at the hospital's coronavirus unit. Of the deaths, 111 occurred in July -- the highest in a month until May this year when 124 patients died.

That record has been broken as 193 patients died at the unit in the first 18 days of this month. Seventy-nine of them tested positive for the virus.

While visiting the hospital on Wednesday afternoon, this correspondent found ambulances and three-wheelers carrying patients lined up in front of the gate of the emergency department.

Inside, general patients, Covid patients as well as the suspected ones and their attendants were crowding corridors.

There were intermittent announcements over the hospital's loudspeakers reminding them of the need to follow social distancing and health guidelines, but not many paid heed to that.

Seeking anonymity, a hospital official said, "No place in the hospital is safe anymore…Infected people are roaming at every corner in the hospital."

During a two-and-a-half hour visit on Wednesday afternoon, this correspondent hardly saw any doctor or nurse attending patients in the Covid wards.

In front of the ICU unit, a nurse was seen going out on her shift change. And at ward 22, a male nurse was seen consulting with a doctor through a narrow gap of an almost shut door of the doctors' chamber.

The hospital authorities have dedicated the ground and top floors of a three-storey building for Covid patients. But with other wards for general patients in between and no separate entry or exit for Covid wards, chances of infection remain very high.

All the Covid wards were full and some were crammed with patients even occupying the veranda with oxygen concentrators or cylinders next to them.

Murshida Khatun, a nurse in the hospital, was taking care of her 35-year-old husband Md Ruhul Amin, who tested positive for Covid, in one of those verandas.

She was not even wearing a mask. Asked, she said, "I am infected too."

Most officials and staffers in the hospital said that with Covid patients overwhelming the facility, the virus has started spreading beyond the dedicated corona unit to other wards, turning the entire hospital into a Covid hotspot.

Due to a lack of screening, infected patients and staffers with mild or no Covid symptoms are entering the hospital and infecting others, they said.

RMCH Director Brig Gen Shamim Yazdani said, "Both are happening. Knowingly or unknowingly, infected patients are getting admitted while admitted patients are being infected by staffers or other patients. It is unavoidable when you are managing all types of patients in the same hospital."

The emergency department has a system of triaging patients during their entry, but the system does not always work, he pointed out.

"When patients come [to the hospital], we ask those with fever, coughs and other symptoms of Covid to go to a separate room where separate doctors and nurses attend to them," Shamim told The Daily Star.

But many asymptomatic patients are not be segregated during triage.

Again, the other patients have to walk through the same corridor with Covid patients when they get admitted.

"We couldn't arrange separate corridors for Covid patients."

He said it would have been ideal if the hospital was declared a Covid-dedicated facility, considering the influx of patients from different districts.

"But it's not easy. What will happen to pregnant women needing a C-section or heart patients who need surgery, and patients needing dialysis? Where will we shift them? We can't abandon them."

Around 891 beds in 45 wards are used to treat patients of important departments such as gynaecology, surgery, burn, medicine cardiology, nephrology, and neurosurgery, he said.

"Already we are asking many critical patients to be cared for at home. In normal times, we would have asked them to get admitted to the hospital."

The RMCH director said during the first wave of the pandemic last year, the hospital saw mostly affluent people getting infected.

"But the Delta variant now has been infecting everyone -- rich and poor, old and young.

"We are seeing farmers, shopkeepers, labourers suffering and dying every day and it happened as they refused to care about maintaining the health rules," Yazdani said, adding that from primary assessment they found that 40 percent of patients were from low-income groups.

Admitting that testing all patients during entry to the hospital could have been the best practice, he said they are unable to do so because of limited testing facilities.

Two RT-PCR laboratories at the RMCH test nearly 600 samples a day -- a large number of those are from Rajshahi, Naogaon, Natore and Chapainawabganj, according to data from the labs.

The RMCH director, however, said rapid antigen test can be initiated at the entry points, adding that around 400 patients are getting admitted to the hospital every day -- 40 of them to the corona unit.

About the haphazard setting up of corona wards, the hospital director said it was not possible for them to arrange the corona wards at certain corners of the hospital as they had to connect the wards with the central oxygen supply lines.

"Not all wards of the hospital needed oxygen supply lines before. We set up a corona ward where we could ensure a proper oxygen supply to the beds."

Coronavirus transmission among doctors, nurses and staff are low as they were vaccinated, he said.

Out of 85 doctors and 200 nurses working in the Covid unit, five doctors and 23 nurses became infected during the ongoing second wave of the pandemic, he added.