Just four years ago, Papia Sultana donated a kidney to save her husband Aman Sardar.

But on Wednesday, when all Aman needed was more oxygen, Papia watched helplessly.

Aman died of Covid-19 at the Rajshahi Medical College Hospital.

Her cries of anguish echoed through a hospital already filled with such grief on a day that saw the highest daily deaths -- 18 -- in the RMCH Covid unit. Eight of them were Covid-19 positive.

The unit is dedicated for the treatment of Covid-19 patients and those displaying coronavirus-like symptoms.

"So much air around; I couldn't give him even a bit of it," Papia wailed.

Aman, 35, of Narayanpur village in Rajshahi's Bagha upazila, was brought to the hospital on June 16 after being diagnosed with Covid-19.

His oxygen saturation level, aided by the hospital's central oxygen supply, was around 93 percent that day.

On the night of June 20, when he started experiencing breathing problems, doctors advised ventilator support at the intensive care unit (ICU).

But there were at least 75 other patients ahead of him in line for a bed at the 20-bed ICU, which was full of critical patients.

On the night of June 22, when Aman's condition deteriorated critically, he was shifted to a recently vacated ICU bed.

Aman could never regain the desired oxygen saturation level and he breathed his last at 11:00am the following day.

"He spent three sleepless days and nights till his death, trying to gasp air at every moment," Papia narrated in a tear-choked voice.

"He was telling us repeatedly that he would feel good if only he was shifted to the ICU. But getting an ICU bed was nearly impossible at that time," she said.

Aman's death, after waiting for days for an ICU bed even as his oxygen levels plummeted, is not an isolated case at the RMCH.

Hosne Ara, 61, a Covid-19 patient, was waiting for an ICU bed with her oxygen saturation level at 70 percent while Muktara Begum, 50, with 60 percent and Sohrab Ali, 60, with 65 percent.

Hospital staffers said the oxygen saturation level of these patients could not be increased even after providing them with oxygen using high flow nasal cannulas at a rate of 60 litres per minute

Rajshahi division has a total 100 nasal cannulas, 65 of them at RMCH.

RMCH Director Brig Gen Shamim Yazdani said doctors usually prescribe ICU beds for patients when their oxygen saturation level dips below 86 percent, but it has become impossible for ICU managers to cope with patients with saturation levels below 70 percent.

"Our main focus now is to provide oxygen to those who can survive with the support. We have to lose hope for others," he said.

Although the hospital authorities have been raising the number of beds and oxygen supply capacity almost daily for its Covid-19 unit, they are unable to increase the capacity of its ICU.

"We can't increase the ICU capacity easily as that would require physically expanding the facility and allocation of ventilators," RMCH Director Yazdani told The Daily Star yesterday.

"Even if we are given ventilators and beds, we would need more than a few months to develop the infrastructure," he said.

The 10-bed ICU was turned into a 20-bed one after the pandemic began last year.

As the number of patients spiked in June, the full 20-bed ICU unit was dedicated for treating Covid patients.

"The demand for ICU beds doubled during June," the hospital director said.

In early June, the number of patients waiting for an ICU bed was around 30 and the number is currently around 70, he said.

"Even the BSMMU has no more than a 20-bed ICU unit," he said.

They had proposed a separate 20-bed ICU for a separate Covid-dedicated hospital in Rajshahi, he said.

The new hospital is going to be housed in the two-storey building of Rajshahi Sadar Hospital, which had housed the RMCH's dental unit for the last 20 years.

Once the proposal is approved, the hospital with a central oxygen supply would take at least two months to become ready for service, he said.

More than 50 new patients are admitted every day and the 357-bed Covid unit was treating 404 patients yesterday, according to RMCH data.

Health professionals say the situation has worsened as the community transmission increased, while a large number of households in various parts of Rajshahi city are reporting Covid-19 cases.

Authorities of Rajshahi City Corporation and Rajshahi Metropolitan Police, who offer free supply of oxygen cylinders, told The Daily Star that they were receiving calls from almost every area of the city.

The month of June has so far seen a record number of deaths at the RMCH's Covid unit, with at least 273 people -- 141 of them Covid-19 positive -- having died in the first 24 days of the month.

The previous monthly deaths' record was 124 in May.

The hospital authorities have installed a second oxygen vaporiser at its oxygen plant on Wednesday to increase oxygen pressure in its 11 Covid-19 wards.

In addition to its central oxygen supply, the hospital is supporting the patients with 183 oxygen concentrators and 725 oxygen cylinders.

The authorities is likely to install another liquid oxygen tank at its plant soon as it plans to further extend the Covid wards.

RMCH provides treatment to patients from all eight districts of Rajshahi division and many districts of Khulna division.

Yesterday, out of a total 404 patients at the hospital, 272 were from Rajshahi, 59 from Chapainawabganj, 32 from Naogaon, 26 from Natore, 10 from Pabna, three from Kustia, and one each from Chuadanga and Dhaka.

According to Directorate General of Health Services (DGHS) data, in all of Rajshahi division only two districts, Rajshahi and Bogura, have ICU beds – 20 at the RMCH and 26 in three hospitals in Bogura.

On Thursday, all 20 ICU beds of RMCH were occupied.

Of the 26 ICU beds in Bogura, six out of eight beds at each of Mohammad Ali District Hospital and Shaheed Ziaur Rahman Medical College Hospital were occupied, and one out of 10 beds was occupied at the TMSS Medical College and Rafatullah Community Hospital.

Dr Habibul Ahsan Takuder, director of Rajshahi divisional DGHS, said most patients needing treatment in ICUs were delaying going to hospitals and so were appearing with 40 percent of their lungs infected.

"Most of these patients fail to regain an expected level of oxygen saturation," he said. "As the number of patients surged, we are focusing only on those who can survive.

"ICU facilities cannot be increased overnight; managing its manpower, logistics and infrastructure requires time," he said, adding that the DGHS has purchased some ICU equipment and those would be supplied to hospitals in Rajshahi division soon.

He said Shaheed Ziaur Rahman Medical College Hospital has prepared the infrastructure for a new 10-bed ICU unit, but other hospitals are not yet ready.

He also said the facilities for RT-PCR tests is increasing as the DGHS has allocated five more RT-PCR laboratories in the division.

Two of the laboratories, one each at Rajshahi Medical College and Rajshahi Tuberculosis Hospital, are likely to start operation from the first week of July.

Three medical college hospitals in Bogura, Pabna and Naogaon are also going to have new RT-PCR laboratories soon, he said.