While the world communities with much better health care facilities than Bangladesh are struggling to manage patients, especially those who have respiratory problems, the Bangladesh government’s initiatives to secure treatment for such patients remains inadequate.

At present, hospitals in Bangladesh have only 1,169 ICU beds that includes ventilation facilities (432 governments, 737 private). 816 of these ICU beds are in Dhaka.

Health and Family Welfare Minister Zahid Maleque on March 21 disclosed that the government was aiming to install 450 more ventilation facilities in the country to provide intensive care treatment to Covid-19 patients.

“We have already received 250 ventilator machines and more 350 are on pipeline of import process,” he said.

Earlier, on March 6 he said he wanted to double the number of ICU beds at all government hospitals to mark Mujib Year.

But public health and intensive care experts said Covid-19 attacks respiratory systems and critical patients will need more ventilators and the country at present is not in a position to match demand.

Ventilators pump air to the lungs through a tube placed in the windpipe.

Health experts also pointed out the shortage of manpower in managing ICU facilities in the country.

Some health experts fear that doctors will be forced to ration care, meaning they would be forced to decide who gets medical attention and who does not.

Essentially deciding who will live or be left to die if the number of Covid-19 positive patients goes higher than that of available facilities. This has already been observed in Italy.

At present Italy, Spain, and New York are struggling to provide ventilators to patients.

After seeing the situation, India is doubling their ventilation facilities by installing 40,000 ICU beds while Pakistan health care authorities said they will install 10,000 more ICU beds if the situation worsens.

A study published in thelancet.com on March 11 said that in China, about 17% of the coronavirus patients actually required ventilation.

However, the Information, Communication, Awareness and Panic Management group of the Integrated Control Room for combating coronavirus in Bangladesh said they are assuming that some 5-6% patients might need ventilation if the crisis emerges. The rest of the patients would not require ventilation.

Focal person of the group, Dr Habibur Rahman in a press briefing on Saturday said they have already installed 36 ICU beds [with ventilation facilities] in the city. And at present no ICU beds are ready outside Dhaka.

The focal person of the Hospital and Patient Care group, Professor Dr Aminul Hasan, said that at present some 90 ICU beds [ventilations] are being installed in Dhaka city alone. 10 more would be installed outside Dhaka, at every medical college hospital, within a week.

Sources from the Hospital and Patients Care group informed that some 11 ICU beds are ready in three private hospitals in the city.

However, Dr MM Aktaruzzaman, senior scientific officer of IEDCR, said the country would need at least two ICU beds in every upazila and five ICU beds in every district, so that  emergency needs can be handled efficiently. Otherwise, we will see more people dying before receiving health care.

And to ensure treatment for  patients, if there is an outbreak, at least 1,000 ventilation beds need to be installed and ready, he added.

The IEDCR official also pointed out that personal protection equipment (PPE) availability has to be ensured so that no health workers have to work in a risky situation.

He also said a hospital dedicated for patients requiring ICU service should be established.

The challenges

Meanwhile, several practicing physicians and respiratory specialists told Dhaka tribune that there is a scarcity of manpower including qualified intensive care specialists and nurses.

In this situation, establishing a dedicated hospital for ICU services or installing thousands of ICU beds with ventilation facilities within a short time could result in inefficient service that would be more deadly.

Dr Shahedur Rahman Khan of the National Institute of Diseases of the Chest and Hospital (NIDCH), said Bangladesh does not have a long history of ICU treatment and so there is a shortage of manpower.

“We hope the government takes decisions keeping in mind whether it is possible to run ICU facilities [with ventilations] with the present manpower, and would not cause difficulty in any treatment during operations,” he added.

Meanwhile, Zunaid Ahmed Palak, state minister for the ICT division, on Monday said the government will manufacture ventilators by engaging with local technological conglomerate Walton and with the support of Medtronic, a global leader in medical technology.

While addressing an online press conference, the state minister said said Bangladesh will be able to manufacture the ventilators as soon as possible.