Why are COVID deaths spiralling in Bangladesh? Health experts weigh in

By | July 12, 2021

Jashore is one of many districts where the community transmission of the Delta variant, originating across the border in India, has caused a sharp upturn in COVID-19 infections and deaths.

Pradeepta Chowdhury, a doctor at Keshabpur Health Complex, told bdnews24.com: “The patients who are coming in now have very low oxygen saturation. It is becoming difficult to save their lives. ”

Usually,  a patient is transferred to Jashore District Hospital or Khulna if his condition is serious. But now, the new patients are either elderly or have comorbidity. Doctors say they are not getting enough time to treat the patients as some are dying even before they can be diagnosed.

“One of the patients was a suspected COVID case. His sample was sent for testing. But he had died before the report came in. We got five to six hours to treat him.”

The coronavirus pandemic which began last year initially ravaged Dhaka and other urban areas. However, the situation has changed dramatically after the arrival of the Delta strain, with border districts and other rural areas bearing the brunt of the pandemic since April.

Over the past few days, single-day caseloads have consistently exceeded 10,000 while the daily deaths, too, are mostly over 200.

According to the health directorate, more than 77,000 people have tested positive for COVID-19 in the past week. The death toll reached 1,354 during that time.

On Monday, the daily tally of infections surpassed 13,000 for the first time, a day after Bangladesh posted its highest single-day death toll of 230.

The prevalence of the Delta variant saw April become the darkest month for the country in terms of COVID-19 deaths, with the government tallying 2,404. Another 1,884 people died from the illness in June.

Division-wise, Dhaka accounted for the highest number of deaths for most of the past year, particularly as severely ill patients were brought to the capital from all over the country.

But during the second wave of the pandemic, Khulna and Rajshahi emerged as COVID-19 hotspots, sometimes registering more deaths than Dhaka in daily counts.

In a grim assessment of the ongoing crisis, the health directorate has already expressed fears that the situation could worsen over the next week.

More than a year into the pandemic, doctors are blaming a lack of public awareness for the uptick in deaths.

The infection has now spread to remote areas but the gravity of the situation seems to be lost even on those who have been infected, they said. Seeking treatment at the last minute can, in most instances, be futile, according to them.

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Public health experts have also come down heavily on the ‘mismanagement’ of the healthcare system during the pandemic. A year has passed but many district hospitals still lack ICUs and other facilities crucial for the treatment of coronavirus patients, they said. As a result, patients are dying while bouncing from one hospital to the other.

The World Health Organization, or WHO, has identified the Delta variant, which is prevalent in most COVID-19 patients, as a major cause of concern around the world.

Scientists estimate that the Delta strain is about 60 percent more contagious than the Alpha variant that spread to most parts of the United Kingdom and Europe in the early stages of the pandemic and twice as contagious as the original coronavirus.

COVID DEATHS SPIRAL

Dr Pradeepta pinpointed the delay in seeking medical attention as the main reason for the surge in COVID-19 deaths in recent times.

“People are going to doctors in nearby villages after coming down with fever. Many people are saying they will get better naturally so they don’t need to get tested for the coronavirus. They only come to the hospital once their condition deteriorates.”

“It turns out that people are dying after a day or less of treatment in hospital. Patients are coming in such a bad state that we don’t have time to provide care. ”

Many critically ill patients need oxygen, which is in short supply in many remote areas.

However, Keshabpur Health Complex has oxygen cylinders at its disposal. Work is also underway to set up a central oxygen line, according to Dr Pradeepta.

However, the hospital still lacks some necessary equipment, he said. “We can’t meet the demand for oxygen here. They have to be referred elsewhere.”

Tanvir Islam, a medical officer at Kurmitola General Hospital in Dhaka, also believes a lack of awareness is to blame for the worsening COVID-19 pandemic.

“I always find patients who, in their own words, have a common cold but their COVID-19 tests then come back positive. Many people don’t want to take the test for fear of being COVID-positive. They tend to wander around and go to public gatherings thinking they only have a cold.”

“Those who are aware of the dangers are coming for treatment as soon as they see the symptoms. Many try to avoid going to the hospital, thinking they have only a common cold or cough. They eventually get admitted at the last moment when they are seriously ill. We can’t do much then. There are many such patients. ”

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Mugda General Hospital Director Asim Kumar Nath reiterated the need for greater awareness about the disease.

He said those with mild symptoms are usually treated at home while those with a bit more serious complications are admitted to hospitals or taken into intensive care.

“Then why would you want the illness to get severe? There are one or two people with diabetes, kidney problems and complex diseases, who may be beyond saving. But there are many patients who would not have died if they had received medical treatment earlier. ”

Dr Asim blamed the Delta variant for the dire situation in the country, which has been compounded by the disregard for health and hygiene guidelines.

“Even now, if everyone wears a mask for a month, then the spiralling infections and deaths can be reined in. A lockdown won’t be necessary.”

Dr Pradeepta also lamented the reluctance among many to wear masks and urged people to get tested for COVID-19 as early as possible.

Dr Asim believes the rate of infection and death will come down once the majority of people is vaccinated.

WHAT THE EXPERTS ARE SAYING

Public health experts criticised the government’s failure to take adequate measures to curb the spread of coronavirus over the past year. The deaths have piled up due to the mismanagement of the health system, according to them.

Virologist Prof Nazrul Islam believes that COVID-19 patients are not getting proper treatment in hospitals across the country.

“People are dying because they are not getting the right medical care or are not finding the right service at the right time. This means that there is extreme mismanagement in medical services,” said Nazrul, a member of the National Technical Advisory Committee on COVID-19.

“One never knows where an ICU bed will be available. This can be managed. There may be a hotline number, where you can call to find out where there is an empty ICU. This will stop patients from going to different hospitals.”

“It has been a year, but we still don’t have hospitals in each district. The ICUs haven’t been set up either. Patients are dying on the way to Dhaka. How many have the ability to come? How many people have money to rent a car? Why haven’t medical services reached the doorsteps of the people yet?”

The former vice-chancellor of Bangabandhu Sheikh Mujib Medical University suggested setting up field hospitals in every division to handle the situation.

“The number of health workers is insufficient for this crisis. Many anesthesiologists have passed the diploma. There are many people just sitting in the health directorate. Is it their job to sit around while so many of our patients are dying?”

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“If the number of health workers is low then the government should recruit more people.”

Dr Mushtuq Husain, an advisor to IEDCR, also attributes the ongoing crisis to mismanagement of the health sector. According to him, the body count will keep increasing unless the spread of the Delta variant is curbed.

“If people who have mild symptoms are not brought within the ambit of the healthcare system or even the telemedicine services, the number of deaths will increase. This is because they won’t be able to understand when their condition is serious. ”

However, the efforts in this regard should not only be limited to medical services.

“People are going out for the sake of their livelihoods,” said Dr Mushtuq. “There must be government and social initiatives to keep them isolated.”

“Bringing every COVID patient who is not going to the hospital under medical management and public health management will reduce the spread of the infection and the risk of death. But that is not being done. ”

“When patients come to the hospital at the last minute, there is nothing that the doctors can do. And if the patient load exceeds the hospital’s capacity then the situation will only be worse.”

Tanvir Islam, a doctor at Kurmitola General Hospital, said the number of health workers in the country was disproportionally lower than the rising number of patients. Besides, the medical system at the Upazila, district and divisional levels are also inadequate compared to the number of COVID patients. There is also a shortage of doctors specialising in intensive and critical care.

Dr Mushtuq said, “Our capacity has increased a lot compared with last year. Even then, if thousands of people are infected in one area, and if their condition worsens, it’s very difficult to handle. That’s why it’s important to improve the quality of management across the board, including hospitals.”

He called on hospitals to employ experts in managing and preventing the spread of the infection.

“Hospitals should not keep any patient whose oxygen level is more than 94,” he said. “No one should occupy the bed with a slight illness. The management inside the hospital needs to be made more dynamic. ”

Dr Mushtuq’s advice is to increase the capacity of hospitals. “Physicians need rest. The number of physicians, as well as volunteers, should be increased.”

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