The first-ever confirmed coronavirus patient from Sylhet district was a doctor who died yesterday at Dhaka's Kurmitola General Hospital.

The district civil surgeon says it is quite difficult now to trace from whom the associate professor of Sylhet MAG Osmani Medical College Hospital had gotten the infection. The issue lies with the fact that officially neither had he come into contact with any corona patient at the Sylhet public hospital, nor had he seen any at his private chamber.

After his family members and colleagues tested negative, Anisur Rahman, Sylhet assistant director of Directorate General of Health Services, said one or more patients might have received treatment from him concealing information of Covid-19 like symptoms or they might have been asymptomatic corona patients.

Whatever the case might be, the death illustrates the risks that healthcare providers are exposed to during the current pandemic.

According to Bangladesh Doctors' Foundation (BDF), at least 65 doctors have tested positive for the coronavirus until April 15 and the total number of infected health service providers is over 100.

One of them is now in intensive care. Another 300 to 350 doctors are in quarantine, said Dr Nirupam Das, chief administrator of the BDF.

"If doctors are getting infected at this rate, the healthcare system will collapse," he said.

According to The Directorate General Health Services' latest figures of registered physicians, there are 93,358 MBBS doctors and 9,569 BDS doctors in the country.

A total of 25,980 doctors are employed at public hospitals. Apart from them, around 70,000 doctors are working in private facilities.

"No patient is a regular patient"

To minimize the risks, experts suggest suspending all treatment procedures, except for emergency care, for example, attending a patient who has suffered a heart attack or a pregnant woman going into labour.

In these cases, healthcare providers should take all precautionary measures and put on personal protective equipment and masks before treating the patient.

"No patient is regular or non-Covid-19 patient now," said virologist Saif Ullah Munshi of Bangabandhu Sheikh Mujib Medical University.

Whoever the patient is and whatever health complaint he has, healthcare providers should follow safety protocols. Moreover, the safety gears must be certified ones, Saif Ullah said.

Meanwhile, all public hospitals across the country have outdoor units open on government orders, even if doctors and experts consider these risky zones for the spread of the virus.

Our correspondents from Rajshahi, Barisal and Rangpur reported that public hospitals in the divisions have their outdoor units open though there were few patients.

With healthcare workers exposed to such infections risks, three employees from two upazila health complexes in Barisal have been tested positive with the coronavirus, including a female doctor and a nurse.

How the virus infected the female doctor is unknown as well because she has not travelled outside Barisal in the last two months and has not come into contact with any identified coronavirus patient.

The nurse and the office staff of Babuganj Upazila Health Complex are suspected to have gotten the infection while caring for a 45-year-old patient with wounds. The patient with fever was later tested positive.

This incident led to the closing down of the upazila health complex in Barisal on Monday and all employees, including doctors, nurses and cleaners went into quarantine.

Keeping outdoor units and private chambers open will increase the risk of infection among healthcare providers, experts say.

"This is a war and it has to have a strategy. Doctors, nurses and other healthcare providers have to be deployed wisely," Saif Ullah added.

However, closing outdoor units should not mean denying treatment. Emergency units should be strengthened with necessary logistics, said Dr Jahidur Rahman, assistant professor at the virology department of Shaheed Suhrawardy Medical College Hospital.

Moreover, after completion of a roster like seven days, doctors should be tested irrespective of any symptoms because they are super-spreaders and so early detection is imperative, he added.

Discrimination when it comes to PPE, masks

Requesting anonymity, a doctor of the Kurmitola General Hospital said healthcare providers were discriminated against when it comes to PPE and masks.

"When doctors are getting PPE, nurses get suits of low quality and cleaners are working only with masks. This is not safe for any of us. We all become vulnerable to infection."

The food delivery staff of corona wards should also get protective gears for their safety and for containing the spreading of infection, the doctor said.

Besides, doctors and nurses are not provided with N95 masks.

Brig Gen Shahidullah, director of Central Medical Stores Depot (CMSD), told The Business Standard, "The whole world is suffering from shortage of N95 masks. The US is taking away all masks."

The reality is, Minnesota-based 3M Co is manufacturing the masks and the USA gets first priority, creating a shortage in other parts of the world.

"We have ordered some masks of N95 standards. I have placed an order for one lakh masks, but we are yet to bring in even 10,000 pieces. The demand is very high in all countries, including Europe, America and Canada, but there is no supply."

Dr Nirupam Das, of the BDF, said many healthcare employees got infected due to the lack of quality PPE.

Mohiuddin Manik, a doctor at Gafargaon Upazila Health Complex, said two doctors from the hospital got infected with coronavirus and were now undergoing treatment at the Kurmitola General Hospital.

He said the hospital has sufficient PPE suits but those were not of standard quality.

Triage or screening

Delayed introduction of triage or screening at hospitals is also responsible for spreading infection among healthcare providers.

Triage is a process of identifying patients with symptoms (fever, cough and breathing difficulty) of probable respiratory diseases at the entrance of hospitals. At this stage, anyone suspected of having the coronavirus will be separated from others for treatment.

More doctors are getting infected at private hospitals and clinics because this method is not being followed.

Besides, private hospitals are not providing doctors with PPE, said Nirupam of the BDF.

It is putting healthcare workers at risk in private institutions like the Insaf Barakah Kidney and General Hospital in the capital's Moghbazar that was closed on Tuesday after nine staff tested positive the day before.

In another private hospital in Tejgaon, 40 health workers went into quarantine after four doctors and two nurses tested positive for the virus.

Experts insist on strict screening of patients at all public and private hospitals across the country.

Doctors said a patient had been diagnosed with Covid-19 after undergoing a surgery for appendicitis and a woman with gynae problem was discovered to have coronavirus after treatment.

Triage will reduce the risk of infection transmission to healthcare providers and other patients.

"The triage system has to be introduced at all hospitals according to the guidelines," said Dr Jahidur Rahman, of the Shaheed Suhrawardy Hospital.

Prof Muzaherul Huq, former adviser of WHO's Southeast Asia region, said Covid-19 patients cannot be treated at the same place where other patients are being treated. We must have dedicated hospitals for Covid-19 patients.

There should be separate accommodation for doctors treating coronavirus patients. Doctors have to stay in quarantine for 14 days after treating coronavirus patients for 14 days. Until it is ensured, the number of infections among doctors or health workers will increase, according to experts.