File photo of a ICU unit at a Hospital Dhaka Tribune

Ventilator, ICU shortage may cripple the country’s Covid-19 response

Shortage of intensive care unit (ICU) beds and ventilators at government hospitals in Bangladesh can put hundreds of lives at risk as the government has so far only dedicated 192 ICU beds for the treatment of Covid-19 patients.

Among the 192 dedicated ICUs beds, 79 are in Dhaka city alone, while the number is only 10 for the rest of the Dhaka Division, and five for Mymensingh Division, as per data compiled by Directorate General of Health Services (DGHS).

There are 22 dedicated ICU beds each in Chittagong and Rajshahi divisions, 18 in Khulna division, 13 in Rangpur division, 11 in Sylhet division, and 10 in Barisal division.

Even though the total number of ICU beds is supposed to be 192, as claimed by authorities concerned, counting them by the area-wise allocations, they add up to 190.

Prime Minister Sheikh Hasina, while speaking at the parliament on Saturday, said the government will take steps to set up ICUs at every district hospital.

On Sunday, Health Minister Zahid Maleque said the government has 10,000 cylinder bottles for providing oxygen support to patients and has ordered for 3,500 more of them.

“We have reserved ICUs for treating the patients, but the outcome is not good. We kept nine patients on ventilation but eight of them died later,” he remarked.

An ICU is a specialized ward for treating seriously ill patients who need constant monitoring. ICU beds include ventilators to help patients minimize breathing difficulties.

Ventilator machines pump air into the lungs of a patient through a tube placed in their windpipe, helping them breathe.

Ground reality

The government has dedicated 79 ICU beds for Dhaka city which has so far reported the highest Covid-19 cases (45%) in the country. A total of 843 people have tested positive for coronavirus infection from Dhaka till now.

Moreover, patients from other districts, who are in critical condition, are also sent to Dhaka for treatment.

There are 13 districts under the Dhaka division. Excluding Dhaka city, the government has allocated only 10 ICUs for treating Covid-19 patients for the division.

The division, excluding Dhaka city, has reported 763 cases across 13 districts.

Dr Sheikh Md Hasan Imam, the director (health) of Health Services Division for the Dhaka division, said they have a total of 31 ICU beds—15 in government hospitals and 26 in private hospitals—for treating all patients.

There are 23 ventilators, 10 under government and 13 under private hospitals in the division, he added.

“15 ICU beds were dysfunctional, which were sent for maintenance. We are expecting to get those back shortly,” he further commented.

For the Chittagong division, which has 11 districts, the government has allotted 22 ICU beds for the Covid-19 patients. 97 cases were reported from nine districts of the division so far.

The government has dedicated five ICU beds for the Mymensingh division which has four districts. Till now, 59 people from all four districts under the division tested positive for Covid-19.

Barisal division has been allocated 10 ICU beds for its six districts. So far, 36 cases were reported from five districts under the division.

Divisional director (health) of Health Services Division for Barisal division Bashudeb Kumar Das, however, claimed they have 15 dedicated ICU beds at Sher-E- Bangla Medical College Hospital.

“We have a total of 28 ICU beds in the hospital. Of them, 13 located in the main building have been kept for regular patients while 15 have been placed at the isolation ward for Covid-19 patients,” he said.

Areas ICU Beds with Ventilation Facilities Covid-19 Cases Dhaka City 79 843 Dhaka Division 10 763 Chittagong Division 22 97 Mymensingh Division 5 59 Rangpur Division 13 44 Barisal Division 10 36 Rajshahi Division 22 08 Sylhet Division 11 07 Khulna Division 18 06 Total 190 1863

In Sylhet Division, which has four districts, there are 11 dedicated ICU beds for Covid-19 patients. So far, seven cases were reported from all districts under the division.

Anisur Rahman, assistant director (health) of Health Services Division for Sylhet division, said they have only two ICU beds for the division right now.

“We are expecting another nine ICU beds to be prepared soon for Covid-19 patients at the Sadar Hospital,” he added.

Rajshahi division, which has eight districts, has been allotted 22 ICU beds for Covid-19 patients. Eight cases were reported from four districts of the division so far.

Dr Gopendra Nath Acharya, director (health) of Health Services Division for Rajshahi division said they have 10 ICU beds dedicated for Covid-19 patients at Rajshahi Medical College Hospital.

“There are six other ICU beds in private hospitals which we may use if needed,” he added.

He further added that they are trying to install seven ICU beds at Bogra 250 bed Mohammad Ali District Hospital.

In Khulna Division, which has ten districts, there are 18 dedicated ICU beds for Covid-19 patients’ treatment. So far, six cases were reported from five districts of the division.

Dr Rasheda Sultana, director (health) Health Services Division for Khulna division, said there are eight ICU beds in Satkhira district.

“We are expecting to get another 10 shortly,” she added.

Rangpur division has 13 ICU beds for Covid-19 patients from its nine districts. So far, 44 cases were reported from all districts of the division.

Rangpur division Health Services Division Director (health) Amin Ahmed Khan said they have kept 10 ICU beds at Rangpur Medical College Hospital for treating coronavirus infected patients.

“There are two ICU beds at Bilashpur Medical College Hospital. But they are only to be used if a frontline government service provider is affected,” he informed.

How many patients need ICUs?

The World Health Organization (WHO) said data from China suggests that 15%–20% of Covid-19 cases required hospitalization, with around 15% of cases presenting severe symptoms, and 5% requiring intensive care.

“Estimates from China also suggest that patients in ICUs require approximately 13 days of respiratory support, while data from Italy show that 10%–25% of patients will require ventilation, and some patients will need ventilation for several weeks,” it pointed out.

The WHO document emphasized that critical interventions, such as ICU beds and mechanical ventilators, must be made available to health care workers and others supporting the response in terms of services and infrastructure, whose training makes them indispensable.