Last-minute detection takes toll on rural Bangladesh

With around 70% of all 128 RT-PCR labs in the capital Dhaka, faraway districts and remote areas are lagging behind in Covid-19 testing but these regions are now contributing to three-fourths daily fatality counts.

"Many of our patients are dying soon after arriving at the hospital. We are not even getting the time to begin treatment," said Brigadier General Shamim Yazdani, director at the Rajshahi Medical College Hospital (RMCH).

He said the number of coronavirus patients in rural areas has increased alarmingly this time. But since the patients remain undiagnosed, they come to the hospital at the last stage.

Prof Dr ABM Khurshid Alam, director general of the health directorate, also said Monday that more than 50% of the Covid patients in hospitals are from rural areas where people consider themselves safe from the pandemic.

"Due to the ongoing monsoon in the country, many people infected with the virus have assumed their illness as seasonal flu or cough, which is discouraging them from taking the Covid-19 test or treatment accordingly."

These patients are coming to the hospital at the last stage of the infection, said Prof Khurshid Alam.

Doctors and public health experts have been advocating for ramping up Covid-19 tests since the virus outbreak in Bangladesh last year. The country is lowest ranked in Covid testing in South Asia.

With the number of testing facilities, including RT-PCR, GenExpert and antigen, increased up to 605 this year, Bangladesh's daily tests still fluctuate in between 30,000 to 35,000.

The disparity between the capital and other districts in availing the Covid test still remains wide when India-bordering Rajshahi, Rangpur and Khulna divisions continue witnessing the brutal surge in infection and death curves in the second wave believed to be triggered by the Delta variant, said doctors.

Fewer tests in more infected areas

Even with higher infection rates in the second wave, rural districts are conducting fewer tests than the capital. In the past 24 hours until Monday morning, the country tested 34,002 samples.

Of these, 16,264 samples were tested in Dhaka division and 4,888 in Chattogram. The most infected Rajshahi conducted 4,233 tests, Khulna 4,121 and Rangpur 1,975. During the time, less than 1,000 samples were tested in Sylhet and Barisal divisions.

Rural people negligent, but is testing available?

The health directorate director general Monday claimed that the rural people assume Covid infection as flu or regular cold, and do not get tested. The remark raises the question whether testing facilities in rural areas are available.

According to the health directorate data, Dhaka metropolis alone has 88 of the total 128 RT-PCR test facilities. Only 27 districts outside the capital have RT-PCR – the internationally considered gold standard method for Covid testing.

Even five districts in Dhaka division do not have RT-PCR labs and only four of 10 districts in Khulna division have RT-PCR.

The three RT-PCR machines Sylhet has are in Sylhet city. Of the eight districts of Rangpur division, only Rangpur and Dinajpur districts have the standard testing facility. Of six Barishal districts, Bhola and Barishal have RT-PCR.

Apart from the standard testing, 48 centres across the country conduct GenExpert tests while 17 centres are in Dhaka and Chattogram.

Recovered after eight-day hospital stay, report yet to come

Monirul Islam in Khulna's Bagerhat said his father developed Covid-like symptoms such as beathing complication and fever 15 days ago. He phoned the district hospital, and a medical team collected the sample from his house.

"As my father's situation deteriorated later, I had to admit him at the district hospital and then at a private hospital in Khulna. He recovered after eight days of treatment, but we are yet to get the test result," he added.

Dr KM Humayun Kabir, civil surgeon of Bagerhat, said they are conducting antigen tests as the district does not have a PCR lab. "If the antigen report comes negative, then we further test it through RT-PCR at Khulna lab."

In north-western division Rajshahi, Naogaon, Chapainawabganj and Natore districts also have to rely on divisional headquarters Rajshahi for PCR test.

In Barisal, five districts similarly have to rely on the Barisal Sher-e-Bangla Medical College RT-PCR lab. Apart from the standard method, the division conducts 50-60 rapid antigen tests per day.

Overwhelmed with the samples, Sher-e-Bangla Medical College takes three-four days to deliver the report.

Contacted, health directorate Spokesperson Prof Nazmul Islam said they have 50,000 per day antigen test capacity. "We are ramping up the antigen tests so that the rural people come under the test coverage."
 
[The Business Standard Bagerhat and Satkhira correspondents contributed to the report]