Doctors working at Intensive Care Units (ICUs) are more susceptible to coronavirus infection as the country lacks preparedness to respond to the pandemic, Dr Ehteshamul Huq Choudhury, secretary general of the Bangladesh Medical Association (BMA), has said.
In an interview with The Business Standard's Tawsia Tajmim, he also talked about the changes in preparedness in the last three months, reasons for the high death rate among physicians, and the challenges of fighting the virus in the upcoming days.
How was our preparation when the virus broke out?
Nothing. I saw no visible preparedness. Our health ministry later moved to take measures as the Wuhan situation deteriorated, but it did not mind the lessons China learnt primarily.
You need to detect the patient first to fight the pandemic. The Chinese doctors who visited the country recently said they knew their enemy while fighting against the outbreak, but Bangladesh is throwing rocks into the dark night.
Detection gives you an extra edge in the fight. What China showed is how to diagnose, detect, isolate and trace the contacts of the infected. Supportive respiratory oxygen supply is required for worse cases while only 5 percent of patients need ICU support. I saw no visible measures of the health directorate over oxygen stock, readying the ICUs and other aspects.
How is the readiness now after three months of the maiden case?
The outbreak in Bangladesh began after three months in China. And since the maiden case detection on March 8, we have passed three months.
Chaos and incoordination marred the first 30 to 45 days since the maiden cases. Later, the situation started improving as the prime minister stepped in.
The Institute of Epidemiology, Disease Control and Research (IEDCR) with only 2,000 test kits said they were ready. The prime minister ordered test facilities in every district. We are now testing nearly 17,000 people daily while we began with only 2,000 kits. Though the number of testing is still not enough, the progress is remarkable.
In the beginning, we could not manage personal protective equipment (PPE) and training for our doctors. We handed substandard masks to them. Things started to change as now almost all the doctors have got standard masks and PPE.
Kuwait Bangladesh Friendship Government Hospital was the lone medical facility for Covid-19 patients while now all public and private hospitals with more than 50 beds are providing treatment.
You claimed almost all the doctors got PPE, but a recent research says 24 percent of medical personnel are yet to receive the protective gears.
I heard about private research. But we did not conduct any survey on that. I just told you what we have been informed by our district representatives. I do not know how the survey drew the conclusion.
If all the medical personnel got PPE, why are the infection and death rates among the doctors so high?
The medical personnel got infected at the primary level as they did not get standard safety equipment and training to use those. Later, they got standard PPE and proper training.
Patients used to avail treatment concealing their medical history and thus infected the doctors. This tendency is also declining.
Now doctors are getting infected as the nature of the treatment is highly specialised and requires heavy protection. One might not get infected while treating patients in hospital wards, but can get exposed to the virus while taking off the protective gears at home.
Therefore, we have to listen to the experts. While we have a crisis of doctors to treat the patients, I wonder who will monitor whether the protective gears are put on and off properly. We even lack knowledge of how to use the safety equipment properly.
Moreover, only our ICUs do not have a negative pressurised system for air ventilation. We readied the units hurriedly without consulting with the experts.
As far as I know, the Bangladesh Army only has negative pressurised air ventilation ICU and infections among doctors are low there. A large number of our doctors are getting infected in ICUs.
Apart from this, doctors who died were aged and had co-morbidity health factors. The rest of the physicians worked in the ICUs.
You have informed the health minister of it. Why didn't you write to the minister earlier?
Though doctors have been getting infected since the beginning, the death rate was not too high. At least 21 doctors died in June. We are losing many of our colleagues recently. More patients are coming and the number of vacant beds is declining fast.
The state, media and we need to encourage the doctors. We need to make them understand that they are safe. They have enough PPE and will be able to get admitted if they fall sick. Besides, we need to cheer up their families.
Public doctors prefer the hospital for admission where they work. But there are general practitioners and physicians working in clinics and private hospitals. They become weak mentally when they get infected, wondering where they will go for proper treatment.
We have to think about them as more doctors are getting infected. We need to give them a message that there is a healthcare facility out there for you. Therefore, we are suggesting a dedicated hospital for the infected doctors.
You talked to the BSMMU (Bangabandhu Sheikh Mujib Medical University) about this. Is there any update on that?
I talked to the BSMMU vice-chancellor this morning too. They are an autonomous facility. We can accommodate the infected doctors if the proposal gets approval in their academic council and syndicate meeting.
If a citizen dies, only his family gets affected. But if a doctor dies, 1,000 people, who he could have served, get affected.
We have talked to the health directorate and the health minister about this. We are hopeful to get a solution soon.
What should the government do now to alleviate the pandemic crisis?
The Bangladesh Medical Association will present a draft to the nation soon in this regard. As a doctor and a former health directorate worker, I think we need to boost surveillance.
First, we need lockdown to be in place. We need to isolate the infected and trace the individual's contacts for testing. All those testing positive must be put in quarantine. The bottom line is – do more and more tests. Locking down a place will not slow down the infection alone. We should conduct more tests too.
Secondly, you cannot expect people to comply with the lockdown on their own. There should be a committee comprising local public representatives, teachers, imams, priests and civil society members. Without involving the public representatives, there is not a single incident in history which yielded success.
Our ministries are issuing separate directives in an uncoordinated manner. People will not listen until their respective local leaders move. The local leaders have the capacity to alleviate the crisis, while the ministries will only provide them with necessary support.
You will not be able to make people comply with the health safety rules with only televised messages. Rather, the proper message needs to be delivered through the appropriate channels.
Besides, capacity of the hospitals needs to be boosted and the government is working on it. The total numbers of hospital beds and ICUs have already been increased.
But unless strict lockdown and proper surveillance are in place, the infection rate will continue rising. If not checked, this rise could cause the entire health system to collapse at some point.