The possibility of Indian variants of the coronavirus entering Bangladesh looms large while there are still no central oxygen lines and intensive care unit (ICU) facilities in district hospitals amid a shortage of manpower.
ICU beds were not vacant in any of the four government-run dedicated Covid-19 hospitals in Dhaka on Monday.
Health experts say Bangladesh should ramp up preparations assuming that the situation will be dire if India's double and triple mutant variants surface here. They earlier warned that the situation would go beyond control if the Indian variants made their way to Bangladesh.
The health directorate says there are 2,773 vacant beds out of 5,570 general ones at 30 public and private Covid-19 hospitals in Dhaka. Besides, out of 759 ICU beds, 248 are vacant. Of the 1,069 ICU beds in the country, only 384 are vacant.
The number of ICU beds has been increased but services cannot be provided due to a lack of skilled manpower. There are 20,937 oxygen cylinders, 1,563 high-flow nasal cannula, and 1,343 oxygen concentrators in the country.
Professor Nazrul Islam, a noted virologist and a member of the National Technical Advisory Committee on Covid-19, told The Business Standard central oxygen lines were supposed to be set up at 79 hospitals but had been done at only 29.
He said hospitals had been struggling in the last few days to handle the increase in patients caused by the South African variant's emergence and the situation would be terrible if Indian variants surfaced here.
Dr Shafiun Shimul, an associate professor at the University of Dhaka and a team member of CoMo (Covid-19 Modelling) Consortium at the University of Oxford, told The Business Standard the Indian variants could enter the country via those who were coming here for goods transportation even if borders were shut.
He said genome sequencing should be carried out to make sure whether the Indian strains had arrived here.
He emphasised importing oxygen from China or other countries, saying "we have already witnessed India's oxygen shortage."
He said oxygen reserves at hospitals outside the capital should also be increased so that the pressure on Dhaka's healthcare facilities lessened.
"We should be prepared with the worst-case scenario in mind," he added.
Professor Nazmul Islam, spokesperson for the Directorate General of Health Services, told The Business Standard they were emphasising quarantine to prevent the Indian variants from coming here.
He said the infection chain of the virus should be broken.
"We are making some preparations every day to tackle infections, but the situation will be difficult to deal with unless the number of patients can be reduced."
The health directorate says tackling the current situation is possible with the existing preparations but it will get difficult if infections increase. It is now emphasising preventive measures to deal with the virus and ways to block the entry of Indian variants to the country.
Infections have already surged in Nepal fuelled by India's mutant strains. The authorities there are grappling to contain the rapid rise in cases, with experts fearing thousands of people in the Himalayan state have been infected by the more infectious mutant strains of India.
Nepal reported 3,032 new infections on Sunday, the highest daily surge recorded this year.
"We have detected the UK variant and India's double mutant variant," Krishna Prasad Paudel, director of Nepal's Epidemiology and Disease Control Department, told Reuters.
The vaccine crisis, meanwhile, has caused uncertainty in the mass inoculation programmes in Bangladesh. The first dose has already been suspended while the second dose has become uncertain for the 13 lakh people who received the first shot as there is no stock. The number of tests has also decreased.
Concern over India's oxygen export ban
Due to the surge in infections, medical oxygen usage at hospitals increased by 40-50% to 150-180 tonnes in the recent months. Local companies meet about 70-80% of the total demand while the rest comes from India.
Linde Bangladesh is the market leader in supplying medical oxygen. Besides, Spectra Oxygen, Islam Oxygen, Pure Oxygen, and others also supply oxygen to healthcare facilities.
Linde's daily production capacity is 90 tonnes. It produces the gas for both medical and industrial use. Spectra's daily production capacity is 25 tonnes, and Islam's 40 tonnes. They also import oxygen from India to meet the additional demand but the neighbouring country banned oxygen export from 22 April.
Sources said five importers, including Linde and Spectra, import liquid oxygen from India through Benapole land port. In the week before 21 April, more than 498 tonnes of liquid oxygen arrived in the country from India through the port.
"At present, we can meet the oxygen demand with our existing capacity. We do not need to import. But we are unable to meet the additional demand as India has banned oxygen exports," said Linde spokesperson Saiqa Mazed.
She said the demand for medical oxygen had increased by about 40% in Bangladesh in the last two months. "To meet the additional demand, we are supplying oxygen only to hospitals. We are already operating at full capacity and our two plants are producing about 90 tonnes of oxygen per day."
The Linde official said India had faced an oxygen crisis as Covid-19 cases had risen there. "In this situation, the Bangladesh government has to secure different sources to import oxygen in order to ensure uninterrupted supply during crisis moments."
Chattogram-based oxygen production company Associated Oxygen Limited, which supplies the gas only to industries, now wants to do so to the healthcare sector.
Its adviser Shohrab Hossain said Chattogram-based companies mainly supply oxygen to industries.
"But now we are ready to provide oxygen to hospitals as per their demands. We have a daily production capacity of 9,600 tonnes," he said.
He said they were trying to supply liquid oxygen to hospitals due to the surge in medical oxygen demand caused by the pandemic.
"To this end, we are working on upgrading some factory equipment and transportation systems," he added.
The health directorate spokesperson said the directorate had discussed oxygen supply with several companies other than the three firms.
Industrial oxygen production will be halted and medical oxygen will be produced if an oxygen crisis emerges, he added.
The import of oxygen at Benapole land port stopped abruptly with India no longer exporting this precious resource in their second wave of the Covid-19 pandemic.
The import of oxygen from India continued till Wednesday last through this port, traders said, adding that no oxygen was imported in the last four days from the neighbouring country.
Sources said a large portion of Bangladesh's medical oxygen demand is met by imports from India. Around 30 thousand tons of oxygen is imported every month from India through Benapole alone.
Benapole port sources said due to friendship between the two countries, Bangladesh's oxygen imports from India remained uninterrupted at this land port even during this Covid-19 pandemic.
India exported 690 tons of oxygen to Bangladesh through Benapole port from 13 April to Wednesday last. But the country, without notice, suddenly halted export of this precious resource, since it was now facing acute shortages of this emergency medical resource in several Indian states.
Under these circumstances, Indian exporters told Bangladeshi traders that they had temporarily stopped exporting oxygen to Bangladesh at the insistence of their government.
Motiar Rahman, director of the Bangladesh-India Chamber of Commerce, said, "Bangladesh is now facing the second wave of the coronavirus, a time when the country needs the uninterrupted supply of medical oxygen in treating critically ill Covid patients. But India itself is now facing a severe shortage of this medical resource with the second wave of the pandemic hitting India hard."