The modus operandi of Covid-19 management in Bangladesh needed to change over time to be in line with the country's requirements and the national guidelines to cope with the pandemic-19 - essentially due to its "novel" character.

"Our primary focus was on prevention, educational programmes for health workers regarding the management of the new disease, and updated training on personal protection," said Dr Tania Mahbub, a consultant nephrologist at the United Hospital and an International Society of Nephrology (ISN) fellow.

While reflecting on her work days during the pandemic with the ISN, she said: "There was triage for preliminary screening for all patients coming to the hospital, since the spread of the novel coronavirus infection in the country."

When a handful of corona positive cases were detected in March, a telemedicine service was developed to prevent disease spread from the Outpatient Clinic (OPD) and patients with Covid-like symptoms were managed in separate zones.

"Special precaution was taken for the Dialysis Unit," she said, adding: "We tried to educate patients about the symptoms of Covid-19, its preventive measures and advised them to seek help through telemedicine rather than coming directly to the Dialysis Unit."

Dr Tania said they emphasized on maintaining regular dialysis in order to prevent volume overload, which may erroneously mimic the Covid-19 infection. But the use of complete PPE was mandatory during the procedures.

Initially, the country had designated hospitals for Covid-19 treatment. But since the community transmission occurred on a large scale, the health authority decided to appoint all hospitals for treating both Covid and non-Covid patients.

Dr Tania said: "We divided our hospital into Covid, non-Covid, and suspected Covid zones and started doing Reverse transcription polymerase chain reaction (RT-PCR)  in our hospital."

"Currently, we are providing renal consultation, dialysis of Covid patients in the Critical Care Area, and have built a negative pressure isolation chamber for Covid positive dialysis patients," she added.

From her experience, it is a challenging job to treat Covid and non-Covid patients in the same hospital, especially when RT-PCR is not readily available and test results take long. 

"In such a scenario, robust and integrated infection control strategy, surveillance, and logistical support are needed."

Dr Tania, however, expressed her concern over the patients' tendency to hide their medical history, which poses greater threat to physicians.

She further said: "Patients these days appear with different symptoms. They incidentally test Covid-19 positive during screening. Sometimes highly suspected cases are found as Covid-19 negative in the initial test, but subsequent test results turn out different."

Thus, Dr Tania Mahbub put special emphasis on wearing proper N95 or equivalent masks/respirator for doctors, whenever they attend a patient.

Bangladesh has unfortunately observed a high rate of physicians' deaths due to Covid-19 within a very short period of time. Therefore, priority measures need to be taken to determine their exact causes of demise.