Upazila Health Complexes Near Border: Underequipped for Covid surge

The World Health Organization (WHO) has announced a new naming system for variants of Covid-19.

From now on the WHO will use Greek letters to refer to variants first detected in countries like the UK, South Africa and India.

The UK variant for instance is labelled as Alpha, the South African Beta, and the Indian as Delta.

The WHO said this was to simplify discussions but also to help remove some stigma from the names.

Earlier this month the Indian government criticised the naming of variant B.1.617.2 – first detected in the country last October – as the “Indian variant”, though the WHO had never officially labelled it as such.

Where is the Indian variant and how is it spreading?
What we know about the different variants
“No country should be stigmatised for detecting and reporting variants,” the WHO’s Covid-19 technical lead, Maria Van Kerkhove, tweeted. She also called for “robust surveillance” of variants, and for the sharing of scientific data to help stop the spread.

Letters will refer to both variants of concern, and variants of interest. A full list of names has been published on the WHO website.

These Greek letters will not replace existing scientific names. If more than 24 variants are officially identified, the system runs out of Greek letters, and a new naming programme will be announced, Ms Van Kerkhove told STAT News in an interview.

“We’re not saying replace B.1.1.7, but really just to try to help some of the dialogue with the average person,” she told the US-based website. “So that in public discourse, we could discuss some of these variants in more easy-to-use language.

On Monday, a scientist advising the UK government said the country was in the early stages of a third wave of coronavirus infections, in part driven by the Delta, or Indian variant.

It is thought to spread more quickly than the Alpha (UK; Kent) variant, which was responsible for the surge in cases in the UK over the winter.

Vietnam, meanwhile, has detected what appears to be a combination of those two variants. On Saturday, the country’s health minister said it could spread quickly through the air and described it as “very dangerous”.

Debhata in Satkhira is separated from the district of 24 Parganas in India by the Ichamati river. The ban on international travel between the two countries does not stop Debhata’s local fry-catchers from swimming to the spots where they find the best Bagda prawn, regardless of whether they are in Bangladesh or in India.

Locals from 24 Parganas do the same, and they meet where the waters of the Ichamati apparently wash away all notions of political boundaries.

And that is what worries one of the doctors of Debhata Upazila Health Complex, Md Abdul Latif.

In a district where Covid-19 positivity rate is 25 percent — more than double that the national positivity rate — Latif’s health centre is woefully underprepared.

“We have 16 oxygen cylinders, but the reason why that is a problem is because we can use eight at a time. We do not have any method of refilling oxygen cylinders in Satkhira, so we have to send the cylinders to Jashore. We send eight at a time. We leave them at Jashore, and go back with the other 8 when they are empty,” he said.

They are also facing a potentially impending crisis of the Indian strain of the Sars-Cov-2 virus without adequate protection for their healthcare workers.

“With regards to PPE, we are doing alright. We have around 300 PPE left from last year, but we do not have any N95 or KN95 masks. But we will manage to serve of course,” Latif said.

The Supply Chain Management Portal of the Ministry of Health and Family Welfare shows that the health complex received 130 N95 masks last year and that was it.
In neighbouring Kaliganj Upazila Health Complex, Store Keeper Srikanta Das had a similar sorry tale. “We have 10 oxygen cylinders but we have to send them to Jashore. They don’t get filled immediately — we leave it and then go pick it up at a later date.”

The upazila health complex, which also serves a locality that is separated from India by just the river is facing an impending crisis with just 2 doctors — which makes the roster system impossible.

According to the government guidelines, facilities are supposed to keep a healthcare provider on duty for a fortnight before following up with a quarantine period of a fortnight.

With the current manpower, this very crucial hospital can barely cover all three of the daily shifts.

Taking the worsened Covid-19 situation in India into consideration, the Bangladesh government is contemplating enforcing lockdown in eight bordering districts: Satkhira, Khulna, Rajshahi, Kushtia, Jashore, Naogaon, Natore, and Chapainawabganj.

But outside the major divisional medical colleges, the situation is pitiful in many places.

For example, while all of these districts got some supply of life-saving N95/KN95 masks last year, this year the government’s own data shows that other than Rajshahi Medical College Hospital, and the occasional general hospitals, most of the healthcare facilities have been supplied with nothing to protect their staff from breathing in the same infected air as the patients.

Store keeper Abul Hashem of Khoksha Upazila Health Complex in Kushtia said that no N95 or KN95 masks exist in store. At least four of their staffers were affected last year. “We however have about 700 PPE,” he said.

But his unit is one of the lucky ones. With 52 oxygen cylinders and 3 oxygen concentrators, he belongs to a district with significantly more oxygen concentrators than the rest being talked about here.

Kushtia has 22 oxygen concentrators, Chapainawabganj has 11, Khulna has 8, Satkhira and Naogaon have 1 each, and Natore has none, according to data from the Supply Chain Management Portal of the Ministry of Health and Family Welfare.

For a population of 23.86 lakh and a positivity rate of above 20 percent, Naogaon has 191 isolation beds for the whole district.

In Chapainawabganj, which has a population of 16.48 lakh and an infection rate above 25 percent, only 20 isolation beds exist, according to the DGHS portal.

Natore has a population of 18.26 lakh and 29 isolation beds. In 24 hours ending yesterday morning, 32 samples were tested for Covid-19 there and 17 came positive, according to the civil surgeon.

Kushtia has a population of 19.47 lakh and a positivity rate above 20 percent but only 115 isolation beds.

Satkhira has a population of 20.80 lakh and a positivity rate above 25 percent. The district has only 86 isolation beds.

Khulna has 52 isolation beds but a population of 23.20 lakh and a positivity rate above 20 percent. Rajshahi fares better with a similar population and a lower positivity rate of 15 percent and 90 isolation beds.

Jashore has 101 beds, but a much lower population and positivity rate – 13.86 lakh and 15 percent.

In fact, some upazila health complexes cannot even keep Covid-19 patients because they do not have isolation beds. Health officials of Nachole Upazila Health Complex in Chapainawabganj spoke about how they refer Covid patients to Rajshahi or Chapainawabganj sadar because they do not have an isolation system.

But once at Chapainawabganj’s general hospital, the patients would find isolation beds if the situation does not get too critical. Even at this point when the surge has not reached its peak, 21 patients occupy the 20 isolation beds there.

There is no intensive care unit there either.

Zahid Nazrul Chowdhury, civil surgeon of Chapainawabganj, stressed the need for more oxygen cylinders. “We are getting 50 percent of the oxygen we currently need,” he said.

In Natore too, the sadar hospital has no intensive care unit. The 31 isolation beds yesterday were filled with 32 Covid-19 patients.

While 16 oxygen cylinders were to support these patients, only 8 can be used at a time, because similar to the hospitals in Satkhira, the Natore Sadar hospital needs to send their cylinders to Rajshahi to get refilled, said civil surgeon Mizanur Rahman.

In addition, the civil surgeon told our Natore correspondent that there was no RT-PCT machine, and whatever tests were being done, were done using Gene Xpert and rapid antigen tests.

Kushtia Medical College has four ICU beds to serve patients from the entire district. The hospital has 34 Covid-19 patients admitted against 30 beds, reported our correspondent.

Though Jashore is a very risky place, being one of the preferred districts for illegal entry from India, there is no central oxygen supply system at its 250-bed general hospital, the most important facility there for serious Covid-19 patients.

The hospital is supported by 265 small and large oxygen cylinders. Each large cylinder can supply oxygen for up to one hour, said Arif Ahmed, RMO of the hospital.

He also said the installation of a central oxygen supply system was ongoing, but the oxygen tank was yet to be imported from India.

The hospital has recently launched an ICU with three beds and very limited facilities.

In Khulna Medical College Hospital (KMCH), there was a 5 kilo litre capacity central oxygen supply system, which has been upgraded to 10 kilo litre by Linde, Bangladesh recently.

However, the capacity of the system is still below the demand of the 500 bed hospital, which has an average of 1,200 patients undergoing treatment daily, said Bidhan Chandra Ghosh, director (in charge), KMCH.

Visiting the KMCH recently, our Khulna correspondent found an oxygen tank of the system was left lying on the ground. He came to know that the tank had been lying there for about six months.

Ashutash Karmakar, executive engineer at the Health Engineering Department in Khulna, said installation of the second oxygen system would start soon as sanctioning of Tk 97 lakh for that purpose was underway.

He also said they were supplying oxygen to the 10-bed ICU unit and 14 high flow nasal cannulas using 100 large oxygen cylinders.

Installation of 10 more ICU beds was underway, said hospital sources.

Khulna had the central oxygen supply system. The government this year installed central oxygen supply system at five district hospitals in Satkhira, Meherpur, Kushtia, Chuadanga and Narail, according to civil surgeons of the respective districts.

Five districts of the division — Jhenidah, Magura, Chuadanga, Bagerhat and Narail — have no ICU facilities.

Farid Hossain Mian, director of hospitals and clinics at the DGHS, told The Daily Star yesterday, “We have directed all healthcare facility heads in the bordering districts where the transmission rate has gone up to increase their capacity [number of beds]. Whatever equipment they need, be it PPE, oxygen cylinders or anything else, we have asked them to collect those from the CMSD [Central Medicine Store Depot]. We have enough stock of all equipment at the CMSD.”

Asked how the hospitals in bordering districts would provide high flow oxygen support to critical patients without a central oxygen supply system, he said they would increase the number of oxygen cylinders in those healthcare facilities.

The physician said they could not start setting up central oxygen supply system at upazila level hospitals. “Except Faridpur General Hospital and Panchagarh Sadar Hospital, setting up of central oxygen supply system has either been completed or is at the final stages.