Opinions vary on govt decision to expand COVID-19 treatment to all hospitals

The government's decision to expand the treatment of COVID-19 to all hospitals in Bangladesh has drawn mixed reactions from health experts and hospital authorities.

On May 24, the Health Ministry ordered all public and private hospitals, clinics and diagnostic centres to provide treatment to both coronavirus and non-COVID patients in separate units of the same facility.

Prof Nazrul Islam, former vice-chancellor of Bangabandhu Sheikh Mujib Medical University, lauded the government's decision, which he believes will ease the plight of patients battling other conditions whose treatment has been hampered by the coronavirus outbreak in the country.

Experts have recommended creating three separate zones -- a red zone for COVID-19 patients, a yellow zone for suspected virus patients and a green zone for general patients - in a hospital to ensure safe distancing between infected patients and others to prevent the transmission of the disease.

Prof Nazrul, also a member of the national technical advisor committee on coronavirus, believes these measures could provide an adequate safeguard against the spread of the disease in hospitals while ensuring that general patients are not denied proper treatment.

"Non-COVID-19 patients were suffering a lot as they couldn't get treatment. Every time they went to a hospital with any sickness, the authorities asked them to do a COVID-19 test. I believe this decision is a positive one."

The patients will be sent to the respective zones based on their condition while the medical workers will provide treatment wearing their PPE, he said.

It is quite challenging in the context of Bangladesh to treat COVID-19 and general patients in the same hospital, according to Prof Ihteshamul Haque Chowdhury, secretary-general of Bangladesh Medical Association.

To provide treatment to the COVID-19 and other patients together, a hospital must have separate buildings, separate entrances and exits and sufficient manpower, he said.

It is very hard for small government hospitals to meet these requirements and this creates the risk of COVID-19 patients spreading the contagion to others, he said.

"A hospital providing treatment to COVID-19 patients needs three times more manpower than usual. Our hospitals already lack in manpower so how will they create separate units? I believe it will be a total mess."

The BMA secretary general raised questions about the decision requiring private hospitals, clinics and diagnostic centres to provide treatment to COVID-19 patients.

Labs must meet the Biosafety Level 2 requirement to set up an RT-PCR machine used to test samples for COVID-19 whereas private hospitals already lack the necessary infrastructure and manpower to do so, he told bdnews24.com.

“How can they separate COVID-19 and non-COVID units? They don’t have that option. A big hospital like Dhaka Medical College is struggling to maintain its COVID-19 unit. Then how can the small hospitals manage it?”

Dr Moniruzzman Bhuiyan, president of Bangladesh Private Clinic and Diagnostic Centre Association, urged member institutions to implement the government's order even though they are likely to face troubles in doing so.

“We’ll see how it goes. We’ll try to comply as much as possible or else inform the ministry about it,” he said.

“It is obvious that there will be problems. Not everyone will be willing to work. Doctors, nurses, other medical workers will ask for a pay rise. They are dealing with the government and private hospitals in the same manner. In that case, hospitals can’t discriminate in terms of giving incentive.”

He requested supplies of PPE for medical workers in private hospitals treating COVID-19 patients.

There is no designated hospital for COVID-19 patients in any country other than Bangladesh, Dr Mushtaq Hossain, former chief scientific officer of IEDCR noted.

Experts have differed in their opinions regarding the issue from the very beginning but a consensus was later reached after watching India’s handling of the situation, he told bdnews24.com.

“Hospitals should treat both COVID-19 and non-COVID-19 patients. They must pay utmost attention to preventing the spread of the infection.”

Hospitals with 50 or more beds also have been directed to maintain separation between coronavirus and general patients, said Additional Secretary Habibur Rahman Khan. 

It is possible to treat all kinds of patients if the hospital authorities try earnestly, according to him.

“Coronavirus patients need some extra care, extra caution. They don’t need any serious treatment, and that’s why we believe it is possible to treat COVID-19 patients and general patients together in the same hospital.  They are able to serve the people throughout the year, as they have certain infrastructure and management. And if they can’t do it, they should close down the hospitals,” he said.