Oxygen and ICU bed use for Covid-19 patients in Bangladesh far below expected levels
Are those sick from Covid-19 in Bangladesh receiving appropriate and adequate treatment in the country’s designated hospitals?
News reports have suggested that there are significant problems in treatment. For example, the UK’s Daily Telegraph most recently has quoted Shamin Talukdar, who runs Eminence, a Bangladeshi public health research organisation as stating:
In many hospitals, junior doctors have been left in charge, abandoned by their superiors who are too scared to come to work, said Dr Talukdar. “They don’t know what they are doing. There’s been very little guidance on what protocols or treatment plans to follow or what drugs to use.”
One set of data that could be cause of particular concern is the divergence between, on the one hand, the levels of both oxygen use and Intensive Care Unit (ICU) bed use for patients hospitalised with Covid-19 and, on the other hand, the numbers one would expect.
Bangladesh official figures state that on June 11th there were 8,764 patients admitted to designated Covid-19 hospitals, of which 456 patients needed oxygen and an additional 99 were using ICU beds. It should be noted that these could be administrative undercounts — but these are the official figures from the Directorate General of Health Services. (Since, as of May 29th, there are only 399 ICU beds in the whole of Bangladesh, this would suggest only a quarter of all the ICU beds are being used!)
However, Imperial College’s modelling estimates, set out in its June 9th Situation Report on Bangladesh that (on the basis of the official number of deaths) there would likely to be about 3,144 patients requiring high pressure oxygen and 946 patients requiring critical care (ICU) beds treatment with mechanical ventilation. What this means is that according to the modelling estimates, there should be at least 7 times the number of patients in Bangladesh needing to receive oxygen than there are, and 10 times the number of patients needing the use of an ICU bed. (These numbers would of course be larger if the Imperial modelling took into account the unofficial Covid-19 deaths.)
The Imperial College estimates are based on first working out the number of actual infections by modelling back from the number of official deaths and then assuming that “5% of all infections will require treatment with high-pressure oxygen and that approximately 30% of hospitalised cases will require treatment with mechanical ventilation (based on analysis of ongoing epidemics in Europe).” (Read this previous blog about Covid-19 infection numbers in Bangladesh.)
So what can explain the significant differences between the numbers of Covid-19 patients given oxygen and ICU beds in Bangladesh — and the numbers Imperial College modelling suggests one would expect?
It is of course possible that the modelling or assumptions behind the modelling could be wrong — that for example in Bangladesh, for one reason or the other, a far smaller percentage than 5% of those infected actually require oxygen and far less than 30% of those hospitalised require to be in an ICU.
However it could also be because of one or more of the following reasons:
- doctors do not know when a person should be put on oxygen or be given an ICU bed, so patients are not receiving appropriate treatment
- doctors/hospital administrators are trying to save oxygen and do not want to fill up the ICU beds — and therefore do not provide them to patients when, medically, they should;
- Many people who require oxygen or ICU beds are not coming for treatment to hospitals — and are suffering at home.
If the reason for the divergence in the numbers is due to any of the above three reasons, this is certainly a matter of concern.
//DB
