As the number of corona cases continues to spike in Bangladesh, health experts have warned that the country’s fight against the deadly virus may suffer a big blow due to acute shortage of ventilators and intensive care unit (ICU) staff in the case of a serious outbreak.

According to the experts, around 80 percent of COVID-19 patients do not need hospital admission. But five percent of such patients become critically ill as their lungs get so damaged that they can no longer breathe and suffer from acute respiratory distress, and this type of patients cannot be saved without intensive care involving ventilators.

For patients with the worst effects of the virus infection, they said a ventilator offers the best chance of survival by pushing air, with increased levels of oxygen, into the lungs of the patients and give them time to fight off the infection and recover.

According to Health Minister Zahid Maleque, the country has 550 ventilators and the government is in a process of procuring 380 more.

Taking to UNB, Bangabandhu Sheikh Mujib Medical University (BSMMU) Vice-Chancellor Prof Kanak Kanti Barua, Dhaka Medical College principal Prof Khan Abul Kalam Azad, medicine department head of Dhaka Community Medical College & Hospital (DCMCH), Prof Harun-or-Rashid, and Gonoshasthaya Kendra founder Dr Zafrullah Chowdhury said the country’s existing ventilators are too inadequate to handle the regular patients, let alone the critical coronavirus-infected ones.

They suggested the government to immediately procure enough number ventilators from China and other countries where it is available, and train some anaesthetists and nurses to handle the serous patients at the ICU and put them on ventilator to boost the country’s preparedness to tackle the pandemic.

Prof Kanak Kanti Barua said the country will surely face a shortage of ventilators if the outbreak goes to a level it has gone in some other countries.

He said the government should take steps for ensuring sufficient ventilators and ICU facilitates and trained manpower across the country as the number of coronavirus cases continue to grow.

“Many people are giving various hypothesis that coronavirus prevalence won’t worsen in Bangladesh due to humidity in our weather. We shouldn’t believe such unproven perception. We should get ready for dealing with the possible worst situation,” he observed.

“We don’t know how long this virus will prevail and how many people may get infected with it. So, we should increase our ICU beds and ventilators so that we can save lives from dying with acute respiratory problem being infected by the virus,” the BSMMU VC observed.

He also said there are ventilators at many hospitals, but doctors will not be able to use all those for the corona patients as there are many other critical patients who also need that support. “We can’t ignore the other patients to save the corona-infected ones. There’s no alternative to increasing the number of ventilators and ICU beds to effectively deal with the coronavirus.”

He said the post-operative system in all public and private hospitals can be equipped with ventilators and ICU facilities. “The government should also keep in touch with private hospitals so that those can also be used in case of any emergency.”

He said 80 percent of corona patients need not to take admission to any hospitals as they can recover from it by remining in isolation at home. “Around 10 percent patients need to get admission to hospitals and oxygen support or proper care at the ICUs while the rest need ventilator support as their lungs get damaged.”

“If the number of patients rise alarmingly, we won’t be able to save many lives without adequate ventilators and ICUs,” the VC added.

Khan Abul Kalam Azad said, “We’ve the shortage of both ICU beds and ventilators. If the virus spreads badly, we ‘ll face serious difficulties in handling the critical patients.”

He, however, said the government has taken initiatives to resolve this problem. “The Health Minister is working on it. The Prime Minister has already instructed to ensure at least 15 ICU beds and required ventilators at all the district hospitals. China has assured us of helping Bangladesh in this regard.”

Dr Harun said the government hospitals have only 25 percent of the total ventilators the country has. “Around 75 percent ventilators are there at the private hospitals. The existing ventilators are very inadequate to handle badly-infected corona patients. Without access to ventilators, many patients will die if the outbreak takes a serious turn.”

Dr Zafrullah said though there are nearly 600 ventilators in the country one-third of them are not functional. “These defective ventilators should be repaired as soon as possible.”

Besides, he said, the hospitals designated for dealing with coronavirus patients are not equipped properly with sufficient ICU beds and ventilators for taking care of the patients.

Zafrullah said there is also a shortage of medical staff required to operate the ventilators and take care of patients at the ICUs. “Before placing a patient on a ventilator, anaesthetists and nurses need to perform some procedures. We don’t have enough trained anaesthetists and nurses to do so.    

He said some doctors and nurse can be given short training so that they can serve the patients at the ICUs and give them ventilator support when it is needed.

Meanwhile, Save the Children on Wednesday urgently called for international assistance to help Bangladesh meet a surge in demand for ventilators to cope with the COVID-19 outbreak and avert a humanitarian disaster in the country.

Most of the country’s intensive care beds and ventilators are in major urban centers, including capital Dhaka, making it difficult for remote communities to access, it said.

“At present, it is difficult for Bangladesh to meet the expected surge in demand for ventilators to help respond to the COVID-19 outbreak,” said Athena Rayburn, Save the Children’s Rohingya Response Advocacy Manager.

“Ventilators and people trained to operate them are urgently needed to protect the host communities and Rohingya refugees to avert a humanitarian disaster. Children are at serious risk of not only contracting the virus, but also of being orphaned or neglected if family members become infected or die,” Rayburn added.

The revenue collection in Bangladesh will face a severe blow due to slowdown in economic activities in the country and elsewhere in the world following the coronavirus outbreak.

"Yes, there’ll be a shock, no doubt about it," a senior official at the National Board of Revenue (NBR) told UNB over telephone.

He mentioned that there has been a discussion at the policymaking level already.

Finance Minister AHM Mustafa Kamal held a meeting on March 31with the NBR Chairman, Financial Institutions Division Secretary, Finance Secretary and Economic Relation Division Secretary.

At that meeting, the Finance Minister expressed concern over the revenue collection in the running fiscal activities due to the COVID-19.

He also told the meeting that the government might seek budgetary assistance from development partners to resolve the financial crisis in the coming budget for 2020-21 fiscal and the government is communicating with them in this regard.

According to well-placed sources, an assessment paper was sent to the Prime Minister through the Finance Minister regarding the shortfall of revenue collection by the NBR.

The NBR official involved in the income tax wing said the NBR high-ups, after the opening of offices following the general holidays would sit to find out the ways to overcome the possible revenue shortfall.

"So far, there’s no plan and no execution. It’ll be a tough a job, very tough job…we’ve to formulate our plan very carefully," he said adding that the taxpayers have to bear the burden, no matter what plan comes out from the NBR.

"So, we’ve to be very careful…there’s no pocket left for revenue collection which is intact till now. We’ve to think which area we’ll focus on as a new one and where we’ll put our pressure," he said. 

UNB File Photo

Responding to a question, he said the main pressure will be on the income tax and VAT wing.

He said there should be some additional efforts to collect undisputed revenue from taxpayers. "But that amount won’t be a very significant," he said.

He also talked about a plan worked out to collect advance tax from big taxpayers which is scheduled for the next fiscal year. "We can collect a major part of the big taxpayers' advance tax that they were supposed to submit in the coming fiscal," the NBR official said.

Regarding putting extra pressure on the taxpayers, he said it would not be a wise decision.

Another senior official at the VAT wing said everything depends on the duration of this uncertain situation.

He said if everything goes well in Bangladesh and the situation in other countries does not improve then it will also affect Bangladesh. "The revenue collection till the mid-March was more or less normal… the stalemate emerged after that."

The NBR official said they have identified some sectors like tobacco, mobile phone, natural gas in industrial arena and construction where the consumption drastically has fallen.

Replying to a query, he also said they did not plan anything till date to overcome the revenue shortfall. "After the holidays, we’ll sit for that."

Deficit in revenue collection was Tk 37,498 crore in July-January of the running fiscal which was Tk 31,508 crore in July-December of the year, according to the NBR data.

According to the Export Promotion Bureau, the country’s export earnings during the July-February period fell by 4.79 percent.

The export earnings in February fell by 1.80 percent to US dollar 3.32 billion from US dollar 3.72 billion during the same month of the last fiscal year.

According to Bangladesh Bank data, the country’s import also dropped by 4.43 percent to US dollar 32 billion during the July-January period.

Only in January, import dropped by 12.87 percent, or US dollar 0.73 billion, to US dollar 4.94 billion from US dollar 5.67 billion in January last year.

The World Bank has estimate that the coronavirus outbreak will cause economic growth to slow significantly this year in China and other East Asian-Pacific countries, throwing millions of people into poverty.

In a worse-case scenario, the region could suffer its sharpest downturn since a devastating currency crisis more than two decades ago, the bank said in an updated forecast released on Monday.

The bank’s report projects that growth in the region would slow to 2.1 per cent this year from 5.8 per cent in 2019 under a “baseline” forecast in which economic recovery takes hold this summer.

Thousands of workers of different hotels, restaurants and sweetmeat shops are going through a tough time without jobs as most eateries have been closed down amid a government-announced general holiday to tackle the coronavirus spread.

Talking to UNB, some restaurant workers and their leaders said most owners shut their eateries without clearing their wages and dues, leaving them at lurch amid an apparent countrywide lockdown and halt in economic activities.

They want their employers to stand by them and help them survive with their family members at this critical time.

They also urged the government to create pressure on the hotel owners to pay their unpaid wages alongside introducing food rationing for them and announcing a small amount of grant or stimulus package for their sector to ease their woes.

“Our owner closed the hotel on March 24 giving us some small amounts of money. Now I’ve no income source, but I’ve to buy food and other essentials for my four family members. I’ve no alternative to begging which is also now not possible as law enforcers don’t allow people to go outside,” Bhara Mia, a waiter wo used to work at a restaurant in the city’s Mouchak area, told UNB.

He said he phoned his employer to clear his dues, but he said he is under pressure to pay the restaurant’s rent. “I don’t know how I’ll support my family and arrange their meals.”

Abul Kalam, a waiter of a restaurant in the city’s Rampura Bazar, said he could not go home as their owners assured that he’ll keep the eatery open. “But the restaurant was shut on March 27. I along with some other co-workers are now staying inside the restaurant amid the risk of coronavirus. We get food from our employer, but he gave us partial salary what I sent home. My family is in serious trouble to meet the daily expenses with that meager amount of money.”

As a waiter, Kalam said, he used to get much more tips than his wage from the customers than his salary. “But now I’ve no tips either. Both the government and the owners should extend their helping hands to assuage our sufferings.”

Contacted, general secretary of Bangladesh Hotel Restaurant and Sweetmeat Workers Federation Anwar Hossain said most hotel restaurant owners shut their shops without paying the dues and wages of their workers, putting them in serious hardship.

He said there are at least 10,000 hotels and restaurants in the capital where around 2,00000 waiters, chefs, cooks, severs and bread-makers work with small amount of wage. “Most waiters depend on tips from customers. Without job and wage, they’re now passing through an inhuman life.”

Anwar said some workers had been able to their village homes before the closure of the public transport while many of them are now stuck in the capital with their families.

He urged the government to ask the hotel owners to clear the dues of their employees and provide them wages until the situation gets normal.

Anwar also urged the government to introduce food rationing system for them and announce a grant so that huge number of low-income workers of the sector can survive with their families.

President of Bangladesh Hotel Restaurant, Sweetmeat and Backer Workers Union Akhtruzzaman said the owners violated the labour law by shutting down their eateries without paying the employees their salary.

As per the labour law, he said the owners should continue to pay their employees during this time of natural disaster. “The owners made good profit round the year. Now they’ve the responsibility to stand by their workers and clear their wages. The government should enforce the labour law in this regard.”

Akhter said they submitted an application to the chief inspector of the Department of Inspection for Factories and Establishment on March 25 for taking action in this regard.

Talking to UNB, Bangladesh Restaurant Owners’ Association secretary general Rezaul Karim Sarker Robin said their sector has been hit hard by the coronavirus shutdown. “There’re around 12 lakh workers directly involved with our sector, besides, over a crore, including fish traders, meat traders, vegetable sellers and grocers are also involved with our sector. With the closure of our eateries all of these people are affected.”

He claimed most eatery owners cleared the wages of their staff, but it’s not enough. “We’re helping our employees as much as we can. But we’re also under pressure. Though the hotels are shut we’ve to pay huge amount of rents and bills of the utility services. We can’t give them wages if our hotels remain closed. It’s only the government which can help our poor workers by providing food and giving some grant.”

Leaders of organisations, working for rights of low-income people, demanded waiver of rent for slum dwellers as they have become jobless due to nationwide shutdown aimed curbing the spread of coronavirus.

Slum dwellers said they live hand to mouth and currently do not have jobs to feed their families during the government-announced general holidays. They said they were worried about their survival.

On March 23, the government declared general holidays from March 26 until April 4. The holidays were later extended to April 14 in two phases. The government asked people to stay indoors and maintain social distancing during this period.

Around 3.5-4 million low-income people live in 3,500-4,000 slums in the capital. One third of the slum dwellers are rickshaw-pullers and many of the rest work as day-labourers, housemaids, van-pullers, vegetable vendors, transport drivers and helpers, said Abul Kashem, joint secretary of Nagar Dariddra Bostibasi Unnyan Sangstha (NDBUS).

He demanded waiver of rent till the coronavirus situation improves. Kashem suggested local MPs, ward councillors and local administration jointly ensure that slum owners will not put pressure on the poor residents for money.

Hannan Akand, joint secretary of NDBUS, said the shutdown of transport has put low-income people, particularly rickshaw-pullers and day-labourers, out of jobs.

He urged the slum owners to waive the monthly rent considering the current situation. “Owners, who’ve built slums on their own land, may waive full rent. On the other hand, owners who’ve built small slums on government land may consider waver of at least half of the rent,” he said.

Hosne Ara Begum, president of Bastibasi Adhikar Surakkha Committee (BOSC), agreed. “They’re finding it very hard to earn a living. How can they pay rent in this situation? The government should urge slum owners to waive monthly rent,” she said.

Fatema Akhter, chairperson of Trinomool Jatiya Federation, said slums owners should make the move on humanitarian ground. Owners of small slums can waive half of the rent but they must receive the amount later when the situation improves, she added.

Ful Banu, 21, a dweller of Comilla slum in Agargaon, said her husband is a rickshaw-puller but now he is jobless as there is no passenger. They are yet to get any relief materials, she said.

“We’re worried about paying the rent of Tk 5,000,” she said, requesting the government to help them survive.

Another resident of the slum, 20-year-old Moushomi, said the authorities concerned should pay attention to their plight and waive monthly rent until the situation improves.

Meanwhile, the death toll from coronavirus has reached 20 in Bangladesh. So far, the country has confirmed 2018 cases – 54 of them in the last 24 hours. 

Dr. Shafi Bhuiyan, an internationally-recognised leader in global public health and education initiative, has suggested people to listen to health professionals only as confusing messages from unlimited sources are flooding the public domain amid global coronavirus pandemic.

"We must listen to health professionals both at home and abroad, others shouldn't talk too much about COVID-19 issues," Dr Bhuiyan, a Bangladesh-origin health professional in Canada told UNB.

He said Bangladesh can ensure the best utilisation of countrywide existing health infrastructure keeping health complexes up to upazila level prepared to deal with the situation as nobody knows how far it might go in Bangladesh.

"We’ve great health infrastructure across Bangladesh up to the upazila level. This must be utilised with required testing and treatment facilities if the situation demands," said Dr Bhuiyan who has founded a programme at Ryerson University's Chang School of Continuing Education that prepares internationally-trained doctors for non-licensed work in Canada's health sector.

The government has decided to provide incentives for doctors, nurses, health workers and other employees of the republic who deployed themselves with bravery in the war against COVID-19.

"I want to reward those who were engaged directly in the fight against COVID-19 since March," said Prime Minister Sheikh Hasina on Tuesday.

He said there is a significant development in Bangladesh's ICT sector which needs to be utilised properly at this difficult time. "We need to create awareness-raising messages in digital form that can easily be understood by common people, even everyone in remote areas," said Dr Bhuiyan.

He said mobile phone operators can generate such messages so that those easily understandable messages reach all the mobile phone subscribers across the country.

For example, he said, subscribers will receive automatic calls every hour, and upon receiving the call, subscribers will hear awareness messages, including the latest government directives, he said.

"This is a new crisis, all must accept the new normal," said the health professional who is monitoring the evolving situation across the world.

Now mobile phone subscribers in Bangladesh hear a recorded message before a phone call gets connected with the receiver of the call.

Talking about mental health at this stressful moment, Dr Bhuiyan said mental health is extremely important, too. "Spending time with families is crucial to stay cheerful instead of getting stressed."

Dr. Bhuiyan who holds position at Ryerson as distinguished visiting Professor, said lessons need to be learned from other countries while dealing with coronavirus issues.

"We know this virus may last for 14 weeks to get its peak anywhere in the world, and the situation may prolong," said the health expert who is living abroad since 2001.

He also laid emphasis on encouraging young people to get them engaged in volunteering.

Meanwhile, Dr. Zhang Wenhong, Professor and Head of the Center for Infectious Disease, Huashan Hospital of Fudan University in Shanghai, will share his experience and answer Bangladeshi counterparts’ questions about the pandemic.

The videoconference will be held on Wednesday at 1pm (BDT), an official at the Chinese Embassy in Dhaka told UNB.

Five more people died from coronavirus in Bangladesh in the last 24 hours, raising the death toll to 17, according to the Institute of Epidemiology Disease Control and Research (IEDCR).

Besides, 41 other people tested positive for COVID-19 in the last 24 hours, raising the number of such cases in the country to 164, said IEDCR director Prof Meerjady Sabrina Flora in an online briefing Tuesday.