Amid all the celebrations surrounding the Golden Jubilee of Independence and the Mujib Centennial in March, there is one undeniable that fact that we can no longer run away from: it was the month we allowed the Second Wave of COVID-19 get out of hand and out of control.

The hospitals are filling up as the country records a rising number of new coronavirus cases but the battle for survival is somewhat uncertain for the more serious patients who require intensive care.

As of March 30, hospitals dedicated for treating coronavirus patients in Dhaka have 108 ICU beds but at the moment, only four are available, according to the Directorate General of Health Services (DGHS).

The situation at private hospitals is no different. There are 188 ICU beds but 144 of them are occupied. People with low or fixed income prefer government hospitals where the treatment is cheap. The cost at private hospitals is much higher.

The acute shortage of much-needed ICU beds means that only a fraction of the serious and critical patients will get life-saving treatment. Bangladesh health authorities reported a record number of cases on three out of the four days till April 1, when it shattered the previous day's record of 5300-odd cases by reporting a whopping 6,469.

Additionally it reported 59 new deaths, the second-highest toll in the entire outbreak since March 2020. The highest remains 62 last June 30 - but the way things are going, it only seems a matter of time before that is eclipsed. The second wave is well and truly here with a vengeance, and it seems set to be much worse than the first.

"It'll be very difficult to manage the situation," said Prof Dr Mohammad Robed Amin, DGHS Director of Non-Communicable Diseases and media cell representative.

ICU beds running short

Among the 10 dedicated hospitals, Bangabandhu Sheikh Mujib Medical University and Kuwait Maitree Hospital have 16 beds, Kurmitola General Hospital has 10, Dhaka Medical College Hospital (DMCH) has 10, Sheikh Russel Gastro Liver Institute and Hospital has 16, Sarkari Karmachari Hospital in Fulbaria has six, Central Police Hospital at Rajarbagh has 15.

Two beds each are available at Sheikh Russel Gastro Liver Institute and Hospital and the Central Police Hospital in Rajarbagh.

Meanwhile, the hospitals are running out of general beds as the number of patients increases. Of the 2,461 beds, 2,127 are currently occupied.

Among the private hospitals, Bangladesh Specialized Hospital has nine ICU beds, Anwer Khan Modern Medical College Hospital has 30, Square Hospital has 19, United Hospital has 22, Evercare Hospital has 40, Asgar Ali Hospital has 32, Ibn Sina Hospital has five, and Impulse Hospital has 35, and AMZ Hospital has 10.

Anwer Khan Modern Medical College Hospital has eight beds available, Square Hospital has five, United Hospital has eight, Evercare Hospital has six, Asgar Ali Hospital has 12, Ibn Sina Hospital has one, Impulse Hospital has three and AMZ Hospital has two.

Among the 925 general beds, 528 are occupied.

Health Minister Zahid Maleque warned that the rise in coronavirus cases at the current rate would overwhelm the healthcare system.

DGHS Secretary Abdul Mannan told our sister newsagency UNB that people must follow the health protocols and directives issued by the government to bring down the cases.

Dr Amin said they are emphasising setting up ICUs at hospitals which have additional space to meet the increasing demand. He noted that the number of ICU specialists must be increased along with ICU beds. "We don't have enough ICU specialists," he said.

Prof Amin said the government is planning to install new ICUs at the district hospitals. "The pressure on [hospitals in] Dhaka will lessen if we set up ICUs at district level."

The recent spurt in cases prompted the Prime Minister's Office (PMO) to issue an 18-point directive this week for the next two weeks to contain the spread. Health Minister Maleque said they proposed partial lockdowns for some places with higher Covid-19 transmission rates.

The government launched a countrywide vaccination campaign on February 7. Those who are 40 years or above and the frontline workers are being prioritised. Till March 29, 5,139,679 people received the first dose, according to government data.

What can be done?

As Bangladesh is experiencing record-breaking Covid cases, experts think 'health emergency', 'nighttime curfew' and area-based lockdown can be the right measures to slow down the virus transmission.

They think the 18-point directive issued by the government on Monday is not enough as the coronavirus situation is going from bad to worse with both high infection and mortality rates in the country.

The experts warned that Bangladesh may experience an 'explosive' Covid situation in the coming months, breaking down the already overwhelmed medical system, if unnecessary public movements and mass gatherings cannot be controlled with the strict enforcement of laws.

They also suggested ramping up contact tracing, mass testing, expanding ICU capacity and ensuring necessary treatment facilities and equipment in every hospital, including upazila health complexes, since the Directorate General of Health Services (DGHS) has identified 31 districts as risky for the virus outbreak with a high infection rate.

According to public health expert Dr MH Chowdhury (Lenin), chairman of the medicine department at Health and Hope Hospital, the government's directives are inconsistent with the coronavirus transmission pace.

"When it's necessary to stop all the social and political gatherings right now, it was said to be discouraged in the directives. When a nighttime curfew should be enforced from 6pm, people are only asked not to come out of their homes unnecessarily. The shopping malls should be allowed to remain open for at best six hours on a limited scale, but the government said both sellers and buyers in shopping malls must follow the health rules," he said.

Dr Lenin said all types of mass gatherings should be controlled strictly, but the government asked to hold public exams maintaining health hygiene rules, which is not possible.

"People are discouraged to go to tourist and recreation spots, movie houses and theatres, and all kinds of fairs. But the Ekushey Book Fair is going on in full swing," he pointed out.

Dr Lenin said the government has instructed all to maintain health safety rules in public transport, but people do not do that for lack of monitoring. "Strong enforcement of law is necessary to force people to abide by those rules."

Dr Be-Nazir Ahmed, former director (disease control) of the DGHS, said, "The directives are not time-befitting and consistent with the current pandemic situation. These instructions should have been given at least one month back when the virus cases started surging."

Dr Be-Nazir said when elections can be held amid such a situation, how can the government ask people not to arrange social programmes and mass gatherings?

The health expert said the government has given a directive to shift kitchen markets to open places, but the shopping malls will remain open. "When people can go to shopping malls in enclosed areas, where's the problem if they visit the kitchen markets?" he asked.

"I think the directives have not been formulated considering the severity of the current Covid situation. So, these directives may not help contain the virus outbreak. We should take the corona situation seriously and come up with serious actions. Or else, we'll have to pay a heavy price in the days to come."

Dr Be-Nazir said all-types of mass gatherings and unnecessary public movement must be stopped to overcome the situation.

"We should announce a health emergency by forming a high-powered committee to enforce it by taking necessary decisions to tackle the situation. The committee should be given the power to issue orders to curtail different services and close shops, offices and restaurants, to involve any organisation in healthcare management. "Adequate funds should be allocated so that the committee can take necessary preventive and curative measures."

He said the committee should also be empowered to convert any community centre, convention centre, hotel or other institutions into temporary hospitals, quarantine or isolation centres.

The expert said the government should engage police, Rab, Ansar, BGB and even the army to enforce the health emergency. "A situation should be created so that people don't venture out of home without masks and any valid reason."

'Suspend the Book Fair'

Dr Lenin said the Ekushey Book Fair should be suspended for at least two weeks while the tourist and recreation spots, movie houses and theatres should be closed right now as part of a move to control mass gatherings and mass movement.

He said people have long been asked to wear masks, but they are not paying heed to it. "So, a heavy fine should be realised from those who don't wear masks."

Dr Lenin said putting the entire country under lockdown is the last weapon to control the mass gatherings, but it will harm the economy badly. "So, we should use other preventative measures like a curfew from 6pm to 6am to control the situation."

Besides, he said, the government should identify the areas where the infection rate is very high and declare those as 'red zones'.

"We need to now enforce area-based lockdown in the red zones. The situation has reached such a level that we won't be able to control the infection rate without controlling the movement of people in corona hotspots."

Dr Lenin said the offices that can be run online should take immediate steps to keep their employees at home. "Other offices that can't be run through online should follow skeleton duty schedules to lessen the presence of their staff."

"The main thing is that we must control the mass movement and mass gathering as much as possible. We should take all possible steps in this regard. Or else, the pandemic will take a tsunami turn in Bangladesh."

Prof Muzaherul Huq, a former adviser to WHO South-East Asia region, said the government should take all-out steps to tackle the situation in the days to come by ensuring proper treatment facilities in all the district and upazila hospitals since the virus case has been gradually growing across the country.

"If the virus continues to spread for two more weeks, it'll put a serious pressure on the healthcare system. The Prime Minister has issued an instruction to ensure ventilators and ICU beds in every district hospital. The government should implement this instruction immediately. There should be sufficient oxygen supply and other necessary equipment in all the upazila health complexes to deal with the Covid patients," he said.

Prof Huq said the Covid patients must be identified quickly and kept in isolation centres. "We also need to locate people who come in contact with the Covid patients and quarantine them."

Too little, too late?

In the wake of the alarming spike in Coronavirus cases, the government towards the end of the week decided to take a tougher position to implement the 18-point directive issued by the Prime Minister's Office (PMO) in an effort to contain the spread.

The move came after the country recorded its highest-ever daily coronavirus cases (6,469) and registered more than 5,000 cases for the fourth straight day on Thursday (Apr 1).

Following the health protocols, all ministries and organisations have been instructed to use only 50 percent of their manpower in office for two straight weeks by State Minister of Public Administration Farhad Hossain.

Strict instructions have been issued to all the ministries and associated organisations asking them to follow the directives, he said.

"We already started following the instruction from Wednesday and the rest of the ministries started implementing the directive from Thursday. All ministries and departments will form a duty roster for all their staffs," he said.

One half of the staff will attend office three days and two days from home in the first week and the second half will work the same way in the second week, Hossain said, adding that pregnant and officials above 55 years old will work online from home.

Besides, all of the private and non-government organisations and offices were also directed to employ 50 percent workers in office and rest through online from home, the State Minister said. Pregnant employees and officials above 55 years old will work online from home.

"We will ensure that no one go outside after 10 pm unnecessarily and also launched monitoring programme on the grass root level. Law enforcers will work in this regard," Farhad Hossain said.

The government will decide the next course of action after maintaining all the directives for two weeks and review the decision after April 12, he said.

The Home Ministry said as the 18-point directive landed on Monday, police already prepared a work plan to implement the instructions across the country including the capital.

Police check-posts have been installed at different places including Dhaka and a massive campaign is operated by cops and local administration to raise awareness among people, Home Minister Asaduzzaman Khan told UNB.

Moreover Health Minister Zahid Maleque said the administration will do everything to constant monitor the implementation of the health directives "The way number of patients is rising if the scenario continues, no hospitals will have seats to admit patients. All must act immediately to curb the massive transmission. The pandemic might take a devastating form if we fail to follow the 18-directives issued by the Prime Minister Sheikh Hasina," the minister said.

Secretary of Health Services Division Abdul Mannan said they have already started following the health directive strictly.

Transport restrictions

Bangladesh Railway is operating keeping 50 percent of its seats vacant to curb the transmission of Covid-19 since Wednesday, said Railway Minister Nurul Islam Sujan.

Half of the 50 percent railway tickets will be available online and rest will be sold at the stations, the minister said adding that "We won't carry any passenger without following the health guideline and take all necessary measures to ensure hygiene in trains and stations."

Bangladesh Road Transport Owners Association Secretary General Khandakar Enayetullah said all buses are carrying 50 percent of passengers with the direction of the government.

BRTA Chairman Nur Mohammad Majumdar told UNB that they have taken overall measures in this regard and mobile courts will be operated to prevent transport workers from violating the instructions.

State Minister for Shipping Ministry Khalid Mahmud Chowdhury said they are also maintaining the 18-point directive by taking only 50 percent of passengers.

Passengers will have to step into launch after following all health guidelines otherwise legal action will be taken, he warned.

Meanwhile incoming flights from all countries of Europe except the United Kingdom have been prohibited to prevent coronavirus transmission, said Civil Aviation Authority Chairman Air Vice Marshal M Mofidur Rahman. The decision to exempt the UK has baffled observers.

Twelve other countries that have been placed on the list alongside Europe are Argentina, Bahrain, Brazil, Chile, Jordan, Lebanon, Peru, Qatar, South Africa, Turkey and Uruguay.

The prohibition will remain in action from April 3 to April 18, Rahman said, adding that the airlines can only carry transit passengers from these nations during this time and they will have to remain inside the Airport terminal during the transit period.

The returnees from foreign countries who are allowed in will have to remain in institutional quarantine for 14 days at a quarantine centre or specific hotel, he said.

Besides, all travellers must have Covid-19 negative certificates (Sample collected within 72 hours) for leaving or entering the country, he added. Passengers will have to wear face shields along with masks.

All the directives came into effect since March 30 and will remain in force until further notice, he said.

Besides, the Election Commission (EC) late in the week postponed all elections scheduled for April 11. The National Cricket League has also been postponed midway.

Movement of all tourist ships on Teknaf-Saint Martin's Island route have been suspended, and all tourist spots in places like Cox's Bazar and Sylhet have been instructed to close.

However, movement of vessels carrying regular passengers and daily essentials will remain normal, subjected to maintaining health guidelines.

Additional Reporting by AR Jahangir and Masudul Hoque