COVID-19 emergency overwhelms govt hospitals

Most government hospitals in the country, especially in Lagos State, have been overwhelmed by upsurge of COVID-19 patients needing intensive care with oxygen support to survive.

The daily rise in cases and deaths in the second wave has made some persons and groups to call for another lockdown, as obtained in United Kingdom (UK) and other climes.

There is also an alarming demand for oxygen in most public hospitals. It was reliably gathered that the second wave infection has brought about increase demand for oxygen at isolation centres across the country. Three hundred cylinders of gas is said to be used daily in Lagos isolation facilities, with a critical patient needing about six cylinders of oxygen within 24 hours.

The situation has raised so many questions than answers as to how many active isolation centres are there across the country and what is the country’s daily oxygen need for effective oxygen therapy, what efforts the Federal Government is making to increase oxygen generation in-country and what is the state of oxygen availability.

However  the collaboration between the Lagos State Government and Bill and Melinda Gate Foundation brought about the Lagos Oxygen Plant within the premises of the Infectious Diseases Hospital (IDH), Yaba.

But the oxygen generator in Gwagwalada, Abuja, provided by the Nigerian National Petroleum Corporation (NNPC), can generate only four cylinders of oxygen a day, while the supply made by the Nigeria Air Force from Yola, Adamawa State, is still very far from the needed quantity.

Many wonder whether there are ongoing collaborations between government and the private sector to increase the oxygen plants or import to make up.

Reacting to the development, Director General, Nigeria Centre for Disease Control (NCDC), Dr. Chikwe Ihekweazu said on Friday: “The fact is that there is no silver bullet to stop the increase in the number of COVID-19 cases. We need a combination of various solutions to do this.

“There is evidence that ‘lockdowns’ can slow COVID 19 transmission by limiting contact between people. However, there is also a profound negative impact this can have on individuals, communities, especially in our social and economic life.

“Our goal at NCDC and the Presidential Task Force (PTF)-COVID-19 is to recommend solutions that mitigate the risk of spread of COVID-19, with limited impact on other aspects of society.”

Ihekweazu, who is also an epidemiologist, urged Nigerians to adhere to public health and safety measures, noting: “We do not want to return to a total lockdown and can avoid this if we all take responsibility.

“Please, wash your hands regularly, avoid mass gatherings, wear a facemask properly and adhere to other public health and social measures. We must protect ourselves and our country.”

On challenges of treatment access and cost, especially on availability of oxygen for patients in Intensive Care Unit (ICU) in Lagos, Ihekweazu said: “The Lagos State Government, Federal Ministry of Health and PTF-COVID-19 have been working hard to meet increasing case management needs, following the increase in the number of cases. Despite the high cost of care, government has continued to provide this free of charge in public treatment facilities.

“We recognise that the provision of oxygen is a challenge, given the number of people who need this for care. However, both Lagos State and Federal Governments have prioritised the establishment of additional oxygen plants and distribution across treatment facilities.”

On oxygen demand surge and COVID-19 management, a clinical researcher at the Nigerian Institute for Medical Research (NIMR), Yaba, Lagos, Dr. Dan Onwujekwe, said, “I wish logistics planning and management shall improve in Nigeria. Most times, the country’s level of preparedness for emergency situations is severely defective or deficient. Concerted response and early intervention at home and in healthcare settings may reduce the overwhelming demand for oxygen therapy.

“I am worried that patients have to get to these advanced stages of COVID-19, because permanent damage to body systems might have occurred and persist as post-COVID-19 syndrome. Again, the solution is prevention, prevention, prevention!”

According to the Medical Director of Medical Art Centre (MART) in Maryland, Lagos and President of African Fertility Society (AFS), Prof. Oladapo Ashiru: “It is a very sad situation in our country. COVID-19 has been around for almost one year and we do not have comprehensive strategic measures to tackle it.

“Ideally, there should be several priorities in place for this pandemic, ranging from preventive, promotive, early diagnosis to categories of therapeutic measures. Each of these priorities must be driven and facilitated by government.

“Alas, it is not the case in Nigeria. Oxygen production in Nigeria is not in abundance. Even now, most of the infrastructure support for the pandemic, including oxygen, is being provided for by the private sector.

“Lagos State Government stands out in trying to provide such support at reasonable cost, but for the private centres, many more would have died from the pandemic.

“One would have expected by now that funds would have been provided by government to partner with a country like China to bring in Respirators, CPAP (Continuous Positive Air Pressure) oxygen machines, several oxygen generating plants and other support systems. Some of our friends have died due to lack of oxygen.”

On the issue of another lockdown in Nigeria, Ashiru said: “The issues of control are straightforward. Today, the number of COVID-19 cases in China is 87,000, 57,000 in Ghana and 103, 000 in Nigeria. Lockdown is not the solution; the way out is to enforce use of complete facemask and social distancing.

“There must be zero tolerance for parties and nightclubs. Just as Thanksgiving holiday created another spike of COVID-19 in the US, in Nigeria, the current spike we are witnessing is as a result of several holiday visitations from US, UK, Europe and South Africa; they have all come and gone.

“Lockdown now is like closing the barn after the horse has bolted. We need to prevent more spread by educating our people effectively on the consequences of social gathering and not wearing mask.”

Ashiru, an adjunct professor at the University of Chicago, Illinois, US and joint pioneer of In Vitro Fertilisation (IVF) in Nigeria, added: “At the Academy of Medicine Specialties of Nigeria, we release fact sheets to deal with the pandemic. One would expect that such preventive measures would be given wide coverage through radio and television.

“Right now, the best information is coming through the social media by private citizens. The situation is so bad now that only the wealthy people can afford to pay the huge sums in the private hospital and if they are lucky, they survive. Many still end up losing their lives after dropping the millions of naira.

“As for the poor masses, the situation is very hopeless. Government seems overwhelmed by the pandemic, but it is not too late to reverse the trend. Immediately the pandemic broke out in China, the government assembled a team through Zoom to publish the various guidelines and protocols to confront the pandemic. Everyone wears facemask. It is not a joke; it is a life- saving device.”

Consultant public health physician and Executive Secretary, Enugu State Agency for Control of AIDS (ENSACA), Dr. Chinedu Arthur Idoko, added: “COVID-19 has probably come to stay, like many other commonly prevalent and endemic disease conditions we have and manage in our environment.

“The approach should consistently be preventive and health promotive, which essentially is to exercise a high index of caution and suspicion both by front-line health workers and the general public.

“The wearing of facemasks should be sustained and culturised, social distancing enhanced and maintained as much as is practically possible, while the habit of frequent hand washing with soap and water or in its absence, use of alcohol-based hand sanitisers engraved.

“The issue of lockdown (though with its attendant gains) comes with a rebound cascade of effects on the economy and socio-cultural and otherwise life of the populace and citizenry.

“You will agree with me that sometimes, the intended regulation of movement and interaction of people during the lockdowns fail to achieve the intended purpose when people living within same neighbourhoods gather together in discussion/ domestic social groups as a result of boredom resulting from the lockdown/restrictions. These sorts of gatherings form an effective cell of viral transmission. It, therefore, remains a balanced approach to the control of this virus.”

On alleged treatment challenges in many centres in Lagos, Idoko said: “One has to first ascertain the veracity of this assertion. However, it is glaringly obvious that we are dealing with a potentially explosive situation, locally and nationally. All hands should remain on deck in all quarters (government and citizenry) to control of this virus. Everyone needs to do their part and actually found to be doing so.”

He said COVID-19 is a difficult and expensive condition to manage and cost of management should not be left solely in hands of the Nigerian populace, as individuals cannot afford it; hence the vital need for adherence to the age-long mantra of prevention is better than cure by all and sundry as a safer option in the predicament we have found ourselves.

Idoko said the issue of oxygen is a medical detail to be left in the hands of the frontline professionals and experts managing the complicated cases, but it does actually re-emphasise the difficulty and expensive nature of managing COVID-19, especially the complicated cases.

On availability of oxygen for patients in ICU, Idoko said the pandemic has put immense pressure on all facets of healthcare delivery nationally and internationally, adding: “It does appear this second wave is presenting with more severe cases; hence the increased demand for oxygen in care and treatment facilities/ outlets.

“There is urgent need for a stepped up provision and availability of materials and equipment needed to handle severe cases and in this sense, oxygen is indispensable. The system has to look more inwards to an expanded, self-sustaining and practically enduring oxygen production, storage and distribution approach, and there is no critical time than now.

“The need to explore a Public Private Partnership (PPP) arrangement by individual states and of course, the Federal Government as a matter of urgency in this respect cannot be over-emphasised.”

Virologist and vaccinologist, Dr. Simeon Agwale, noted: “I don’t think the solution is another lockdown, but we can adopt what other countries are doing. For an example, travellers to the US and UK will need to present negative coronavirus tests within three days before boarding to be granted entry into these countries. Travellers can also provide documentation that they had the infection in the past and recovered.

“In addition, we can introduce rapid antigen test to be conducted at the airport for all arriving passengers using well characterized test kits.

“Honestly, if we really want to control this disease, we will have to make treatment free and available to those that need it. In addition, we need to develop a strong research culture to enable us understand the dynamics of the disease in our setting, conduct clinical trials of repurposed drugs and new therapies and build local capacities for manufacturing our drugs, vaccines and other medical supplies.”

Onwujekwe added: “The continuing upsurge in cases, severity and related deaths in Nigeria appears to justify total lockdown as part of the solutions. I believe most governments are being careful about implementing this drastic measure because of the peculiar poverty level of most Nigerians.

“They are also aware that there is little hope in providing support to the population during such total lockdowns. How will families that rely for their daily feeding on the meagre proceeds of daily ‘hustling’ on the streets hawking, for example, pure water or peanuts, survive total lockdowns?

 “Perhaps the surge also shows a failure of population adoption of preventive measures, as they are not being practised by the majority of the populace. Many people in crowded places outrightly refuse to wear facemasks.

“Most people squeeze them in their pockets and wear them only when compelled to do so as a precondition for entry into public places. Many wear them wrongly on their jaws. Some think their religion protects them from COVID-19.

“Many Nigerians, including religious leaders, still believe the pandemic is a deceitful campaign by governments and their agencies at all levels.”

The clinical researcher said Lagos is in trouble now from the upsurge in severe cases in need of hospital care, adding: “Hospital services are overwhelmed by severe cases. The implications are alarming. A health care delivery system that has already been weakened by many constraints for years can hardly be expected to cope.

“In all situations, however, no matter how dire, the Almighty shows His mercy. Hospital treatment of severe COVID-19, as at now, is beyond the reach of majority of patients. The direct financial costs to patients mentioned are shocking.

“But I hope that soon, a cheaper prophylactic and treatment approach that has been reported for months from other countries shall be found effective and safe for treating most Nigerians.

“Combined with primary prevention, this chemoprophylaxis and treatment approach will reduce demand for and cost of hospital care.”  (The Guardian)