Tension over rising oxygen demand in hospitals

Twenty four hours after the country, last Thursday, recorded 23 Coronavirus (COVID-19)-induced deaths- the highest single-day count of fatalities, situation degenerated further last Friday with the number of infections soaring to 1, 867- the highest single-day count since the pandemic broke out in Nigeria.

While there is a nexus between Nigerians’ failure to adhere to safety guidelines handed out by the Nigeria Centre for Disease Control (NCDC), especially the non-pharmaceutical interventions, and the rising number of infections/deaths, the availability or otherwise of oxygen therapy for critical cases plays a major role in stemming the spike in deaths casualties.

With social distancing letup among Nigerians giving cause for concern, and generating anxiety, as well as the mutated form of COVID-19 being deadlier and more easily transmitted, the shortage of medical oxygen in hospitals and isolation centres across the country could be shot up.

Nearly two weeks after the Federal Government warned of the need to address the shortage of oxygen in public hospitals, not much has been achieved in that regards, except for the sheer brilliance of some state governments, including Lagos State, which is making serious moves to ensure the availability of medical oxygen in isolation centres in the state.

Oxygen therapy, one of the most necessary medical treatments in the world, is key to the management of critically-ill patients suffering from diverse conditions, including COVID-19, heart failure, obstetric complications, trauma, and respiratory diseases like pneumonia.

While the shortage of supplemental oxygen, especially in the third world is often an issue of supply and distribution, the situation is made worse by unstable electricity in hospitals, insufficient equipment to deliver the medical gas to patients, as well as poor clinical skills to effectively provide oxygen therapy. The situation is even worse in the country where oxygen supply and standard health management has remained long-standing challenges.

In the penultimate week as the second wave of COVID-19 gathered steam, the Chief Medical Director (CMD) of Lagos University Teaching Hospital (LUTH), Idi-Araba, Prof. Chris Bode, in an emergency press conference, warned of dire consequences, as “the mutated form is deadlier and more easily transmitted.”

The warning dovetailed reported acute shortage of oxygen at the Lagos University Teaching Hospital (LUTH), and the University of Nigeria Teaching Hospital (UNTH), Enugu.

Medfical experts in Enugu, on Saturday, said that the spike in the second wave of the pandemic has pushed upwards, demands for oxygen by health institutions and individuals, especially as critical cases may require up to six or seven cylinders of oxygen within 24 hours to stay alive.

They regretted that little or no effort was being made to provide oxygen plants at various tertiary hospitals and isolation centres by the Federal Government.

The immediate past Chairman of the Nigeria Medical Association (NMA), Enugu State, Dr. Ike Okwesili, who lamented that oxygen supply and standard health management have remained a challenge in the country, attributed the problem to the inability to keep the supply chain moving, adding that matters were made worse by citizens’ refusal to heed the established infection prevention and control measures outlined by the government since the virus hit the country.

Okwesili, who is the NMA’s National Committee Chairman on Health Bank, stressed that flouting approved protocols was responsible for the spike in Enugu State, to the extent that some residents continually argue with health professionals over the existence of the disease.

“The import is that most patients having let down their guard will present in an emergency situation, since the health facilities that are just coping in stable times are more likely to be stretched with a sudden burst of the virus in the state,” he said. He said it was still a challenge to determine the exact quantity of oxygen needed to treat critical cases in the state since most cases are hardly presented to hospitals, and the reliance on vendors for the supply of the products when needed.

Noting that oxygen can be delivered in mobile cylinders, concentrators, and from a central supply and piped to the patients, the former NMA chair added that the reliance on cylinders for oxygen was causing shortage.

He explained that during the first wave of the disease, CACOVID and other well-meaning individuals and groups partnered with the federal and state governments to increase oxygen concentrators in the states, which would require constant electricity to function.

He, however, pointed out that the pandemic has presented an opportunity for a review of the performance of the National Strategy for the Scale up of Medical Oxygen in Health Facilities 2017 -2022.

“The COVID-19 pandemic is equally an opportunity to put in place processes to strengthen the health sector in the country, through the provision of loans and credit facilities. The development of the health bank is just the tonic that we need to improve the poor health indices in the country, and build our economy by retaining money spent on medical tourism.

“The way forward remains prevention so as not to stretch the precarious health systems. We can as responsible citizens keep the infection down by abiding by the simple infection control and prevention measures; masking, social distancing and hand hygiene,” he said.

The immediate past Chief Medical Director (CMD) of the UNTH, Dr. Christopher Amah, who said that the demand for oxygen has increased with the spike in infections, said that governments at various levels must prioritise the installation of oxygen generating plants in hospitals.

He said that it was dangerous for health institutions to depend on vendors for the supply of oxygen, especially with the spike, adding that the development could endanger lives of the people it was meant to save.

“With Oxygen from individuals, quality assurance is not guaranteed and in the situation that we are currently, anybody can do anything, call it oxygen, and present it to the public. It is dangerous. It is bad because you spend more than what you should have spent when the same oxygen is provided in their right value,” said he.

“The way out will be for the governments to take out projects to ensure that major teaching hospitals and federal medical centres have oxygen generating plants. This is something you generate from air. What will cost money is the plant itself. There are also oxygen concentrators which are simple machines that can attract air and then you can use them by the ward of the patient’s bed side”.

The COVID-19 isolation centres in the state rely on vendors for their oxygen needs, even with the rising number of confirmed cases. This is as a result of the collapse of the oxygen plant at the UNTH. Since the plant collapsed, the hospital has relied on vendors for supplies.

The CMD of the hospital, Dr. Obinna Onodugo, told The Guardian that the institution gets its “oxygen supplies from a vendor,” adding that, “he has been supplying us accordingly and we have not been in lack of Oxygen.”

He said his management was doing all within its powers to put the oxygen plant back to work as a way of strengthening the health sector in the state.

The Lagos State government recently activated an Oxygen Plant within the premises of the Infectious Diseases Hospital (IDH), Yaba to provide swift support to COVID-19 patients who require oxygen therapy.

The state Commissioner for Health, Prof. Akin Abayomi, while activating the plant said that the deployment and activation of the oxygen plant was in furtherance of the commitment of the state government to deploy effective response to the COVID-19 pandemic.

“We recognise the importance of generating oxygen because of the large number of patients who are currently on admission in our isolation centres, and are largely depending on oxygen. This has resulted in an escalating and alarming demand for oxygen. “The oxygen plant facility could not have come at a better time than now, when the state is recording an increase in the number of people presenting with difficulty in breathing and requiring urgent oxygen therapy,” he added.

Built in collaboration with the Bill and Melinda Gates Foundation, Abayomi, who disclosed that about 300 cylinders of gas were being used a day in the state isolation facility, stressed that a patient with a critical case may use about six cylinders of oxygen within 24 hours.

The commissioner averred that high purity oxygen is needed in healthcare facilities and essential for patients undergoing COVID-19 treatments.

“This is particularly useful for patients with comorbidities who require prompt oxygen for survival. Oxygen from the plant will be very helpful for effective treatment due to proximity of the plant which serves as source.

 “This collaboration between the Bill and Melinda Gates Foundation is a good example of collaboration between government and the private sector,” he said.

The second wave of the pandemic has shot up oxygen consumption in Rivers State, checks at the University of Port Harcourt Teaching Hospital (UPTH), and the state isolation centre showed that the medical gas is available.

It was gathered that the state government is the main source of supply of oxygen, with the help of some organisations and individuals. However, replenishing it is low, hence its unavailability sometimes when needed.

A senior nurse at the Intensive Care Unit (ICU) UPTH, who craved anonymity said: “We do not have regular supply of oxygen here, and that has affected the speed of work at the ICU. Oftentimes, we have high number of patients seeking medical attention, but we only admit the ones we can attend to.”

Speaking on availability of oxygen in isolation centres in the state, a consultant obstetrician/gynaecologist, Dr. Eli Sukarime, confirmed that there is more consumption of oxygen at the moment.

He also noted that the volume of consumption depends on the severity of the patients at the centre, just as he stressed the need for firms and individuals to join forces with the government and prioritise its supply as the fight against the pandemic continues.

When contacted, the Chairman of NMA in the state, Dr. Chizindu Alikor, refused to speak. Several phone calls and text messages sent to him were ignored, after which he simply said: “I cannot talk to you.”

At the Aminu Kano Teaching Hospital, Kano (AKTH), the demand for oxygen has reached 80 cylinders (6 cubic feet) daily. This is apart from 20 cylinders of (1.5 cubic feet) daily to support the high demand.

The Assistant Director, Nursing/Anesthesia, Maikudi Danjuma, explained that five operating theatres require not less than three giant cylinders, while patients at the main theatre make use of five cylinders daily.

Apart from the theatres, Maikudi, who is also in-charge of oxygen procurement at the hospital explained that oxygen demand at other departments include “15 cylinders at the Intensive Care Unit, six cylinders at the Special Baby Care Unit, and 20 cylinders in the two emergency units.”

He added that 10 cylinders are equally required daily at the dedicated isolation centre for COVID-19 patients.

He revealed that the hospital charges between N500 per hour/per adult, and N250 per hour/per minor.

“The demand is getting high daily, especially with the presence of COVID-19 pandemic. Daily, patients consume not less than 80 cylinders of (6 cubic feet) oxygen, and we also deployed 20 cylinders (of 1.5 cubic feet) daily. This is the minimum utilisation in case there is no case of leakage.

“The hospital spends between N1.3m to N1.4m to replenish its oxygen stock monthly, and that is on highly subsidised rate because we are enjoying 40 per cent discount. At the same time, AKTH also charge patients very low. For instance, adult patients pay N500 per hour and minor patients pay N250 per hour.”

Maikudi, however, expressed concern about the absence of an oxygen plant in the hospital, which would have drastically reduce the monthly cost of replenishment, and also reduce charges for patients per hour.

 “We have written several proposals to the management, and I am aware that the proposals were forwarded to Abuja many years ago, but to no avail,” he explained.

“The worry now is that we have only one company supplying the hospital oxygen at a very cheap rate. They were three of them before now, but two went underground. We don’t pray for anything funny to happen to the one that is left because if that happens, we would be in trouble,” Maikudi explained.

Even though the Chief Medical Director of the University of Calabar Teaching Hospital (UCTH), Prof. Ikpeme Ikpeme, failed to respond to calls or messages placed to his mobile phone, reliable sources at the facility say that it has enough oxygen to cope with COVID-19 and non-COVID-19 cases.

The top sources maintain that the hospital’s oxygen bank was in good standing and the plant working well. They said: “We do not have any challenge in the area of oxygen for now, even though we do not have a large number of cases that require oxygen. But what we have is okay for our patients.”

Prof. Ikpeme, in a recent statement, said: “We are determined to take back every inch of territory; painstakingly, inch-by-inch until we return to our pre-eminent position in service delivery and care in our community of influence. It’s our drive, our promise and our commitment.

“We are acutely aware that this must be an on-going process and must outlast the tenure of any particular management, but we are determined to put our hands on the plough and commence the hard work necessary in this direction.” (The Guardian)