RESPIRATORY INFECTION

Covid-19: More oxygen needed

A victim is bound to end up in one of ill-equipped facilities.

In Summary
  • The virus attacks the lungs and it becomes harder for a patient to get enough oxygen into their bloodstream to support their kidneys, liver and heart.
  • In cases where pneumonia inhibits breathing, treatment involves ventilation with oxygen.
A medical worker wearing a protective mask and suit speaks with a patient suffering from coronavirus disease (Covid-19) in an intensive care unit at the Oglio Po hospital in Cremona, Italy, on March 19, 2020.
A medical worker wearing a protective mask and suit speaks with a patient suffering from coronavirus disease (Covid-19) in an intensive care unit at the Oglio Po hospital in Cremona, Italy, on March 19, 2020.
Image: REUTERS

What we feared most has come knocking. The coverage by mass media sent us into panic even before a single case was reported locally. Now we have seven confirmed cases. Our ability as a country to self-quarantine has also been a major problem. This means more people are still vulnerable.

At the initial stages, our focus was mainly in keeping the virus out rather than preparedness and mitigation. This was thought to be a Chinese disease hence our major concern was with flights and travellers from the Asian country. We then concentrated on testing to diagnose people who had already presented with symptoms.

The government on Saturday started to randomly collect samples to help with surveillance. Those surveillance studies will help us understand how prevalent milder cases are in populations. And the addition of those milder cases into data sets will help researchers determine, more accurately, how deadly this virus is, whom it tends to infect, and how often people spread it before showing symptoms.

All that information can then be used to better halt the spread of the illness.

One of the things the virus does is that it attacks the lungs and it becomes harder for the patients to get enough oxygen into their bloodstream to support their kidneys, liver and heart. In cases where pneumonia inhibits breathing, treatment involves ventilation with oxygen. Ventilators blow air into the lungs through a mask or a tube inserted directly into the windpipe.

Perhaps, as a matter of urgency, the government and stakeholders should ensure that the oxygen facilities in our hospitals are in working condition and workers are trained to effectively use them.

A New England Journal of Medicine study of 1,099 hospitalised patients with the coronavirus in China found that 41.3 per cent needed supplemental oxygen and 2.3 per cent needed invasive mechanical ventilation.

Now that suspected cases are being reported in the countryside, one wonders whether we have adequate medical oxygen to handle extreme cases. 

The two main sources of oxygen in hospitals in low-resource settings are through concentrators and cylinders.

Concentrators, on the one hand, are the cheapest and most scalable way to supply oxygen, but most health facilities lack key requirements for operating these: A reliable and clean power supply, as well as regular service and spare parts.

Cylinders, on the other hand, do not require power and are easy to maintain. While they are the best and most cost-effective solution for these facilities, facilitating access to oxygen through cylinders still means overcoming challenges of steep prices and intermittent supply.

It is not a question of whether rather than when a victim will be referred to one of our ill-equipped facilities. Perhaps, as a matter of urgency, the government and stakeholders should ensure that the oxygen facilities in our hospitals are in working condition and workers are trained to effectively use them.

Again, it is also time we found a sustainable strategy to ensure constant supply of oxygen to all health facilities all year round. The World Health Organization has declared oxygen an essential drug but in the country, it is a preserve of the critically ill because we cannot provide it to all deserving cases.

Executive director, Centre for Public Health and Development, Nairobi

A special artificial respiration device in an intensive care unit where patients with the coronavirus disease (Covid-19) could be treated in Hanau, Germany, on March 17, 2020.
A special artificial respiration device in an intensive care unit where patients with the coronavirus disease (Covid-19) could be treated in Hanau, Germany, on March 17, 2020.
Image: REUTERS