COVID-19

Upscale testing and medical oxygen supply to fight coronavirus

The World Health Organization has declared oxygen an essential drug

In Summary

• 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.

• One wonders whether we have adequate medical oxygen to handle extreme cases.

A nurse holds a completed test with patient samples at a drive-through testing site for coronavirus, flu and RSV, currently by appointment for employees at UW Medical Center Northwest in Seattle, Washington, U.S.
A nurse holds a completed test with patient samples at a drive-through testing site for coronavirus, flu and RSV, currently by appointment for employees at UW Medical Center Northwest in Seattle, Washington, U.S.
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. Coronavirus cases continue to rise by the day. Our ability, as a country, to self-quarantine has also been a major question. This means more people are still vulnerable.

At the initial stages, our focus was mainly on keeping the virus out of the country rather than turning the focus on preparedness and mitigation. This was thought to be a Chinese disease hence our major concern was with flights from the Asian country. By doing this, we may have delayed the vulnerable population safe.

We have concentrated on testing to diagnose sick people who already have the symptoms. We should actually roll-out a plan where we go out and take samples in as many places as possible to help with surveillance in the communities.

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. Again, without testing, we’re in the dark and the virus will spread further. We don’t know what the prevalence actually is.

Without adequate testing mechanism, what we are going to deal with are cases of full-blown infection, which raises the question of our ability to handle extreme cases.

The virus attacks the lungs and becomes harder for 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.

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, already there are suspected cases being reported in the countryside subcounties. 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 are the cheapest and most scalable way to supply oxygen, but most health facilities 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 oxygen facilities in our hospitals are in working conditions, staff trained to effectively use them.

Again, it is also time we find a sustainable strategy to ensure a 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 can not provide it to all deserving cases.

The writer is the executive director Centre for Public Health and Development, Nairobi and the CEO of HewaTele, a Social Enterprise working to increase access to oxygen in medical facilities.