…100% of patients at LUTH on oxygen
…Critical patient consumes 6 cylinders daily at IDH
…Nigeria far from meeting oxygen capacity —Experts
By Chioma Obinna
There is a surge in the demand for medical oxygen as Nigeria is faced with an onslaught of COVID-19 cases which have skyrocketed to over 1,000 infections in the last few weeks.
Compared to the first wave of COVID-19 when only a few patients had severe cases, almost 100 percent of patients are currently on oxygen, struggling to pull through.
Findings by Sunday Vanguard showed that no day passes without admission of patients needing oxygen across Covid-19 treatment centres nationwide.
Sadly, in a resource-poor country like Nigeria where oxygen remained a luxury even before the outbreak of coronavirus, most of the hospitals are seriously overstretched and struggling to cope
Sunday Vanguard reports that Nigeria may be in for a major oxygen crisis if nothing is done to address the situation as the second wave of the virus rages.
Oxygen is an essential therapy but access to oxygen therapy is highly limited in low resource countries like Nigeria.
That was the fate of Janet Oluagha, (not real name).
It was the worst Thursday for the family of Janet Oluaha as they tried to access oxygen in one of Lagos State’s popular COVID-19 treatment centres recently. Her SpO2 (oxygen level) dropped as low as 57.
Sadly, there was no ready oxygen as a huge number of patients were on oxygen at the centre.
Janet, who was diagnosed with COVID-19, is alive today courtesy of a private hospital where she was finally rushed to. But one pertinent question is how many Nigerians can afford such a luxury where millions are charged as hospital bills?
Unlike Janet, not many of these patients were lucky to be alive as you read this article.
Many have died due to oxygen shortages in Nigerian hospitals. Sadly, the recent increase in severe cases of COVID-19 requiring oxygen in major public hospitals may have worsened the situation.
According to the Lagos State Commissioner for Health, Prof Akin Abayomi, a large number of patients who are currently on admission in the isolation centres are largely dependent on oxygen and this has resulted in an escalating and alarming demand for oxygen.
Abayomi said a patient with a critical case may use about six cylinders of oxygen in 24 hours.
What oxygen is
According to medical experts, Oxygen is essential for life and it is what all living beings breathe in.
The exchange of oxygen into the blood takes place in the lungs which are often affected by coronavirus.
For a patient to be confirmed hypoxemia – insufficient oxygen in the blood or low blood oxygen saturation, the World Health Organisation, WHO, recommended the threshold of SpO2, when it is less than 90 percent.
Also, hospital findings have shown that oxygen was vital in the treatment of symptomatic COVID-19 patients with respiratory symptoms. It increases concentrations in the lungs, meaning more oxygen can get into the blood.
It has also been found that if the SpO2, (oxygen measurement) level falls below 95 percent in a symptomatic patient, oxygen therapy is indicated.
Globally, oxygen therapy has been used in medicine for nearly a century but Nigeria still faces a staggering burden of deaths due to lack of access to oxygen.
According to data obtained from the Federal Ministry of Health, aside from COVID-19, in Nigeria, more than 625,000 deaths occur annually due to diseases associated with hypoxaemia.
Apparently, to prevent these deaths and ensure the availability of medical oxygen and pulse oximeters, the country came up with a National Policy on Medical Oxygen.
According to a former Minister of Health, Professor Isaac Adewole, the policy was also to improve equitable access to medical oxygen in health facilities in Nigeria.
Sadly, despite this policy, health watchers are of the view that not much has been done in terms of oxygen availability in the country.
Director-General of World Health Organisation, WHO, Tedros Adhanom Ghebreyesus, had earlier alerted that the world faces a shortage of oxygen concentrators as the number of worldwide cases of coronavirus infection increases.
It noted that many countries are now experiencing difficulties obtaining oxygen concentrators, adding that demand currently overwhelms supply.
However, the situation is currently not different in Nigeria as many of the hospitals are already stretched.
A source at the Infectious Disease Hospital, IDH, Yaba, Lagos, told Sunday Vanguard that the oxygen consumption in the treatment of severe cases in the second wave is becoming overwhelmed all over the nation.
He lamented that there has been an upsurge in mortality due to severe cases requiring oxygen
According to the source, while some consume as much as 15 litres per minute, not less than 300 large cylinders of cylinders are consumed by COVID-19 patients daily.
The source said the amount needed by an individual varies depending on the oxygen saturation which is measured by the Pulse Oximeter.
“Averagely more than 100 cylinders are consumed on daily basis at IDH. The hospital can cope since there are different supply chains of oxygen, “ he added.
The source also said the recruitment of more doctors and nurses by the state government has helped to boost capacity at the hospital at the moment.
“Also, an Oxygen plant was commissioned last week Friday, which can produce up to 60 large cylinders of Oxygen in 24 hours,
“Some oxygen plants are being developed in some General Hospitals. However, oxygen consumption in the treatment of severe cases in this second wave is becoming overwhelming all over the nation.
“The mortality has been quite much as some patients need much oxygen flow at the rate as much as 15 litres per minute.
“Some patients use as much as three to six cylinders of oxygen per day. Lagos State government is building some oxygen plants to boost the supply. There is a need for both the state and federal government to build oxygen plants to meet up with the necessary demands,” the source stated.
At the Lagos University Teaching Hospital, the situation is no different as 100 percent of COVID-19 patients at the hospital require oxygen.
Currently, the hospital is struggling to meet up with their requirements and other facilities are overstretched.
In a chat with Sunday Vanguard, Chairman, Medical Advisory Committee, CMAC, Lagos University Teaching Hospital., LUTH, Professor Wasiu Adeyemo, lamented that during the first wave, very few people required oxygen, but now almost 100 per cent of patients in LUTH are on oxygen.
Tracing the increase in severe cases to late presentation, he disclosed that many of the patients presented at the time their SpO2 became low.
Adeyemo told Sunday Vanguard that daily, over 100 cylinders are consumed by COVID-19 patients at LUTH while the total overall consumed by all patients in the hospital was averagely 250 cylinders daily.
Stating that oxygen requirements of each patient differ, he said overnight some consume as much as 70 litres of oxygen.
Stating that LUTH has an oxygen plant and other sources, he said :”LUTH is struggling to cope but we can do better. There is a need for us to produce and make available more oxygen to hospitals to help our patients. Nigeria is very big. I do not know the capacity in the country but definitely, I do not think that we are there in terms of oxygen supply.’’
He regretted that before COVID-19, there were challenges regarding oxygen supplies in the country, adding that the pandemic has compounded an already bad situation.
Why COVID-19 patients need oxygen
He explained that patients need oxygen because the virus affects the respiratory system, blocks the airways, and makes it difficult for a patient to breathe properly.
“A patient with COVID-19 consumes oxygen because of the pathology in the lungs. That is why virtually all of them will die if they don’t get oxygen on time.
“There was a patient we saw yesterday and the SpO2 was around 97, but this morning we confirmed her COVID status and the SpO2 is going 91. We had to put the patient on oxygen to avoid a crisis.
“You know in our environment, people come late generally to the hospital and it is also compounded by the conspiracy theories about COVID-19. Some people believe it is malaria and the indication to suspect COVID-19 only comes up when people begin to struggle for breathing. The government of Nigeria and, especially Lagos State government have done a lot. I am telling you as a doctor and somebody who simply wears the shoe, our people are not responsible. “Government is not going to wear a mask for everybody. They are really creating problems for us in the hospital. Our facilities are being overstretched. That is the truth,” Adeyemo said.
Nigeria grappling with oxygen capacity
In 2017 and 2018, a government led, NGO supported, multifaceted oxygen improvement programme was implemented to increase access to oxygen therapy in 29 hospitals in Kaduna, Kano, and Niger states. The programme installed pulse oximeters and oxygen concentrators, trained health care workers, and biomedical engineers (BMEs), and provided regular feedback to health care staff through quality improvement teams.
In a country like Nigeria where current data is not readily available, statistics obtained from the National Policy Document on Medical Oxygen showed that at least 30 public sector oxygen plants have been established in Nigeria, of which 21 are purportedly functioning; 6 are of unknown status, and three are non-operational.
In Lagos, the state government is establishing oxygen centres in 10 high burden Local government areas as part of efforts to boost access to medical oxygen in public hospitals. Already, the state government has activated Oxygen Plant within the premises of the Infectious Diseases Hospital, IDH, Yaba in collaboration with the Bill and Melinda Gates Foundation, to provide swift support to COVID-19 patients who require oxygen therapy.
According to the Lagos State Commissioner for Health, Prof. Akin Abayomi, amidst the increased demand for oxygen at the isolation centre occasioned by the second wave of COVID-19 infection, the deployment and activation of the oxygen plant are in furtherance of the commitment of the State government to deploy effective response to the COVID19 pandemic.
To prevent what looks like an impending oxygen crisis, the President of Nigeria Medical Association, NMA, Prof Innocent Ujah called for the establishment of oxygen production centres nationwide.
Ujah in a chat with Sunday Vanguard confirmed that investigations from the hospital visited by his team showed that many hospitals are already overstretched and may not cope if the second wave continued.
Ujah who noted that more oxygen in hospitals would save more lives and reduce fatalities from COVID-19 said: “There is a high demand for oxygen in the hospitals and non-availability of oxygen increases the risk of mortality for patients who need it. With the advent of COVID-19, there is a higher demand for clinical oxygen. “We are calling on the federal and state governments to establish oxygen plants because the information we obtained from JUTH when we visited clearly showed that hospitals are overwhelmed. Most of the critical cases need oxygen and it is the same oxygen that we take for granted.
“It is imperative for government to establish an oxygen plant not only for COVID but other medical problems.”
He said without enough oxygen, many COVID-19 patients who need oxygen may die.
“Oxygen is everywhere in the air. All we need to do with technology is to trap it and turn it into functional use particularly for those who are critically sick,” he added.