Breathing life into Covid-19 patients, one oxygen cylinder at a time

Wednesday July 08 2020

Oxygen cylinders at a hospital in Nyeri. PHOTO | JOSEPH KANYI | NATION MEDIA GROUP


As the Covid-19 pandemic bites and numbers begin to spike, pushing the curve off the charts in Kenya, hospitals across the counties are struggling to put in last minute touches to ensure their readiness for reopening.

In this pandemic, Dr Bernard Olayo, a public health specialist at the World Bank Group is hoping to avoid the painful choices he faced as a young doctor because of lack of oxygen. Using a milkman model, his team has set up plants in Nakuru, Siaya and Nairobi counties, serving 186 public hospitals across 13 counties.

“I have never seen a more rapid investment in health infrastructure like what I have witnessed with the set up for Covid-19,” he said during a phone interview with Nation.

But there is a dent in this approach which Kenya seeks to use to reopen the economy. By dwelling solely on the number of available bed space across the required 300 beds in each county, Dr Olayo says, the preventive measures that are key in containing the spread of the virus are being overlooked.

Bed space, ICU facilities and essential medical supplies needed to treat the respiratory disease and keep patients alive are not just enough, but oxygen.


An intensive care unit at a Narok hospital. FILE PHOTO | NATION MEDIA GROUP


It is easy to take oxygen for granted. In fact, for a long time, Dr Olayo says, people plugged onto oxygen support in hospitals were thought to be on their deathbed.

As Covid-19 hits the country with over 8,500 cases and 169 deaths so far, use of medical oxygen is seen as a simple treatment that saves lives. There is already global shortage of medical oxygen needed to treat pneumonia, malaria, and other diseases.

A lot of attention has been focused on the lack of ventilators. Although the mechanical device is coveted for its ability to push life-saving oxygen deep into damaged lungs to help patients breathe, the lack of oxygen itself is equally worrying, given that it is an essential medicine also needed to run a ventilator.

Covid-19, the illness caused by the coronavirus, attacks the respiratory tract, inflaming the lungs and making it difficult for patients to breathe.

“If patients have access to oxygen as an initial treatment, however, it may prevent many of them from becoming so critically ill that they would require one of the limited number of ventilators to breathe,” says Dr Olayo.

Normally, oxygen crosses tiny air sacs called alveoli into the capillaries, tiny blood vessels that lie beside the air sacs and is then carried to the rest of the body. But as the immune system wars with the virus, the battle itself disrupts this healthy oxygen transfer. Some Covid-19 patients recover, sometimes with no more support than oxygen breathed in through nasal prongs, while others deteriorate, often quite suddenly, developing a condition called acute respiratory distress syndrome (ARDS). Oxygen levels in their blood plummet and they struggle ever harder to breathe.

For patients who develop severe symptoms of the disease, oxygen is the key treatment they should get, Dr Olayo adds, because it cuts down hospitalisation time as well as severity of the disease. Depending on the age of the patient and severity of their condition, one oxygen cylinder used in the ICU will last for 28 hours when an adult patient is plugged on.

In Kenya, however, the use of oxygen as a method of treatment has been dented by public perception that if a patient is given oxygen, their condition must be so dire and they are close to dying.

“There is this myth that patients only receive oxygen when they are just about to die. This myth has been fuelled by the traditional rationing in our public hospitals seeing patients plugged in at a very late stage when they are about to die. As a result, the public begins to associate oxygen with mortality,” he says.

There is a need to educate the public that we all use oxygen to stay alive. It is not a foreign thing. When we get sick our bodies cannot inhale enough oxygen therefore, the supplementary medical oxygen is given to boost.

Lack of oxygen already leads to hundreds of thousands of deaths each year. Now, with the epidemic spreading rapidly the World Health Organization estimates that with about one million new coronavirus cases globally every week, the world will need 620,000 cubic meters of oxygen per day, or 88,000 large cylinders.

 Many patients severely ill with Covid-19, the illness caused by the coronavirus, require help with breathing at some point. With the highly contagious respiratory infection rapidly spreading in regions of the world where many hospitals are poorly equipped and lack the ventilators, tanks and other equipment necessary to save patients whose lungs are failing, the WHO is hoping to raise $250 million (about Sh26.6billion) to increase oxygen delivery to those regions in South Asia, Latin America and parts of Africa.

The WHO, Unicef and the Bill & Melinda Gates Foundation in 2017 began searching for ways to increase oxygen delivery in poor and middle-income countries — not in anticipation of a pandemic, but because oxygen can save the lives of premature infants and children with pneumonia.

Dr Olayo has been addressing the perennial shortage through his enterprise, Hewatele, an innovative organization working to ensure all patients—even in remote areas of the country—have access to oxygen.

The WHO has purchased 14,000 oxygen concentrators, which filter oxygen from the air, to be sent to 120 countries, and the agency hopes to buy 170,000 more concentrators over the next six months at a cost of $100 million (equivalent of Sh10.7 billion).

Dr Tedros Adhanom Ghebreyesus, the director-general of the UN health agency, warned that “80 percent of the market is owned by just a few companies, and demand is outstripping supply.”