Kenya: Covid-19 - How Oxygen Shortage is Changing Medical Care

The most commonly used drug in emergency medicine is slowly becoming unavailable even in the largest hospitals in the country, with many already running out of it.

Listed as an essential medicine by the World Health Organization (WHO), oxygen, which is breathed in by healthy persons for free, has now become the most precious commodity, more precious than oil.

The supply of the gas has been dwarfed by rising demand, leading to panic - from patients and families, and doctors - in hospitals across the country.

Oxygen which is used in all major surgeries, by slightly over 30 per cent of ambulance patients during transit, in resuscitation, the critical care unit and for patients who need ventilatory support.

Other patients who need oxygen are those with tuberculosis and asthma.

The precious commodity is now unavailable thanks to the treatment demands of Covid-19.

Commodity rare

The pandemic has made it nearly impossible for this drug to be available for patients who need it, at a critical time when the world is sourcing for it.

It is for this reason that major hospitals have yet again cancelled all elective surgeries such as kidney transplants so that the little oxygen that they have is given to Covid-19 patients.

Typically, a Covid-19 patient is assessed using a pulse oximeter - a handheld device that measures blood oxygen saturation levels and identifies which patient needs oxygen.

The optimal oxygen saturation level (SpO2) in adults with Covid-19 is uncertain.

However, a target SpO2 of 92 per cent to 96 per cent seems logical, considering that indirect evidence from the experience in patients without Covid -19 suggests that an SpO2 less 92 per cent may be harmful.

Oxygen supply is typically achieved using oxygen cylinders (filled at oxygen plants), oxygen concentrators (concentrating oxygen from air on-site), oxygen plants (piped directly or distributed via cylinders) or liquid oxygen (delivered from a specialised gas plant and stored on-site at very high pressure).

The case of KNH

Dr Evanson Kamuri, the Kenyatta National Hospital (KNH) Chief Executive Officer (CEO) explains that previously, the facility required oxygen in ICU, theatres, and the accident and emergency unit, but with Covid-19 much has changed leaving those in need in a dilemma.

"It is for this reason that we have scaled down elective surgeries at the facility and are only doing cancer and obstetric procedures," he said, noting that it is not only KNH that is facing a shortage.

Dr Kamuru further noted that a serious case could consume up to 15 liters of oxygen in a day, especially at the facility where 50 per cent of the patients admitted require oxygen "on a bad day".

The facility, he said, receives oxygen in bulk through a huge tank from which it flows through a pipe, or in cylinders, because not the entire hospital is piped.

The hospital has gone from using 3,000 liters to 8,000 liters per day because of rising needs brought on by the pandemic.

Oxygen points

During Easter for example, the hospitals' boss says that half of the 94 Intensive Care Unit (ICU) beds at the facility were occupied by Covid-19 patients who needed oxygen.

It is for this reason that the facility decided to put oxygen points on walls - so that patients can be connected directly to the supply as and when needed.

"This has completely drained our oxygen capacity because we went from receiving a bulk supply of oxygen once a week to receiving daily supplies. We now have close to 900 oxygen points not only in ICU wards but also oxygen dependent areas," he said.

The facility had an oxygen plant that worked for 18 years it has become obsolete and efforts to recondition it have been futile, he said.

"With our own plant, we should be able to buy oxygen for around Sh75, down from Sh120, which will do wonders for our patients," he said.

Dr Kamuri also noted that oxygen can save lives when used appropriately but that there are instances when it can be harmful.

"There is a misconception that a patient cannot be given too much oxygen, which is very incorrect because too much oxygen can lead to oxygen failure or even death," he said.

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