Sunday Magazine

Scarcity: How COVID-19 is impacting Oxygen-related deaths

The current spike in COVID-19 cases occasioned by the third wave of Coronavirus pandemic may have contributed to worsen scarce medical oxygen for the management of critical ailments. What is certain is that available oxygen not only falls far short of what is required, its exorbitant cost also makes the live-saving product out of reach and inaccessible to the needy, reports APPOLONIA ADEYEMI

 

What began as a mild fever triggered by asthma for Lady Charity Okonkwo 15 years ago ended in sending the once vibrant school principal to early grave. Sadly, the condition of Okonkwo, which deteriorated severely, had resulted in breathing difficulty for which she required an oxygen therapy.

 

However, the non-availability of medical oxygen at the Igando General Hospital, where she was cared for prompted her referral to other facilities. Efforts to get the oxygen service in a nearby hospital in Egan, Lagos State, also proved abortive, prompting the family of Okonkwo to rush her to R-Jolad Hospital, a privately owned facility in the Gbagada axis of Lagos. During the over 18 hours it took conveying the then severely ill Lady Okonkwo, 45 years, from Igando to R-Jolad, her breathing difficulty had worsened, making her to slip into a coma.

 

Although, the needed oxygen treatment was administered on her on being admitted at the R-Jolad, she passed on 30 minutes afterwards. The death of Lady Okonkwo could have been prevented if the oxygen therapy was administered on her without delay. Okonkwo is not the only victim that has been sent to early grave on account of limited supply or non-availability of oxygen treatment in the country.

 

Many children, especially under-five suffering pneumonia have equally died from inability to access oxygen treatment when they needed it most. While some of the affected children, especially in far-to-reach communities were unfortunate to have accessed care in facilities that lacked medical oxygen, many were unable to access the live-saving treatment based on its exorbitant cost estimated at between N5,000 to N6,000 per hour.

 

The cost of medical oxygen could even be higher, depending on the type and location of the facility from where it is accessed. Highlighting how high cost of medical oxygen deny children access to needed oxygen, the Advocacy Specialist at the Save The Children International, Folake Kuti, said there were high incidence of death among children suffering pneumonia in Lagos and Jigawa states, where Save The Children International, a non-governmental organisation (NGO) is implementing the INSPIRING Project, an acronym for Integrated Sustainable Pneumonia And Infectious Disease Reduction in Nigeria.

 

The INSPRING report estimates that Jigawa State records about 14,988 cases of pneumonia while Lagos State records about 17, 955 cases every year. Pneumonia reportedly killed 880,000 U-5 children globally in 2016 alone. Half of these were recorded in only five countries, one of which is Nigeria which also recorded about 19/1000 deaths of U-5 children in 2016. According to Kuti, whenever children that are down with pneumonia get to the stage when they require medical oxygen, “many poor parents of the affected children begin to run helter-skelter.

 

“For those parents, the mere mention that their children needed oxygen is interpreted as a death sentence.” She said majority of the poor mothers and fathers are not able to squeeze out between N5,000 to N6,000 per hour for the payment of medical oxygen.

 

They will still be running from pillar to post, looking for the needed money to pay for the service when the affected children will pass on, thereby contributing to the burden of death from lack of access to oxygen treatment.

 

On the contrary, what could have been an ideal medical oxygen situation is what was prevalent at the Paediatric Oncology Unit, Lagos University Teaching Hospital (LUTH) where each of the 20-bed in the ward was supplied with a pipe supplying oxygen to every childhood cancer patient that needed it to live; the LUTH project was funded and installed at the cost of N3.2 million some years back by the Abecenna School, as part of its Corporate Social Responsibility (CSR) programme, according to Dr. Nneka Nwobi, a medical doctor and CEO, Children Living With Cancer Foundation (CLWCF), the nongovernmental organisation (NGO), which advocated and sourced for the establishment of the oxygen project.

 

Part of the benefits of this project is that it ended the era of conveying heavy gas cylinders from the ground floor to the first floor, where the paediatric oncology ward is domiciled.

 

Similarly, it terminated delays in providing oxygen to patients that needed it as at when due.

 

Although, the LUTH example is the ideal, it is different from what is obtainable in many public hospitals in the country. Going by the experience on ground, many children, especially under-fives have died as a result of lack of oxygen to ease their respiratory difficulties. The reason for this situation is the current decay witnessed in the nation’s health system. There is acute shortage of oxygen treatment that should normally be available in secondary and tertiary health facilities.

 

Also, the advent of the Coronavirus Pandemic has contributed significantly to compound the already bad situation. This week alone, Africa has recorded a 43 per cent week-on-week rise in COVID-19 deaths, as hospital admissions increase rapidly and countries face shortages in oxygen and intensive care beds.

 

The World Health Organisation (WHO) estimated that fatalities increased to 6,273 in the week ending on July 11 from 4,384 deaths in the previous week. Africa is now less than one per cent shy of the weekly peak reached in January when 6,294 deaths were recorded. At the local level, the third wave of Coronavirus Pandemic that has hit Lagos is already unfolding: the state alone recorded 153 of Nigeria’s new 166 cases.

 

Some Nigerians infected with COVID-19 end up with breathing difficulties. Although, such patients required oxygen therapy to beat the ailment, getting access to this medication hasn’t been easy due to its acute shortage.

The challenge posed by limited supply of oxygen against the background of reported rise in new Coronavirus cases was highlighted at the weekly World Health Organisation (WHO) virtual press briefing on COVID-19 which held on Thursday.

 

According to the WHO Regional Director for Africa, Dr. Matshidiso Moeti, the demand for medical oxygen has spiked and is now estimated to be 50 per cent higher than at the same time in 2020; yet, supply has not kept up. “A rapid WHO assessment of six countries facing resurgence found that just 27 per cent of the medical oxygen needed is produced.”

 

Moeti said insufficient quantity, disrepair or poor maintenance of production plants as well as challenges in distribution, scarcity of cylinders, personnel or technical skills are among the barriers to adequate medical oxygen supply in Africa, including Nigeria. Explaining why oxygen therapy is key in the treatment of COVID-19, a Public Health Physician, Dr. Japhet Olugbogi, said COVID- 19 is a respiratory tract-based disease which means the virus dwells in the respiratory tract: in the nose, the trachea, the lungs, the larynx commonly called the voice box; these are the places where the viral loads of COVID-19 is very high.

 

Based on the fact that virus dwells in those places, one of the commonest things that happens to somebody that has COVID-19 is that he finds it difficult to breathe because of the cough, sore throat, hoarseness of the voice and because of that the fellow may  require oxygen.

 

The public health physician said, “Somebody that cannot breathe well will not be able to take in the sufficient amount of the oxygen the individual needs.” Olugbogi, who is also the chairman, Lagos Nigeria Medical Association (NMA) Committee on Infectious Diseases, said at the peak of the COVID-19 in the country, some patients were using more oxygen than was available in stock.

 

“That is why there was a shortage of oxygen.” For instance, he said: “A colleague, a medical personnel that was treated at one of the Isolation centres in Lagos, had sent a text message, saying he alone had consumed 30 cylinders of oxygen.

 

“We were praying for him; you can imagine if one COVID-19 patient for over two weeks consumed over 30 cylinders of oxygen, what will happen if we have hundreds of patients like that who needed to consume as much oxygen as well.

 

That is why there was a shortage of oxygen then.” However, he explained that the importance of oxygen in sustaining wellness and overall health cannot be over-emphasised. According to him: “Without adequate oxygen, death is just seconds away.”

 

Oxygen therapy, one of the necessary medical treatments in the world, is key to the management of critically-ill patients suffering from diverse conditions, including COVID-19, heart failure, obstetric complications, trauma, and respiratory diseases like pneumonia, the Coronavirus, among others. Olugbogi said, “Oxygen is life.

 

The air we breathe in is rich in oxygen. Anybody who cannot breathe in oxygen in a few minutes will pass away. “Similarly, when somebody cannot breathe well or has difficulty breathing, what it means is that the person is not taking in sufficient amounts of oxygen. When you give them medical oxygen, they can breathe better.”

 

Consequently, when such medical oxygen is not available to save lives, it could be categorised as a public health problem. As at January 2020, the shortage of oxygen therapy for critical Coronavirus cases in the country played a major role in the spike in death casualties.

 

By February, 2021, the demand for oxygen treatment by Coronavirus patients in Lagos State alone spiked to between 300 and 400 cylinders per day across state-owned treatment facilities, said the Commissioner for Health in Lagos, Prof. Akin Abayomi. To this end, he said Lagos would inaugurate 10 Oxygen and Sampling centres to be sighted in COVID-19 high burden areas for the management of severe-tocritical cases.

 

“This life-saving gas helps patients breathe when they cannot do so on their own, and timely access to oxygen is critical to ensuring the patient’s survival,” Abayomi stressed. Going by the scarcity of oxygen to address respiratory challenges arising from Coronavirus and other ailments, the Federal Government last month approved the establishment of 38 oxygen plants across the country.

 

One of each plant will be set up in all the states while Abuja and Lagos are expected to have two plants each. While reacting to what should be done to make medical oxygen readily available, the President of Nigeria Association of Resident Doctors (NARD), Dr. Okhuaihesuyi Uyilawa, said the situation of medical oxygen in the country presently has improved resulting in more availability of the product.

 

He confirmed that most hospitals, including the Irrua Specialist Teaching Hospital in Edo State and other hospitals now have oxygen plants and that both the Federal and state governments have improved funding to get oxygen, adding that patients that need oxygen support are able to get them when they need them.

 

“From last year till now, because of COVID- 19, scarcity of oxygen has reduced; oxygen therapy is no longer as scarce as it used to be.” However, Uyilawa urged governments at all levels to increase funding for health; “with this we can get better health care delivery, better oxygen therapy availability, resulting in better healthcare”.

 

He also called for the expansion of health insurance, saying every Nigerian deserves to be covered under health insurance. “If every Nigerian has health insurance, they will definitely pay less to manage their health challenges,” he added.

 

On her part, Dr. Nwobi, who founded the NGO that sourced the laudable oxygen project in LUTH paediatric oncology unit, recommended the procurement of oxygen concentrators, which are medical devices used for delivering oxygen to persons with breathing-related disorders. Individuals whose oxygen concentration in their blood is lower than normal often require an oxygen concentrator to replace that oxygen. She said the availability of these oxygen concentrators which cost up to N300,000 to N500,000 could help to bridge the gap of oxygen scarcity.

 

The oxygen concentrators, according to her, will remove relying solely on using cylinders, the use of which could be associated with the burden of conveyance to the point of usage. The device takes in air, separates the oxygen and delivers it into a person via a nasal cannula. Oxygen concentrators ensure that the person who is breathing gets the right amount of oxygen that he needs.

 

Based on their goal to reduce pneumonia deaths among under-five in the country, Kuti said Save The Children International has advocated to the Lagos State Government to make oxygen treatment free for children in the state as a measure to curb under-five death occasioned by breathing difficulties arising from pneumonia.

 

She said the international NGO has already made donations of free oxygen concentrators to some public hospitals in Ikorodu Local Government in Lagos State and Kiyawa Local Government in Jigawa State where the INSPIRING project is currently being implemented. Speaking on tackling oxygen scarcity in Africa, including Nigeria, the WHO Regional Director for Africa, said, “The number one priority for African countries is boosting oxygen production to give critically ill patients a fighting chance.

 

“Effective treatment is the last line of defence against COVID-19 and it must not crumble.” On the way forward, Olugbogi called on governments to make policies that will restrict any business corporation from jerking up the price of oxygen treatment, adding: “Government can provide oxygen treatment” to break the chain of monopoly of private business interests that hoard the life-saving product.

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