COVID-19: Inside Uganda’s Oxygen Shortage Situation

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Oxygen is one of the only treatments for severe Covid-19 infections.

Without it, patients can suffocate.

As supplies fell short in India, ordinary people with no medical experience found themselves begging or bartering for oxygen cylinders on social media.

Here in Uganda, several COVID-19 patients have died due to shortage of oxygen in hospitals.

Journalist Andrew Mwenda tweeted about his aunt Adyeri Komukyeeya who succumbed to COVID-19 over oxygen shortage.

“She was in good health last night. This morning she got breathing difficulties, was taken to hospital but there was no oxygen. So she died.”

Dr Milly Grace Arach, who was working in Gulu Regional Referral Hospital, succumbed to COVID-19 due to lack of oxygen.

Gulu West MP, Mr Ojara Mapenduzi, said the oxygen plant at the hospital cannot generate enough oxygen.

Several other Ugandan doctors and high profile citizens have also succumbed to COVID-19 due to lack of oxygen in public and private medical facilities.

This development has raised concerns about government’s ability to contain the COVID-19 resurgence without ample medical oxygen supply.

Action being taken

According to Health Ministry Permanent Secretary, Dr Diana Atwine, all Regional Referral Hospitals have installed oxygen plants (15Nm3/hr) producing about 30 to 48 cylinders of 6,800 litres of oxygen per day.

She further said government was already procuring 8 more oxygen plants (200Nm3/hr) to boost the existing capacity for Regional Referral Hospitals. “Each plant will produce over 500 cylinders per day,” Atwine told ChimpReports in an interview on Wednesday morning.

“Similarly, two more (250Nm3/hr) plants are being procured for Mulago and Namboole and additional 10,000 oxygen cylinders for mobile distribution,” she added.

MoH PS Dr. Diana Atwine and Director General Henry Mwebesa with other officials at Kagadi General Hospital in 2020

An average non-COVID-19 critical patient consumes one-to-two oxygen cylinders per day.

However, a severely ill COVID-19 needs four to six cylinders per day.

The current national daily oxygen consumption stands at 3,000 cylinders per day, where each cylinder is 6,800 liters.

On social media, critics have been wondering why the Health Ministry took long to procure these essential equipment well knowing the second wave of COVID-19 was around the corner.

Dr Arthur Kirungi, a procurement specialist at the Ministry of Health, says buying this sophisticated equipment is as hard as milking a rock due to high demand as COVID-19 ravages developed economies.

“When you blame them (Health Ministry) for not procuring enough ICU beds, Oxygen plants, vaccines and other scarce requirements for this fight without putting in mind the fact that access to these in the world market has been made next to impossible by the most powerful countries then we are demanding for miracles from them without naming them prophets,” said Kirungi.

Global challenge

According to the Bureau of Investigative Journalism, the oxygen shortage crisis is global.

Each day, tens of thousands of people around the world are admitted to hospitals with Covid-19, driving the demand for the oxygen far beyond the supply.

In the last two months, the unmet, global need for medical oxygen has more than tripled, from less than 9 million cubic meters a day to more than 28 million, according to a coalition of aid groups that are tracking the crisis.

For example a patient hospitalised with the virus needs between 14 and 43 cubic meters of oxygen per day for roughly two weeks – an amount so great that hospitals in Europe struggled to cope.

UPDF says it’s producing medical oxygen to supply Heath facilities across Uganda

In response to the oxygen crisis, India banned all exports of liquid and cylinder oxygen.

In Argentina, hospitals struggled with severe shortages during a Covid-19 surge in late April.

Medical oxygen supplies are already at crisis levels in some cities and states in United States due to severe surges in coronavirus disease hospitalizations.

In Southern California, the shortages have affected not only hospitals and other health facilities but also emergency medical transportation practices.

These shortages apply to wall oxygen in hospitals as well as portable oxygen (cylinders and concentrators) in hospitals and medical facilities and for at home and emergency use. Oxygen shortages were also reported in New York City and Texas during the COVID-19 hospital surges last year and are occurring in other countries.

Oxygen makes up 21 percent of the atmosphere. A handful of companies capture and purify it in bulk, but they sell most of it to industry.

However, many poorer parts of the world lack the infrastructure needed to deliver or make use of the medical grade supplies those companies sell, which are designed to be delivered via pipes to hospital rooms.

Government intervention

Observers say Uganda needs to emulate the Argentine government which froze oxygen prices for 90 days to reduce the cost of oxygen in medical facilities.

Argentina also ordered suppliers to stop manufacturing the product for industrial use and instead supply only hospitals.

Nevertheless, experts believe oxygen has been a “blind spot” among health ministries.

They argue that governments need to create comprehensive national medical oxygen strategies that take capacity and strategic deployment into account, with workers trained up to give patients oxygen safely and maintain and fix equipment.

Announcing a lockdown recently, President Museveni said despite the rapid escalation of the outbreak, the hospitalization rates signaled that the health system “is beginning to get strained, we must do everything to protect the integrity of the health system.”

He revealed that the severely and critically ill COVID-19 patients have more than doubled, straining the available oxygen supply.

“With the estimated COVID-19 patient increase in the coming weeks, the daily oxygen consumption will rise to 25,800 cylinders per day in one month, unless we change the course,” Museveni warned.

“This is nearly a 9 -fold increase in the overall national oxygen requirement.”

The current overall national oxygen production (oxygen plants linked to national and regional referral hospitals), including the private sector is 3,005 cylinders against daily consumption that stands at 3,000 cylinders.

Museveni said the current oxygen challenge is the availability of empty cylinders for distribution.

“Of course if cases keep expanding, it can also outstrip our production capacity,” he cautioned.

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