The shortage of oxygen required for the medical treatment of COVID-19 cases is not likely to be resolved any time soon.
The Directorate General of Health Services (DGHS) has taken an initiative to meet this crisis, but it will take at least one and a half or two months, or even more, for this to see results.
Public health experts and officials of oxygen manufacturing plants have said that this oxygen crisis has emerged simply because necessary measures were not taken in time.
Oxygen is extremely important in the treatment of coronavirus patients. Not all hospitals have a central system for uninterrupted supply of oxygen for the patients. Most hospitals use oxygen cylinders.
There is a shortage of cylinders in the market. It has been reported that many persons are buying oxygen cylinders and keeping these away in case these are not available in the advent of an emergency.
There are four companies that produce oxygen in Bangladesh. They said that they are producing enough oxygen to meet the demand, but the health department does not have the capacity to utilise this.
The eight-member public health advisory committee advised the health directorate to ensure an adequate supply of oxygen. A member of the committee, on condition of anonymity, told Prothom Alo, “We gave the health directorate an estimate of how much oxygen would be required in each district.”
Problems in the availability of oxygen began emerging from April. There were reports of patients suffering, some even dying, due to the lack of oxygen. Due to the shortage of cylinders in a hospital, two brothers of a large business firm had to share a single oxygen cylinder during their treatment. One of them passed away.
On 25 April Prothom Alo published a report on the shortage of oxygen. Yet on that day, during the regular news bulletin, the additional director general of the health directorate, Nasima Sultana, said that there was no shortage of oxygen supply in the hospitals.
Other than the sufferers, official documents record the shortage of oxygen at the hospitals. A project, funded by the World Bank, has been taken up for central oxygen supply system in government hospitals. UNICEF will assist in the implementation of this project at 81 hospitals. The officials documents say that high-flow oxygen is required for coronavirus patients with acute and complicated symptoms. With the mounting number of patients, the hospitals are coming under pressure and the situation is worsening due to the inadequate supply of oxygen. It was further said that at the district and upazila level, no hospital had oxygen production facilities. Many medical colleges and tier-three hospitals did not have the high-flow oxygen required for COVID-19 patients.
Cylinders have to be changed when the oxygen finishes and many health workers are unwilling to undertake this task in fear of infection. And as uninterrupted supply of oxygen is not possible with cylinders, this is an added risk for patients with acute and complicated symptoms.
According to the health directorate’s reports of 24 June, there are 14,690 beds and 376 ICU beds for COVID-19 patients in 110 hospitals of 8 divisions in the country, including in Dhaka and Chattogram cities. These hospitals in total have 9,973 oxygen cylinders. COVID-19 hospitals are basically dependent on oxygen cylinders.
The World Health Organization (WHO) director general, Tedros Adhanom Ghebreyesus, speaking at press briefing on 24 June in Geneva, said from the very outset they had stressed the need for oxygen in the treatment of coronavirus patients with acute and complicated symptoms. Oxygen must be administered to patients whose oxygen level in the blood decreased.
Professor Khan Abul Alam Azad of Dhaka Medical College said that the lungs are damaged by coronavirus and cannot supply enough oxygen to the blood. When the blood’s oxygen level falls, the function of certain vital organs of the body rapidly deteriorates. He said that 95 per cent of the coronavirus patients admitted require oxygen.
The national guidelines concerning the treatment and management of coronavirus also highlight the importance of oxygen. Medical experts say that the blood level of a coronavirus patients may fall before any serious discomfort is felt and that is why oxygen must be kept ready.
Hospitals in general use 15, 50 and 65 litre oxygen cylinders. Some coronavirus patients require 10 litres of oxygen per minute. Then such cylinders are not mush use for these patients.
Cylinders have to be changed when the oxygen finishes and many health workers are unwilling to undertake this task in fear of infection. And as uninterrupted supply of oxygen is not possible with cylinders, this is an added risk for patients with acute and complicated symptoms.
Oxygen production
Permission of the government’s drug administration directorate is required for the business pertaining to supply of oxygen for medical purposes. The four oxygen companies in the country are Linde Bangladesh, Islam Oxygen, Spectra Oxygen and Bangladesh Industrial Gases.
The concerned businesspersons say that over the past three months the demand for oxygen had increased by three times and they are producing an adequate supply to meet the demand. However, due to the government’ management shortfalls, the oxygen is not be being utilised.
Chief executive officer of Islam Oxygen, Badruddin Al Hussain, told Prothom Alo that they supply 15, 50 and 65 litre oxygen cylinders. These cost Tk 12,000, Tk 18,000 and Tk 22,000 respectively.
The manufacturer says that that they have not increased the price of cylinders. The dealers regularly bring empty cylinders for refilling. They take Tk 35 for each refill.
Fresh crisis
The explosives department is responsible for quality control of the oxygen cylinders. Chief explosives inspector Manzurul Hafiz told Prothom Alo that there are around 75,000 to 80,000 oxygen cylinders of various sizes around the country, but there are no records of how many there are in the hospitals and how many in people’s homes.
Treatment of COVID-19 patients in the country first began in March at the Kuwait-Bangladesh Friendship Hospital in the capital city. That hospital still does not have a central oxygen supply system. Work on a central oxygen supply system began one and a half months ago at the Kurmitola General Hospital. This is yet to be completed.
The businesspersons say that many patients with respiratory problems keep oxygen cylinders at home upon the advice of their physicians. Some members of the family know how to use these. One of the top officials of a large company, on condition of anonymity, said, “Cylinders are being hoarded. People are doing this out of panic. This is dangerous.”
Manzurul Hafiz went on to say, “This is dangerous on two accounts. On one hand, due to this hoarding, the persons who need oxygen are not getting it. On the other hand, there is the risk of the cylinders exploding if stored in a place where the temperature is high.”
Experts say that physicians determine how much oxygen is required. The prime minister’s personal physician, ABM Abdullah, said, “Oxygen is a medication. Like any other medication, it had certain dosage. Not anyone can simply fix the dosage.”
In a public notice on 14 June, the drug administration directorate said that people should not buy oxygen cylinders and keep these at home without a physician’s prescription. Hoarding at home is causing a shortage of oxygen cylinders. Those who require oxygen are not getting it, leading to unwarranted sufferings.
Director (hospitals) of the health directorate, Aminul Hasan, speaking to Prothom Alo, said that there are problems pertaining to oxygen in some places outside of Dhaka. Initiative has been taken to create a central oxygen supply system in 53 hospitals. Efforts are also being made to procure 1000 high flow oxygen cylinders.
Central oxygen supply systems are required for administering oxygen through high flow nasal cannula. This cannot be done with cylinders.
Aminul Hasan said, “It will take one and a half to two months to complete the central oxygen supply system. And work orders have been placed for the procurement of high flow oxygen systems.”
According to a company involved in setting up the central oxygen supply system in several hospitals of Dhaka, it will take two to two and a half months to set up the system in a 100-bed hospital and 4 to 5 months in a 250-bed hospital and 8 to 9 months in a 500-bed hospital.
Treatment of COVID-19 patients in the country first began in March at the Kuwait-Bangladesh Friendship Hospital in the capital city. That hospital still does not have a central oxygen supply system. Work on a central oxygen supply system began one and a half months ago at the Kurmitola General Hospital. This is yet to be completed.
*This report has been rewritten in English by Ayesha Kabir