When a coronavirus pandemic attacks vulnerable countries in Africa and South Asia, experts say there are only a few weeks to help fill in the chronic deficiencies of what medical personnel need to help people breathe.
Not a ventilator, but oxygen self.
Medical oxygen is a core component of a rescue therapy hospital that provides patients with severe cases of COVID-19, as the world waits for scientists to find vaccines and treatments.
Pandemic has pushed even the most advanced health system to its extent, with concerns often focused on providing mechanical ventilators at the high-tech end of the respiratory aid spectrum.
But experts worry this has distorted the narrative of what constitutes an effective response, giving the wrong blueprint for countries with underfunded health systems.
“The reality is that oxygen is the only therapy that will save lives in Africa and Asia-Pacific now,” said Hamish Graham, a consultant pediatrician and researcher at Melbourne University Hospital and the International Center for Children’s Health.
“I am worried that undue focus on the ventilator without repairing the oxygen system will kill.”
A February report on thousands of cases in the Chinese epidemic found that nearly 20 percent of patients with COVID-19 needed oxygen. Of these, 14 percent require some form of oxygen therapy, while another five percent require mechanical ventilation.
In severe cases of COVID-19, the virus attacks patients’ lungs in the form of pneumonia, causing inflammation that prevents them from absorbing oxygen.
This can cause their blood oxygen levels to fall far below normal, a condition known as hypoxemia that can eliminate important oxygen organs and “substantially” increase the risk of death, Graham said.
“In the hospital at high-income countries“We just take oxygen,” he told AFP.
“In low-resource settings, health workers are well aware of the challenges as they struggle to get oxygen to patients every day.”
Many large hospitals throughout Sub-Saharan Africa and South Asia will have several oxygen cylinders in the operating room and ward, as well as concentrators – portable devices that filter and purify the surrounding air.
But surveys across Africa and Asia-Pacific have shown that less than half the hospitals have oxygen available on the ward at any given time, Graham said, and even fewer have a pulse oximeter that allows medical staff to measure blood oxygen level and guide the dosage.
Oxygen supplies have long been a source of warning among specialists who treat pneumonia, preventable infectious killers of children under the age of five.
In Nigeria, one of the countries hardest hit, the government introduced a national policy several years ago to improve the treatment of pneumonia, but experts say it hasn’t trickled down to the regional level.
Adamu Isah, who heads Save the Children’s work on pneumonia in the country, said the charity recently assessed primary health care facilities in the two states and found that oxygen supply was “truly alarming”.
Former clinical doctor, Isah said it was common to see children “suffering and gasping for air”.
“If you don’t have something like an oxygen system, you find yourself helpless, there’s really not much you can do,” he told AFP.
A 2018 report published by Every Breath Counts, a coalition of UN agencies, businesses, donors and aid agencies, said oxygen supply was “very limited” in countries throughout South Asia and Sub-Saharan Africa.
It cites a survey that suggests only one in 10 children with pneumonia in Nigeria receives the oxygen they need. In Ethiopia, the study found that while 64 percent of children’s wards in hospitals have a supply of oxygen, only 14 percent of health workers are trained to use it or standard operating procedures.
Leith Greenslade, lead coordinator for Every Breath Counts, said the mining industry often has a better supply of oxygen for its workers than underfunded hospitals.
“This health system in Africa and South Asia could not be more affected by a pandemic like this because they have not invested in respiratory therapy,” he told AFP.
“This is what scares me.”
Although pneumonia kills 800,000 children per year worldwide, activists say it has not received the same attention as other infectious diseases such as HIV, malaria and TB.
Greenslade said global health authorities also “totally ignored” oxygen, and this meant very little information about supplies.
“The absence of global data on this matter will be a big problem when trying to respond to COVID-19 because we are very blind, we really don’t know which country is more in need than others,” he said.
The pandemic is still largely in its early stages in Africa and parts of Asia, giving the international community “a possible two-month window” to act, he added.
While it is still unclear how new corona virus will spread in poor countries, there is an acute fear in densely populated cities and refugee camps.
Experts say there is no one-size-fits-all approach, urging low-income countries to go beyond locking up and immediately improve the basic health system.
“As everywhere, leveling the curve is the idea, but if your health system does not have intensive care – or, like Malawi, has 25 beds for 17 million people – you cannot level the curve as far as Will work,” Gwen Hines said , Save the Children’s executive director for the global program.
Malawi, one of the poorest countries in Africa, has begun recording COVID-19 cases, but the court last week temporarily blocked a government lockout order.
Hines said his organization had worked to provide solar-powered concentrators to the country, which had intermittent electricity, had no domestic oxygen factories, and often struggled to secure imports of medicines.
Mechanical ventilators used in well-funded health systems are “wrong focus” for resource-poor countries, where they will have little impact, said David Lalloo, head of the Liverpool School for Tropical Medicine, which also has a large program in Malawi.
He said the international community must prioritize the supply of oxygen and protective equipment for health workers.
Experts worry that the international community may not act fast enough, because cases are increasing in Africa and Asia at the same time when Europe and the United States are at their peak.
But Graham said it was also important that the response was more strategic than “buying equipment and disposing of it in the hospital”, urging proper training and maintenance of staff.
‘Solidarity and collaboration’
In Nigeria, Isah said his equipment wish list would start simple, with a pulse oximeter, then an oxygen concentrator that could be used in small health care settings, and finally high-tech equipment such as ventilators.
But he said the “big fear” was competition in global supply chains for basic devices.
He called for “solidarity and collaboration” with rich countries helping those who struggle to overcome COVID-19.
“My fear is that if this COVID pandemic lasts longer than a few months, we will face a very serious problem, there will be many lives lost,” he said.
“Countries in Europe and the US and other places, they might have the financial capacity to address needs, or they can get support easily, but in Africa we don’t have those resources, even in peacetime.”
© 2020 AFP
‘Suffering, breathing heavily’: experts warn about lack of oxygen in poor countries threatened by viruses (2020, 22 April)
taken April 22, 2020
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