COVID-19 Pandemic: What’s wrong with our oxygen supply?

Abdul Matin, retired headmaster of Badshail High School, died at Mohammad Ali Hospital in Bogura on Friday morning. He was among the seven Covid-19 patients who died at that hospital within a span of 13 hours (from 8pm Thursday to 9am Friday), allegedly due to lack of high flow nasal cannula, which is essential in providing oxygen to critical Covid-19 patients. The hospital, designated for treatment of Covid patients, has only two high flow nasal cannulas, although it is supposed to have four (two of which could not be used). The DGHS, despite being informed of the situation earlier, did not respond.

The deaths of Covid-19 patients due to lack of oxygen supply or unavailability of high flow nasal cannulas is not unique to Mohammad Ali Hospital. The media has reported the deaths of five patients in Satkhira Medical College Hospital, allegedly due to an oxygen crisis. The hospital was supposed to have 38 high flow nasal cannulas, according to DGHS. However, hospital authorities said they had only 30 functioning cannulas.

This discrepancy between DGHS figures of available high flow nasal cannulas in Covid-designated hospitals and their actual availability was revealed by a Prothom Alo report titled "Discrepancies in distribution of oxygen supply equipment", published on July 3, 2021. The report suggests that while DGHS claimed that 200 high flow nasal cannulas were available at Narail District Sadar Hospital, in reality, there are only two high flow nasal cannulas at the hospital, neither of which are functional.

In a similar case, the DGHS says there are three functioning high flow nasal cannulas in Naogaon Sadar Hospital, while in reality there is none. The situation is the same in Bangamata Fazilatunnessa Mujib General Hospital in Sirajganj and Natore Sadar Hospital, where there are no high flow nasal cannulas, while DGHS figures say there is one in each of these hospitals.

In the capital itself, some hospitals where Covid-19 patients are being treated do not have high flow nasal cannulas. Dhaka Infectious Disease Hospital in Mohakhali, for instance, has been treating Covid patients since last year. However, they were allocated only two high flow nasal cannulas—that too only recently—which they haven't yet received.

Among other Covid hospitals in Dhaka, National Institute of Kidney Diseases and Urology (NIKDU) and National Institute of Neurosciences and Hospital (NINS), both in Sher-e Bangla Nagar, do not have high flow nasal cannula as per a list shared by the DGHS on its website.

"High flow nasal cannulas are not required in every hospital. Hospitals which are equipped with dedicated ICU and HDU might not always require high flow nasal cannula, especially if they have special oxygen supply. If a patient can be given proper HDU support, then high flow nasal cannula might not be required," said DGHS spokesperson Nazmul Islam. When asked when these hospitals might get high flow nasal cannulas, he suggested they will be provided based on demand from hospitals. But the problem is, Dhaka Infectious Disease Hospital, NIKDU and NINS do not have ICU/HDU beds. So what happens to critical Covid-19 patients there? If the data published by DGHS on these hospitals are not correct, then this is another symptom of the inaccuracies and inadequacies that have characterised our Covid response.

It is important to understand here why high flow nasal cannulas are indispensable in treating critical Covid-19 patients. They can supply 60-70 litres of oxygen per minute to patients, which is crucial to those at a critical stage, as against the meagre 15 litres of oxygen that a non-breather mask can supply.

Despite its importance, there remains uncertainty over when all Covid-designated hospitals will have sufficient high flow nasal cannulas to treat critical patients. "We have been discussing this for sometime now, but no one seems to be taking this seriously. Every hospital treating Covid-19 patients should have high flow nasal cannula. However, that is not the case," said Prof Dr Nazrul Islam, former VC of BSMMU, also a member of the National Technical Advisory Committee on Covid-19.

In view of the spiralling Covid-19 cases in the country, Prof Dr Nazrul Islam further suggested, "We need to assess our total need of oxygen. We needed overproduction after India stopped export of oxygen to Bangladesh. But we don't know if that has happened. The government needs to be fully transparent about the needs and local production capacity of oxygen to meet demand. In June 2020, the Prime Minister directed that ICUs should be set up in every district hospital, but even now ICUs have not been established in 37 district hospitals. Now my point is, once the Prime Minister gives an instruction, what happens after that? Who ensures that these directives are being executed? There should be an investigation into why this directive has not been implemented yet, because lives are being lost due to this."

"It should also be investigated properly if there are now sufficient high flow nasal cannulas available in other Covid treatment hospitals," Prof Islam added in light of the incident at Bogura's Mohammad Ali Hospital.

In June 2020, ECNEC approved two projects to upgrade health facilities to fight the pandemic, for which Tk 2,492 crore was approved. The World Bank and Asian Development Bank (ADB) had each committed to fund the projects. The Covid-19 Emergency Response and Pandemic Preparedness Project, involving Tk 1,128 crore, was supposed to upgrade heath facilities to detect and treat Covid-19.

The second project, involving Tk 1,365 crore, was called the Covid-19 Response Emergency Assistance. It was meant to strengthen the government's capability to contain the pandemic. A report published by this daily quoted a planning ministry official saying that essential medical equipment will be procured through the fund.

The World Bank was supposed to give Tk 850 crore to support the former project, while ADB was meant to provide Tk 850 crore for the latter. So, what happened to these two ECNEC projects? The Prime Minister had stressed on quick implementation, with specific suggestions to ensure oxygen supply to district hospitals. But the misery of Covid patients in the districts in recent weeks due to lack of healthcare facilities, including oxygen, has been only too obvious. Who should be held responsible for this?

The Health Services Division has put up a shoddy performance, not utilising even one-fourth of the ADP allocation in the first nine months of the fiscal year. Of the allocated fund of Tk 11,979.34 crore, the HSD could only utilise 2,515.54 crore—around 21 percent of its ADP allocation—between July 2020 and March 2021.

Why this apathy and negligence? There are budget allocations and ECNEC-approved capacity development projects, but where is the progress? While it is a given that fighting Covid-19 is not a task that can be pulled off overnight, 15 months is a good enough time to strengthen the basic infrastructure and ensure treatment of Covid-19 patients, which is their basic human right.

With regard to the mismatch in DGHS data of available high flow nasal cannulas in Narail, DGHS spokesperson Nazmul Islam informed this writer that it had been a case of misunderstanding. Two hundred nasal cannulas had been sent to Narail District Sadar Hospital, which the authorities thought were high flow nasal cannulas. But if that was the case, why was this not clarified and rectified immediately? At which end did the communication gap occur?

The health ministry and its wings have made enough "mistakes" and "errors" in managing Covid-19, and it is high time the concerned authorities assess the performance of this ministry, its departments and its officials to identify if there are flaws in the system that need to be flushed out, or if the faults lie at individual levels, in which case, the culprits should be held accountable for their failures. Whatever the case, it is a generational challenge we are fighting—there are hundreds and thousands of human lives that are at stake here.

The price for falling short—if lives do indeed matter—will be steep.

Tasneem Tayeb is a columnist for The Daily Star.

Her Twitter handle is: @tasneem_tayeb